[Cesarean section, techniques and skin suture materials]. / Taglio cesareo, tecniche e materiali di sutura della cute.

AIM: The aim of the study was to compare the outcome, complications and costs of three skin suture techniques after Caesarean section. METHODS: The study sample was 310 women who underwent caesarean section between 2003 and 2007. The sample was divided into three groups: an intradermal suture with non-reabsorbable thread was applied in 98; metallic clips were placed in 90; 2-octyl-cyanoacrylate (2-OCA) glue was used for wound closure in 112. The sutures were checked at 4 days and 2 months after the operation to determine cosmetic outcome, patient compliance, strength of incision closure, allergic reactions, suture infection, and total cost of each technique. RESULTS: No substantial differences in strength of incision closure or cosmetic outcome between the techniques were found. Compliance was better in the group that received 2-OCA, while the total cost of suture alone was lower in the group that received the non-reabsorbable intradermal suture. CONCLUSION: The results suggests that following Caesarean section according to Stark, skin suture with 2-OCA glue has the advantage of greater patient compliance, while intradermal thread suture is less costly with a cosmetic outcome comparable to that of the other two techniques.

[Chronic lumbago after unstable intertrochanteric femoral fracture: a new syndrome or sporadic feature of hip biomechanics after surgery? A case report]. / Lombalgia cronica invalidante dopo frattura intertrocanterica instabile di femore: nuova sindrome o sporadica alterazione biomeccanica dell'anca dopo la chirurgia? Case report.

OBJECTIVE: Only in 2002, more than 86,000 hip fractures were registered in Italy in male and female patients over 45 years old, with 9% progression compared to 1999. In this paper, we report a clinic case of a patient experiencing working problems for a chronic back pain after an unstable extracapsular hip fracture. SUBJECT AND METHOD: The patient, a 54 years old woman, factory worker, complaining of low back pain weeks after the hip fracture, was evaluated and scheduled for a computer tomography examination of the lumbar spine. The C.T. scans were evaluated to assess eventual evidence of disc problems and/or cross sectional changes in density and fibro-adipose degeneration of muscular body of the psoas muscle. RESULT: Because back pain matched with the evidence of cross sectional changes in psoas density without any evidence of disc herniation, the patient was scheduled for aspecific back pain training. After a specific rehabilitation protocol the patient had 75% pain relief after four weeks. CONCLUSION: Age and diseases related changes are commonly seen in the lumbar spine, but the relationship between these changes and symptoms of back pain is not straightforward. Our case report suggest that back pain following extra capsular hip fracture may involve the psoas muscle. The prognosis might be favourable following a specific back training that is actually object of an ongoing controlled trial.

The influence of treatment on the pathology of club foot. CT study at maturity.

We performed CT to investigate how treatment may modify the basic skeletal pathology of congenital club foot. Two homogenous groups of patients treated by one of the authors (EI) or under his supervision were studied. The first included 32 patients with 47 club feet reviewed at a mean age of 25 years and treated by manipulation, application of toe-to-groin plaster casts and an extensive posteromedial release. The second included 32 patients with 49 club feet reviewed at a mean age of 19 years and treated by the Ponseti manipulation technique, application of toe-to-groin plaster casts and a limited posterior release. At follow-up the shape of the subtalar, talonavicular and calcaneocuboid joints was found to be altered in many feet in both groups. This did not appear to be influenced significantly by the type of treatment performed. Correction of the heel varus and the increased declination angle of the neck of the talus was better in the club feet of the second group, whereas reduction of the medial subluxation of the navicular was better in the first. There was a marked increase in the external ankle torsion angle in the first group and a moderate increase of this angle in the second group, in which medial subluxation of the cuboid on the anterior apophysis of the calcaneum was always corrected. Equinus was corrected in both groups but three-dimensional CT reconstruction of the whole foot showed that cavus, supination and adduction deformities were corrected much better in the second group.

A radiographic comparative study of two series of skeletally mature clubfeet treated by two different protocols.

OBJECTIVE: To compare the radiographic features of two series of congenital clubfeet to determine whether a different treatment protocol may influence the radiographic results at the end of skeletal growth. DESIGN AND PATIENTS: Two series of patients with congenital clubfeet, treated by two different manipulative techniques and by two different complementary soft tissue release operations, were radiographically studied at skeletal maturity. Twenty-one normal feet of the unilateral cases in both series served as controls. Anteroposterior and lateral radiographs of the feet were taken with the patient standing, and several radiographic parameters were studied. RESULTS AND CONCLUSIONS: The size of the talus and calcaneus and the height of the talar trochlea were smaller than normal in all cases of clubfeet, were similar in both series and were not influenced by treatment, whereas all the other radiographic parameters studied were more or less different between the two series and seemed to be influenced by treatment. In no treated clubfoot of either series was a normal radiographic foot anatomy restored, not even in those feet that had an excellent clinical result.

Immunophenotypic changes of fetal cord blood hematopoietic progenitor cells during gestation.

We measured cell surface expression of CD34, HLA-DR, CD38, CD19, CD33, CD71, and CD45 antigens in the hematopoietic progenitor cells of fetal cord blood to investigate immunophenotypic changes at different gestational ages. These antigens were identified by flow cytometry in 11 fetuses (gestational age 19-24 wk, in 12 preterm (25-28 wk) and in ten newborn infants born at term. The frequency and number of CD34+ cells were higher in the blood of the 11 fetuses; in addition, a statistically significant inverse correlation between number of CD34+ cells and advancing gestational age was noted. The numbers of CD34+ CD19+, CD34+ CD33+, and CD34+ CD45+ coexpressing cells were significantly higher in the fetuses, whereas CD34+ CD38+ cells were more represented in the neonates at term. Gestational age was inversely correlated with the number of CD34+ CD19+ and CD34+ CD33+ coexpressing cells. A positive correlation between gestational age and CD34+ CD38+ cells was noted. The number of CD34- CD19+, CD34- CD38+, and CD34- CD45+ cells was higher in term infants; furthermore, a significant correlation between advancing gestational age and CD34- CD38+ or CD34- CD45+ cells was demonstrated. The proliferative capacity was also higher at lower gestational ages. These data suggest that the development and lineage commitment of fetal cord blood hematopoietic progenitor cells are very active during the last two trimesters of pregnancy. The most significant changes of hematopoietic cells maturation seem to occur within 25 wk of gestation.

Sacro-coccigeal teratoma: antenatal diagnosis and management.

We report a case of sacro-coccygeal teratoma (ScT) in a 29 years old primigravida at 19 weeks of gestation. Ultrasonographic evaluation in antenatal management of these abnormalities is discussed. The main sonographic criteria appear to be two: dimension and rapid growth of the tumour. Cariotype must be performed to exclude aneuploidy, frequently associated.

Antenatal molecular diagnosis of X-linked ichthyosis by maternal serum screening for Down's syndrome.

A case of X-linked ichthyosis diagnosed antenatally by molecular analysis of fetal DNA is described. The diagnosis was made at 16 weeks gestation, following the finding of a maternal serum unconjugated estriol level lower than 0.1 MoM when performing a triple test. Fetal DNA was obtained from cultured amniocytes; two specific regions were amplified by polymerase chain reaction at 5' and 3' ends of the steroid sulfatase (STS) gene on Xp22.3 region. Analysis showed complete deletion of the STS gene on the distal tip of the X-chromosome short arm.

Risk for spontaneous preterm delivery by combined body mass index and gestational weight gain patterns.

BACKGROUND: To investigate whether maternal anthropometric factors interact with one another or with other risk factors, thus modifying the risk of spontaneous preterm delivery. METHODS: We carried out a case-control study of 230 spontaneous preterm births with intact membranes between 24 and 35 weeks gestation and 460 control term births. All the patients had prenatal care at the same institution. Logistic regression analysis was used to test for possible interactions adjusting for potential confounders. RESULTS: A pre-pregnancy body mass index < or = 19.5 Kg/m2 (odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.20-2.38) and a rate of weight gain < or = 0.37 Kg/week during the second and third trimesters (OR = 2.4, 95% CI = 1.69-3.42) were associated with an increased risk of spontaneous preterm delivery. The risk of spontaneous preterm delivery associated with a low second/third trimester weight gain was greater among patients with a body mass index < or = 19.5 (OR = 5.63, 95% CI = 2.35-13.8) compared to those with a body mass index > 19.5 (OR = 2.45, 95% CI = 1.60-3.75, adjusted p value for interaction = 0.05). The risk of spontaneous premature delivery associated with a maternal pre-pregnancy weight < or = 48 Kg was higher among smokers (OR = 5.81, 95% CI = 1.60-22.9) than among non-smokers (OR = 2.4, 95% CI = 1.53-3.74, adjusted p value for interaction = 0.05). CONCLUSIONS: The risk of spontaneous preterm delivery associated with a low pre-pregnancy body mass index is greater among patients with low rate of gestational weight gain during the second and third trimesters compared to those with a higher rate. The results of this study support the recommendation for increased rates of weight gain to patients with low body mass index compared to those with a higher body mass index.

Antenatal and delivery risk factors simultaneously associated with neonatal death and cerebral palsy in preterm infants.

To evaluate the simultaneous effects of antenatal and delivery risk factors on neonatal death and cerebral palsy in preterm infants, we conducted a cohort study of 363 singleton pregnancies delivered between 24 and 33 weeks gestation. Neurodevelopmental outcome of the infants was evaluated at 2 years of corrected age. Risk factors associated with death or cerebral palsy were analysed by politomous logistic regression. Overall, the mortality rate was 14.6% (53/363) and the prevalence of cerebral palsy among surviving infants was 12.3% (38/310). Decreasing gestation and meconium-stained amniotic fluid were the only antenatal factors associated with increased odds for both death and cerebral palsy. The effect magnitude and the predictive value of gestational age were greater for death than for cerebral palsy. After adjustment for confounders, prolonged (> or = 48 h) rupture of membranes (odds ratio 2.98, 95% confidence interval 1.12-7.96) and male sex of the infant (odds ratio 3.01, 95% confidence interval 1.32-6.71) were significantly associated only with cerebral palsy. We conclude that neonatal death and cerebral palsy share few common antenatal risk factors. The characteristics of antenatal risk factors for cerebral palsy suggest that bacterial infestation of the amniotic cavity may be implicated in the etiology of the cerebral impairment.

[Echographic diagnosis of thyroid hemiagenesis]. / Diagnosi ecografica di emiagenesia tiroidea. Descrizione di due casi.

Thyroid hemiagenesis is a rare anomaly with an uncertain incidence, since some patients have been found in a euthyroid state without abnormalities. Females account for 75% and males account for 25% of the cases, giving a female to male ratio of 3:1. The left lobe is absent in 80% of cases and the right lobe is absent in 20% of cases (a left to right hemiagenesis ratio of 4:1). The isthmus is absent in 50% of the patients. A variety of pathological conditions have been found in the remaining thyroid tissue in association with thyroid hemiagenesis: hyperthyroidism, multinodular goiter, hypothyroidism, benign adenoma, adenocarcinoma, Grave's disease. The differential diagnosis would include unilateral inflammatory disease and infiltrative disease, such as amyloidosis. We present two cases diagnosed in pediatric age, with absence of the left lobe and of the isthmus. Thyroid hemiagenesis has been found in association with congenital hypothyroidism in one case. The other patient was found to be in a euthyroid state without abnormalities. The diagnosis of thyroid hemiagenesis should be considered in any patients where, on physical examination, no apparent thyroid tissue is noted on one side of the neck. Sonography demonstrates an absent lobe, an eventually absent isthmus, and an eventually coexiting pathological condition in the remaining thyroid tissue. Sonography may be useful in distinguish between unilateral thyroiditis or other infiltrative processes and true hemiagenesis. Scintigraphy shows the remaining thyroid tissue uptake, and may reveal ectopic thyroid tissue not seen by ultrasound. Ultrasound may be useful in monitoring asymptomatic patients according to the high frequency of pathological condition associated with thyroid hemiagenesis.

[Impingement syndrome of the shoulder. Clinical data and radiologic findings]. / Il conflitto antero-interno della spalla. Dati clinici e bilancio radiologico.

Subcoracoid impingement syndrome pain is elicited by some positions of the upper limbs, i.e., adduction and inward rotation, whenever coracohumeral space reduces. Although acquired or congenital malformations of the humeral head and/or coracoid apophysis are the most common causes of painful syndromes, repeated flections and inward rotations of the upper limbs, typical of some sports, such as swimming and tennis, and of some sports, such as swimming and tennis, and of some kinds of work, are predisposing factors. The subcoracoid impingement syndrome exhibits on pathogenomonic signs at clinics and the specificity of diagnostic methods is low, which calls for reliable radiologic assessment of this condition. Fifteen patients with subcoracoid impingement syndrome underwent X-ray, US, CT and MR studies. Plain radiography detected no specific signs of this syndrome, but yielded useful information regarding other painful syndromes of the shoulder, such as anatomical variants of the acromion and degenerative changes. US yield was poor because of the acoustic window of the coracoid apophysis, but supraspinatus tendon changes were demonstrated in 2 cases. CT and MRI proved to be the most reliable and accurate diagnostic methods, the former thanks to its sensitivity to even slight bone changes and to its capabilities in measuring coracohumeral distance and acquiring dynamic scans and the latter because it detects tendon, bursa and rotator cuff changes. To conclude, in our opinion, when the subcoracoid impingement syndrome is clinically suspected, plain X-ray films should be performed first and followed by MR scans.

[Diagnosis of gastroesophageal reflux in childhood. Comparison of ultrasonography and barium swallow]. / Diagnosi di reflusso gastro-esofageo nell'età pediatrica. Confronto tra ecografia e pasto baritato.

Gastroesophageal reflux (GER) is a very common event in the pediatric patient. An accurate and atraumatic imaging technique must be used to differentiate normal from abnormal conditions. Sonography (US) appears to answer this purpose, as recently shown in the international literature. One hundred and seventy-eight patients with suspected GER were enrolled in this study; their age ranged 10 days to 15 years. They were examined with both US and barium swallow, in a double-blind trial. The patients were divided into three groups, according to GER severity, i.e., absent or physiologic GER, moderate GER and severe GER. We considered not only the number of reflux episodes, as related to patients' age, but also reflux volume, esophagus clearing time and possibly coexisting hiatal hernia or esophagitis. US and barium swallow results were in agreement in 93% of the cases. In the other cases US demonstrated more severe GER than barium meal. No statistically significant differences were observed in the various age groups. Since US is a relatively cost-effective, noninvasive and physiologic method which is widely available and uses no ionizing radiations, it can be recommended as the screening test of choice in symptomatic children and in the follow-up.

[Echinococcosis/hydatidosis in children: combined medical and surgical treatment]. / Echinococcosi/idatidosi in età pediatrica: trattamento combinato medico-chirurgico.

The outcome of 5 children with visceral hydatid cysts treated with Albendazole and surgical therapy is reviewed. The diagnoses were confirmed by immunological tests, X-ray, ultrasound scanner (US) and computer tomography. The therapeutic approach was correlated to the type of infection pictures. Immunological tests, X-ray and US were performed with the aim to evaluate the response to the therapeutic protocol. Combination of pharmacological and surgical treatment resulted in a complete resolution for all patients without any recurrence and further dissemination of infection.