[Percutaneous drainage of abdominal abscess. A clinical case and issues of operative ultrasonography in urology]

Percutaneous drainage of intrabdominal abscesses currently is a well established technique. The use of ultrasound, ever more frequently utilized in urology department, made urologists autonomous in ultrasound diagnosis and operative stage. We report on a patient admitted to emergency department in whom acute prostatitis was diagnosed. Urological consultation was obtained. The ultrasound examination performed, permitted to reveal the real syntomatology origin and to make an evaluation about the possible application of ultrasound in diagnosis and treatment of abdominal abscesses. This was also an occasion to re-examine some not urological ultrasound cases and their treatment. We believe that, also for the urologists, morphological knowledge of most frequent abdominal pathologies, visible by ultrasound, is useful to avoid diagnostic mistakes and useless and hazardous treatments. In our experience we confirm that percutaneous and non invasive techniques, if well utilized, have a good cost/benefit ratio. The percutaneous treatment is also useful to convert an urgent surgical operation into a well established and programmed one.

Total gastric replacement following gas bloat in a 21-month-old child

A 21-month-old child with a previously repaired left congenital diaphragmatic hernia underwent a 360 degrees 'loose-wrap' Nissen fundoplication for gastroesophageal reflux. Failure to replace the dislodged nasogastric tube on the 2nd night led to severe gas bloat and total gastric infarction. A 30-cm retrocolic, N-shaped, isoperistaltic jejunal pouch was constructed for gastric replacement. A pyloromyotomy ensured free emptying and a pouchostomy secured the pouch to the abdominal wall. At 8 months all nutrition was oral except for a biannual vitamin B12 injection, there was no dumping, and the pouchostomy was removed. By 18 months growth, originally along the 10th centile, was sustained at the 50th centile. Our early impression recommends a 30-cm retrocolic, isoperistaltic, N-shaped jejunal pouch similar to that of Hays and Clark as a safe and effective replacement for the stomach in children.

Multicenter evaluation of the fully automated COBAS AMPLICOR PCR test for detection of Chlamydia trachomatis in urogenital specimens

The fully automated COBAS AMPLICOR CT/NG test for the detection of Chlamydia trachomatis was evaluated in a multicenter trial. Test performance was evaluated for 2,014 endocervical swab and 1,278 urine specimens obtained from women and for 373 urethral swab and 254 urine specimens obtained from men. Culture served as the reference test. Culture-negative, COBAS AMPLICOR-positive specimens that tested positive in a confirmatory PCR test for an alternative target sequence within the C. trachomatis major outer membrane protein gene were resolved as true positives. The overall prevalence of chlamydia was 4.3% in cervical swabs and 11.0% in urethral swabs from men. When the results for each specimen type were considered separately, the resolved sensitivities were 96.5% (83 of 86) for endocervical swab specimens, 95.1% (39 of 41) for urine specimens from women, 100.0% (41 of 41) for urethral swab specimens from men, and 94.4% (17 of 18) for urine specimens from men; the resolved specificities were 99.4% (1,912 of 1,924) for endocervical swab specimens, 99.8% (1,204 of 1,207) for urine specimens from women, 98. 5% (325 of 330) for urethral swab specimens from men, and 100.0% (236 of 236) for urine specimens from men. For the subset of patients from whom both swab and urine specimens were collected, the combined results for both specimen types were used to identify all infected patients. Using these combined reslts as criteria, the resolved sensitivities for the COBAS AMPLICOR test were 82.6% (38 of 46) for endocervical swab specimens, 84.4% (38 of 45) for urine specimens from women, 84.2% (16 of 19) for urethral swab specimens from men, and 89.5% (17 of 19) for urine specimens from men. In comparison, the sensitivity of culture was only 56.5% (26 of 46) for endocervical specimens and 63.2% (12 of 19) for urethral specimens from men. The internal control provided in the COBAS AMPLICOR test revealed that 2.9% of specimens were inhibitory when they were initially tested. Nevertheless, valid results were obtained for 99. 1% of specimens because 68.7% of the inhibitory specimens were not inhibitory when a second aliquot of the original sample was tested. Two additional COBAS AMPLICOR-positive specimens were detected by retesting inhibitory specimens. The COBAS AMPLICOR CT/NG test for the detection of C. trachomatis exhibited equally high sensitivities and specificities with both urogenital swab and urine specimens and, thus, is well-suited for use in screening.

Aesthetics and lateral thoracotomy in the neonate

BACKGROUND

Lateral thoracotomy is a relatively common procedure in the neonate. Early reports on the incidence of shoulder deformity, scoliosis, and winged scapula rapidly led to a muscle-sparing approach. Scar cosmesis, however, received less attention. Better education and increasing sophistication have led to a higher aesthetic expectation by the public.

METHODS

Since 1988 the authors have combined both principles in the high axillary skin crease approach to lateral thoracotomy in 27 children with esophageal atresia and tracheoesophageal fistula and two children with a patent ductus arteriosus.

RESULTS

Access was not restricted, and early healing was uncomplicated by wound breakdown or infection. Scar aesthetics is excellent and is enhanced by the natural tendency of the scar to migrate into the axilla. Long-term morbidity has been singularly absent.

CONCLUSION

Parent appreciation and operator satisfaction have been noteworthy.

Quantitative analysis of penile ultrasonographic shape during the erectile cycle: a new diagnostic tool for erectile dysfunction? Repeatability of the method and preliminary results

Penile modifications during erection interest not only penile length and circumference, but also its size and shape. In this investigation, the size and shape repeatability of a single standardized ultrasonographic image of penis during flaccidity and erection was quantified in a group of 19 patients complaining of erectile dysfunction. The penis of each patient was placed in the dorsal position and scanned by a 10 MHz linear ultrasonographic probe at the site of maximal corporeal size: (1) during flaccidity; (2) after an intracorporeal injection of 10 micrograms alprostadil; and (3) after a genital stimulation. Each scan was repeated three times for each patient and printed. On each print the outline of the tunica albuginea was drawn, digitized, and mathematically reconstructed by Fourier series that allow a separate quantification of the size and shape differences. Reliability of the tunica albuginea outline and repeatability of probe positioning were separately assessed within patient and functional phase, and found to be good. The actual examinations of two impotence patients performed using the described method are also given. The shape of the corpora cavernosa may be potentially indicative of the homogeneous function of the tunica albuginea, and it may be of use in patients' follow up.

Cardiac autonomic patterns preceding occasional vasovagal reactions in healthy humans

BACKGROUND

The wide range of clinical presentation of orthostatic vasovagal syncope suggests different underlying changes in the cardiac autonomic modulation.

METHODS AND RESULTS

To evaluate the beat-by-beat modifications in the neural control of heart period preceding a syncopal event, we studied RR interval variability in 22 healthy subjects who experienced fainting for the first time during a 90 degrees head-up tilt and in 22 control subjects by means of time-variant power spectral analysis. Sympathetic and vagal modulations to the sinoatrial node were assessed by the normalized power of the low-frequency (LF, approximately 0.1-Hz) and high-frequency (HF, approximately 0.25-Hz) oscillatory components of RR variability. When the patients were supine, no differences were observed in the hemodynamic and spectral parameters of the 2 groups. During the tilt procedure, RR, LFNU, and HFNU (NU=normalized units) values were relatively stable in control subjects. During early tilt (T1), subjects with syncope had reduced RR intervals compared with control subjects. In 13 subjects with syncope, RR decreased while LFNU and LF/HF increased in the last minute of tilt before syncope (T2). Conversely, in the remaining 9 fainters, LFNU and LF/HF decreased from T1 to T2 and HFNU increased slightly.

CONCLUSIONS

Two different patterns may be recognized in the cardiac autonomic changes preceding an occasional vasovagal event, namely, one characterized by a progressive increase of the marker of cardiac sympathetic modulation up to the onset of syncope, the other by a sympathetic inhibition with an impending vagal predominance. The recognition of different pathophysiological mechanisms in fainters may have important therapeutic implications.

Tracheal ring-graft reinforcement in lieu of tracheostomy for tracheomalacia

Three children with tracheomalacia had tracheal reinforcement with free three-quarter circumference ring grafts of autologous cartilage taken from the costal margin. A low cervical manubrium-splitting approach gave excellent access to the anterior mediastinum and the intrathoracic trachea in two children. The first child, a neonate with oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF), had 11 grafts to support the whole of the trachea from the cricoid to the carina and never required a tracheostomy. For the first 5 years she had frequent pneumonic episodes and on one occasion bilateral pneumothoraces. These episodes and radiographic lung hyperinflation, attributed to distal bronchomalacia, have reduced spontaneously in frequency and severity. At 9 years of age she has a well-supported trachea with palpable cartilage rings in the cervical segment. The trachea has grown to approximately 75% of expected normal size for her age. Another child with tracheomalacia related to innominate-artery compression and who presented with 'dying episodes' was completely relieved and resumed a normal life without a tracheostomy following insertion of four grafts to the intrathoracic trachea. He remains well and symptom-free 8 months postoperatively. A third child had cartilage-graft reinforcement of the lower cervical trachea, including the tracheostomy site, to achieve tracheostomy closure at 16 months of age. Five years later he continues to have a well-supported trachea showing acceptable growth. However, he has ongoing evidence of tracheo-bronchomalacia presenting as expiratory wheezing, lung hyperinflation, and pneumonic episodes that are diminishing spontaneously with growth. Our experience, limited to three children, recommends primary tracheal reinforcement with autologous free costal-cartilage grafts for tracheomalacia in the neonate and young infant. This procedure and the anterior mediastinal approach are well-tolerated, providing instant tracheal support, removing the need for a tracheostomy, and allowing the child's rapid return to the family. Long-term follow-up, presently 9 and 5 years in two children originally presenting with OA and TOF, indicates adequate tracheal growth and an aesthetically acceptable appearance. It is relevant to prognosis that relief of the life-threatening tracheal component exposed the full extent of the bronchial cartilaginous weakness, which has significantly detracted from the quality of life for these two children with OA and TOF-related tracheomalacia.

Evaluation of pre- and postprandial growth hormone (GH)-releasing hormone-induced GH response in subjects with persistent body weight normalisation after biliopancreatic diversion

BACKGROUND

Obesity is characterised by growth hormone (GH) abnormalities, including a blunted response to stimulation and a 'paradoxical' increase after meals. The blunted GH release is reversed by a surgical intestinal bypass procedure. However, this does not mean that normal GH dynamics have been restored. The present study assessed whether post-surgical weight reduction in obese patients normalised the modulation of GH release produced by metabolic fuels.

SUBJECTS

Ten obese female subjects, aged 23-54 y, were studied before and after biliopancreatic diversion (BPD). All patients, after surgery, had experienced a significant reduction in body weight (mean body mass index (BMI) 25.78 +/- 1.01 kg/m2 vs 44.68 +/- 1.73 kg/m2). Two groups were also studied as controls: Ten normal body weight female subjects and ten patients suffering from anorexia nervosa (AN, mean BMI 17.46 +/- 1.12 kg/m2).

MEASUREMENTS

We have studied the GH response to a GH releasing hormone (GHRH) bolus (1 microg/kg i.v., at 13.00 h) before and after a standard meal.

RESULTS

In post-BPD subjects, the GH response to GHRH in the fasting state, was clearly augmented in comparison with the pre-BPD values (peak values 18.06 +/- 4.56 vs 3.24 +/- 0.68 microg/L). In post-BPD subjects the postprandial GH response was further augmented in comparison with the fasting test (peak 30.12 +/- 4.99 microg/L, P < 0.05). This pattern was similar to that observed in anorexic patients.

CONCLUSION

The surgical procedure restores a normal GH response to GHRH in the fasting state, but the 'paradoxical' GH response after meals remains present, suggesting a persistent GH derangement in such patients, which is not related to body weight per se. The surgical procedure makes obese patients similar to anorexics, in the relationships between metabolic fuels and GH secretion. The persistence of the GH postprandial response to GHRH in post-BPD subjects suggests a role for metabolic fuels in the regulation of somatostatin (SRIF) secretion.

Upper digestive tract dyspepsia and early gastric cancer

AIM

The study of the frequency and evolution of upper digestive tract dyspepsia in a group of patients operated for early gastric cancer (EGC) and to perform a strategy of diagnosis for the patients with long term upper digestive tract dyspepsia.

METHODS

Clinical data of 35 patients operated for EGC were retrospectively evaluated. The frequency, characteristics and evolution time of upper digestive tract dyspepsia, main when it began more than 6 months before surgery, were analyzed. Radiologic and endoscopic exams carried out for diagnosis were also evaluated. Histological diagnosis of surgical specimens were considered, looking for the presence of chronic atrophic gastritis, intestinal metaplasia, and peptic gastric ulcer.

RESULTS

Long-term upper digestive tract dyspepsia was present in 27 patients (mean evolution time of 43.4 months). Clinical changes of previous symptoms that suggested gastric carcinoma were not found in 15 patients. Concurrent peptic gastric carcinoma were not found in 15 patients. Concurrent peptic gastric ulcer along with EGC was diagnosed by histology in 11 patients, and chronic atrophic gastritis and intestinal metaplasia were both present in the non-tumoral gastric mucosa in all cases.

CONCLUSIONS

1) Unspecific upper digestive tract dyspepsia is frequently found in patients with EGC. 2) Endoscopy should be the first exam performed in patients with upper digestive tract dyspepsia. 3) The patients with gastric ulcer, chronic atrophic gastritis or intestinal metaplasia must be submitted to sequential endoscopic follow-up.

Elective delayed reduction and no anesthesia: 'minimal intervention management' for gastrochisis

PURPOSE

In a pilot study of 14 children, born when the authors were on a 1:5 "on take" for neonatal referrals, a policy evolved of elective delayed midgut reduction without anaesthesia or sedation in the incubator on the neonatal surgical unit. There was no other form of selection, and it was fortunate that the authors did not encountered any adverse criteria in this small series.

METHODS

Bowel reduction, which was pain free, was undertaken conventionally with the same attention and with no greater difficulty than under general anesthesia. Delaying midgut reduction for more than 4 hours led to more stable cardiovascular, respiratory, and renal parameters. Moderate lower limb congestion cleared rapidly.

RESULTS

At the end of the procedure, all children were conscious, and 12 were alert and indistinguishable from normal babies. A mild periumbilical infection developed in two patients. Eleven of the 12 surviving children established enteral nutrition within 11 to 32 days, eight within 18 days. Another child with ileal atresia and bowel dilatation required bowel tailoring and lengthening (LILT) to allow enteral nutrition. All are physically and developmentally normal, and none has required umbilical herniorrhaphy or umbilicoplasty. All except one have a "scarless" abdomen and an aesthetically normal umbilicus. In marked comparison, two children immediately and obviously were unwell with abdominal pain, tachycardia, and metabolic acidosis. Abdominal wall cellulitis rapidly developed in both. At laparotomy one had a midgut volvulus and died at 22 months of short bowel syndrome (SBS) and the other with a perforated segmental ileal atresia died at 7 months of Enterobacter cloacae septicaemia.

CONCLUSIONS

Our small study suggests that delayed midgut reduction without anaesthesia appears safe, carrying no additional morbidity or mortality. It helps avoid anaesthesia, muscle relaxants, and ventilation and has obvious resource benefits. The conscious child is a safety asset, and any postreduction deviation from a "normal, well-perfused, comfortable, and painfree" child is an indication for urgent laparotomy. This "minimal intervention management," when applicable, has become our preferred first option for children with gastroschisis. Further extension of this study will determine those not eligible for this technique and establish "exclusion criteria."

Silent memory induction in maternal immune young animals

Maternal immunity was shown to be an effector mechanism which does not include transfer of memory. 'Boosting' of maternal immunity by vaccination was not effective. Transferred maternal immunity negatively interfered with the induction of optimal protection by vaccination. Antibody formation was not observed after vaccination of maternally immune piglets. In contrast, induction of memory had occurred in animals under maternal immune suppression. Vaccination in young animals negatively interfered with or abrogated, effective maternal immune protection. There was no correlation between specific serum antibody titres in piglets and protection to PRV. Thus apart from protection provided by antibodies contributions of other soluble factors and the cellular immune compartment as represented in colostrum and/or milk were important for protection.

Kinetics of Chlamydia trachomatis clearance in patients with azithromycin, as assessed by first void urine testing by PCR and transcription-mediated amplification

METHODS

Test-of-cure of 19 patients with Chlamydia trachomatis genital infection was assessed by daily collection of first void urine for 7 days just after treatment by azithromycin single-dose.

RESULTS

Detection by PCR and TMA of C. trachomatis showed a good correlation between both methods. The observation that post-therapy chlamydial nucleic acid detection is associated to bacterial clearance suggests that all the patients were cured.

One-stage neonatal reconstruction without stoma for Hirschsprung's disease

Interest in primary one-stage reconstruction for Hirschsprung's disease has been increasing steadily because of the obvious clinical quality issues and resource benefits. This report describes one surgeon's 13-year experience with 52 children who had proven Hirschsprung's disease. The patients were managed in a neonatal surgical unit by a one-stage neonatal reconstruction without stoma. Results indicate that the procedure is not age- or weight-dependent; it should be considered only when parameters for safe neonatal anesthesia, nursing, surgery, and expert pathology are available. Complication rates have decreased with time and compare favorably with those of traditional "safe" multistage approaches. Children with Down's syndrome have a greater risk for complications because of poorer early healing and reduced resistance to infection, and more cautious postoperative management is required. Clinical quality issues, specifically absence of stoma-related concerns, fewer hospitalizations, and less need for surgical interventions, are significantly better. There were no procedure-related deaths. Given an appropriate infrastructure, the one-stage reconstruction without stoma is applicable in the neonatal phase, and is safe and effective therapy, having major quality and resource benefits.

Unusual EEG pattern linked to chromosome 3p in a family with idiopathic generalized epilepsy

OBJECTIVE

To map the gene causing an unusual EEG pattern of delta bursts that appears to segregate as an autosomal dominant trait in an Italian family. The EEG pattern was observed in four family members affected by idiopathic generalized epilepsy (IGE) and in six other clinically unaffected members.

METHODS

All available family members underwent clinical and EEG examination. DNA samples were obtained and used to perform a whole-genome scan with 270 microsatellite markers. After the first linked marker was identified, 12 additional markers in the same chromosomal region were tested to confirm linkage and define a candidate interval.

RESULTS

The gene responsible for the EEG trait was mapped to an 11-cM interval on the proximal short arm of chromosome 3 (3p14.2-p12.1).

CONCLUSION

In this family, a characteristic EEG activity is due to the effect of a single gene on chromosome 3p. A gene encoding a Ca2+ channel subunit maps in the interval and is a potential candidate for the trait. The clinical expression of epilepsy in four family members may reflect the interaction of additional genes, though environmental or other factors cannot be excluded.

Inhibition of human immunodeficiency type 1 virus replication in monocytic U-937 cells by superinfection with Chlamydia trachomatis

The aim of this study was to investigate the effects of infection of monocytic cells with both the human immunodeficiency type 1 virus (HIV-1) and Chlamydia trachomatis on the replication of each pathogen. U-937 cells, chronically infected with HIV-1 (strain LaVLai), either induced to differentiate into immature macrophage-like cells by 32 pM 12-O-tetradecanol phorbol-13-acetate or uninduced, were superinfected with C. trachomatis serovar L2. Both HIV-1 infection and differentiation rendered the U-937 cells highly susceptible to C. trachomatis lytic infection. Differentiation and superinfection of HIV-1-infected cells with C. trachomatis both affected cell viability and reduced viral production in vitro. RT activity was one tenth the original value after differentiation of HIV-1-infected cells, one twentieth the original value after superinfection with C. trachomatis, and one hundredth the original value after differentiation and superinfection with C. trachomatis.

The Malone antegrade colonic enema procedure: outcome and lessons of 6 years' experience

The successful management of faecal incontinence can dramatically improve the quality of life of affected children. The introduction of the non-refluxing, catheterisable appendico-caecostomy provides the opportunity to treat previously resistant patients. Over a 6-year period, 29 children had a Malone antegrade continent stoma for enema administration (MACE). Incontinence was related to spina bifida in 12 children, ano-rectal anomaly in 12, Hirschprung's disease in 2, followed excision of a pelvic tumour in 2, and was secondary to intractable chronic constipation in 1. The conduit was fashioned from the appendix (20), a caecal tube (8), or a gastric tube (1). Surgical complications were stomal stenosis (11), wound infection (1), anastomotic leak (1), MACE stoma prolapse (1), and a pressure sore (1). Colonic irrigation was achieved with washouts of saline (24), saline plus phosphate (4), and saline plus Picolax (1). Twenty-three patients have complete control of bowel function, but 4 still soil. Two remain incontinent, 1 of whom is still being instructed. One child subsequently had a colostomy, but still uses the MACE stoma. Successful bowel management requires motivation, dedication, commitment, and the input of a clinical nurse specialist. The MACE is a relatively straightforward operative procedure that provides an effective washout technique that is acceptable to both parents and children.

Easy Medic: an Internet application for the general practitioner

A research project has been carried out to develop a client server application which supplies the general practitioner (GP) with a 'personal digital assistant' (hand-held mobile computer) to connect to Web servers at a hospital site through the Internet. This allows the doctor to book medical examinations, hospital admissions and manage patient data. The application used advanced object-oriented techniques, on both the client and the server side. The connection to a Web server was achieved through GSM wireless cellular telephones using standard Internet protocols (HTTP, TCP/IP and CGI). Conventional telephone lines can be used as well. Other application modules on the client side provided patients medical record supervision, GP schedule management, general information about hospitals and clinics, and pharmacy consultation. These services should help GPs in their daily work. Moreover, the quality of health-care resource management and cost supervision should improve, since each GP 'transaction' is automatically entered in realtime into a database at the server. The services are under test in the health-care system of an urban area in southern Italy.

Role of planimetric analysis in diagnosing thyroid follicular lesions on fine needle aspiration biopsies: a study with histologic correlation

BACKGROUND

Follicular lesions represent a gray area of interpretation in fine needle aspiration biopsy (FNAB) of the thyroid, with as much as 25% inconclusive reports. We identified "predominantly follicular lesions" (PFLs) as the cytologic category most apt to take advantage of planimetric analysis to reach a more definitive diagnosis.

STUDY DESIGN

Sixty-eight cases of FNAB were diagnosed as PFL among the 1,296 FNABs submitted to our institution between January 1994 and June 1995. These cases underwent planimetric analysis with a Leica semiautomatic image analyzer. A smear from a colloid nodule was used as a reference slide. Nuclear areas, perimeters, form factors and maximum diameters were evaluated. Cases in which nuclear areas and maximum nuclear diameters values were found to be > or = 30% higher than the corresponding values found in the reference slide were reported to the clinician as suspicious for malignancy ("flagged" by the computer). These cases required closer follow-up with repeat FNAB within a month, ultrasound and nuclear imaging studies. Nineteen of these cases underwent surgical resection.

RESULTS

Histologic reports diagnosed 9 cases of follicular carcinomas, 4 cases of follicular adenomas and 6 cases of nodular hyperplasia. When nuclear areas, perimeters and maximum diameters were all utilized, all the malignant lesions were reported correctly by the computer analysis as flagged, and all the benign lesions were reported as "not flagged." The sensitivity and specificity were 100%, and statistically significant correlations were proven.

CONCLUSION

Although the above data provide strong evidence for the value of planimetric analysis in differentiating between follicular lesions, we cannot reach definitive conclusions on the basis of such a limited number of cases. However, the results stimulated our current efforts in applying planimetry along with the evaluation of other biologic markers to a larger set of cases.

TRF1 promotes parallel pairing of telomeric tracts in vitro

Human telomeres consist of long arrays of TTAGGG repeats bound to the telomere-specific proteins, TRF1 and TRF2. Here we describe the structure of in vitro complexes formed between telomeric DNA and TRF1 as deduced by electron microscopy. Visualization of TRF1 bound to DNA containing six or 12 tandem TTAGGG repeats revealed a population of DNAs containing a spherical protein complex localized just to the repeats. Mass analysis of the protein complexes suggested binding of TRF1 dimers and tetramers to the TTAGGG repeats. The DNA was not significantly compacted or extended by protein binding. TRF1 formed filamentous structures on longer telomeric repeat arrays (>/=27 repeats) consistent with the presence of an array of bound TRF1 dimers. Unexpectedly, there was a strong propensity for two telomeric tracts to form paired synapses over the TRF1 covered segment. Up to 30% of the TRF1-bound DNAs could be found in a paired configuration with a strong bias for a parallel as contrasted to an antiparallel arrangement. TRF1-induced pairing was confirmed using a ligation assay which detected the formation of DNA multimers dependent on the presence of TRF1 and a 27mer repeat array in the DNA. These findings suggests that this protein may have an architectural role at telomeres. We discuss the possibility that TRF1-dependent changes in the conformation of telomeres are involved in the regulation of telomere length.

Concepts and considerations for repair of a severe cloacal anomaly

A 1.8 kg chromosomally normal child was suspected antenatally to have a cloacal anomaly and oligohydramnios. Both parents had a chromosome 9 inversion (inv [9] [p11 q13]). Postnatal study showed a high confluence of the urinary, genital and intestinal tracts. Because of prematurity, a right colostomy was performed on a short colon, but the genitourinary tract was not drained. Poor weight gain, urinary tract infection and septicaemia led to a one-stage reconstruction at 5 months of age and a weight of 3.2 kg. Follow-up although short at 15 months, is encouragingly suggestive of urinary and faecal continence. The vagina is patent. This paper considers concepts in cloacal management and submits for evaluation an alternative surgical plan to the presently almost exclusively accepted posterior sagittal approach of Peña and De Vries.

Effective prophylaxis of influenza A virus pneumonia in mice by topical passive immunotherapy with polyvalent human immunoglobulins or F(ab')2 fragments

The effectiveness of polyvalent plasma-derived human immunoglobulins (IVIG) in passive immunotherapy of influenza virus pneumonia was assessed, using the Strain Scotland (A/Scotland/74 (H3N2)) adapted to BALB/c mice by repeated lung passages. Haemagglutinin antibodies in two batches of IVIG at 10 mg/ml had a titre of 1/16. Intravenous injection of 1000-5000 microg of IVIG, 3 h after infection, gave 60-70% protection, whereas intranasal injection of 25-50 microg protected 90% of mice infected with a lethal dose of influenza virus. F(ab')2 fragments were at least as protective as intact IVIG, suggesting that complement or Fcgamma receptor-bearing cells were not required. Topical passive immunotherapy with IVIG or F(ab')2 gave protection up to 8 h after infection, but not at 24 h, suggesting that anti-influenza A antibodies in IVIG, delivered locally, are only effective at early stages of the infectious process. The potential value of topical administration of IVIG or F(ab')2 fragments for influenza A pneumonia prophylaxis was further demonstrated by the protective effects of their intranasal administration 24 h before challenge.

Nitric oxide plasma levels in patients with chronic and acute cerebrovascular disorders

BACKGROUND

The authors carried out a study on plasma level of nitrites, stable end-products of nitric oxide, aimed at investigating some features of the cerebral microvascular function in chronic and acute cerebrovascular disorders,

METHODS

The series consists of 16 patients with chronic cerebral vascular disease, 11 patients with TIA, 28 patients with thrombotic stroke and 27 normal controls; the diagnosis was done on the basis of clinical, ultrasonographic and tomodensitometric findings. For each subject the determination of nitrate plasma levels by a method based on the colorimetric reaction (developed by nitrites dissolved in an acid solution containing sulfanilamide) was performed; this reaction yields quantitative results exactly corresponding to the amount of nitric oxide.

RESULTS

In chronic cerebrovascular patients NO2-values tendentially higher (16.4 +/- 0.52 mumol/l) but not statistically different from those of controls (13.2 +/- 0.52) were obtained; also the values found in the group with TIA, even if slightly reduced (8.0 +/- 1.4 mumol/l), did not differ from controls; in the stroke group a significant (p < 0.05) reduction (6.4 +/- 0.52 mumol/l), as compared to controls, was found.

CONCLUSIONS

On the basis of these results and of the literature data on the physiopathological profile of NO, the authors suggest a compensatory increase of the basal tone of NO in chronic cerebrovascular diseases, while an impaired endothelial synthesis of the marker could play a critical role in TIA patients and more evidently in stroke patients, presenting a wide microvascular area completely and irreversibly excluded.