[Intestinal perforation due to accidental ingestion of foreign bodies]. / Perforazione intestinale da ingestione accidentale di corpo estraneo.

Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).

[Health effects of the Chernobyl disaster. Fifteen years afterwards]. / Efectos en la salud por el desastre de Chernobil. Quince años después.

The Chernobyl nuclear accident of 1986 released large quantities of radioactive material causing heavy contamination in widespread areas of the former Soviet Union. Each summer, several hundred children visit Spain from Chernobyl. In this article we describe the accident, the environmental contamination, the mechanisms of radiation injury and the dose-response relationships. We review the health effects of exposure to ionizing radiation and the health impact of the Chernobyl catastrophe. We propose guidelines for the medical management and evaluation of children on temporary visits. The health status of adults and especially that of children in Belarus, Ukraine and the Russian Federation has been adversely affected. According to present knowledge, Chernobyl has given rise to a marked increase in the incidence of papillary thyroid cancer, psychological consequences and socioeconomic disruption. Many studies report that the incidence of other diseases has increased, but not all health problems seen after the nuclear accident can be attributed to radiation. Given the long latency period for diseases induced by radiation exposure, long-term follow-up of all potentially affected individuals is important. Fifteen years after the Chernobyl accident the international community is still learning scientific, medical and humanitarian lessons.

Efectos en la salud por el desastre de Chernobil. Quince años después / Health effects of the Chernobyl disaster. Fifteen years afterwards

El accidente de la central nuclear de Chernobil en 1986 ocasionó la liberación de grandes cantidades de material radiactivo, y causó la contaminación de amplias zonas de la antigua Unión Soviética. Cada verano, en España se recibe la visita de cientos de niños de Chernobil. En este artículo se describe el accidente, la contaminación ambiental, los mecanismos de lesión por radiación y la relación dosis-respuesta. Se revisan los efectos sobre la salud de la exposición a radiación, y el impacto de la catástrofe de Chernobil. Se hace una propuesta de actuación y valoración sanitaria con los niños en acogimiento temporal. En Bielorrusia, Ucrania y la Federación Rusa, el nivel de salud de la población, especialmente infantil, se ha visto afectada. Con los datos actuales, sabemos que las secuelas de Chernobil son un marcado incremento en la incidencia de carcinoma papilar de tiroides, consecuencias psicológicas y socioeconómicas. Muchas publicaciones señalan un incremento de otras enfermedades; pero no todos los problemas de salud vistos tras Chernobil pueden atribuirse a la radiación. Dado el largo período de latencia de las enfermedades inducidas por radiación, es importante el seguimiento de la población afectada. Quince años después de Chernobil la comunidad internacional sigue aprendiendo lecciones científicas, médicas y humanitarias (AU)

[Hepatitis C virus infection mimicking hemorrhagic fever: a case report] / L'infezione da virus dell'epatite C che si manifesta come febbre emorragica: descrizione di un caso.

Acute C hepatitis, compared with hepatitis A or B, may sometimes be associated with extrahepatic manifestations of a haematologic nature. The first case of hepatitis associated with aplastic anemia was reported by Lorenz in 1955. We observed a patient who developed acute hepatitis, associated with febrile purpura: pancytopenia was present, but not aplasia. This association is frequent in Flavivirus-related infections, like Dengue and Yellow Fever, and principally affects children and young people. HCV belongs to the Flavivirus family and so in this case clinical signs may have developed as a consequence of HCV infection.

[Paraesophageal hiatal hernia]. / Ernia iatale paraesofagea.

Paraesophageal hiatal hernia is an uncommon disease but it frequently presents in aged people, causing chronic vague abdominal symptoms up to surgical emergencies from incarceration, strangulation or obstruction. The authors describe the physiopathology and clinical anatomical features of paraesophageal hiatal hernia. Important diagnostic radiological and instrumental aspects are then illustrated, versus sliding esophageal hiatal hernia. There are followed by a description of possible complications of this lesion and therapeutic implications.

[The importance of using the cerebral function monitor (CFM) in the neurological prognosis of neonates in intensive care]. / Importanza dell'uso del Cerebral Function Monitor (CFM) nella prognosi neurologica dei neonati ricoverati in Terapia Intensiva.

Cerebral function monitor (CFM), unlike traditional EEG, allows a long-term evaluation of electric brain activity, without interfering with the nursing of the newborn in the intensive care unit. Our aim was to evaluate the prognostic value of CFM for neurological outcome. We studied 102 newborns (gestational age 34.5 +/- 4.36 weeks; weight 1980 +/- 720 grams) by Multitrace CFM (Lectromed) 5 hours daily in the first week following admission. The patients also underwent cerebral echography, EEG and neurological follow-up to the 24th month. CFM was found to correlate well with the EEG recorded 3 months later. The persistence for at least one week of an I.C. tracing or the normalization of initial tracing have a good prognostic value (positive predictive value 95.23%), a persistently pathologic registration has a negative prognostic value (negative predictive value 85.18%), that even increases if cerebral echographic alterations are demonstrated (98.57%). The association of CFM and ultrasound abnormalities determines a relative risk for neurological motor impairment of 69.14, whereas CFM alone gives a relative risk of 6.4.

[Postoperative complications after thyroid surgery. Review of the literature and personal experience]. / Le complicanze post-chirurgiche dopo intervento sulla tiroide. Revisione della letteratura ed esperienza personale.

The authors make a review of the literature on the complications which occur after thyroidectomy. They report, moreover, a study carried out on 192 thyroidectomy performed between January 1992 and May 1995. The surgical technique employed foresees the systematic search for and saving of laryngeal nerves fibers and the parathyroid gland. Results were the incidence of postoperative hypocalcemia and of permanent hypocalcemia. The authors also analyse problems related to laryngeal nerves in matters of thyroid surgery. After a short introduction on surgical anatomy, attention is drawn to the "recurrent nerve risk" but also the superior laryngeal nerve too, often injured with modifications of the vocal tone and serious consequences for particular professional groups.

[Postoperative pain control]. / Controllo del dolore postoperatorio.

Pain was and in part still is a constant feature of surgical practice: before, during and after surgery. To start with painful symptoms represent a fundamental diagnostic element, given that in over 60% of cases pain is the primary indication for surgery. During the operation, pain used to constitute the main impediment to the surgeon's activities, until the introduction of ether and the birth of modern anesthesia. Lastly, the postoperative period is also painful so much so that whereas until fifty years ago patients were above all afraid of the operation, patients nowadays are concerned about the pain during the days after the operation. Moreover, over 50% of patients undergoing surgery are unsatisfied with the treatment of postoperative pain, in spite of the fact that drugs are available which enable us to control it. The authors studied the quality of postoperative analgesia in 357 patients, who received treatment with ketorolac tromethamine 30 mg i.v. on leaving the operating theatre, and subsequently i.m. every 8 hours starting from 3 hours after surgery. The use of ketorolac tromethanine demonstrated effective analgesia and was well accepted by patients, without revealing any particular collateral effects.

[Enterococcal endocarditis: clinical features and therapeutic approach]. / Endocardite da enterococco. Rilievi clinici e approccio terapeutico.

Enterococci are implicated in about 20% of cases of infective endocarditis, topically in aged subjects with gastro-intestinal and/or genitourinary diseases. These forms are usually associated with an increased morbidity and mortality, in that also reflecting the difficulties encountered to set up a specific therapeutic approach. Among the various antibiotics effective against enterococci, particular attention has been recently given to those belonging to glycopeptide group. In the current study we have assessed the efficacy of teicoplanin associated to ampicillin plus sulbactam in 27 consecutive patients with enterococcus-mediated endocarditis, admitted to our hospital between June 1987 and September 1995. In 17 patients the source of infection has been identified in the gastrointestinal tract. The clinical recovery and the bacteriologic eradication have been achieved in 24/27 (88.8%) patients. The results indicate the necessity of a prophylactic antibiotic treatment in aged individuals with diseases affecting the gastrointestinal tract and further suggest the efficacy of teicoplanin and ampicillin plus sulbactam association for the treatment of endocarditis caused by enterococci.

[Role of dietary prevention in newborns at risk for atopy. Results of a follow-up study]. / Ruolo della prevenzione dietetica nei neonati a rischio per atopia. Risultati del follow-up.

The Authors have studied the role of various preventing diet for a primary prophylaxis of allergy in 125 newborns at risk of atopy: 30 exclusively breast-fed, 50 hypoallergenic milk fed, 30 soy milk fed, and 15 with conventional milk formula. IgE values were determined at 5 days, 6 months, and 12 months of age, IgE values at 5 days were compared to newborns not at atopic risk. The clinical follow-up lasted 4 years. Total IgE values at 5 days were significantly higher in new-born at atopic risk. Only breast-feeding subjects had IgE normal values at six months. Allergic symptoms were observed in 14% of infants with a guided diet and in 53% of infants with a conventional diet. Breast fed subjects had atopic disorders in only 8% of cases, subjects with hypoallergenic formula in 12% while soja milk fed in 25%. The Authors stress the role of breast feeding in preventing allergic disorders in subjects at atopic risk or, when human milk misses, of a hypoallergenic formula, more than soy milk and conventional formula and confirm the possibility of diet and ambiental prophylaxis of allergy.

[Acute abdomen caused by the rupture of a solitary non-parasitic cyst of the liver]. / Addome acuto causato dalla rottura di una cisti solitaria non parassitaria del fegato.

A rare case of acute abdomen caused by the rupture of a solitary, non-parasitic cyst of the liver is reported. Considering the rarity of the event, it was considered interesting to examine the anatomo-pathological, clinical and diagnostic aspects as well as the various surgical and other treatment possibilities for these conditions. Stress is also laid on the fact that surgical treatment is only indicated in the case of complications, while in uncomplicated forms the treatment of choice of alcoholisation.

[In vitro and in vivo effects of cefodizime and ceftriaxone on oxygen-dependent killing of neutrophils of elderly patients with exacerbation of chronic bronchitis]. / Effetto in vitro e in vivo del cefodizime e del ceftriaxone sul killing ossigeno-dipendente dei granulociti neutrofili di pazienti anziani con bronchite cronica riacutizzata.

The immunomodulating activity of some chemotherapeutic agents, is particularly interesting. Our study has evaluated the in vitro and in vivo effects of two third generation cephalosporins: cefodizime and ceftriaxone, on the chemiluminescence of polymorphonuclears of 20 elderly patients affected by acute exacerbation of bronchitis. Twenty healthy patients have been also evaluated in vitro. Antibiotics have been used in vitro at the concentration of 50 g/ml while in vivo a group of 10 patients have been treated with cefodizime (2g/daily in 2 divided doses), another group of 10 patients with ceftriaxone (2g/daily as a single dose); in both groups the antibiotic treatment was given for 7-10 days. A significant potentiation of chemiluminescence has been shown in both groups of patients treated in vivo; whereas the preincubation in vitro of the polymorphonuclear suspension, both in healthy patients and in elderly bronchopathic ones, with antibiotics, has not changed the activity of oxygen dependent killing. Finally, we believe that bactericidal properties of the antibiotic still remain now the most important criteria of choice in order to assure effective control of infections.

Development of a physical characteristics assessment (PCA): a checklist for determining appropriate computer access for individuals with cerebral palsy.

The physical characteristics assessment (PCA), a newly developed illustrated checklist, is designed for use by allied health and education professionals to identify a viable method for an individual with cerebral palsy to access a computer. The PCA was developed in response to a documented void of such assessments in the literature. The value of PCA was assessed with respect to content validity, clinical utility, reliability (inter-rater), and opinion of persons with cerebral palsy and health and education professionals. Professionals (n = 72) and persons with cerebral palsy (n = 78) from 20 sites in Canada, Chile, England, Israel, Spain, and the United States participated in the study. Statistically, the PCA produced a highly significant (p < 0.001) assessment time savings compared with non-PCA methods. A statistically significant difference in the number of user/computer interface changes during five post-assessment computer training sessions was not shown between the PCA and non-PCA methods. Inter-rater reliability ranged between 90% and 100% (n = 33 pairs). Both persons with cerebral palsy assessed via the PCA and professionals using the PCA gave positive opinions. Overall results support the value of the PCA.

Risk factors for adolescent suicidal behavior: loss, insufficient familial support, and hopelessness.

Upon admission to an inpatient psychiatric facility, 20 adolescent serious suicide attempters and 20 nonattempters matched on depression scores were asked about their perceived hopelessness, social support, and loss preceding hospitalization. Attempters and nonattempters were similar in psychiatric status, gender, age, race, and socioeconomic status. Measures included Reynold's (1987) Suicidal Ideation Questionnaire (SIQ) and assessment for recent loss of a significant other. Also included were versions of the Beck Depression Inventory (Beck, 1967), Beck Hopelessness Scale (Beck, Schuyler, & Herman, 1974), Suicide Intent Scale (Beck et al., 1974), and Sarason's Social Support Questionnaire (Sarason, Levine, Basham, & Sarason, 1983) modified to retrospectively assess the period of time just prior to hospitalization. Classification of serious suicide attempt using both staff screening and the Suicide Intent Scale was validated by attempters' high scores on the SIQ. Data show that loss and low family support were the best predictors of an adolescent's suicide attempt. Also, suicide attempters reported more hopelessness than did nonattempters. The influence of recent loss on serious suicide attempts, especially when paired with a perceived lack of family support and hopelessness, provides evidence for a "stress-vulnerability" model of adolescent suicide behavior.