Cognitive dysfunction and psychopathology: a cohort study of adults with intellectual developmental disorder.

BACKGROUND: Cognitive impairment of intellectual developmental disorders (IDD) is determined by several different combinations of specific cognitive alterations. People with IDD present a rate of mental health problems that is up to 4 times higher than that of the general population. Despite this, the relationship between specific cognitive dysfunctions and co-occurring mental disorders has not been adequately studied. The aim of the present paper is to investigate the association between specific cognitive dysfunctions and specific psychiatric symptoms and syndromes in people with IDD. METHODS: One hundred and twenty adults with mild to moderate IDD living in residential facilities underwent a clinical and instrumental assessment for specific cognitive and psychopathological features. RESULTS: Participants with IDD and ASD have significantly lower scores compared to those without respect to who has not the diagnosis on the Processing Speed Index (PSI) and Perceptual Reasoning Index (PRI) on the WAIS-IV and higher time scores on the TMT A. Moreover, there is a significant association between years of hospitalisation and TMT B and TMT B A time scores; the longer a participant with IDD was hospitalised, the worse their performance on the TMT. Although not statistically significant, many psychopathological clusters showed substantial cognitive profiles. CONCLUSIONS: Although further research is needed, neuropsychological and IQ tests scores seem to be differently associated to various psychopathological conditions co-occurring with IDD, and with ASD especially. Cognitive assessment seems to support diagnosis and treatment of psychopathological co-occurrences in persons with IDD, also in consideration of indirect implications including a better knowledge of the patient's characteristics beyond IQ deficit.

Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial.

AIM: This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome. METHOD: Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analyses of the potential predictive factors for failure were performed. RESULTS: The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler-guided dearterialization were associated with a better outcome. CONCLUSION: THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.

[Doppler-guided transanal haemorrhoidal dearterialisation: a casuistic contribution]. / Dearterializzazione emorroidaria transanale Doppler-guidata: contributo casistico.

The search of innovative procedures, able to associate the possibility of treating the hemorrhoidal disease with of "mini-invasiveness", is of growing interest. This paper reports the results obtained during our experience in threating the hemorrhoidal disease with Doppler-guided THD (Transanal Hemorroidal Dearterialisation), which is a technique improved in the last 4 years (February 2004 - November 2009) on a sample of 408 patients. The aim of this study is to evaluate, in a short-term follow-up period, the level of satisfaction and post-operative pain, normal working routine recovery time and the incidence of early and late post-operative complications in our patients. Our results encourage the use of this technique which appears to be safe, quickly performed and characterized by minimal pain and low incidence of complications in the post-operative period.

Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease.

BACKGROUND: Transanal haemorrhoidal dearterialisation (THD) is a nonexcisional surgical technique for the treatment of piles, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the haemorrhoidal plexus. The aim of this study was to assess the long-term efficacy of this treatment. METHODS: The procedure was carried out using a proctoscope with a Doppler probe. The terminal branches were located with Doppler and then sutured. RESULTS: From January 2000 to May 2006, we performed THD in 330 patients (180 men; mean age, 52.4 years), including 138 second-degree, 162 third-degree and 30 fourth-degree haemorrhoids. There were 23 postoperative complications (7 cases of bleeding, 5 thrombosed piles, 4 rectal haematomas, 2 anal fissures, 2 cases of dysuria, 1 of haematuria and 2 needle ruptures). The mean postoperative pain score was 1.32 on a visual analog scale. 219 patients were followed for a mean of 46 months (range, 22-79), including 100 patients with second-degree, 104 with third-degree and 15 with fourth-degree haemorrhoids. The operation completely resolved the symptoms in 132 patients (92.5%) with preoperative bleeding and in 110 patients (92%) with preoperative prolapse. CONCLUSIONS: The efficacy and relapse rate of this procedure appears to be similar to that of traditional surgery and stapled haemorrhoidopexy. The technique was effective and safe for all degrees of haemorrhoids because of the excellent results, low complication rate and minor postoperative pain.

Simultaneous occurrence of metastasizing carcinoid tumour of the gallbladder and chromophobe renal cell carcinoma in a young man.

Carcinoid tumour is an endocrine neoplasia described for the first time in 1888 and rarely observed in the extrahepatic bile ducts. Gallbladder carcinoid tumour was first reported by Joel in 1929. An endoluminal gallbladder lesion, with a bizarre echogenicity, and a mass in the upper pole of the left kidney were found in a 27 year-old man. The patient underwent a cholecystectomy with partial hepatectomy and a polar renal resection. Histological examination revealed a typical gallbladder carcinoid tumour with regional lymph nodal metastasis and a renal cell carcinoma, with morphological and histochemical features of the chromophobe type. This is a distinctive, rare variant, often described in the literature in association with other neoplastic and non-neoplastic diseases. To our knowledge, this is the first report of gallbladder carcinoid tumour with an unexpected aggressive behaviour in a very young patient, with concurrent renal cell carcinoma, chromophobe variant.

[Sclerosing peritonitis. A complication of LeVeen peritoneovenous shunt]. / Peritonite incapsulante. Una complicanza dello shunt peritoneo-venoso di LeVeen.

Sclerosing peritonitis (abdominal cocoon syndrome) is a rare chronic affection of the peritoneum; its etiology is multifactorial and it affects all ages. Capsulating membranes seem to grow from a poorly cellular connective deposition in many layers on the intestinal peritoneum and are casually detected by surgery or autopsy. The placement of the peritoneovenous shunt can favour the deposition of fibrin on the visceral peritoneum, determining the formation of sclerosing membranes. When mechanical occlusion occurs, surgery is the choice therapy in order to remove the obstacle and, if possible, the membranes as well.

[Bilateral renal oncocytoma. A clinical case and review of the literature]. / Oncocitoma renale bilaterale. Caso clinico e revisione della letteratura.

Renal oncocytoma is an epithelial tumour of the kidney, originally considered benign neoplasm, but now it is thought have a limited but real malignant or metastatic potential. Usually monolateral, in 6% of cases it is bilateral in a synchronous or metachronous way. A case of bilateral renal oncocytoma in a 56-year-old woman, observed by chance during a follow-up carried out after breast cancer is described. The etiopathogenic and clinical-therapeutic aspects of this neoplasm are examined, and the conclusion is drawn that the most correct therapeutic approach must aim at both the protection of kidney function and complete removal of the tumour.

[Rectal endometriosis. Apropos of a clinical case]. / Endometriosi rettale. A proposito di un caso clinico.

Regarding a case of rectal endometriosis, presenting with cyclic menstrual rectal bleeding, the authors discuss the clinical and treatment aspects of such a rare pathology. History was sufficient to indicate the diagnosis which was confirmed by the histological examination of the excised rectal tract. These observations underline the diagnostic difficulty; the surgical approach is the treatment of choice when medical treatment gives no success.

[Acute obstruction of the abdominal aorta]. / L'ostruzione acuta dell'aorta addominale.

The acute occlusion of abdominal aorta is a rare event that may have severe clinical results. Personal experience in three cases of acute thrombosis treated in emergency surgery are presented. Aorto-iliac thromboendarterectomy, aorto-bifemoral bypass and thrombectomy with Fogarty catheter were performed. In the first case, after the operation, a renal ischemia occurred. The second and the third patient died after seven days and twenty-four hours respectively.

[Sertoli cell tumor. Case report]. / Tumore a cellule di Sertoli. Descrizione di un caso.

A case of Sertoli cell tumor is described. It represents 1% of testicular neoplasms. Its clinical features, histology, histogenesis and treatment on the basis of the current literature are reported. The malignant potential of this kind of tumor is also stressed.

[Perineal recurrence of rectal cancer after abdomino-perineal resection]. / La recidiva perineale del tumore del retto dopo amputazione rettale per via addomino-perineale secondo Miles.

An interesting case of perineal recurrence of rectal cancer after abdomino-perineal rectal amputation according to Miles is reported and it is emphasized how local recurrences after radical operations are a serious problem due to their frequency, the seriousness of the situation and scarce therapeutical possibilities available. The etiopathogenetical and clinical-therapeutical aspects were examined with respect to the problems of rectal neoplastic recurrence and it was noted that only aggressive surgical action, only in a very limited group of patients, increases survival, offering substantial advantages in terms of quality of life with respect to alternative therapies that have proved ineffective. The prevention of recurrence can only be achieved with suitable surgical and adjuvant medical treatment which together with an early diagnosis of the neoplastic recurrence are necessary to obtain best results.

[Urachal cyst. A case report and review of the literature]. / La cisti dell'uraco. Descrizione di un caso e revisione della letteratura.

The pathology of urachal disease is rarely seen. This article refers to a case of urachal cyst in a twenty-five-year-old male. In order to discuss the pathogenic, clinical and therapeutic aspects of this rare pathology, it is necessary to carry out a complete revision of the literature. Diagnosis is helped by ultrasound and CT scan of the lower abdomen, while fistulography is necessary when there is cutaneous drainage. The treatment consists of surgical approach which includes complete en-bloc excision of the cyst together with possible urachal residue. Such treatment is indispensable in order to avoid acute infection and/or malignant degeneration, frequent complications which are very serious.

[Cholangiojejunostomy of the duct of the 3d segment. Palliative treatment of cholestatic jaundice caused by neoplastic obstruction of the hepatic hilus]. / Derivazione bilio-digiunale sul dotto del III segmento. Trattamento palliativo dell'ittero colostatico da ostruzione neoplastica dell'ilo epatico.

Cholangiojejunostomy of the duct of the III segment in the palliative treatment of mechanical jaundice from neoplastic obstruction of the hepatic hilus. The neoplastic obstruction of the liver hilus has an almost total absence of forewarning clinical signs and therefore results in surgery at a late stage when the patient is not susceptible to radical treatment. It is therefore necessary to use palliative treatment in order to resolve the serious jaundice, the main cause of a quick death. Among the palliative treatment the Authors report their experience of intrahepatic cholangiojejunostomy of the duct of the III segment that they consider the most suitable technique for its ease of execution, its constant anatomical situation and the peripheral position of the anastomoses in relation to the neoplastic lesion. This allows a lasting biliary decompression with a good residual life.

[Peritoneal echinococcus: report of a case]. / Echinococcosi peritoneale: a proposito di un caso.

The Authors report a case of peritoneal echinococcal cyst and discuss the pathogenetic and clinical aspects as well as the diagnostic and therapeutic approaches of such a particular localization. They underline the need of a radical surgical treatment in order to definitively eliminate the parasite and the disease.

Colostomy plug devices: a possible new approach to the problem of incontinence.

The authors report their experience in the use of the Conseal (Coloplast S.p.A., Bologna, Italy) Colostomy Plug, a new device for the regulation of continence in patients with colostomies. The devices were tested on 57 patients divided into two groups: Group A (36 patients) fit with a two-piece Conseal system and Group B (21 patients) fit with a one-piece Conseal system. All patients had the same colostomy type, and all were trained for self-irrigation. The objectives of this randomized, prospective study were to determine compliance with the different systems, to identify the advantages, and to verify the possible different applications among the population of irrigated patients. The following results were obtained. Regarding compliance: Group A's results were excellent in 22.2 percent and good in 52.7 percent of patients. Group B had better compliance than Group A (excellent in 66.6 percent and good in 19 percent of patients). Regarding controlled evacuation, continence time, and silent gas emission: in Group A, the device permitted controlled evacuations (23.8 percent of patients practicing daily washouts) with silent and odorless gas emission (100 percent of cases). In Group B, the results concerning improvement in continence were good (33.3 percent of patients) and excellent concerning the emission of flatus. Regarding the potential use of both systems in different groups of self-irrigated patients: the study has revealed the Conseal Uni-system as being ideal for patients with a well-constructed stoma, slight gas distention, and a better psychologic adaptability to larger-sized systems. In all other cases, the alternative two-piece system is more suitable, owing to the better safety it offers.