Biodiversity of entomopathogenic nematodes in Italy.

An investigation was carried out on the distribution and biodiversity of steinernematid and heterorhabdtid entomopathogenic nematodes (EPN) in nine regions of Italy in the period 1990-2010. More than 2000 samples were collected from 580 localities and 133 of them yielded EPN specimens. A mapping of EPN distribution in Italy showed 133 indigenous EPN strains belonging to 12 species: 43 isolates of Heterorhabditis bacteriophora, 1 of H. downesi, 1 of H. megidis, 51 of Steinernema feltiae, 12 of S. affine, 4 of S. kraussei, 8 of S. apuliae, 5 of S. ichnusae, 3 of S. carpocapsae, 1 of S. vulcanicum, 3 of Steinernema 'isolate S.sp.MY7' of 'S. intermedium group' and 1 of S. arenarium. Steinernematids are more widespread than heterorhabditids and S. feltiae and H. bacteriophora are the most commonly encountered species. Sampling sites were grouped into 11 habitats: uncultivated land, orchard, field, sea coast, pinewood, broadleaf wood, grasslands, river and lake borders, caves, salt pan and moist zones; the soil texture of each site was defined and the preferences of habitat and soil texture of each species was assessed. Except for the two dominant species, S. feltiae and H. bacteriophora, EPN occurrence tends to be correlated with a specific vegetation habitat. Steinernema kraussei, H. downesi and H. megidis were collected only in Sicily and three of the species recently described - S. apuliae, S. ichnusae and S. vulcanicum - are known only from Italy and seem to be endemic.

[Intestinal perforation due to accidental ingestion of foreign bodies]. / Perforazione intestinale da ingestione accidentale di corpo estraneo.

Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).

[Acute appendicitis or diverticulitis of the right colon? Diagnostic dilemma in emergency surgery]. / Appendicite acuta o diverticolite del colon destro? Un dilemma per il chirurgo d'urgenza.

Diverticulitis of the right colon is a rare disease in the Western countries, so that the diagnosis still remains very difficult and frequently indistinguishable from acute appendicitis preoperatively. In presence of acute abdominal discomfort with pain referred to the right lower quadrant region, fever and hyperleukocytosis, nausea and vomiting, surgeons operate with a margin of uncertainty, because of the increased morbidity and mortality associated with delay in diagnosis and consequent perforation of acute appendicitis. Moreover the unexpected inflammatory colonic mass of uncertain etiology is sometimes mistaken for carcinoma at laparotomy and consequently a right hemicolectomy is performed. In these cases it should be better that right-sided colonic diverticulitis should be taken into account allowing a more correct surgical approach and even conservative treatment alone. Therefore, in case of suspected appendicitis, since our experience and literature data indicate that the mean age for right diverticulitis is over 40 years, also in presence of a significative Alvarado's score, computed tomography is strongly recommended, if the age is over 40 years.

[Colonic perforations after self-expandable metallic stenting: two case reports]. / Perforazioni del colon-retto dopo posizionamento di stent metallico autoespansibile: presentazione di due casi clinici.

The use of self-expandable metallic stents in colorectal stenoses, both benign and malignant, is a recently born treatment, quickly widespread because of its simplicity and therapeutic efficacy. It is particulary useful, like emergency temporany treatment, in malignant colonic obstruction; in these cases the temporary endoprosthesis positioning allows the intestinal transit and to overcame the emergengy phase. After patient conditions improvement, he can be operated and the endoprosthesis removed within operating specimen. In some particularly serious cases, when only a derivative intervention is mandatory because of the general conditions of the patient or the advanced stadium of the illness, stenting can also represent definitive palliative treatment. In fact, it allows contemporary resolution of the occlusion and of the physiopathologic alterations, with hospital cost reduction and a quality life imprevement for the patient thanks to the colestomy absence. In benign pathologies, self-expandable stents are used for a long time in the superior gastrointestinal and biliary tract; now stents have found employment also for the treatment of the post-operative fistula, intestinal diverticular occlusion and for the treatment of post-anastomotic or radiotherapy strictures. The Authors report two cases observed in emergency with complication determinated by positioning of colonic endoprosthesis for previous occlusive episode. The first case, a 56 year-old woman with a decubitus perforation occurred by stent, previously positioned with only palliative intent for a sigma-rectal metastatic cancer: in the second case, a 75 year-old man, the endoprosthesis had been positioned for a postoperative benign stricture of colorectal anastomosis for neoplasm: in this case the stent had determined a vescico-rectal fistula and after a new intestinal occlusion.

[Traumatic lesions of the diaphragm]. / Le lesioni traumatiche del diaframma.

The Authors studied 30 cases of diaphragmatic traumatisms from 1972 to 2003 to stress the difficulty to achieve an early diagnosis and the need of their immediate treatment: 26 of these patients were male and 4 female (6.5:1); the pathogenesis was in 50% of cases an open trauma and in 50% a closed trauma. The mean age was 36.6 years (33.4 in the open trauma and 41.4 in the closed). The left hemi-diaphragm was affected more frequently (63%) than the right (37%). The associated lesions were mainly of the parenchymatous abdominal organs (spleen 43.3% and liver 49%), while in the thorax lung was involved in 20% of cases and heart in 3.3%. All patients underwent plastic surgical intervention of the diaphragm. In only one case, particularly severe, the operation consisted in placing a pleuric drain and death occured a few hours later. Mean mortality was 30% (33.3% in open and 26.6% in closed traumas) and mean hospital stay was 36.2 days. Accurate diagnosis in emergency is difficult because of the frequent associated lesions, typical of these patients. Despite of the optimisation of the rescue and the new imaging technologies, the gold standard for treatment is not yet reached. There is still a considerable amount of misdiagnosis, a relevant mean hospitalization, a high mortality and a very high morbidity. The best approach to thoraco-abdominal traumas is still to fear a diaphragmatic lesion up to contrary demonstration, in order to achieve precocious diagnosis and surgical treatment, to avoid complications of delayed treatment.

[Abdominal compartment syndrome: patophysiologic and clinic remarks]. / La sindrome compartimentale addominale: rilievi fisiopatologici e clinici.

The abdominal compartment syndrome is a high grade abdominal hypertension with clinical evidence of multiorgan failure (MOF). It is more and more frequently observed in intensive-care units as a complication in critical patients, but especially in traumatology and surgery. The incidence is highly variable according to the different trials but the severity of scores is the common factor. All the possible mechanical, haemorrhagical, inflammatory and traumatological causes act but do not enable the stability of the abdominal content, abdominal compliance and parietal tension. The initial triad of effects consists in diaphragm elevation and visceral and vascular compression and therefore triggers a physio-pathological way that leads to a respiratory, renal and cardiovascular dysfunction and to parietal, hepatic and intestinal ischaemia and consequent bacterial translocation: sepsis and MOF. Burch's classification (1996) reports four levels of gravity from low (<15 mmHg) to severe (>35 mmHg): both of the first grades should be managed in intensive-care units with conservative pharmacological procedures, while for the two others a surgical approach of laparotomy with drainage and temporaneous closure of the abdominal wall should be considered. As mortality is still very high (29-62%), especially when multiorgan failure is already set; bladder pressure of all critical patients should be monitorized to treat immediately any potential abdominal hypertension.

[Packing: current concepts of "life-saving" surgery]. / Packing: attuali concetti di una chirurgia "salvavita".

Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in Damage Control Surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. It's possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure--like hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: these three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 60%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions; in these situations is possible a MOF syndrome due to excessive intraabdominal pressure (overpacking) or to an abdominal compartment syndrome.

[Small intestine tumors: our experience in emergencies]. / Tumori dell'intestino tenue: nostra esperienza in urgenza.

Small bowel tumours are relatively rare neoplasms; unusual occurrence associated with nonspecific symptoms, and low-sensitivity tests availability, are responsible for diagnostic delay. A retrospective study was performed on 42 cases with acute presentation, from 1972 to 2001; median age was 52 years (range 14-79) and there was a slight female prevalence (57.1% vs 42.9%). The most common acute presentation was occlusion (57.1%), followed by gastrointestinal (GI) bleeding (23.8%), perforation (14.3%) and occlusion/perforation (4.8%). Benign neoplasia were 38.1% (16 cases) and adenoma is was the most common type; malignant forms were 61.9 (26 cases) and adenocarcinoma and lymphomas were the most common histotype. Radical surgical procedures were possible only in 57% of malignant forms (24 patients); morbility was 4.8% (2 cases: 1 anastomotic dehiscence and 1 subphrenic abscess); mortality was 14.3%. From our retrospective study, we can state that survival for malignant lesions is strictly dependent of early TNM staging and possibility of radical surgical procedure. An extremely high index of suspicion in evaluating mild and often misleading symptoms, integrated with specific diagnostic studies, should be the proper approach. Prognosis for benign from is excellent in all cases.

[Difficult endoscopic extraction: pneumomediastinum and bilateral pneumothorax after attempted endoscopic extraction of needle incarcerated in hiatal hernia]. / Estrazione endoscopica difficile: pneumomediastino e pneumotorace bilaterale dopo tentativo di estrazione endoscopica di un ago da rammendo incarceratosi in una ernia iatale.

From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.

[Damage control surgery: the technique]. / Damage control surgery: le tecniche.

Abdominal packing and planned reoperation is a lifesaving technique for temporary control of haemorrhage in severely injured patients. Morbidity and mortality, however, remain significant. The purpose of this study is to evaluate all surgical technique and our results during 31 years of trauma surgery. In the last 12 years the Authors have performed 11 packing. They stressed fully "damage control technique" in trauma surgery in the last four years. Overall mortality was 45.5%.

[Peritoneal papillary serous carcinoma: clinical report]. / Il carcinoma papillare sieroso del peritoneo: caso clinico.

Peritoneal papillary serous carcinoma (PPSC) is a rare tumour that involves the surface of the peritoneum, with prevalence in female patients and can originate from a single or multicentric focus is here described. A primary peritoneal serous carcinoma is here described. The patient has been treated with paclitaxel 175 mg/m2 and carboplatinum AUC 6.

[Use of adhesives in emergency surgery]. / L'uso dei collanti in chirurgia d'urgenza.

In a prospective study, the Authors present an analysis on the use of surgical adhesives in the wounds treatment. In sixteen months we have treated 157 patients exclusively with a surgical tissue adhesive 2-octylcianoacrylate to repair traumatic wounds and surgical ones. In the Emergency Department were treated 110 patients (70%) with 2-octylcianoacrylate for skin incisions, lacerations and the length of lesion. We have paid attention to prepare regular wound edges, irrigation and debridement when appropriate to reduce skin tension at the site of laceration. Forty-seven patients (30%) whit surgical skin incisions for thyroidectomy, appendicectomy, hernio-plastic and safenectomy were treated with 2-octyl-cianoacrylate. In both groups of patients, the surgical adhesive has made possible a simple and quick wounds repair as well as good aesthetic results. No relevant complications have been arisen. The writers recommend the surgical adhesive in Emergency Department to abridge waiting time and to avoid the psychological impact caused by local anaesthesia, suture and medications especially in the treatment of all wounds types in children.

[Height percentiles of children at 6 to 11 years of age in the area of Lazio]. / I percentili della statura di bambini laziali da 6 a 11 anni.

BACKGROUND: In this paper we present growth height standards obtained by an auxological study on a primary school population of central Italy (Lazio), in the 1991-1992 and 1992-1993 school-years. METHODS: 4,175 children were included in the study: 2,024 females and 2,151 males, aged from 6 to 11 years. The sampling rate corresponds to more than 98% of the total primary school-population of the areas mentioned. The statistical analysis of the collected data was carried out by the Dipartment of Statistics of the University of Rome, using the widely available statistics packages STAT-GRAPHICS and SAS. RESULTS AND CONCLUSIONS: The analysis of height mean and standard deviation showed an increasing trend of height related to age, without significant differences by sex. The mean heights for females and males were practically the same in each age class. Height variance increases with age, too. This fact necessitates the use of the weighted regression technique to evaluate the functions that express the height growth trend. The relationship between height and age is linearlike and almost coincides for the two sexes. The height percentiles were calculated and the relative curves were developed, based on the distribution of normalized residuals. The centile curves confirm that there are no significant differences in the growth trends for both sexes and therefore the lines are overlapping. Substantial differences exist only in the end centiles (3th and 97th) and age extremes (6 and 11 years), possibly because of the small number of subjects.

17-Heteroaroyl esters of corticosteroids. 2. 11 beta-Hydroxy series.

The preparation and topical antiinflammatory potencies of a series of 17-furoyl and -thenoyl esters of 9 alpha-fluoro-11 beta-hydroxy-16 methyl and 9 alpha-chloro-11 beta-hydroxy-16-methyl corticosteroids are described. The 17 alpha-esters were introduced to the 9 alpha-fluoro 11-ketones or to the appropriate delta 9(11) compounds by direct acylation with the appropriate heteroaryl carbonyl chloride in the presence of 4-(dimethylamino)pyridine. Functionalization of the C ring was completed by standard methods. The most extensively studied heterocyclic acyl group was 2-furoyl, but 3-furoyl and 2- and 3-thenoyl derivatives were also investigated. Antiinflammatory potencies were measured in mice by a 5-day modification of the Tonelli croton oil ear assay. The most potent topical antiinflammatory agents were 1e, dexamethasone 17-(2'-furoate) 21-propionate, and 2c, the 21-chloro 17-(2'-furoate) in the 9 alpha-chloro series, both being 6 times as potent as betamethasone 17-valerate. Several other 9 alpha-chloro-11 beta-hydroxy-17-heteroaryl carboxylates (2a, 2b, 2d, and 2g) were at least 4 times as potent as betamethasone 17-valerate. Evaluation of 2c in the clinic confirmed that the compound is a potent topical antiinflammatory agent in humans.

Synthesis and structure-activity studies of corticosteroid 17-heterocyclic aromatic esters. 1. 9 alpha, 11 beta-dichloro series.

The preparation and topical antiinflammatory potencies of a series of 9 alpha, 11 beta-dichloro-16-methyl corticosteroid 17-heteroaryl carboxylates are described. The 17-acyl group was introduced to the 9 alpha, 11 beta-dichloro 21-acetate by direct acylation with the appropriate heteroaryl carbonyl chloride in the presence of 4-(dimethylamino)pyridine. Alternatively, the 21-functionalized 17-hydroxy delta 9(11) compound was acylated at 17, followed by C-ring chlorination. The most extensively studied heterocyclic acyl functionality was the 2-furoyl, but the 3-furoyl, and 2- and 3-thenoyl derivatives were also investigated. Antiinflammatory potencies were measured in mice by a 5-day modification of the Tonelli croton oil ear assay. The most potent topical antiinflammatory compounds were 17-heteroaryl esters in the 16 alpha-methyl series where the 21-substituent was chloro or fluoro. Thus 2p [21-chloro 17-(2'-furoate)] was 8 times as potent as betamethasone valerate, while 2s [21-fluoro 17-(2'-furoate)], 2r [21-chloro 17-(2'-theonate)], and 2v [6 alpha-fluoro 21-chloro 17-(2'-furoate)] were 3 times as potent as betamethasone valerate.

Novel 17 alpha-chloro-17 beta-sulfinyl steroids as specific inhibitors of sebaceous gland activity: potential antiacne agents.

The preparation and antisebaceous gland activities of a series of 17 alpha-chloro-17 beta-sulfinyl steroids are described. They were obtained from the corresponding 17 alpha-sulfides by chlorination and oxidation with iodobenzene dichloride in aqueous pyridine at -40 degrees C. A single-crystal X-ray structure determination of 17 alpha-chloro-17 beta-(benzylsulfinyl)-1,4-androstadiene-3,11-dione (4) established the absolute configuration at sulfur to be R. From an analysis of their CD spectra, some of the other alpha-chloro sulfoxides were also assigned the same absolute stereochemistry at sulfur. Inhibition of sebaceous gland activity, after topical application of the test compounds, was determined in hamsters and found to reach a maximum with 4. The 17 beta-sulfone and 17 alpha-sulfide corresponding to 4 were less potent. Subcutaneous administration of 4 produced no antiandrogenic effects in either hamsters or rats.

The influence of esterification on the topical antiinflammatory activity of 7 alpha-chloro- and 7 alpha-bromo-16 alpha-methylprednisolones.

The effect on topical antiinflammatory potency of altering the ester functions of 7-halogenocorticosteroids was examined. Highest potencies for both 7 alpha-chloro- and 7 alpha-bromo-16 alpha-methylprednisolones were generally achieved through diesterification at the 17- and 21-positions. However, among these diesters, structure seems to be more important for topical potency than lipophilicity.