Comparing the responses of countries and National Health Systems to the COVID-19 pandemic: a critical analysis with a case-report series.

This review aimed to compare the different responses of countries to the pandemic, their National Health Systems, and their impact on citizens' health. This work aimed to create a narrative plot that connects different discussion points and suggests organizational solutions and strategic choices in the face of the pandemic. In particular, this work focused on public health organizations, specifically the European Union and vaccination politics. It is also based on a case report series (about the United States, Germany, Vietnam, New Zealand, Cuba, and Italy), where each country has responded differently to the pandemic in terms of political decisions such as vaccination type, information to citizens, dealings with independent experts, and other specific country factors. In comparing the various models of care systems response to the pandemic, it emerges that: we have found some (few) good practices, but without global coordination, and this is obviously not enough. It is now quite clear that there cannot be a "good answer" in a single nation. Uncoordinated local responses cannot counter a global phenomenon. The second point is that the general context must be considered from a strategic point of view. With the threat of new pandemics (but also of health disasters linked to climate change, pollution, and wars), humanity finds itself at the crossroads between investing in a "democratic" management of international bodies but without power (and at the mercy of the need for funds with consequent conflicts) or in some new leadership proposals that advocate efficiency and problem-solving (and that would probably be able to implement it) but that would place processes totally outside of the public's control.

Colonic duplications: clinical presentation and radiologic features of five cases.

Diagnosis of colonic duplication can pose a potential problem even for those familiar with gastro-intestinal tract duplications in general but unaware of the condition due to its rarity and its apparently bimodal clinical presentation. In this report of five cases of surgically proven pediatric colonic duplication, we illustrate how the condition manifests clinically and describe the imaging features in an attempt to illustrate this bimodal presentation of the condition. The possible etiology, associated congenital anomalies and modes of clinical presentation are reviewed based on literature review as well as on our own experience.

In vivo and in vitro 31P-NMR preliminary studies of the VX-2 carcinoma in rabbits.

In vivo and in vitro 31P-NMR spectroscopy was used to study the high energy phosphate metabolism of VX-2 tumors implanted into rabbit liver, kidney, and hind-limb muscle. Tumors, at various stages of growth, were first examined by in vivo 31P-NMR spectroscopy, then they were excised and underwent histologic examination and biochemical analysis; both in vitro 31P-NMR and standard enzymatic techniques were used. There was good correlation among the in vivo NMR spectra, the in vitro NMR data, and the biochemical analyses. Although the tumor spectra showed characteristics similar to those reported in the other tumor models, there was a striking variability in the spectra obtained from tumors implanted in the same site and from different sites. There was poor correlation between the degree of necrosis in the tumor and the tumor pH and between the Pi:ATP ratio and necrosis. This variability has important implications for the potential value of using 31P-NMR spectroscopy to monitor tumor growth and therapy in vivo.

Neonatal gastrointestinal emergencies.

Intestinal obstruction is the most common and important gastrointestinal emergency in the newborn period. This article presents a general approach to neonatal obstruction and discusses the most common specific cases of obstruction. The importance of the plain abdominal radiograph is emphasized.

The radiology of necrotizing enterocolitis.

This article reviews the radiology of necrotizing entercolitis (NEC), with an emphasis on the sensitivity and specificity of the typical plain film findings. An approach to radiologic diagnosis is suggested. The more recently described entity of perforation without NEC also is described.

Meta analysis of the relationship between tuberous sclerosis complex and renal cell carcinoma.

The association of angiomyolipoma with tuberous sclerosis complex (TSC) patients is well recognised. Some literature has suggested that patients with TSC are at increased risk of renal neoplasm, particularly since angiomyolipomas can be locally invasive and demonstrate tumor like neovascularity on angiography. In an attempt to place in context one case of metastatic renal cell carcinoma in a patient with TSC a meta analysis of the literature was performed. One pediatric patient with TSC and metastatic renal cell carcinoma was evaluated. Reviews and case reports of TSC and renal cell carcinoma and related imaging findings were identified by searching the MEDLINE database, the 'bibliography of reviews' in Index Medicus, personal files and the reference lists from all identified reviews. Individual cases suitable for review in the available literature from 1922 through 1993 comprised the data base. The data base was analysed with the method of proportions and unpaired two-tailed Student's t-test for different populations. A cumulative summary of the literature amassed 107 additional cases from 62 reports over 71 years. Our case is the 17th case, to our knowledge, of renal cell carcinoma in TSC. Analysis of the distribution of characteristics and incidence of; renal cysts, renal cell carcinoma, and lymph node involvement demonstrate no increased risk of renal cell carcinoma in patients with TSC (P = NS). Though anecdotal evidence has suggested a relationship between TSC and renal cell carcinoma, meta analysis of cases of coincident TSC renal complex, cystic changes, angiomyolipoma and renal cell carcinoma implies an identical, though small, risk of malignancy in TSC patients as compared with the normal population.

Nonfixation of an atretic colon predicts Hirschsprung's disease.

PURPOSE: After noting the colon to be nonfixed and coiled in the pelvis of a patient with colonic atresia and total colonic Hirschsprung's disease, the authors sought to determine whether this colonic position might be predictive of aganglionosis in the atretic colon. METHODS: The authors reviewed all cases of colonic atresia treated in their institution over the past 2 decades with regard to colonic orientation and the presence of aganglionosis. RESULTS: We identified 9 patients with colonic atresia. Two of these patients, as well as one patient with ileal atresia, also had long-segment Hirschsprung's disease. All 3 of these patients had foreshortened nonfixed colons located predominantly in the pelvis. None of the other 6 patients with colonic atresia had this configuration. Reviewing 12 reported cases from other institutions of total colonic aganglionosis associated with atresia, 7 appear to have had a pelvic nonfixed colon; colonic orientation could not be determined from the remaining reports. The diagnosis of Hirschsprung's disease was not established in any case before repair of the atresia, and each patient required a secondary enterostomy. CONCLUSIONS: An early gestational atresia, occurring before secondary retroperitoneal fixation of the colon at approximately 11 weeks may result in interruption of caudal migration of enteric nerves manifesting as Hirschsprung's disease distal to the atresia. Moreover, the aganglionosis may be predicted by a foreshortened, nonfixed colon coiled in the pelvis. Thus, biopsy of the colon should be performed at initial exploration in all cases of atresia in which the colon is not properly fixated to avoid immediate or delayed anastomosis to an aganglionic colon.

Esophageal replacement in children who have caustic pharyngoesophageal strictures.

Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx, and esophagus is a challenging reconstructive problem. The authors report on seven patients who required total esophageal replacement from the pharynx to the stomach. Injury occurred from alkali in six and acid in one. Age at injury ranged from 14 months to 14 years (mean, 4.5 years.) in five boys and two girls. Time from injury to esophageal replacement was 6 months to 10 years (mean, 3.5 years). Two required pharyngeal reconstruction before and one after esophageal replacement. Six patients had an isoperistaltic right or transverse colon interposition. One who had gastric necrosis had an ileo-right colonic substernal interposition with creation of a jejunal reservoir. Results of barium swallows showed intact anastomoses in all patients. There were no leaks. Most had some degree of mild to moderate aspiration, and one who had left vocal cord paralysis had initially massive aspiration. Three patients currently eat regular diets; four eat but still require supplemental tube feeds. The authors conclude that children who have hypopharyngeal scarring and obliterated esophageal inlet can undergo a successful colonic esophageal replacement with high proximal pharyngocolic anastomosis.

Local morphologic changes related to laryngeal carcinoma.

In a series of 178 patients who underwent partial or total laryngectomy for laryngeal carcinoma, the morphologic changes at a distance from the neoplasm were investigated with whole organ serial sections. We found 60 cases with extensive squamous metaplasia of the epithelium outside of the vocal cords, 24 case with hyperplastic epithelium of the vocal cords, 29 cases with mild or moderate dysplasia, 5 cases with foci of in situ carcinoma, 3 cases with a second carcinoma with minimal stromal invasion, and 4 cases with a double synchronous primary carcinoma. In 55 cases we observed the contemporary presence of a carcinoma and a mono-or bilateral laryngocele. In the excretory ducts of the salivary glands present in the laryngeal mucosa we found a reserve cell hyperplasia in 100% of the cases, a mature squamous metaplasia in 25%, and an oncocytic metaplasia in 14%. These observations led us to consider the laryngeal cancer as an organ disease, in which the oncogenic stimulus operates on all the laryngeal structures and determines lesions of different severity up to neoplasm.

Syncopes with reference to sex and age.

The incidence of different types of syncopes and their relationship to sex and age were studied. In agreement with previous findings in the literature, a cause of syncopes in a large proportion of patients could not be determined. Vasovagal syncopes clearly prevailed among diagnosed syncopes with a female prevalence. Other syncopes (due to orthostatic hypotension, carotid-sinus syndrome etc.) had a male preponderance. Syncopes with poor prognosis prevailed in elderly patients.

Electroencephalographic and electrocardiographic features of vasovagal syncope induced by head-up tilt.

Two hundred and seventy-nine consecutive patients referred for transient loss of consciousness, compatible with syncope, underwent head-up tilt to 70 degrees during polygraphic (EEG, ECG, pneumographic) and blood pressure monitorings. Vasovagal syncopes occurred in 28 patients with the following EEG changes: progressive slowing until the appearance of middle or high amplitude delta waves generalized and synchronous in 9 patients; delta waves suddenly followed by transient flattening of EEG activity in 16 patients. In 2 patients EEG could not be interpreted because of muscle and/or movement artifacts. Fifteen out of 28 patients exhibited a marked cardioinhibition, expressed by long-lasting cardiac pauses; a relationship between duration of EEG flat and duration of asystole was not found.

Micturition syncopes.

Micturition syncope accounts for 8.39% of the total number of syncopes and is prevalent among men in the 50 and 60 year age groups. The cardiovascular vegetative nervous system is unaffected in patients with micturition syncope. Sixty-one percent of patients with micturition syncope also exhibit other kinds of syncope. These patients experience vasovagal reaction during the vegetative activation tests more often than patients exclusively with micturition syncope.

[Extrauterine endometriosis: three new cases]. / L'endometriosi extrauterina: tre nuovi casi.

Extragonadal endometriosis is rarely diagnosed preoperatively due the variety of its localizations. Presentation to general surgeons may be atypical and pose diagnostic difficulties. The Authors report three cases surgically treated between 2000-2003. The Authors stress the peculiarity of one of these cases with endometrial tissue involvement of the intestinal mucosa. They also discuss about various aetiological hypothesis, symptomatology, differential diagnosis and need for multidisciplinary treatment.

Acute chest syndrome of sickle cell disease: radiographic and clinical analysis of 70 cases.

BACKGROUND: Acute chest syndrome (ACS) is a pulmonary illness with fever, chest pain, leukocytosis and new pulmonary opacity in a patient with sickle cell disease. It is a common reason for hospitalization in sickle cell patients, and a significant cause of mortality. The etiology of ACS is unclear. Lung or bone infarction and infection, among other possible causes, have been proposed. OBJECTIVE: We reviewed the chest radiographs and medical records of 41 patients with 70 episodes of ACS and correlated the clinical and radiographic courses in an attempt to better characterize and understand the syndrome. RESULTS: In 87 % of episodes, no identifiable etiology of ACS was found. This group of patients had a median age of 14 years and showed dramatic clinical and radiographic improvement within 24 h of therapy. In the remainder of episodes (13 %), an identifiable etiology was found, usually bacterial pneumonia. These patients were younger than the group without an identifiable etiology (median age 2 years) and had a prolonged radiographic course of illness. CONCLUSION: The chest radiographs of children with ACS without an identifiable etiology have an extremely typical appearance and evolution. Only in cases which do not have this typical pattern should infection be suspected as the underlying cause.

Bilateral ureteral obstruction and renal failure due to a perforated appendix.

Bilateral ureteral obstruction secondary to appendicitis is rare. We here report a case in which the obstruction caused anuria and renal failure.

Benign pneumatosis in children.

BACKGROUND: In pediatrics, pneumatosis intestinalis (PI) is usually due to necrotizing enterocolitis in premature newborns. Beyond infancy, PI is uncommon. "Benign pneumatosis" is PI in patients with few or no symptoms that resolves with conservative management. OBJECTIVE: Our goal was to better characterize benign PI in children. Our investigation focused on identifying underlying risk factors, symptoms at time of diagnosis, management and outcome. MATERIALS AND METHODS: Available medical records and radiographs of children with pneumatosis intestinalis from 1990 to 1998 were reviewed for underlying conditions, symptoms at time of radiographs, management and outcome. RESULTS: Thirty-seven children (mean age 4 years) were included. Thirty-two children had identifiable risk factors. Twenty-five children were immunocompromised by their underlying conditions or therapeutic regimen. Thirty-five children were managed conservatively with resolution of PI. Two patients, however, required surgery and one patient died. CONCLUSION: Benign pneumatosis does occur in children. The majority have underlying risk factors, most commonly related to immunosuppression. Clinical deterioration is the most useful indicator for surgical intervention. In most patients PI resolves with conservative management.

Gallium scanning in children with fever of unknown origin.

Scintigraphy with Gallium 67 is frequently used in the evaluation of children with fever of unknown origin (FUO). Its usefulness in this setting, however, has not been definitely established. We reviewed the clinical records and imaging studies of 30 children with FUO who had Gallium scans. We defined FUO as a febrile illness of greater than two weeks duration which remained undiagnosed after initial clinical, laboratory and radiographic evaluation. 4 of 30 children had positive Gallium scans. Of 25 children with only systemic signs and symptoms in addition to fever, 1 had a positive scan. Of 5 children with more focal complaints, 3 had positive studies: all had localized infections which had remained occult despite imaging with other modalities. We conclude that in most children with FUO, who have only systemic complaints, Gallium scanning is rarely useful. It may be very helpful, however, when there is a suspicion of localized infection, even if other imaging studies are negative.

Feeding difficulties in the first days of life: findings on upper gastrointestinal series and the role of the videofluoroscopic swallowing study.

BACKGROUND: Feeding difficulties in the newborn period are a common indication for an upper gastrointestinal (UGI) series. OBJECTIVE: To review the radiological findings in infants with feeding-related difficulties, with no other medical problems, and to evaluate the role, if any, of the videofluoroscopic swallowing study (modified barium swallow, MBSW). MATERIALS AND METHODS: We retrospectively reviewed all the UGI and MBSW studies performed at our institution over a 5-year period in infants under 1 month of age. We found a total of 77 patients referred for feeding-related problems. RESULTS: All patients had at least one UGI study performed at our institution, and 17 patients had at least one additional MBSW. The most frequently found abnormality that could directly account for the patients' symptoms was swallowing dysfunction. This was detected in 19 patients; in 10 of these patients the swallowing dysfunction was seen only on the MBSW. CONCLUSION: Swallowing dysfunction with aspiration is a common cause of feeding-related difficulties in childhood. In infants with feeding difficulties, a MBSW may demonstrate aspiration when the UGI is negative.