Fishbone ingestion: two cases of late presentation as pediatric emergencies.

The authors report 2 cases of pediatric emergencies caused by fishbone ingestion. In the first case, 2 fishbones within the sac of an inguinal hernia were detected during an emergency operation for suspected testicular torsion; in the second case, a big fishbone was found in the omentum covering an inflammed appendix during an emergency appendicectomy. In some cases this three foreign bodies can be detected with a simple abdominal X-ray; the relationship between the fish species involved and the diagnosis is discussed.

Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin.

OBJECTIVE: Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. METHODS: 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. RESULTS: Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. CONCLUSIONS: The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.

[Transplantation of the left lung in a 2-month-old piglet. The Study Group for Lung Transplantation]. / Il trapianto di polmone sinistro nel suinetto di due mesi. Gruppo di Studio per il Trapianto di polmone.

Experimental surgery in animals remains an irreplaceable model for the clinical application of a new technique. We performed a single lung allotransplantation in young pigs. The pigs were organized into groups: 1) 6 to assess the surgical anatomy; 2) 10 to receive left transplantation; 3) 3 to study the pathophysiology of the transplanted lung. The preliminary results demonstrated that the surgical model is useful.

[Sickle cell anemia in surgical patients. Significance and problems]. / La falcemia nel paziente chirurgico. Significato e problemi.

Drepanocytosis, a disease notoriously widespread among blacks, is surprisingly frequent in certain Italian islands. Surgical aspects of the disease are discussed: erythrocyte sequestration attacks, pigmentary cholelithiasis, priapism, malleolar ulcers and vaso-occlusive attacks. A knowledge of such aspects is considered fundamental for the purposes of a reasoned differential diagnosis in the field of paediatric pathologies requiring surgery.

[Experimental intrauterine surgery. Morphological study of lung development in the sheep fetus with congenital diaphragmatic hernia]. / Chirurgia sperimentale endouterina. Studio morfologico dello sviluppo polmonare nel feto di pecora con ernia diaframmatica congenita.

Experimental comparison of the lungs of 7 sheep foetuses with surgically induced CDH and 7 controls permitted an assessment to be made of the changes that take place in lung growth, generally described as hypoplasia, through a study of their morphology and histology, and the lung: lamb weight ratio. Changes increased in gravity in function of the duration of hernia. They included: reduced alveolar expansion, fewer generations of bronchi and alveoli, and septal thickening. An increase in the smooth muscle component of 5th-6th generation arteries (i.e. resistance) may offer an explanation of the hypertension characteristic of CDH, and the non-reactivity of these vessels in response to vasodilators. It is also suggested that damage to the mesenchyma can be regarded as the sole cause of the changes in lung growth observed in CDH. Early treatment before these changes become irreversible is thus advisable.

[Experimental intrauterine surgery: the creation of a congenital diaphragmatic hernia in a sheep fetus]. / Chirurgia sperimentale endouterina: la creazione di un'ernia diaframmatica congenita nel feto di pecora.

Up to 50% of the neonates operated during the first hours of life for a congenital diaphragmatic hernia die. The presence of a severe lung hypoplasia, which is at the origin of hypoxia, acidosis, increased pulmonary vascular resistance and right to left shunt, explains the poor clinical results, in spite of surgical success and intensive therapy. A modern approach to the problem includes treatment with pulmonary vasodilator drugs, whose effects are still discussed. Perhaps the prenatal recognition of the defect could improve prognosis. Lots of experience are needed to know more on the subject. This could be obtained with an experimental approach on newborn animals with a CDH. The article relates authors experience in the creation of a CDH in a foetus of sheep, by means of a surgical intervention during its intrauterine life.