Hepatopulmonary fusion in a newborn. An uncommon intraoperatory finding during right congenital diaphragmatic hernia surgery: case description and review of literature.

Hepatic pulmonary fusion is a rare malformation associated with right congenital diaphragmatic hernia (CDH), often only discovered during surgical repair of the defect. Fourteen previous cases have been reported in the literature. We describe a case of a full term male newborn with prenatal ultrasound diagnosis of right CDH who underwent a thoracoscopy converted to a thoracotomy, due to this rare aforementioned intraoperative incidental finding. We reviewed the previous reported literature, especially focusing on the chosen surgical approach, concluding that an early and appropriate preoperative imaging investigation may be crucial for the best management of these kinds of patients.

Transumbilical laparo-assisted appendectomy: a safe operation for the whole spectrum of appendicitis in children-a single-centre experience.

The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52' Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings.

Gesture and the processing of speech: neuropsychological evidence.

Patterns of speech-related ('coverbal') gestures were investigated in three groups of right-handed, brain-damaged patients and in matched controls. One group had anomic aphasia with a primarily semantic impairment ('semantic'); one group had a primarily phonological impairment, reflected in both repetition and naming ('phonologic'); a third group had a primarily conceptual impairment, with relatively good naming ('conceptual'). Coverbal gestures were video recorded during the description of complex pictures and analyzed for physical properties, timing in relation to speech and ideational content. The semantic and phonologic subjects produced a large number of ideational gestures relative to their lexical production, while the related production of the conceptual subjects was similar to that of the unimpaired controls. The composition of ideational gestures in the semantic and phonologic groups was similar to that of the control groups, while conceptual subjects produced fewer iconic gestures (i.e., gestures that show in their form the content of a word or phrase). The iconic gestures of the conceptual patients tended to start further from their lexical affiliates than those of all other subjects. We conclude that ideational gestures probably facilitate word retrieval, as well as reflect the transfer of information between propositional and non-propositional (visual and motoric) representations during message construction. We suggest that conceptual and lexical processes differ in the way they constrain ideational gestures.

[Early prognosis of severe cranio-cerebral injuries]. / Frühprognose schwerer Schädel-Hirn-Verletzungen.

Severe head injuries are still associated with a high mortality (30-60%). Depth and duration of coma are poor prognostic parameters because of therapeutic concepts such as sedation and mechanical ventilation. That is the reason why we looked for prognostic parameters that are independent of therapy and can be obtained during the normal routine at an ICU for head and trauma patients. METHODS. The medical records of 59 patients with severe head injury were studied and analyzed by statistical means. Exclusion criteria were, e.g., thoracic trauma or abdominal injury. All data tested are parameters routinely measured at our ICU. The statistical analysis was based on calculation of the odd's ratio and its range of confidence. RESULTS. We evaluated 16 parameters correlating to patient lethality. All of them can be obtained by routine diagnostic procedures, OP findings and intensive care monitoring. The relevant criteria that raise the mortality risk to 1.9-7.7 are: age, subdural hematoma, subarachnoid hemorrhage, brain edema, midline shift, pupillary reflexes, motoric answer to pain, hemisyndrome, intracranial pressure, heart rate, blood pressure, necessity for vasocactive drug application, coagulation tests, blood glucose and diabetes insipidus. CONCLUSIONS. The evaluated risk factors permit early estimation of the patient's outcome independent of therapeutical interventions. Further studies are necessary to create a score on the basis of the parameters found.