Retroperitoneoscopic vs open dismembered pyeloplasty for ureteropelvic junction obstruction in children.

PURPOSE: To compare the effectiveness, potential advantages and complications of classical open pyeloplasty with retroperitoneoscopic pyeloplasty in children. MATERIALS AND METHODS: Two patient cohorts with confirmed ureteropelvic junction obstruction (UPJO) undergoing open or retroperitoneoscopic pyeloplasty over a 7-year period were analysed comparatively. RESULTS: Operative time was significantly longer in the retroperitoneoscopic group (mean 155 min) compared to the open pyeloplasty group (mean 98 min, P<0.05). Mean hospital stay was shorter in the retroperitoneoscopic group (mean 4.1 days, compared to 5.1 days, open). Complication rates were similar (open, 27% vs retroperitoneoscopic, 29%). These included anastomotic urinary leakage, stenosis and infection. Anastomotic leakage was more common in the retroperitoneoscopic group. There was a 6.6% conversion rate in the retroperitoneoscopic group. Success, defined as improved ultrasonic or renographic parameters, with resolution of symptoms where discernable, was noted in 96% of the open group and 97% of the retroperitoneoscopic group with a mean follow up of 38 and 25 months, respectively. CONCLUSIONS: Retroperitoneoscopic pyeloplasty is as safe and effective as open pyeloplasty. This technique is now our procedure of choice for children>4 months old. The advantages are more obvious in children over 4 years than in infants. This technique remains difficult to perform and teach.

The GLUR2 subunit of AMPA receptors: synaptic role.

Ampa receptors mediate the majority of excitatory synaptic transmission in the brain. Thus, the mechanisms that control the developmental and activity-dependent changes in the functional synaptic expression of AMPA receptors are of fundamental importance. Here we focus on the role of GluR2 subunit in synaptic function and plasticity.

Lymphatic preservation using methylene blue dye during varicocele surgery: a single-center retrospective study.

OBJECTIVE: Hydrocele and testicular edema caused by division of lymphatic vessels during varicocelectomy could lead to decrease in testicular function. In-vivo methylene blue mapping of testicular lymphatic vessels should prevent damage to the lymphatic system. MATERIALS AND METHODS: We retrospectively compared outcomes for 46 patients who received an intraparenchymal injection of 0.25 ml of vital dye (isosulphan blue) before a laparoscopic or an inguinal/subinguinal spermatic vein ligation with 93 controls in whom no mapping technique was adopted. RESULTS: Methylene blue mapping of testicular lymphatics reduced the incidence of postvaricocelectomy hydrocele from 6.4% (6/93) to 2.1% (1/46); the incidence of hydrocele was 0% in all cases of successful lymphatic mapping. CONCLUSION: Mapping of testicular lymphatic drainage with intraparenchymal vital dye is an easy, safe, rapid and cost-free technique. We stress the importance of sparing the lymphatic system to ensure the best andrological outcome.

Evidence for the improved exposure of the ophthalmic segment of the internal carotid artery after anterior clinoidectomy: morphometric analysis.

BACKGROUND: Although resection of the anterior clinoid process (ACP) is valuable in the surgical treatment of aneurysms of the ophthalmic (C6) segment of the internal carotid artery (ICA), quantitative assessment of this adjunct is incomplete. Our morphometric study assesses the effectiveness of the anterior clinoidectomy for exposure of the C6 segment of the ICA. METHODS: Ten formalin-fixed adult cadaveric heads were dissected bilaterally and pterional craniotomies were performed bilaterally. Measurements before and after resection of the ACP included the length of C6 segment of the ICA on its lateral aspect; C6 segment length on its medial aspect; and medial length of the optic nerve from the optic chiasm to falciform ligament (before ACP resection) then to the annulus of Zinn (after ACP resection). FINDINGS: Height and width of the intradural ACP were 8.67 +/- 2.63 and 6.57 +/- 1.68 mm, respectively. After clinoidectomy, mean length of the lateral C6 segment of the ICA increased 60% and mean exposure of the medial C6 segment of the ICA increased 113% (p < 0.001). Exposure of the optic nerve increased 150% (p < 0.001) after clinoidectomy and sectioning of the falciform ligament. No correlations were found between the lengths of the ACP and entire C6 segment, or the ACP size and amount of the C6 segment covered by the clinoid. CONCLUSIONS: Exposure of the C6 segment of the ICA is markedly increased by increase of the mobility of the optic nerve with clinoidectomy and section of the falciform ligament.

[Congenital megacystis in a female fetus. Case report]. / Megavescica in feto di sesso femminile. A proposito di un caso.

The Authors report a case of congenital megacystis without other anomalies, diagnosed in a 27GW female fetus. At prenatal counselling the diagnostic hypothesis formulated were obstructive uropathy (cloacal malformation, uro-genital sinus, urethral atresia), functional alteration (neurogenic bladder, primitive myopathies) or Prune Belly Syndrome (rare in females). The outcome following treatment suppose a visceral myopathy, for this condition, however definitive etiology is obscure.

Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinical series.

AIM: Treatment of ophthalmic segment aneurysms is technically demanding and still associated with a relatively high morbidity and mortality. The refinements of surgical techniques combined with the development of indirect methods of treatment have greatly improved the outcome in treating these lesions. We present our clinical experience and discuss treatment strategies. METHODS: Seventy-eight consecutive patients with 88 ophthalmic segment aneurysms were admitted to our service from January 1997 to June 2003. Forty-three patients presented with unruptured aneurysms and 35 presented with subarachnoid hemorrhage (SAH). Management strategies included surgical clipping alone in 53 patients, clipping and hemicraniectomy in 2, coiling in 17, external carotid artery-middle cerebral artery (ECA/MCA) by-pass in 2, and coil occlusion of the internal carotid artery in 2. Two patients underwent no treatment. RESULTS: In the group of 41 treated patients with unruptured aneurysms, 40 (97.6%) had good outcomes (GOS 1-2) and 1 patient had poor (GOS 3) outcome at discharge. Procedure-related morbidity was 15.7% (8/51 procedures), and permanent morbidity was 9.75% (4/41 patients). In the 35 patients who presented with SAH, mortality was 14.3% (5 patients); at discharge, 21 patients (60%) had good (GOS 1-2) and 9 (25.7%) poor (GOS 3) outcomes. The overall outcome was good (GOS 1-2) in 63 patients (80.8%) and poor (GOS 3-4) in 10 patients (12.8%). Overall mortality was 6.4% (5 patients all with SAH). CONCLUSIONS: Direct obliteration of the aneurysm utilizing advanced surgical techniques is our preferred treatment approach, whenever possible. In case of unclippable large or giant aneurysms, the surgical or endovascular occlusion of the proximal internal carotid artery with or without an extracranial-intracranial by-pass is an option. A highly skilled team including a cerebrovascular and an endovascular surgeon is essential to achieve good outcomes in treating these lesions.

The paraclinoid aneurysms and the distal dural ring: a new classification.

AIM: The aneurysms of the paraclinoid region are a heterogeneous group of lesions, whose terminology and classification are contradictory because of the complex anatomy and the lack of key anatomical references. A surgical anatomical study to identify an anatomical reference is presented, a new classification of these aneurysms is proposed, and radiological guidelines are given to distinguish an intra from extradural lesion on the x-rays. METHODS: A surgical anatomical study of the paraclinoid region has been performed on 10 human cadaveric heads, formalin-fixed and injected with colored silicone rubber, and on skulls, with particular emphasis on the distal dural ring (DDR), anterior clinoid process (ACP) and their relationships with the cavernous, clinoid and ophthalmic segments of the internal carotid artery. On the basis of anatomical considerations a new classification of the aneurysms of the paraclinoid region centered on the DDR has been presented. Furthermore, 50 skulls and 5 injected cadaveric heads underwent radiological evaluation in order to develop x-ray criteria to identify the DDR. RESULTS: The key anatomical element is the DDR. This allows the differentiation of aneurysms of the paraclinoid region into 4 groups (supra-DDR, para-DDR, infra-DDR, transitional). The radiological identification of the planum sphenoidale, tuberculum sellae and optic canal allows to distinguish intra versus extradural lesions. CONCLUSIONS: A new classification of the aneurysms of the paraclinoid region which uses the DDR as key anatomical element is proposed. Radiological guidelines able to identify the DDR and, thus, to distinguish intra versus extradural aneurysms are provided.

Structure of inorganic and carbonaceous particles emitted from heavy oil combustion.

The combustion of heavy fuel oil for power generation is a great source of carbonaceous and inorganic particle emissions, even though the combustion technologies and their efficiency are improving. The information about the size distribution function of the particles originated by trace metals present into the fuels is not adequate. In this paper, we focused our attention on the larger distribution mode of both the carbonaceous and metallic particles. Isokinetic sampling was performed at the exhausts of two typical heavy oil flames and the samples were size-segregated by mean of an 8-stages Andersen impactor. Further investigation performed on the samples using electronic microscopy coupled with X-ray analysis (EDX) evidenced the presence of solid spherical particles, called plerosphere(1) as analogy with cenosphere, with typical dimensions ranging between 200 nm and 2-3 microm, whose atomic composition contains a large amount of the trace metals present in the parent oils (Fe, V, Ni, etc). EDX analyses revealed that the metal concentration increases as the plerosphere dimension decreases.

Monitoring of fuel consumption and aromatics formation in a kerosene spray flame as characterized by fluorescence spectroscopy.

The large presence of aromatic compounds in distillate fossil fuels should allow, in line of principle, to follow the fuel consumption and/or the presence of unburned fuel in a high temperature environment like a burner or the exhaust of combustion systems by exploiting the high fluorescence emission of aromatic fuel components. To this aim an UV-excited fluorescence source has to be used since the aromatic fuel components are strongly fluorescing in the UV region of the emission spectrum. In this work UV-excited laser induced fluorescence (LIF) diagnostics was applied to spray flames of kerosene in order to follow the fuel consumption and the formation of aromatic species. A strong UV signal was detected in the spray region of the flame that presented a shape similar to that found in the LIF spectra preliminary measured on the cold spray and in the room-temperature fluorescence of fuel solutions. The decrease of UV signal along the spray flame region was associated to the consumption of the fuel, but more difficult seems to be the attribution of a broad visible emission, that is present downstream of the flame. The visible emission feature could be assigned to flame-formed PAH species contained in the high molecular weight species, hypothesizing that their fluorescence spectra are shifted toward the visible for effect of the high temperature flame environment.

One-trocar transumbilical laparoscopic-assisted appendectomy in children: our experience.

The authors report their experience with one-trocar transumbilical laparoscopic assisted appendectomy (TULAA). From January 1998 to June 2000, 150 patients underwent appendectomy using this technique. Ages ranged from 2.5 to 17.4 years. The procedure was completed using only one trocar in 116 cases (77.3%); in 28 patients (18.7%) one or two additional cannulas were needed. Conversion to open surgery became necessary in 6 cases (4%). Mean operative time was 35 minutes, mean hospital stay 3.5 days. There were no major complications and no mortality in this series. The advantages of a one-trocar appendectomy compared with open surgery are the same as those reported for conventional laparoscopic appendectomy: i.e., excellent exploration of the abdominal cavity, the possibility of discovering extra-appendiceal lesions, easy and rapid localization of the appendix and a shorter hospital stay. The additional advantages of TULAA compared with conventional laparoscopic appendectomy are a low rate of intraoperative incidents, minimal scarring, less postoperative pain and a more rapid return to unrestricted activities.

Analysis of exhausts emitted by i.c. engines and stationary burners, by means of u.v. extinction and fluorescence spectroscopy.

Optical investigations of the exhausts emitted by internal combustion (i.c.) engines and a stationary burner were performed, in order to assess their relative role as sources of organic matter to the atmosphere. Extinction spectra of air-diluted exhausts in the 200-400 nm u.v. band reveal the expected existence of gaseous trace-species (NO, NO2 and SO2) and carbonaceous particulate matter (soot). In addition, after subtracting the absorption contribution from known species, a strong residual absorption band remains below 250 nm, which is attributed to organic aromatic matter, involving no more than two aromatic rings. A set of ex situ extinction and laser induced fluorescence (LIF) experiments were carried out on condensed combustion-water samples. Extinction measurements from the water samples show absorption spectra similar to those observed from air-diluted samples, which are attributed to low volatility organic compounds, as they are trapped in the condensed phase. Combining the indications of extinction data for both air-diluted and condensed samples, it is suggested that the absorbing species might be molecular clusters of one/two aromatic rings. LIF spectra from condensed samples evidence two fluorescence bands, centered above 300 and 400 nm, respectively, whose intensities correlate with the combustion regimes. Analogous optical analysis on rain samples, collected in an urban area, showed that rain absorption and fluorescence spectra are similar to those found in condensed exhaust samples, which is consistent with the prevailing contribution of i.c. engines to the urban air pollution. The combined experimental data suggest that the absorbing and fluorescent species trapped in the condensed samples are organic (aromatic) compounds, involving mostly one two aromatic rings structural units, since they do not absorb above 250 nm. The overall molecular weight of the trapped material is likely heavy as they show low volatility.

Intrapatient comparison of an intermittent and a continuous flow cell separator for the collection of progenitor and stem cells from the blood.

BACKGROUND AND OBJECTIVES: Continuous-flow and intermittent-flow blood cell separators (CFCS and IFCS) are both used to collect stem cells from the blood to rescue patients undergoing myeloablative treatment for cancer. MATERIALS AND METHODS: We designed a study to compare the collection efficiency of the two systems. The continuous-flow Cobe Spectra and the intermittent-flow Haemonetics MCS-3P were used to collect cells on consecutive days from 9 patients mobilised with G-CSF with or without chemotherapy. Blood obtained before leukapheresis and the leukapheresis product were analysed for their content of red and white cells, platelets, CD34-positive cells, GM-CFC, CFC-E, and BFU-E. An extraction ratio was calculated. RESULTS: We found that the CFCS extracted about 4 times more mononuclear cells per unit time, 3 times more CD34-positive, and 4 times more clonogenic cells than the IFCS. The subject acceptability of the two systems was similar. CONCLUSION: The CFCS is a more efficient system for stem cell collection. IFCS requires a longer harvesting time for the same result.

[ARDS in plasmodium vivax malaria]. / ARDS bei Plasmodium-vivax-Malaria.

Acute renal failure, disseminated intravascular coagulation, ARDS, hypoglycaemia, coma or epileptic seizures are manifestations of severe Plasmodium falciparum malaria. On the other hand, vivax malaria or benign tertian malaria is usually free from complications. In the present report we describe a case of acute tertian malaria with a severe and complicated course. In this situation bacterial coinfection should always be suspected and treated empirically with broad-spectrum antibiotics, until the results of cultures are available. Mixed plasmodial infection (P. vivax and P. falciparum) must be excluded by repeated and meticulous examination of blood smears. Newer techniques such as PCR processing or ParaSight F Test are mentioned.

Intracavitary chemotherapy with thiotepa in malignant pericardial effusions: an active and well-tolerated regimen.

PURPOSE: Malignant pericardial effusion, although highly variable, is an uncommon complication of cancer. It is often associated with symptoms like dyspnea, chest pain, and cough, which may be severe and disabling. We analyzed the results of our current treatment policy to evaluate the effectiveness and tolerance of a new approach for this disorder. PATIENTS AND METHODS: Patients with malignant pericardial effusions were treated with intracavitary thiotepa (15 mg on days 1, 3, and 5) through an indwelling pericardial cannula after extraction of as much pericardial fluid as possible on day 0. Responses were assessed by clinical examination, computed tomographic (CT) scan, and echocardiography before treatment, 1 month after treatment, and every 2 months thereafter. Twenty-three patients with malignant symptomatic pericardial effusion were treated and all were assessable for effectiveness and tolerance of the procedure. RESULTS: Nine patients with breast cancer, 11 with lung cancer, two with an unknown primary tumor, and one with metastatic melanoma were treated. In all but three patients, systemic medical treatment was started after completion of intracavitary therapy. Nineteen patients responded to treatment (83%; 95% confidence interval, 61% to 95%) with a rapid improvement of symptoms. The median time to pericardial effusion progression was 8.9 months (range, 1 to 26). No significant side effects were registered, except one patient who had transient grade III thrombocytopenia and leukopenia and one patient who had grade I leukopenia. CONCLUSION: A short course of intracavitary treatment with thiotepa is highly effective and well tolerated in the treatment of malignant pericardial effusion.

Incidence of insulin dependent diabetes mellitus in children 0-14 years old in the Veneto Region, Italy.

The objective of this study was to provide reliable data on the incidence of type 1 diabetes, in children aged 0-14 years, in the Veneto region, and to better understand its geographical variability throughout Italy and Europe. All new cases of type 1 diabetes diagnosed between 1st January 1993 and 31st December 1994 among residents in Veneto were recorded. Clinical records from 33 hospitals in the region were used as the primary source for this study. The number of disease-related free-of-charge prescriptions served as a secondary source. The completeness of ascertainment was estimated at 89%. The mean incidence estimated over the 1993-1994 period was 10.7 per 100,000/year. The Veneto region appears to have a relatively high incidence of IDDM among non-insular Italian regions. No significant sex-related difference in incidence was noted; the male/female ratio was 1.5.

[Paraplegia following intrathecal chemotherapy]. / Paraplegie nach intrathekaler Chemotherapie.

The occurrence of major neurologic disturbances is a rare complication of intrathecal cytotoxic drug administration. We describe the case of a 30-year old man with relapsed lymphoblastic lymphoma and CNS involvement who was treated by systemic chemotherapy (ESHAP) and intrathecal injections of methotrexate, cytarabine, thiotepa and hydrocortisone. Thereafter he developed persistent paraplegia with sensory and sphincteric insufficiency. The role of the drug in causing this syndrome was suspected when more common causes, such as a meningeal carcinomatosis, had been excluded by means of CNF analysis and radiological examinations. We review this and other published cases and discuss the possible pathogenesis, as well as the clinical and paraclinical findings in paraplegia following intrathecal chemotherapy. Patients particularly at risk are those who receive intrathecal chemotherapy for over CNS disease rather than as prophylaxis, those who receive several injections and patients who are concomitantly treated with radiotherapy to the brain or systemic high-dose methotrexate or cytarabine.

Temperature and size of single transparent droplets by light scattering in the forward and rainbow regions.

A light-scattering anaysis based on Lorenz-Mie theory shows that the size and refractive index of transparent droplets can be determined by measuring the polarized components of the scattered light at two angles in the forward direction. The horizontally polarized cross section C(HH)(33°) depends exclusively on the droplet diameter, whereas the ratio C(HH)(33°)/C(HH)(60°) is a sensitive function of the refractive index and hence of the temperature. On this basis, a new optical system for measuring the temperature, size, and velocity of transparent droplets has been developed. This system can make possible the determination of droplet temperature within a few degrees centigrade. In addition, a critical review of the rainbow method to determine droplet temperature is also presented. These techniques have been applied to vaporizing tetradecane droplets (D(0) = 72 µm), which are heated up in a tube furnace with a temperature range of 20°-200 °C.

[Pericardial effusion in patients with malignant neoplasms]. / Perikarderguss bei Patienten mit malignen Neoplasien.

Pericardial effusions are often present in patients suffering from tumoral diseases, especially lung and breast cancers. Between September 1984 and February 1991 we observed 21 patients with "malignant pericarditis", of whom 57% had carcinoma of the bronchus and 33% a carcinoma of the breast. The symptoms most frequently seen were dyspnea (in 76% of the patients) and tachycardia (67%), accompanied by enlargement of the heart on chest radiograph. The effusions were bloody in all the patients, and the pericardial fluid cytology was positive in 9 of 10 of the lung cancer patients. 16 patients were treated by pericardiocentesis and in 10 of these thiotepa and hydrocortisone were instilled intrapericardially. In this manner it was possible to avoid recurrences of major effusion. The survival of the patients who received the intrapericardial instillation seems to be longer than that of the remaining patients.

Thyroid storm with encephalopathic symptoms due to Graves' disease and inappropriate secretion of thyrotropin.

A 41-year-old woman is described, first hospitalized in the neurosurgical department for a transient ischemic attack with left hemiparesis followed after 6 hours by tonic-clonic seizures starting from the left hemiface and quickly generalized. Brain computed tomography (CT) scan and magnetic resonance imaging were normal. Clinically the patient presented tremor, tachycardia, generalized muscle weakness, and profuse diaphoresis. T4 and T3 were elevated. The patient was transferred from the neurosurgical to the medical department where a thyroid storm due to autoimmune Graves' disease with normal thyrotropin (TSH) values responsive to thyrotropin-releasing hormone (TRH) stimulation was diagnosed. A syndrome of inappropriate secretion of TSH was suspected in an unusual presentation as autoimmune Graves' hyperthyroidism. The TSH alpha-subunit and alpha-subunit/TSH molar ratio were normal, which supported the diagnosis of non-neoplastic inappropriate secretion of TSH. However, severe autoimmune Graves' hyperthyroidism is very rare indeed because autoantibodies to thyroid antigens are generally non-detectable in such patients. Our patient was treated initially with barbiturates, then with dexamethasone, Lugol's solution, methimazole and propranolol. Treatment of this patient proved difficult, and definitive improvement was obtained only after triiodothyroacetic acid administration, but methimazole and propranolol administration could not be discontinued. Fine needle aspiration biopsies of the thyroid in 2 occasions showed follicular or follicular-papillary proliferation with lymphocytic infiltration as in chronic thyroiditis. The patient is now in good clinical conditions and is followed up regularly. Autoimmune Graves' hyperthyroidism may be associated in extremely rare instances with non neoplastic inappropriate secretion of TSH.