An open, controlled study of two non-absorbable antibiotics for the oral treatment of paediatric infectious diarrhoea.

Forty-nine children in need of antibacterial treatment for a severe episode of bacterial diarrhoea were consecutively treated with either an oral paediatric suspension of rifaximin (100 mg every six hours for an average of four days: 24 patients), or paromomycin (125 mg every six hours for an average of four days: 25 patients). Stools (number and form), enteritis symptoms and signs, and intolerance manifestations were all monitored on each day of treatment. A stool culture was performed on the first available stool after enrolment and after the end of treatment to monitor the drugs' antibacterial activity. A similar rate of bacteriological cure, with normalisation of stools and elimination of the clinical symptomatology, was attained by the two antibiotics, with statistical significance of changes vs. baseline being apparent on the second treatment day, in both treatment groups. Rifaximin results were quicker (treatment lasted three days in several cases) and on the whole slightly better (though without statistical significance) than those of paromomycin: 21/24 vs. 20/25 children were completely cured, with a failure rate of three and five cases, respectively. Systemic and local tolerance of both treatments were very good in all children.

[Postmenopausal endometrial tuberculosis. A clinical case]. / Tubercolosi endometriale post-menopausale. Caso clinico.

Post-menopausal tuberculosis of the female genital tract is an uncommon condition that has received relatively little attention in the literature. The case described by the authors is about a sixty year old woman whose condition was brought to attention by leukorrhea and abnormal bleeding associated with a smear test suggesting CIN 1. An endometrial aspiration biopsy revealed necrotic debris with focal granulomata and numerous acid-fast bacilli. Fungal stains were negative while mycobacterium tuberculosis was found. After three months of combination antimycobacterial treatment, she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by six months of post-operative drug therapy.

[Laparoscopic treatment of ovarian cysts in women over 40]. / Trattamento laparoscopico delli cisti ovariche in donne al di sopra dei 40 anni.

BACKGROUND: Laparoscopy constitutes the main surgical method for treating benign ovarian pathology in women under 40 years of age. The discussion is about the possibility of extending this surgical method to patients over 40 in whom the risk of malignant ovarian pathology is either borderline or considerably higher. The objective of this study was to evaluate the feasibility of laparoscopic treatment for these patients, who have been submitted to adequate screening, comparing the results of echographic diagnosis, laparoscopy and histology. METHODS: This study includes 65 patients, all over 40 (average age 51 years, range 41-71 years): 34 were in menopause and 31 had a normal menstrual cycle. All were suffering from ovarian pathology. They were selected on the basis of a diagnostic protocol and then submitted to laparoscopic treatment and a follow-up check. RESULTS: The laparoscopic approach led to a clear improvement of the diagnosis compared to echography and dosage of the markers. The percentage of similarity between echographic and laparoscopic diagnosis was 84.6% while in the case of echographic diagnosis and histological examination this was 78%. The percentage of similarity between laparoscopic and histological diagnosis was 94%. Only one case of conversion to laparotomy occurred. CONCLUSIONS: Patients over 40 years of age can present a wide range of pathologies that can be treated by means of laparoscopy. Never the-less, also when confronted with an unclear diagnosis, which would otherwise require laparotomy, the laparoscopic approach significantly improves of the diagnosis without any ultimate worsening of the prognosis.

[Further experience with the use of gastrointestinal segments in bladder reconstruction in the complex of exstrophy-epispadias]. / Ulteriori esperienze sull'uso di segmenti gastro-intestinali nella ricostruzione vescicale del complesso estrofia-epispadia.

It is a matter of discussion if bladder augmentation should or should not utilize in the treatment of exstrophy-epispadias complex. When staged functional bladder reconstruction is adopted in the most difficult cases, or when one desires to avoid early and/or subsequent urinary diversions, sometimes a bladder enhancement could be necessary. The indications should be: a progressive damage to the upper urinary tract, after bladder closure at birth, due to a very small, no compliant detrusor plate (this is a rare condition: only one case in our series); a bladder capacity < or = 80 mls at the time of bladder neck reconstruction (this is a frequent but questionable condition: three cases in our series); a progressive damage of the upper urinary tract after bladder neck reconstruction (this is an unexpected, but not rare condition: 3 cases in our series); during every undiversion procedure (bladder augmentation is nearly mandatory during undiversion in cloacal or bladder exstrophies previously diverted: 4 cases in our series). In our experience, 12 bladder augmentations (in 11 patients, over 85 cases we observed) were done at median age of 8 years and 5 months. Different intestinal segments have been used: the sigmoid colon, the ileo-cecal portion, an ileal tract and the stomach. Follow-up ranges from 11 years to 12 months; until now, we observed few surgical complications: a bowel obstruction in one patient, a left ureteral partial stenosis at level of the anastomosis with the gastric patch wall in another patient and bladder lithiasis in 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipoblastoma and lipoblastomatosis in children.

Lipoblastoma and lipoblastomatosis are rare mesenchymal benign tumors of embryonal white fat. They are found primarily in children less than 5 years of age. This tumor presents in two forms: a localized well-circumscribed lesion (lipoblastoma), or a multicentric type (lipoblastomatosis). The authors presents three cases, two of them with a buttock lesion, the last with a paravertebral one. It is recommended a complete but conservative excision of the tumor because there is a natural tendency to involution, although in the first year of life a local reexcision for recurrence is sometimes described.