[Intestinal intussusception: easy diagnosis in the 21st Century? Outcome of five years experiences]. / Invaginazione intestinale: una diagnosi facile nel 21 degrees secolo? Outcome degli ultimi 5 anni.

UNLABELLED: Intussusception is an entity well codify in pediatric surgery, with guidelines well defined since years in terms of imaging and procedures. MATERIAL: From January '99 to Dec. '03, 25 children were admitted to the Department of Pediatric Surgery of the Children's Hospital of Milan. All the aspects related to the pathology have been evaluated in the study. RESULTS: 25 patients have been studied. 23/25 presented severe pain, 19/25 normal bowel movements in the last 3 hours and in 9/25 a mass were detected at clinical examination.19/25 were submitted to laparotomy after failure of reduction through barium enema, and in 17/19 a manual reduction were performed. Only 2 patients required a bowel resection with primary anastomosis. The analysis of the delay of diagnosis, the delta-T between beginning of the symptoms and first medical evaluation was of 16,23 h. (3-72), and the delta-T between the first evaluation and diagnosis was 18,7 h. The interval between diagnosis and surgery was of 4,3. CONCLUSION: Authors believe that intussusception still represent a challenge for medical and surgical emergency team, supported by the data in literature. Imaging procedures must not be constricted in case of minimal suspicions of intestinal intussusception.

[Small bowel overgrowth: a frequent complication after abdominal surgery in newborns]. / Sindrome dell'intestino infetto: complicanza frequente dopo chirurgia addominale nel neonato.

BACKGROUND/PURPOSE: Surgery for congenital or acquired gastroenterological disorders, and particularly that associated with short bowel, is not infrequently complicated by Small Bowel Bacterial Over growth (SBBO). Aim of this study is to evaluate the clinical course of children undergoing bowel surgery in the newborn period, assessing the development of SBBO and the response to intensive treatment with a "bowel cocktail" of gentamycin, metronidazole and cholestyramine. METHODS: 17 children with various conditions were studied clinically and by Breath Hydrogen Test (fasting and after glucose). 14 children underwent more than one procedure. All children were treated with overall "bowel cocktail" of gentamycin, metronidazole and cholestyramine. RESULTS: 5 children recovered after one course of treatment and 11 children relapsed at least once and required further courses of therapy. One child died from TPN related liver failure and another following a liver and small bowel transplant for short bowel syndrome. A third child required total intestinal tube splinting according to Sauer and another one required a tapering of the preatretic enlarged jejunal loop. CONCLUSIONS: Our study suggests that children undergoing bowel surgery in the neonatal period and those having more than one procedure are at greater risk of developing small bowel bacterial overgrowth postoperatively. Interestingly, loss of the ileocecal valve was not associated with an increased risk of bacterial overgrowth.

[Chronic idiopathic gastric volvulus in children]. / Il volvolo gastrico cronico idiopatico in età pediatrica.

OBJECTIVE: We report clinical, radiograpic and instrumental data about 18 cases of gastric chronic idiopathic volvulus observed since 1997 to june 2000. METHOD: All cases diagnosed by barium meal, performed for vomiting or after a pHmetric esophageal monitoring, in cases of atipical symptoms of gastroesophageal reflux disease. RESULTS: All patients underwent a conservative treatment (antireflux position and procinectics): 5 recovered after 1 year of treatment and 13 were operated on because they did not improve during medical therapy or relapsed after the end of conservative treatment. CONCLUSION: Abnormal position of the stomach is not an absolute indication for surgical treatment. When medical treatment does not obtain improvement in symptoms, surgical option has to be discussed.

Solid and cystic tumor of the pancreas--case report.

Pancreatic tumors are rarely present in childhood. The authors present a case of papillary-cystic tumor in a 13-year-old girl, treated by partial pancreatoduodenectomy, with preservation of the pylorus. The histologic pattern was of a papillary cystic tumor without evident atypical nuclei. One year after operation, the girl is well without any finding of disease.

Hypertension in a group of centenarians.

The aim of the present study was to evaluate the frequency of hypertension in a group of extremely old persons: 73 centenarians resident in Calabria were studied, aged 100-110 years, (mean age 102.95 +/- 2.0), 54 women (73.9%) and 19 men (26.1%), in the period January 1st and April 30th, 1994. All the centenarians were visited at their homes. Hypertensive centenarians were 14 (19.1%), women 12 (85.7%) and men 2 (14.3%). Even if blood pressure progressively increases with age, we have not found it in centenarians. The lesser frequency of hypertension in centenarians certainly depends on genetic and constitutional factors, but also their way of life and alimentary habits (decreased sodium intake, increase of calcium and potassium intake), as we have proven in a recent work, could be determinant. Moreover, the presence of hypertensive centenarians might mean that hypertension does not prevent to reach an age by far above the average, if it is the only risk factor.

Multidimensional evaluation in a group of centenarians.

A group of 40 Calabrian centenarians (12 males, 28 females) was studied from June 1 to December 31, 1993. Their age was ranging from 100 to 107 years (mean age: 102.3 +/- 1.8 years). Clinical evaluation was performed by recording anamnestic data, an objective examination, and by assessing cognitive performance, emotional and nutritional status, as well as functional activity. The following tests were applied: mini mental state examination (MMSE), geriatric depression scale (CDS), activity of daily living (ADL), and instrumental activity of daily living (IADL). The nutritional status was estimated by collecting answers to a questionnaire regarding nutritional habits and by measuring body weight, height and calculating body mass index (BMI). In assessment of the socio-economic conditions, the following parameters were considered: years of education, type of job, type of residence ownership, heating system used, toilet set available and the regular income. Our multidimensional evaluation has revealed, in agreement with other findings, that the Calabrian centenarians seem to be a selected population with an amazingly high activity, who overcame severe age-dependent diseases, probably because of their genetic pattern and of the environmental factors which may favor longevity.

A case of Paget's disease in an ultracentenarian subject with endoprosthesis of Moore type without cementation.

Paget's disease is an osteopathy the incidence of which increases with aging; in the 8th decade, it occurs in 11% of the population. Complications of this pathology often occur, and appear prevalently in form of basilar disease. We report a case of an ultracentenarian patient (aged 107) who suffered a cervical right femur fracture after falling in her own house at the age of 104 years. Radiological and laboratory findings revealed a mono-osseal Paget's disease of the right femur. Because of her good conditions, the patient underwent an operation of non-cemented endoprosthesis of Moore type, with a good post-operatory course and a physiokinetic therapeutic treatment. A kinesiologic evaluation was made, by measuring articular range of motion (ROM) through the neutral zero methods and evaluating the muscular strength: it showed a constantly progressive functional recovery of the lower limbs in both subjective and objective terms.

Occurrence of the Chiari network in a centenarian: echocardiographic study and magnetic resonance imaging.

An occasional finding of Chiari network in the right atrium of a centenarian patient confirms that it may be considered as a "normal anatomic variation" compatible with a long life span. The finding is documented by using echocardiographic and cardiac nuclear magnetic resonance imaging in a 102-year-old man.

[Abdominal aortic aneurysm in the elderly]. / L'aneurisma dell'aorta addominale nell'anziano.

AIM: Complication-free abdominal aortic aneurysm is often asymptomatic and its diagnosis is therefore frequently coincidental. Abdominal aortic aneurysm (AAA) is often suddenly manifested during the rupture stage, resulting in the patient's death. The importance of early diagnosis is therefore clear, enabling optimal monitoring and correct management. EXPERIMENTAL DESIGN AND SUBJECTS: This retrospective study evaluated the incidence of AAA in 1304 over-65-year-olds in care. The authors examined the presence of AAA-related symptoms, risk factors and the concomitance of other pathologies. RESULTS: Four subjects were diagnosed with AAA, equivalent to 0.3% of the total population. All were male, smokers, with multidistrict atherosclerosis in association with other pathologies. CONCLUSIONS: The incidence of AAA in the population of over-65-year-olds examined was lower than that reported in the literature. This discrepancy was due to the fact that the abdominal aorta is not usually examined in clinical practice. However, the high mortality rate of AAA during rupture prompted the authors to evaluate this disorder in high-risk patients.

[Vulvo-vaginitis in pediatric age]. / Vulvo-vaginite in età pediatrica.

In pediatric gynecology, inflammatory vulvo-vaginitis are very common. Their diagnosis cannot be based either on the symptoms (itching or pain) or on the signs (leucoxanthorrhea) for these classifications are "non-specific". At the Consulting Room of pediatric gynecology of the Vittore Buzzi Hospital, 215 "non-specific" vulvo-vaginitis cases have been analyzed through bacteriological and microscopical examinations of vaginal secretions. The vaginal tampon resulted negative in 53% of the cases and positive in the remaining 47%. Comparing these results with microscopical examinations we obtain: 81.8% of sensibility, 77.4% of specificity, 87.8% of negative predictive value and 62.2% of positive predictive value. In particular, this last figure is influenced by the high number of false positives of the vaginal tampons, due to the growth "in vitro" of opportunist germs momentarily quiescent "in vivo". Thus it is useful to associated the microscopical examination (that will indicate all the cases in need of treatment) and the bacteriological examination (that will indicate the right cure).

[Intestinal resection in children: personal experience and suggested follow-up. Preliminary results]. / Resezioni intestinali in età pediatrica: esperienza personale e proposta di follow-up. Risultati preliminari.

In the paediatric field cases of patients subjected to massive intestinal resection (M.I.R.) are more and more frequent; this survival of individuals with a small intestine shorter than 30 centimeters is not to be considered exceptional. Without going as far as such extreme limits of short residual intestine, intestinal resections contributed to create a new pathology represented by those patients who, once they have been subjected to particularly extended intestinal resections, need a particularly responsible nutritional therapy, sometimes with very long hospitalizations. The present study is to appraise the nutritional parameters and the residual absorption capacity of a group of patients in pediatric age subjected to intestinal resection, in order to draw up a record enabling to monitor, as time goes on, the intestinal functionality of those patients and to observe as early as possible the consequences of an alteration of intestinal physiology while creating the premisis for appropriate measures of nutritional supplementing.

[Massive intestinal resection in the newborn: nutritional and feeding problems]. / Resezioni intestinali massive nel neonato: problemi di nutrizione e di alimentazione.

Authors present their experience about nutritional treatment of short bowel syndrome in newborns. Their results seem to demonstrate that right approach to this problem is to start enteral nutrition as soon as possible, using mainly human milk and polimeric nutritional solutions. There are several experimental evidences that this kind of nutritional approach promote intestinal adaptation following massive intestinal resections.

[Neonatal scrotal hemorrhage caused by post-traumatic hemoperitoneum]. / Emorragia scrotale neonatale da emoperitoneo post-traumatico.

The Authors describe a case of neonatal scrotal hematoma due to post-traumatic intra-abdominal hemorrhage. Differential diagnosis with testicular torsion and other causes of neonatal acute scrotum is considered and discussed.

[Our experience in the subject of gastroesophageal reflux disease]. / La nostra esperienza in tema di malattia da reflusso gastroesofageo.

From January 1st, 1983 to March 31st, 1988, 66 children with GER were tested with barium esophagogram, esophageal pH monitoring and esophagoscopy. A medical therapy was given to 49 children and 46 had a clinical improvement; 13 were operated. Early diagnosis is very important to prevent complications: in fact our data show that older children have the worst complications, while infants with GER and severe esophageal pH monitoring have only I-II grade esophagitis.

Acute urinary retention due to didelphys uterus associated with an obstructed hemivagina in a 5-month-old infant.

A double uterus associated with an obstructed hemivagina is a rare malformation syndrome that has been described in about one hundred cases in the world literature. The malformation is diagnosed after menarche because of symptoms caused by hematocolpos or hematometra, and it is occasionally associated with ipsilateral renal agenesis. In the case described here, the malformation was symptomatic when the patient was 5 months old, and was associated with ipsilateral renal hypoplasia. The clinical and etiologic implications are discussed.

[Congenital segmental dilatations of the intestines]. / Le dilatazioni segmentarie congenite intestinali.

Four cases of this rare disease are presented and the reports of the literature are reviewed. The anamnestic, clinical, roentgenologic and anatomo-pathologic findings are discussed mainly in view of aetiopathogenesis and differential diagnosis with numerous congenital obstructive diseases.