Hepatopulmonary fusion in a newborn. An uncommon intraoperatory finding during right congenital diaphragmatic hernia surgery: case description and review of literature.

Hepatic pulmonary fusion is a rare malformation associated with right congenital diaphragmatic hernia (CDH), often only discovered during surgical repair of the defect. Fourteen previous cases have been reported in the literature. We describe a case of a full term male newborn with prenatal ultrasound diagnosis of right CDH who underwent a thoracoscopy converted to a thoracotomy, due to this rare aforementioned intraoperative incidental finding. We reviewed the previous reported literature, especially focusing on the chosen surgical approach, concluding that an early and appropriate preoperative imaging investigation may be crucial for the best management of these kinds of patients.

Kidney length and scarring in children with urinary tract infection: importance of ultrasound scans.

BACKGROUND: Many studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy is the most sensitive diagnostic method in the identification of irreversible renal lesions (scars) in children with previous episodes of acute pyelonephritis (APN). This study assessed the reliability of ultrasound in identifying reflux nephropathy in children with acute pyelonephritis with or without vesicoureteric reflux (VUR). METHODS: Eighty children (45 female and 35 male, age range 5 months to 10 years, average age 2 years 1 month) with a positive history for at least one episode of APN participated in this study. All children underwent voiding cystourethrography, DMSA scintigraphy 4 to 8 months after the most recent episode of APN, and an ultrasound test evaluation less than 2 months after DMSA scintigraphy. RESULTS: Voiding cystourethrograms showed VUR in 52 children (68%); 13 of these were bilateral, for a total of 65 refluxing kidney units of the 154 (42%) evaluated; DMSA scintigram was normal for 108 of 154 kidneys (70%). Of the 65 kidneys with VUR, DMSA scintigram displayed normal findings in 29 cases (45%) and pathologic findings in 36 (55%). In the 79 nonrefluxing kidneys, DMSA scintigram was normal in 69 cases (87%). The relative risk of scarring in VUR kidneys is 2.6. The ultrasound study recorded a maximum longitudinal diameter between the 5th and 95th percentiles in 80 of 89 (81%) kidneys without VUR and in 21 of 65 (32%) with VUR. A significant correlation was found between maximum longitudinal diameters and DMSA scintigraphic findings in kidneys with VUR and those without VUR, respectively. CONCLUSION: This study establishes that ultrasound scans, by means of a simple and reproducible measurement technique, maximum longitudinal diameter, have a predictive value with regard to the presence of scars, with few exceptions. This finding, in our opinion, could lead to a decrease in the number of invasive procedures, in particular DMSA scan, in patients with APN.

[Spigelio's hernia. Anatomo-clinical considerations and description of 5 clinical cases]. / Le ernie di Spigelio. Considerazioni anatomo-cliniche e descrizione di 5 casi clinici.

Spigelian hernia, or ventro-lateral hernia is a rare clinical condition, it represents about 1.5% of hernial formation cases of the abdominal wall. It is localised laterally to the rectus muscle and emerges from the semilunar arch. The line, which joins the IX rib to the pubic tubercle, defines the limit between muscular and aponeurotic portion of trasversus abdominis muscle. Diagnosis often results misunderstood. As a matter of fact, this hernia has typically an intraparietal localization and the clinical picture seldom presents characteristic signs. The hernial sac and its content can be appreciated subcutaneously in only 2% of cases. It is estimated that about 50% of patients affected by this condition have a certain diagnosis before surgery. The early clinical signs are generally aspecific and deceitful, represented by oppressive grief and rarely by an abdominal wall tumor; it occurs that it starts with a complication: intestinal occlusion (23%), subocclusion (8%), strangulation (20%, but some authors report percentage up to 50%). We report 5 cases who came to our observation during the last 7 years; all patients underwent elective surgery, and specifically 3 patients in day surgery. Starting from the discussion of these cases, we review anatomy, etiology, clinical nature, instrumental investigation and surgical technique of this rare kind of hernia, comparing our experience to literature reported case histories.

Melanoma antigen genes 1 and 2 are differentially expressed in human gastric and cardial carcinomas.

BACKGROUND: MAGE genes encode for tumor-rejection antigens and are expressed in tumors of different histologic types but not in normal tissues, with the exception of testis and placenta. The aim of this study was to evaluate the frequency of MAGE-1 and -2 expression in gastric and in cardial carcinomas; these conditions have been described as two distinct diseases, having different etiologies, epidemiologic patterns, and gene mutations. METHODS: Two groups of patients were studied: patients with distal gastric carcinoma and patients with carcinoma of the cardia. A group of patients with intestinal metaplasia in the gastric mucosa and controls were also included. All of them underwent upper GI endoscopy. Paired biopsy specimens were taken for routine histology and for RNA extraction, to study the expression of MAGE-1 and -2 genes. RESULTS: None of the intestinal metaplastic samples or controls expressed MAGE-1 and -2 at detectable levels. Whereas 40% of the gastric cancer patients expressed either MAGE-1 or -2, 26.6% transcribed both. In the cardial cancer group, 20% of the cases expressed at least one MAGE, and only 6.6% expressed both genes. These results might reinforce the concept that cancer of the cardia is a distinct neoplastic disease with regard to esophageal and gastric (distal) carcinomas. CONCLUSIONS: Here we show that MAGE gene expression occurs in advanced stages of gastric and cardial cancer and therefore appears to be a late event. This might point to a reconsideration of their potential role in cancer immunotherapy.

Expression of the epidermal growth factor receptor gene in human intestinal metaplasia: a preliminary report.

BACKGROUND: The role of growth factors/receptors in the etiopathology and/or development of gastric cancer has recently come under scrutiny, since overexpression or amplification of the EGF system has been found in many intestinal type gastric cancers and related to a more aggressive behavior. Since these gastric carcinomas appear to develop from intestinal metaplasia, a study was planned to investigate whether overexpression of the EGF-receptor gene also occurred in intestinal metaplastic mucosa. METHODS: Patients underwent upper GL endoscopy. Gastric biopsies for routine histology, Helicobacter pylori detection, quantification of intestinal metaplasia and EGF-R expression analysis were performed. A 30mer EGF-R specific oligonucleotide was end-labeled and used to probe a dot blot filter containing the RNA from the bioptic samples. RESULTS: Though all the gastric samples transcribed the EGF-R gene to a detectable level, overexpression of the EGF-R gene was found in the metaplastic mucosa in a minority of patients. CONCLUSIONS: These preliminary findings suggest that overexpression of the EGF-R gene is infrequent in the metaplastic gastric mucosa.

[Chlordesmethyldiazepam as an anesthesia-inducing agent: time of loss of consciousness. Statistical analysis in man]. / Il clordemetildiazepam come farmaco ipnoinducente: tempo di perdita di coscienza. Analisi statistica nell'uomo.

.1 mg/kg e.v. of chlordesmethyldiazepam, a 1.4 benzodiazepine derivative, were given in induction of anaesthesia of 60 plastic-reconstructive surgery patients respectively in 30 (Group 1.30 patients) and in 60 sec (Group 2.30 patients) to assess the times to spontaneous closing of the eyes and to disappearance of the palpebral reflex. It is concluded that the reflex times are not significantly different in both groups.

[Advantages and disadvantages of peripheral anesthesia (subarachnoid and peridural) in urological surgery]. / Vantaggi e svantaggi delle anestesie periferiche (subaracnoidea e peridurale) in chirurgia urologica.

The pros and cons of spinal anesthesia for urological surgery are discussed and the technical details described of both subarachnoidal and peridural blocks, as they are routinely performed in the author's experience. An evaluation and a comparison on the two techniques give place to the following remarks: spinal anesthesia, not higher than L4-L5, is suitable for surgery on the lower urinary tract and male genitalia, as far as reach and level are concerned; it ensure lesser blood losses because of its know effects on vascular regulation; the awakeness of the patients ensures a quicker recognition of possible complications; peridural, as compared with subarachnoidal block, affords better bleeding control, lesser side effects, a more prolonged anesthesia.

Fractionation and characterization of hydatid fluid antigens with identification of an antigen similar to human serum albumin.

Human and sheep hydatid fluids were separated by ultrafiltration, gel chromatography and immunoabsorption into several immunogenic fractions in which both parasite antigens and host substances were present. The immunological characterization of proteic antigens was carried out by immunodiffusion and immunoelectrophoresis with rabbit and ram antisera. A line of identity was observed between a human fraction (labelled as III) and a sheep fraction (labelled as 2B). Further evidence of the presence of a parasitic antigen in fraction III was given by its reaction against an antiserum from ram directed against sheep fraction 2B. The immunological characterization of fraction III indicated a close similarity between human serum albumin and parasitic antigens.

Unusual technical procedures in reconstructive urological surgery.

Three successful technical procedures for the correction of complex defects of the urinary excretory pathway and the renal vessels are described. The authors emphasize their original technique which allowed kidney preservation and yielded good long-term results. They suggest that this conservative approach be used in more patients to avoid unnecessary nephrectomies.

[Usefulness of the Doppler velocimetry in patients undergoing direct arterial surgery]. / Utilità della velocimetria Doppler nei pazienti sottoposti a chirurgia arteriosa diretta.

Two patients with an atypical and particularly troubled history, due to numerous direct and indirect interventions of vascular surgery, have been monitored in haemodynamic investigation using only Doppler velocimetry. The use of angiography would have necessitated other general anaesthesiae which would have further compromised the already critical conditions of the patients. Doppler velocimetry proved suitable for surgical indication in emergency situations. The value of an arteriograph under general anaesthesia is, however, unquestionable in cases of choice surgery.