The effect of crack cocaine addiction and age on the microstructure and morphology of the human striatum and thalamus using shape analysis and fast diffusion kurtosis imaging.

The striatum and thalamus are subcortical structures intimately involved in addiction. The morphology and microstructure of these have been studied in murine models of cocaine addiction (CA), showing an effect of drug use, but also chronological age in morphology. Human studies using non-invasive magnetic resonance imaging (MRI) have shown inconsistencies in volume changes, and have also shown an age effect. In this exploratory study, we used MRI-based volumetric and novel shape analysis, as well as a novel fast diffusion kurtosis imaging sequence to study the morphology and microstructure of striatum and thalamus in crack CA compared to matched healthy controls (HCs), while investigating the effect of age and years of cocaine consumption. We did not find significant differences in volume and mean kurtosis (MKT) between groups. However, we found significant contraction of nucleus accumbens in CA compared to HCs. We also found significant age-related changes in volume and MKT of CA in striatum and thalamus that are different to those seen in normal aging. Interestingly, we found different effects and contributions of age and years of consumption in volume, displacement and MKT changes, suggesting that each measure provides different but complementing information about morphological brain changes, and that not all changes are related to the toxicity or the addiction to the drug. Our findings suggest that the use of finer methods and sequences provides complementing information about morphological and microstructural changes in CA, and that brain alterations in CA are related cocaine use and age differently.

Bronchioloalveolar carcinoma arising in congenital cystic adenomatoid malformation in a child: a case report and review on malignancies originating in congenital cystic adenomatoid malformation.

A type I congenital cystic adenomatoid malformation (CCAM) in the left lower lobe was removed from a 11-year-old boy with a 3-month history of recurrent pneumonia. As incidental finding, a bronchioloalveolar carcinoma (BAC) was found in the lung parenchyma adjacent to the cyst. A left lower lobectomy was performed. At 18 months after surgery the patient is well and free of neoplastic disease. To the best of our knowledge, this association has not been reported previously in a pediatric patient. Malignancies complicating CCAM are rarely seen, but have been reported in adults. Including our case, eight cases of BAC and five cases of rhabdomyosarcoma (RMS) in association with CCAM have been reported so far. As CCAM can host metaplastic mucous cells, primitive mesenchymal cells and differentiated but poorly organized striated muscle fibers, it has been proposed that CCAM may act as a predisposing condition for oncogenesis. Our experience adds further support that CCAM can act as a premalignant lesion. Previous reports of both BAC and RMS in asymptomatic CCAM suggest prompt resection shortly after diagnosis.

[Idiopathic varicocele in children. Epidemiological study and surgical approach]. / Varicocele idiopatico in età pediatrica. Studio epidemiologico e approccio chirurgico.

BACKGROUND: Idiopathic varicocele is one of the most frequent conditions capable of reducing male fertility. Early detection and adequate therapy make it possible to prevent the infertility related to this disease. METHODS: The results of a clinical and instrumental (Doppler) epidemiological study conducted in 766 subjects of peripuberal age are reported. The clinical and functional results in those subjects undergoing surgery for varicocele. The technical options adopted for varicocele correction were either microsurgical venous bypass between the internal spermatic vein and the inferior epigastric vein or laparoscopic ligation of the internal spermatic vein in a retroperitoneal site. RESULTS: The epidemiological investigation conducted by the authors showed a high incidence (48.5% including the subclinical forms) of idiopathic varicocele in the male population. The clinical and instrumental (Doppler) follow-up carried out at 3, 6 and 18 months postoperatively showed satisfactory results, particularly in patients submitted to microsurgical venous bypass, with a relapse rate of only 2.6%. CONCLUSIONS: On the basis of the results obtained, the authors advocate an early surgical approach to varicocele. Among the corrective techniques available, microsurgical treatment is, in the authors' opinion, capable of yielding the best clinical and functional results.

[The role of continent perineal colostomy in surgical emergencies of the distal bowel]. / Il ruolo della colostomia perineale continente nelle emergenze chirurgiche del grosso intestino.

Diverting colostomy is commonly required in surgical emergencies of the distal colon, especially if the patient is in poor condition. This paper shows that the colostomy could be unnecessary in most cases. In the last 10 years, 6 patients (4 with high-risk or postoperative complicated Hirschsprung disease, 1 with intestinal neuronal dysplasia and 1 with iatrogenic rectal stenosis obstruction) have been submitted to primary continent perineal colostomy-modified Duhamel's procedure. The modified technique consists of the exteriorization of the normal colon or ileum by a retrorectal and trans-anal way, while the excision of redundant tissue and rectal spur section are postponed at least for 10 days. In personal experience this peculiar surgical approach allows to avoid not only the complications due to the fashioning of a contraindicated primary anastomosis, but even those due to stomy performance and its closure, promoting good anatomo-functional results in all patients. The advantages of modified Duhamel's operation compared to other procedures (Swenson-Pellerin or Soave pull-through) depend on the rapidity of execution and on the quality of short and long term outcome.

[Rare anorectal malformations. Intermediate-type anal agenesis with a rectocutaneous fistula]. / Malformazioni anorettali rare. L'agenesia anale di tipo intermedio con fistola retto-cutanea.

A case of anal agenesia with recto-cutaneous fistula is presented. The recto-cutaneous fistula in an intermediate or high anomaly seldom noticed so that it is not included in the common classifications. The surgical approach performed by us was that described by Mollard. The anterior perineal pull-through, under proximal protective enterostomy, allow to reduce the rate of postoperative complications and sequences and obtain--as in our patient--a normal continence and sphincteric function with an excellent esthetic outcome.

Complicated total esophagogastric dissociation: case report.

The Authors describe a case of massive haemorragic gastritis in a child who previously underwent total oesophagogastric dissociation without complementary pyloroplasty. The complication was successfully treated by an emergency resection of the fundus. The Authors believe that the complication was probably related to vagal denervation with consequent gastric stagnation and hypergastrinaemia.

Surgical treatment of chordee without hypospadias.

OBJECTIVE: The aim of this study was to retrospectively assess the efficacy of the surgical techniques commonly used in three types of chordee without hypospadias (Devine and Horton classification). METHODS: Twenty-six patients, ranging in age from 3 to 14 years, had chordee without hypospadias and underwent Nesbit dorsal plication (9 cases out of 12, type III), associated extensive mobilization of the urethra (10 cases out of 10, type II), and vascularized neourethra (3 cases out of 4, type I). RESULTS: Eleven subjects undergoing follow-up investigation for the milder forms of chordee were satisfied with the outcome achieved; there was no impediment of any kind in the sex lives of 5 adult subjects. Of the 11 patients undergoing follow-up after more complex surgery for Devine and Horton type I-II chordee without hypospadias, a residual abnormal curvature was present in 4 subjects. These patients were submitted to one or more reoperations with outcomes defined as satisfactory. CONCLUSION: To avoid the risks of persistent chordee, the authors suggest more radical and accurate operations for the treatment of type I and II pseudohypospadias.

[Unusual anorectal anomalies. A clinical contribution]. / Anomalie anorettali rare. Contributo clinico.

Anorectal malformations (ARM) include a spectrum of anomalies which have been subdivided as "high", "intermediate" and "low"; a fourth group, defined as "miscellaneous", collects the forms which are most rarely observed. It is important, for a specialist, to know the last ones under the diagnostic and/or therapeutic profile. In this paper, the various problems observed in five cases of ARM considered particularly rare are analysed: a case of anorectal agenesia with recto-cloacal fistula and short uro-genital sinus; a rectal atresia with normal anal canal; a case of anorectal stenosis; an incomplete anal membrane; an anal agenesia with scrotal fistula.

Secondary omental torsion in children: report of two cases and review of the literature.

Torsion of the greater omentum (TGO) may be due to a congenital abnormal attachment of its free edge. There are no specific symptoms that allow a preoperative differential diagnosis of this condition from common pathologies such as acute appendicitis. Attachment of the omentum to the large bowel and the absence of concomitant diseases make it possible to distinguish TGO secondary to a congenital attachment anomaly from omental infarction, primary TGO, and TGO secondary to an acquired attachment anomaly (attachment to cysts, tumours, hernias, surgical scars, or perforated bowel segments). Resection of the ischaemic portion of the omentum permits complete resolution of the clinical symptoms. The authors report two cases of TGO in children due to abnormal attachment of the greater omentum to the ascending and transverse colon, respectively.