Calcium-binding proteins as markers of layer-I projecting vs. deep layer-projecting thalamocortical neurons: a double-labeling analysis in the rat.

The thalamus contains two main populations of projection neurons that selectively innervate different elements of the cortical microcircuit: the well-known "specific" or "core" (C-type) cells that innervate cortical layer IV, and, the "matrix" (M-type) cells that innervate layer I. Observations in different mammal species suggest that this may be a conserved, basic organizational principle of thalamocortical networks. Fragmentary observations in primate sensory nuclei suggest that M-type and C-type cells might be distinguished by their selective expression of calcium binding-proteins. In adult rats, we tested this proposal in a systematic manner throughout the thalamus. Applying Fast-Blue (FB) to a large swath of the pial surface in the lateral aspect of the cerebral hemisphere we labeled a large part of the M-type cell populations in the thalamus and subsequently examined FB co-localization with calbindin or parvalbumin immunoreactivity in thalamic neuron somata. FB-labeled cells were present in large numbers in the ventromedial, interanteromedial, posterior, lateral posterior and medial geniculate nuclei. Distribution of the FB-labeled neuron somata was roughly coextensive with that of the calbindin immunolabeled somata, while parvalbumin immunoreactive somata were virtually absent from dorsal thalamus. Co-localization of FB and calbindin immunolabeling ranged from >95% in the ventromedial and interanteromedial nuclei, to 30% in the dorsal lateral geniculate. Moreover, in the ventromedial and interanteromedial nuclei nearly all of the calbindin-immunoreactive neurons were also labeled with FB. In most other nuclei, however, a major population of M-type cells cannot be identified with calbindin immunolabeling. Consistent with studies in primates and carnivores, present data show that in rats M-type cells are numerous and widely distributed across the rat thalamus; however, calbindin is expressed only by a fraction, albeit a large one, of these cells.

[Tension-free laparoscopic versus open inguinal hernia repair]. / Ernioplastica laparoscopica versus ernioplastica laparotomica nel trattamento delle ernie inguinali primitive.

AIM: During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique, esthetic, and functional benefits of mini-invasive surgery. Anyway controversy persists regarding the most effective inguinal hernia repair. The aim of this study is to compare the open technique and the laparoscopic approach concerning: complications, recurrences, recovery time and return to usual activity. METHODS: A randomized prospective analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period. Male well-informed patients with primary monolateral inguinal hernia (ASA I-II) were divided into 2 groups and consecutively treated; group A was treated with laparoscopic transabdominal preperitoneal approach (TAPP) (median age 47+/-7 years, 57 patients), group B with open mesh herniorrhaphy (45+/-6 years, 64 patients). RESULTS: Complication rate was 5.26% for group A (none needed conversion) and 4.68% for group B. All complications were considered minor. No recurrences were observed over a 12-month follow-up in both groups. Post-operative hospital stay and return to activity show statistically significant differences. Median post-hospital stay was 1.7 days for group A while it was longer (2.9 days) for group B. Significant difference was observed in the duration of convalescence too (group A 9.3+/-7.2 days; group B 12.1+/-7. 1 days). CONCLUSION: On the basis of our experience, even if a longer follow-up is needed, the validity of laparoscopic approach to inguinal hernia is confirmed. General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity.

[Fournier syndrome: multidisciplinary approach]. / Sindrome di Fournier: approccio multidisciplinare.

Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and genito-perineal region, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of this mechanisms: local trauma, extension from a perineal, periurethral or ischiorectal infection. It is associated with a high mortality rate. Predisposing factors included diabetes mellitus, steroids or chemotherapy, alcohol abuse, malignancy and radiation therapy. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support, immediate extensive surgical debridement and hyperbaric oxygen therapy. The use of etherologue serum is a valuable adjunct in the therapy of Fournier's gangrene. We report a case of Fournier's syndrome treated with etherologue serum immuno-therapy, together with the conventional multidisciplinary approach. The postoperative course was uneventful and the patient was discharged on day 50 post intervention in good general conditions. The 3 years follow-up showed no recurrence of the disease. In conclusion we remark that the survival can be improved in patients with Fournier's gangrene by multidisciplinary approach.

[Functional results of colorectal and coloanal anastomosis with and without pouch]. / Considerazioni sui risultati funzionali delle anastomosi colorettali e coloanali con e senza pouch.

In the last two decades one of the main targets of anorectocolonic surgery has been to develop sphincter saving procedure able to achieve good results with acceptable five-years survivals, optimal local control of the diseases and low rate of local cancer recurrence. Partially the development of new operative techniques such as low colorectal and coloanal anastomoses with or without pouch, the TME operation and the nerve sparing procedure have reach this target. In fact, often after these operations we can observe a functional syndrome called "Post Anterior Resection Syndrome". The basis of this syndrome have to researched in anatomical and physiological alterations that followed a reconstructive operation. It is characterized by frequency and fragmentation of the stool, feeling of incomplete evacuation, tenesmus and urgency. Fecal continence may be compromised to different levels: usually with alteration limited to soiling and impaired control of flatus, occasionally with loss of liquid stool, rarely with loss of solid stools. The anorectal function will be altered for long time following the surgical procedure and the stabilization of functional results may require 1-3 years. On the basis of these considerations, the authors examine the etiopathogenesis and clinical presentation of the "Post Anterior Resection Syndrome", suggesting some expedients to prevent the functional problems. Analysing our experience and a wide specific bibliography, they also underline the indispensable point to achieve a good functional results after a reconstructive procedure. The author conclude asserting that the absence of these points have to be carefully valued because, in these situations, a simply colostomy is able to guarantee a better quality of life that a colorectal/coloanal anastomoses with or without pouch but associated to functional problems.

[Morgagni-Larrey diaphragmatic hernia: report of a case]. / Ernia diaframmatica di Morgagni-Larrey: descrizione di un caso.

The Authors presents a Morgagni-Larrey's diaphragmatic hernia case, observed during subocclusive manifestation. They emphasize the utility to perform always the surgical intervention, also in the asintomatic cases.

[Complicated Spigelian hernia: our experience]. / Ernia di Spigelio complicata: nostra esperienza.

We present a case of complicated Spigelian hernia presented with symptoms of intestinal occlusion, in a 50 years old woman. Spigelian hernia represents 1-2% of all abdominal hernias and can occur anywhere along the semicircular line of Douglas. The patient underwent emergency surgery followed by polypropylene plastic repair. The postoperative course was uneventful and the patient was discharged on day 8 post intervention in good general conditions. The 2 years follow-up showed no recurrence of the disease. Clinical examination is the foundation of the diagnosis, whereas radiological findings (ultrasonography, TC) allow the exclusion of other pathologies in the differential diagnosis. The preoperative diagnosis is difficult, mainly because of the non-specificity of symptoms as well as the few cases reported in the literature. In conclusion, we remark that the surgery remains the most effective treatment of Spigelian Hernia.