Association between surgical hernia repair techniques and the incidence of seroma: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Ventral hernia repair (VHR) includes the surgical reconstruction of the abdominal wall (AW) using different surgical techniques. Although such procedures are usually devoid of complications, the formation of seroma may frequently occur. We performed a systematic review to assess the evidence from randomized controlled trials (RCTs) comparing VHR techniques and their impact on seroma formation. METHODS: We included RCTs having seroma formation as primary endpoint. We included patients of both sexes (age > 18). For data synthesis we applied a random-effects model and calculated risk ratios (RR) with 95% confidence intervals (CI) using the Mantel-Haenszel method. Risk of bias (ROB) and publication bias were evaluated following Cochrane recommendations. RESULTS: After database search and article screening, 21 records were included in this review. Ten RCTs compared onlay vs. sublay mesh placement techniques. Pooled analysis showed a significantly higher risk ratio for seroma in the onlay cohort (RR = 2.61, 95% CI 1.86-3.66, I2 = 0, GRADE quality of evidence, moderate). Five RCTs compared laparoscopic intraperitoneal onlay mesh repair vs. open mesh placement. Pooled analysis showed that seroma formation did not differ significantly between groups (RR = 1.91, 95% CI 0.69-5.28, I2 = 66%, GRADE quality of evidence, poor). High ROB was found in all studies and significant publication bias was detected in both meta-analyses. CONCLUSION: Compared to sublay ventral hernia repair, the onlay procedure is associated with a significantly higher risk of seroma. No significant differences were observed when laparoscopic VHR was compared with the open surgical procedure. Due to the diversity of surgical techniques reported in included RCTs, it is currently not possible to draw conclusive clinical recommendations. Future studies should be standardized to provide detailed data allowing thorough evaluation of the impact of the evidence on clinical practice.

[Permanent childhood hearing impairment: universal newborn hearing screening, PCHI management]. / La sordita infantile: lo screening uditivo neonatale universale, il percorso del paziente ipoacusio i eta pediatrica.

The most recent advances in technology and scientific knowledge have allowed better outcomes in permanent childhood hearing impairment (PCHI) than in the past period. The Universal Newborn Hearing Screening with OtoAcoustic Emissions provides an early identification/habilitation program for hearing impaired children, giving them immediate access to intervention when needed. The aim of this paper was to treat the organization and management of health care procedures for PCHI in Italy, which are not well coordinated with respect to other European Countries. Pediatrician and neonatologists appear to be especially engaged in these aspects.

The clinical and organisational appropriateness of tonsillectomy and adenoidectomy-an Italian perspective.

The objective of the document is to define the most appropriate indications and health-care procedures for tonsillectomy and adenoidectomy and is intended for use by paediatricians, general practitioners, and otolaryngologists involved in the treatment of adenotonsillar pathologies. After a systematic review and grading of evidences from the literature, the document was drafted by a multidisciplinary panel with identified key clinical questions related to indications for surgery, surgical and anaesthesiology procedures, clinical management and organizational issues. It should be stressed that the document was not aimed at providing graded recommendations per se, but to offer suggestions and advices. The document will be updated within December 2006.

[Epidemiology of tonsillectomy and/or adenoidectomy in Italy]. / Epidemiologia degli interventi di tonsillectomia e/o adenoidectomia in Italia.

OBJECTIVES AND METHODS: Aim of the study was to describe frequency, causes, regional variations, setting and risk of mortality of tonsillectomy and adenoidectomy in Italy. The study is based on hospital discharge data for the years 1998-2000 provided by the Ministry of Health. RESULTS: During the year 2000, 61.280 tonsillectomy with or without adenoidectomy and 32.655 adenoidectomy alone were performed in Italy. ICD-9-CM codes reported on discharge abstracts indicated that the most frequent causes of tonsillectomy were chronic tonsillitis (45%) and hypertrophy of tonsils and adenoids (43%). The total tonsillectomy rate was 10.6 x 10.000 (CI 10.5-10.7) in 2000, and it was stable throughout the study period. We observed a wide geographical variability of regional tonsillectomy rates, standardised by age and sex. They ranged from 3.5 x 10.000 (CI 3.1-4.0) in Basilicata to 19.0 (CI 18.6-19.5) in Piemonte. We found an inverse correlation (r = -0.50) between regional tonsillectomy rates for tonsillitis and minimum temperatures recorded in capitals of the regions. Most operations were performed in the acute setting with a hospital stay longer than one day. The mortality risk associated to surgery was estimated to be at least of one case over 95.000 operations. CONCLUSIONS: The observed variability of regional tonsillectomy rates, only partly explained by weather differences, may be ascribed to disagreement among physicians. Inappropriate variations and setting were the two main reasons conducive to the development of the guidelines "Clinical and organisational appropriateness of tonsillectomy and/or adenoidectomy in Italy", in the frame of LINCO project and of the Italian National Program for Guidelines.

[Adolescent health care in pediatric departments of Tuscany]. / Attivitá assistenziali per adolescenti nelle unitá operative di pediatria della toscana.

BACKGROUND: Admission to Pediatric Departments for 0/18- year-old patients is an important issue for the best organization of pediatric hospital assistance. Aim of the study. To locate adolescent health care and identify the percentage of adolescent admissions to Pediatric Departments in an Italian region (Tuscany). METHODS: Adolescent health care in pediatric departments and pediatric admissions (0-18 years old) in 1999 into the reference hospital of Pisa and into 5 other regional hospitals in Tuscany are reported. The percentages of patients, subdivided by age, hospitalyzed in Pediatric Departments have been determined. RESULTS: In 1999 the admissions for subjects aged 0 to 18 years were 12573 of which 4966 adolescents (39.6 %). The percentage of adolescent admissions is not smaller than children's admissions (aged 0 to 1 year: 16.2%; aged 2 to 5 years: 26.2%; aged 6 to 9 years: 17.8%; aged 10 to 14 years: 20.4%; aged 15 to 18 years: 19.2%). Analysis by age demonstrated a continuous decrease of patient percentages admitted to Pediatric Departments with the increased age. A minority of 15/18- year-old subjects has been admitted to Pediatric Departments. CONCLUSIONS: The percentage of adolescent admissions is similar to there of children. Most adolescents are admitted to structures unsuitable for assistance to subjects aged 0 to 18 years. These data underline the necessity for a strong recovery of adolescent admissions to pediatric structures also equipping suitable nursing rooms.

Coordinate regulation of RARgamma2, TBP, and TAFII135 by targeted proteolysis during retinoic acid-induced differentiation of F9 embryonal carcinoma cells.

BACKGROUND: Treatment of mouse F9 embryonal carcinoma cells with all-trans retinoic acid (T-RA) induces differentiation into primitive endodermal type cells. Differentiation requires the action of the receptors for all trans, and 9cis-retinoic acid (RAR and RXR, respectively) and is accompanied by growth inhibition, changes in cell morphology, increased apoptosis, proteolytic degradation of the RARgamma2 receptor, and induction of target genes. RESULTS: We show that the RNA polymerase II transcription factor TFIID subunits TBP and TAFII135 are selectively depleted in extracts from differentiated F9 cells. In contrast, TBP and TAFII135 are readily detected in extracts from differentiated F9 cells treated with proteasome inhibitors showing that their disappearance is due to targeted proteolysis. This regulatory pathway is not limited to F9 cells as it is also seen when C2C12 myoblasts differentiate into myotubes. Targeting of TBP and TAFII135 for proteolysis in F9 cells takes place coordinately with that previously reported for the RARgamma2 receptor and is delayed or does not take place in RAR mutant F9 cells where differentiation is known to be impaired or abolished. Moreover, ectopic expression of TAFII135 delays proteolysis of the RARgamma2 receptor and impairs primitive endoderm differentiation at an early stage as evidenced by cell morphology, induction of marker genes and apoptotic response. In addition, enhanced TAFII135 expression induces a novel differentiation pathway characterised by the appearance of cells with an atypical elongated morphology which are cAMP resistant. CONCLUSIONS: These observations indicate that appropriately timed proteolysis of TBP and TAFII135 is required for normal F9 cell differentiation. Hence, in addition to transactivators, targeted proteolysis of basal transcription factors also plays an important role in gene regulation in response to physiological stimuli.

The TATA-binding protein and its associated factors are differentially expressed in adult mouse tissues.

We have investigated the expression levels of the TATA-binding protein (TBP) and several TBP-associated factors (TAFIIs) in differentiated adult mouse tissues. Immunoblots performed using monoclonal antibodies show that there are considerable variations in the levels of TBP and many TAFII proteins present in various tissues. Consequently, the relative levels of TAFIIs and TBP vary significantly from one tissue to another. TBP and several TAFIIs are overexpressed in both testis and small intestine, while in marked contrast, many of these proteins, including TBP itself, were substantially down-regulated in nervous tissues and in the heart. These tissues do, however, show a high expression level of the TBP-like factor, which thus may represent an alternative factor for the specialized transcription program in some differentiated tissues. While there are significant variations in the levels of TAFII28 protein, reverse transcription-coupled polymerase chain reaction shows similar expression of the TAFII28 mRNA in different tissues. The variations in TAFII28 protein levels therefore result from post-transcriptional regulatory events.

Identification of a novel gene, PSD, adjacent to NFKB2/lyt-10, which contains Sec7 and pleckstrin-homology domains.

We have identified a novel human gene on chromosome 10q24 located contiguously to the 3' end of the NFKB2/lyt-10 gene in a tail to tail arrangement. We describe here a cDNA of 4307 bp, isolated from an adult human brain cDNA library, which contains an open reading frame encoding a putative protein of 645 amino acids with a predicted molecular weight of 71 kDa. Database homology searches indicate that this is a novel gene coding for a putative protein containing two discrete domains with significant homology to the Sec7 and pleckstrin-homology (PH) domains, respectively. We named this gene PSD (plekstrin-Sec7 domains gene). Northern blot analysis of a panel of RNAs from normal human tissues using the PSD cDNA as probe revealed the presence of three different tissue-specific transcripts of approximately 4.3, 2.3, and 1.8 kb, the longest of which is expressed only in brain. Our data suggest that the PSD gene may code for a protein related to a recently identified protein family containing both the Sec7 and the PH domains thought to be involved in signaling transduction processes.

Molecular analysis of cutaneous B- and T-cell lymphomas.

Among extranodal non-Hodgkin's lymphomas, primary cutaneous lymphomas (CLs) represent a consistent group of B- and T-cell malignancies. We investigated the arrangement of Ig and T-cell receptor (TCR) genes, together with the involvement of several oncogenes and the tumor-suppressor gene p53, in a panel of primary cutaneous B- and T-cell lymphomas (CBCLs and CTCLs). Southern blot analysis was performed to detect rearrangements of the Ig, c-myc, bcl-1, bcl-2, bcl-3, bcl-6, and the NFKB2/lyt-10 genes in 52 cases of CBCLs and of the TCR, bcl-3, and NFKB2/lyt-10 genes in 38 cases of CTCLs. tal-1 gene deletions were analyzed in CTCLs by means of polymerase chain reaction (PCR). p53 gene mutations were assayed using PCR, single-strand conformation polymorphism analysis, and direct DNA sequencing in CBCL and CTCL cases. Clonal rearrangements of Ig genes or oncogenes were found in 25 of the 52 CBCLs. In particular, we detected rearrangements of the bcl-1 locus (2 cases), the bcl-2 gene (2 cases), the NFKB2/lyt-10 gene (2 cases), and the bcl-6 gene (1 case); interestingly, 4 of these cases showed a germline arrangement of the Ig genes. Clonal rearrangements of TCR genes were detected in 37 of the 38 CTCLs. Rearrangements of the NFKB2/lyt-10 gene were present in 2 cases and tal-1 gene deletions in 3 CTCL cases; p53 gene mutations were detected in 1 CTCL case. Overall, our data indicate that (1) clonal rearrangement of Ig genes is frequently undetectable by means of Southern blot in CBCLs (60%); (2) genetic lesions are involved in a limited but significant fraction of primary CLs showing a molecular marker of clonality (13/62; 20%); and (3) rearrangements of the bcl-1, bcl-2, or bcl-6 loci, associated with specific subsets of nodal lymphoid neoplasias, are rarely observed in CBCLs. Moreover, our results suggest that tal-1 gene deletions may play a pathogenetic role in non-acute T-cell malignancies and that, in the context of lymphoid malignancies, CLs may represent a favorable target for the possible oncogenic potential of the NFKB2/lyt-10 gene.

[The superior thoracic outlet compression syndrome: a report of a case in childhood with complete cervical rib]. / Sindrome compressiva dello stretto toracico superiore: descrizione di un caso in età pediatrica con costa cervicale completa.

Authors report a paediatric patient with thoracic outlet syndrome (TOC) and complete cervical rib. The symptoms at the time of presentation result from pressure on either the subclavian vessels or the lower trunk of the brachial plexus. TOC is infrequent in young people and usually the symptomatology does'nt need a surgical approach. Some Authors affirm that there are necessary impulsive moments like growth, increased muscular mass and rib ossification, decreased elasticity of ligaments, vessels, muscles and nerves, for outcoming the clinical manifestations. Paediatric competention has risen until adolescent age and may be more frequent the observation of this syndrome that present problems of both diagnosis and management.

Relevance of antibody valency in EGF receptor modulation.

Binding characteristics of a monovalent bispecific monoclonal antibody (bsMoAb), which recognizes both epidermal growth factor receptor (EGF-R) and drug doxorubicin (DXR) were compared with those of the parental bivalent MoAb directed against the EGF-R binding site. Scatchard analysis indicated that both MoAbs bound to EGF-R-overexpressing A431 cells with the same affinity. In tracer amounts, both MoAbs also displayed the same capacity to be internalized after binding to the cell surface. However, when the MoAbs were used at saturating concentrations, down-modulation of the receptor was greater with the bivalent MoAb. The bivalent MoAb also inhibited proliferation of A431 cells both in vitro and in vivo whereas the bsMoAb was inhibitory only in vivo. These data suggest that MoAb bivalency is required for EGF-R down-modulation and in vitro cell growth inhibition.

[Mucopolysaccharidosis IS: Scheie's syndrome. A report of 2 brothers]. / Mucopolisaccaridosi tipo IS: sindrome di Scheie. Descrizione di due fratelli.

We describe two brothers affected by MPS type IS (Scheie syndrome). Mucopolysaccharidosis type I consists of three clinical entities of varying severity, all due to alfalevo-iduronidase enzyme deficiency. The MPS IS in characterized by joint stiffness, aortic valve disease and corneal clouding. The intellect is normal. All these findings are present on our brothers; furthermore retinal degeneration also occurred. It could give in the future attendant deterioration of vision.

[Hypoglycemia secondary to transitory hyperinsulinism in infancy: a case report]. / Ipoglicemia da iperinsulinismo transitorio nel lattante: descrizione di un caso clinico.

We refer about an infant with transitory hyperinsulinism who first developed symptoms at the age of nine month treated with diazoxide. The therapy was successfully discontinued at the age of twenty-one month. The follow-up until the age of 38 month revealed a normal growing up and a normal neurological development. The main cause of hypoglycaemia are discussed referring the different cases of hyperinsulinism of the recent literature.

[Recurrent meningitis. Description of a case in a girl with dermal sinus]. / Meningite ricorrente. Descrizione di un caso in bambina affetta da seno dermico.

The authors describe a case of recurrent meningitis in a child with a dermal sinus. All the conditions causing this severe pathology are considered, particularly those in the pediatric age. The surgical treatment of the congenital malformation gave a complete resolution of the recurrent infections.

[Klippel-Feil syndrome. Description of a case associated with familial mental retardation]. / Sindrome di Klippel-Feil. Descrizione di un caso associato a ritardo mentale familiare.

The authors describe a case of Klippel-Feil syndrome with involvement of the cervical spine and severe mental deficiency which was also present in many relatives of the maternal side. It is discussed as this mental deficiency could be due either to the syndrome itself or to a nonspecific X-linked mental retardation.