Brainstem areas activated by intermittent apnea in awake unrestrained rats.

We investigated the role of the autonomic nervous system to cardiovascular responses to obstructive apnea in awake, unrestrained rats, and measured expression of Fos induced by apnea in the brainstem. We implanted a tracheal balloon contained in a rigid tube to allow the induction of apnea without inducing pain in the trachea. During bouts of 15s of apnea, heart rate fell from 371±8 to 161±11bpm (mean±SEM, n=15, p<0.01) and arterial pressure increased from 115±2 to 131±4mmHg (p<0.01). Bradycardia was due to parasympathetic activity because it was blocked by the muscarinic antagonist, methylatropine. The pressor response was due to vasoconstriction caused by sympathetic activation because it was blocked by the α1 antagonist, prazosin. Apnea induced Fos expression in several brainstem areas involved in cardiorespiratory control such as the nucleus of the solitary tract (NTS), ventrolateral medulla (VLM), and pons. Ligation of the carotid body artery reduced apnea-induced bradycardia, blocked heart rate responses to i.v. injection of cyanide, reduced Fos expression in the caudal NTS, and increased Fos expression in the rostral VLM. In conclusion, apnea activates neurons in regions that process signals from baroreceptors, chemoreceptors, pulmonary receptors, and regions responsible for autonomic and respiratory activity both in the presence and absence of carotid chemoreceptors.

[Hemorrhages of the upper gastrointestinal tract. A comparison of the diagnostic accuracy between endoscopic and radiological examinations]. / Le emorragie del tubo gastroenterico superiore. Raffronto dell'accuratezza diagnostica fra esame endoscopico e radiologico.

One hundred and forty-eight patients admitted for upper gastrointestinal hemorrhage, but excluding esophageal varices, underwent optic fibre gastroscopy at the time of admission and were then examined using a barium meal after a 24-48 h interval. The aim of the study was to compare the sensitivity, specificity and diagnostic accuracy of the two tests. A correct diagnosis was obtained using both procedures in 58.2% of cases. Endoscopy provided an accurate diagnosis in 35.1% of patients, whereas gastrointestinal x-rays showed the exact site of the lesion in only 6.7% of cases. Endoscopy had a sensitivity of 92.5% compared with 60.7% for the barium meal. Endoscopy also had a higher level of specificity (100%) versus the barium meal (33.3%). The results obtained from the pathological examination of specimens confirmed the accuracy of endoscopy. In conclusion, early endoscopy is a reliable procedure in the emergency assessment of the hemorrhaging patient; routine x-ray examination does not appear to add additional information and may be reserved for subsequent use if endoscopy gives doubtful or misleading indications of the site of bleeding.

[Retrocaval ureter in children: a rare form of obstructive uropathy]. / L'uretere retrocavale nel bambino: una rara forma di uropatia ostruttiva.

Retrocaval ureter is a rare anomaly, often misdiagnosed for years, presenting with sign of urinary infections and obstruction. Recognition of this anomaly is rare in childhood. We report a case of a 9 years old boy, who was successfully treated by ureteral section, excision of the retrocaval segment and uretero-ureteral anastomosis. Current diagnostic procedures and different methods of treatment are reviewed.

[Renal ectopia in childhood. Experience in 13 cases]. / Ectopia renale in età pediatrica. Esperienza su 13 casi.

Renal ectopy is a rare congenital malformation related to an abnormal migration of the kidney from the sacral to the lumbar region. Three possibilities are present: absent migration (pelvic ectopia), excessive (intrathoracic ectopia) or to the opposite side (crossed ectopia). During the last 10 years in the Department of Pediatric Surgery of the Niguarda Hospital 13 cases of renal ectopy have been observed. Five patients had a crossed ectopy (4 with fusion) and eight had a simple ectopy (1 intrathoracic, 7 pelvic). Female were more affected than males (9 cases) and the right side was involved in 8 cases, the left in 4 cases and both kidneys in 1 case. Associated anomalies were present in 7 patients: 6 cases with exclusively genito-urinary malformations while 1 patient only was polimalformed (cloacal exstrophy, MMC, bilateral TEV). Correct diagnosis was obtained during urologic screening in 5 cases (1 suspected antenatally), while in 7 cases was related to the associated symptoms (UTI, hematuria, abdominal pain). Seven patients were surgically treated for the associated urologic abnormalities while in the remaining six cases no treatment was required.

Primary adenocarcinoma of terminal ileum with clinical and gross morphologic features simulating Crohn's disease. A case report.

We report a case of primary adenocarcinoma of the terminal ileum, which presented with clinical, radiologic and surgical findings indistinguishable from Crohn's disease. The age of the patient and the rapidly progressing symptoms were the only preoperative clues to the diagnosis of an occult malignancy. Frozen sections of an intraoperative biopsy established the correct diagnosis and led to a radical change in the treatment. This is the third report of adenocarcinoma of the small bowel simulating Crohn's disease.