Critical reflections on the use of human cultured keratinocytes in children with burns.

The authors report on their experience in the use of cultured keratinocytes in severely burned children, observed in the Surgical Emergency and Pediatric Surgery Department at the Gaslini Institute of Genova. Seventeen cases are described, divided into three groups: patients treated exclusively by autografts; patients treated both by auto- and allografts; patients treated exclusively by allografts. Indications to the various techniques are reported, and the advantages and disadvantages of cultured skin are discussed. Some of the most likely causes of failure are pointed out, with an update review of the literature.

A rare complication due to sulfuric acid ingestion.

The authors present a case of pyloric and duodenal obstruction in an 8-year-old child, resulting from accidental ingestion of sulfuric acid. A marked pyloric and duodenal cicatrizing stenosis resulting from ingestion of sulfuric acid is seen infrequently, especially in pediatric age. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis. This dynamic pathophysiologic event imposes postponement of surgical intervention because of various time length between ingestion of acid and onset of gastric outlet obstruction (17 days to 5 years). Clinical features included postprandial epigastric distress, repeated non-bilious vomiting, and marked weight loss. The authors also discuss the various surgical procedures that were employed to relieve the obstruction. Notwithstanding a potential risk of malignant evolution, a gastro-jejunostomy is the treatment of choice because of the age of the patient, and good postoperative results are confirmed by barium studies.

[A multicenter epidemiological study of burns of the head in childhood in the period of 1986-1990]. / Studio epidemiologico multicentrico delle ustioni nell'estremo cefalico in età pediatrica nel periodo 1986-1990.

A retrospective study was performed over the children admitted to three regional pediatric burn units, over a 5-year period (1986-1990). Out of 695 pediatric patients, 270 (38.8%) were admitted with burns of the head and neck. This whole childhood age group (up to 14 years of age) was examined epidemiologically. The age group presenting the highest incidence was within 0-3 years (71%); scalds were involved in high percentage (68%) and many injuries occurred at home (93%). Epidemiological aspects of the report are discussed with particular consideration of preventive programs.

[Primary torsion of omentum in childhood]. / La torsione primitiva dell'omento nel bambino.

The authors report a case of a primary torsion of the omentum in an eleven-year old child who had been operated with a diagnosis of acute appendicitis. They take the opportunity to re-examine this idiopathic lesion with a review of world literature and case reports and they discuss the etiology, pathogenesis and pathology. The importance for the surgeon to inspect the omentum in all the so-called "negative" acute abdomen is enhanced.

[Neuroblastoma. Clinical aspects and therapy]. / Il neuroblastoma. Clinica e terapia

A general account of questions relating to neuroblastoma is followed by the presentation of 53 personal cases observed between 1955 and 1974. Appraisal of the salient data offers information relating to prognosis and treatment in line with the more extensive series presented in the U.S. literature and elsewhere. Cases diagnosed and treated in the first year of life have a distinctly encouraging prognosis. It is felt that accurate clinical, radiological and laboratory screening should be relied upon in individual cases to decide whether or not surgical management is indicated, whereas the high rate of intra- and post-operative mortality would seem to militate against the resort to desperate attempts to achieve total extirpation, accompanied by damage to essential structures, especially since the pratical results achieved are no more than comparable with those offered by conservative surgery. It is hoped that a strip test suitable for use in routine practice will be evolved, bearing in mind the peculiar features of neuroblastomas.