Italian normative data for a stroke specific cognitive screening tool: the Oxford Cognitive Screen (OCS).

Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education- and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.

Correlation between Down's syndrome and malformations of pediatric surgical interest.

PURPOSE: This is a collaborative study carried out by Pediatric Surgeons of the "G.D'Annunzio" University and the Regional Association of Down Children of Abruzzo (Italy). METHODS: Data were collected of malformations combined with Down Syndrome (DS) during a 10-year period in a population of defined age to look for a possible improvement of the patients' life conditions. Reportedly, 50% of these patients may reach an age of about 60 years. RESULTS: One hundred twenty-seven DS subjects from this region were evaluated, 54% of whom had associated malformations (13% cardiac, 41% extracardiac, and 13% both). Seventeen patients of 53 underwent surgery for extracardiac malformations, with gastrointestinal malformations prevailing. The largest number of DS babies were born from mothers under 30 years of age; this is attributed to the largest birth rate and the least prevention at this age. Mothers older than 38 years gave birth to DS babies with the lowest rate of associated malformations. CONCLUSION: The role of the pediatric surgeon in multidisciplinary assistance for DS patients is stressed.

Multicystic kidney joined to the homolateral testis by an ectopic vas deferens: embryological hypothesis for a new description.

Ectopic location of the vas deferens is a rare congenital anomaly with multiple variations. The frequent association with ano-rectal abnormalities and hypospadias is well known. We report two cases of a newborn and a 3-year-old child with ectopic vas deferens coupled with a left multicystic kidney without any ureteral structure. Furthermore, the latter had a contralateral vesicoureteral reflux and anal agenesis with recto-bulbar fistula. Our attempt with this report is to explain the development of such anomalous deferential outlet into the multicystic kidney, according to the most qualified theory of the Wolffian duct embryology.

Thrombolysis enhancing activity of a low molecular weight dermatan sulfate (Desmin 370) in experimental pulmonary embolism in rats.

The effect of Desmin 370 (D370), a low molecular weight dermatan sulfate, on the extent of lysis of radiolabelled pulmonary emboli in rats was evaluated. 125I-fibrin labelled blood clots were embolized into the lungs via a jugular vein, and the degree of lysis was calculated, at predetermined intervals, by the residual radioactivity in the lungs. A single i.v. injection of D370 (50 mg/kg) caused a significant increase in the rate of lysis, which was visible at 30 min and persisted for the whole experimental period (2 h). This effect was prevented by epsilon-aminocaproic acid (1 g/kg). At comparable antithrombotic dosages, heparin (2 mg/kg) also produced a significant enhancement of thrombolysis while hirudin (2 mg/kg) was totally ineffective. Heparin, however, produced a much more pronounced anticoagulant effect than D370. No changes in the plasma levels of plasminogen activator and plasminogen activator inhibitor activities were observed after treatment with D370. Moreover, the dermatan sulfate failed to enhance the blood fibrinolytic activity measured by a solid phase 125I-fibrin assay. These results extend previous data indicating that D370 may be efficient also in the therapy of thrombosis and provide direct evidence that this effect occurs, at least in part, via degradation of thrombus associated fibrin.

Prevention of reperfusion syndrome in acute muscular ischaemia with free radical scavengers and membrane-protecting compounds: an experimental study.

The prevention of oxidant-induced damage following reperfusion was experimentally evaluated. Two pharmacological regimens containing different combinations of antioxidant factors and membrane-stabilizing compounds, such as alpha-tocopherol (vitamin E), methionine, dexamethasone, mannitol and cysteine, were administered. The reduced/oxidized glutathione (GSH/GSSG) ratio in muscle was used to evaluate oxidative stress. Ischaemia was induced by occluding the aorta and the inferior vena cava with an irrigation-occlusion catheter. After 4 h of ischaemia, five sheep were reperfused without any treatment (control group) and five treated with an endoaortic bolus administered at declamping (treatment 1). In five other sheep, treatment started during ischaemia (treatment 2). Ischaemia and, in particular, reperfusion significantly reduced the muscle GSH content, compared with the basal value in the control group; thus the GSH/GSSG ratio decreased significantly in the control group from 10.5(2.2) (mean(s.e.) basal value) to 0.687(0.3) at reperfusion (P < 0.009). Both treatments 1 and 2 significantly prevented a reduction in GSH content induced by reperfusion following ischaemia; the GSH/GSSG ratio (10.5(2.2) basal value) increased to 19.67(4.6) with reperfusion in the treatment group 1, mainly because of a lower decrease of GSH and a lower level of GSSG while it did not change in treatment group 2 (10.7(5.0)). Levels of creatine phosphokinase did not change in the treated groups, although they increased significantly in the control group (P < 0.006). Although oxidative stress is not the only cause of damage in revascularization, this study confirms the protective ability of treatment with free radical scavengers and membrane-stabilizing compounds.

[Surgical and radiological intervention in the treatment of peripheral arteriovenous fistulas]. / Chirurgia e radiologia interventistica nel trattamento delle fistole artero-venose periferiche.

The Authors report five examples of arteriovenous fistulas examined in the last two years. The different aetiology concerning these lesions, the most suitable diagnosis and the therapeutic tactics are examined and discussed. When they present results and considerations, they show optimism and discrete realism about results and prognosis as a consequence of technological progress and more and more common multidisciplinary approach towards this pathology.

Traumatic amputation of the upper limb: replantation of the arm.

From 1970 to 1985, 13 patients were treated as a result of an upper limb traumatic sub-amputation. Three of them were younger than 15 years and another one was only 3 years old at the time of the trauma. All the elements involved in the treatment of the lesions are described. When it was possible, an end-to-end anastomosis was used for the repair of arteries and veins. Otherwise, when the loss of tissue was marked, a saphenous vein graft was used. The fracture was treated, when possible, with an intramedullary fixation, surely less traumatizing for soft tissues than a plate. The repair of the nerve was at times simultaneous at other times delayed. The followup has shown a good functional restoration of the limb and of the joints affected by the trauma and a normal development of the patients in terms of age.

Late urologic complications in aorto-iliac reconstructions.

Aortoiliac reconstructive hydroureteronephrosis after surgery may be due to an incorrect position of the .0.prosthesis, anteriorly to the ureter, to a reactive retroperitoneal fibrosis or to a sclerotic outcome caused by vessel and ureter dissection. It is important to consider the possible correlation of hydronephrosis with recurrent prosthetic infections, both as a consequence and as a pre-existing cause of the infective process itself. In the present study, 100 patients were examined, all affected with chronic peripheral obstructive arterial disease and operated on for aortoiliac reconstruction by the same surgeon. A clinical, laboratory and echographic study was performed, after a follow-up period from surgery ranging between 23 and 146 months (72 months on average). Four of them (4%) showed unilateral hydronephrosis, always asymptomatic and resulting from a retroperitoneal fibrosis. When hydronephrosis was moderate or severe, an intravenous pyelography was performed. Only one patient required ureterolysis and "wrapping" of the ureter with adipose tissue, and insertion of an indwelling ureteral catheter, due to marked hydronephrosis and a reduction in the diameter of contralateral kidney. From this retrospective study, the opportunity and the prognostic importance of a perspective study of the patients undergoing aorto-iliaco-femoral reconstruction for an obstructive or aneurysmal disease is evidenced.

Complications following the treatment of abdominal aortic aneurysms.

The complications following the surgical treatment of 328 cases of abdominal aortic aneurysm are reported. In some cases such complications are predictable and their knowledge is useful to reduce the operative mortality. Cardiac and renal complications were more frequent in emergency, while surgical complications were mostly observed in patients with large aneurysms involving the iliac arteries. Duodenal lesions were caused in patients affected by inflammatory aneurysms. The late complications observed were: ureteral stenosis, infections, pseudoaneurysms and occlusion of a branch of the bifurcated graft.