[The phantom breast syndrome]. / Síndrome del seno fantasma.

BACKGROUND: The phantom breast syndrome (PBS) is a complication of mastectomy which consists of a sensation of breast persistence after mastectomy. MATERIALS, PATIENTS AND METHODS: The incidence, clinical course and location of PBS in 97 operated women were studied for a 15-year period. All women were interviewed in postoperative follow-up controls after mastectomy. RESULTS: The incidence of PBS was 29 patients out of the 97 total. The syndrome was present for more than 48 months in eleven of these patients. In most cases the location of "phantom sensations" was the nipple (15 cases) and the entire breast in five patients. In only three patients was phantom breast pain (PBP) reported whereas some discomfort was reported by the other patients. CONCLUSIONS: The incidence of PBS in our series was similar to that reported by other authors, but PBP was less common. Neither postoperative sequelae nor the antitumoral specific therapy seemed to have influence on the emergence of PBS.

[Induction of general anesthesia with ketamine for short surgical interventions in pediatric patients with chronic hepatic pathologies]. / L'induzione dell'anestesia generale con ketamina per brevi interventi chirurgici in pazienti pediatrici affetti da patologie epatiche croniche.

Serum levels of bilirubin and of other four enzymes known to be elevated in liver diseases were measured preoperatively and controlled on the first and fourth postoperative day in 14 children with chronic liver disease and anesthetised for liver biopsy using Ketamine (7 patients, group A) or other drugs (group B). Serum levels of gamma GT, Ph. Alk, direct and indirect bilirubin show neither significant variations nor differences between the two groups of patients. SGOT and SGPT basal levels were similar in the two groups and were rather two-fold the normal values. At the first postoperative day, in group B only SGOT levels increased significantly. Moreover, their increase over the basal levels monitored at the first day was significantly lower in the group of patients anesthetised with Ketamine than in group B. In group A, SGPT values were constant showing a small, non significant decrease, while in group B, above levels present a significant increase at the postoperative day and a significant difference between the two groups. At the fourth day, SGOT and SGPT differences versus basal values were not significant. Our experience shows that - as known by normal subjects - Ketamine has no hepatic toxicity in pediatrics patients affected by chronic liver disease, too. Finally, our study suggests that Ketamine must be used in hepatopath children whenever they have to be submitted to total anesthesia.

[Long-term development of chronic hepatitis caused by virus B in childhood]. / L'evoluzione a distanza dell'epatite cronica da virus B in età pediatrica.

Ten children with chronic hepatitis B have been followed for at least 3 years. All patients received 2 liver biopsies, the first after 1 year of continuous liver disfunction and HBsAg positivity, and the second 2 years after, that showed a mild improvement of the histologic lesions in 4 cases of chronic persistent hepatitis (CPH) and in 1 case of chronic lobular hepatitis (CLH). Three children out of 5 with chronic active hepatitis (CAN) changed to CPH and the other 2 remained unchanged without any evidence of cirrhosis. No patient received any drug for the treatment of hepatitis.

[Vertebral abnormalities and atresia of the esophagus]. / Anomalie vertebrali e atresia dell'esofago.

Out of a series of 50 infants suffering from oesophageal atresia, muscular-skeletal anomalies were found in 17 of them (34%), and in 15 of these the vertebral column was abnormal (30%). 5 (10%) were affected by V.A.T.E.R. syndrome. The most frequent vertebral anomaly was characterised by isolated thoracic hypersegmentation, which was found to be regularly associated with Vogt type 3a of oesophageal atresia, with a large distance between the two ends of the oesophagus. This represents an important factor in determining the correct surgical approach, even if in this series the presence of an extra segment did not seem to significantly increase the rate of anastomotic leakage or of mortality. Vertebral anomalies in risk group A, according to Waterston's classification, were quite uncommon.

[Sylvatic rabies: a pediatric problem?]. / La rabbia silvestre: un problema pediatrico?

Rabies epizooty has been recently reported from several Italian provinces: Bolzano, Udine, Belluno, Brescia, sondrio, Varese, Como and Bergamo. The rate of spread of the infection through wild animals has been estimated in 50 Km/year. We have reviewed the fundamental characters or rabies virus, the pathogenesis and clinical manifestations of disease. Furthermore the fundamental guidelines of passive and active immunization will be stressed with spread emphasis to the pre-exposition active immunization in children-living in high risk areas.

[Biliary atresia: pathogenetic considerations emerging from the histopathologic analysis of the liver parenchyma]. / L'atresia biliare: considerazioni patogenetiche emergenti dall'analisi istopatologica del parenchima epatico.

Nine patients had been surgically treated for extrahepatic biliary atresia from 1974 to 1982. The analysis of the hepatic specimens obtained during the surgical exploration revealed a wide spectrum of histopathologic lesions. In 3 patients we found severe Giant-cell transformation, while in the other 6 it was not possible to ascribe the histopathologic picture to a univocal pathogenesis. Comparing our results to the reports of other Authors we believe biliary atresia can not be explained by a single pathologic mechanism. The obstruction of the extrahepatic bile ducts might be the common morphologic denominator of different pathologic entities, from each of them it depends a different evolution of the hepatic lesions and a different survival after Kasai's operation.

[Transverse colon atresia. Case presentation (author's transl)]. / Atresia del colon trasverso. Osservazione di un caso.

The Authors report about a case of colonic atresia localized on the transverse colon a few cms after the right flexure curd by one time resection and end-to-end anastomosis. The pathology of the lesion is atypical since features of Bland-Sutton and Louw's classification types II and III were mixed together at the atresia site while the radiological features were those typical of type II.