Persistent nonbilious vomiting in a child: Possible duodenal webbing

An association between malrotation and congenital duodenal webbing is rare. We present our experience with four patients at two centers, and a review of published reports. There are currently 94 reported cases of duodenal pathology associated with malrotation. However, only 15 of the 94 cases (15.9%) include patients with malrotation and a duodenal web. We suggest that nonbilious vomiting in a child must prompt the surgeon to consider duodenal pathology even in the presence of malrotation

Gastric transposition as a valid surgical option for esophageal replacement in pediatric patients: Experience from three Italian medical centers

Background: Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies (peptic or caustic ingestion). The purpose of our work was to describe the experience of gastric transposition in three Italian centers. Methods: This is a retrospective study. The data were extrapolated from a prospective database. We included all patients who had undergone gastric transposition in the last 15 years. Results: In the 15-year period, eight infants and children (3 males and 5 females) underwent gastric transposition for esophageal replacement. Six patients had long-gap esophageal atresia, and two had caustic esophageal stenosis. There were no deaths in the series. Three patients had an early postoperative complication: Two had a self-limited salivary fistula at three weeks, and one (a patient with jejunostomy) had a jejunal perforation treated surgically. One late complication, anastomotic stricture, was recorded that required two endoscopic dilatations. The median follow-up was 60 months (range: 18-144 months). At final clinical follow-up, six patients had no eating problems, and two patients had some difficulties with eating (jejunostomy in situ), but they underwent logopedic therapy with improved outcomes. All patients had an increase in body weight and height postoperatively. Conclusion: Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results, both in terms of surgical technique (simplicity, reproducibility, complication rate) and clinical follow-up (good oral feeding of young patients, normal social life and regular growth curves)

URACHAL CYST: AN UNSPECTED COMPLICATION

The urachus is the remnant of the allantois, which usually becomes obliterated shortly after birth. Urachal remnants due to an incomplete obliteration of different portion of the urachus are rare, but they need to be treated surgically because of their potential for infectious complications and malignant degeneration. We present a case report with an unespected postoperative complication. M.E., a 10 years old boy, came to the Accident and Emergency Department for an acute abdominal pain, without other symptoms, twice in one year. The blood tests, urine sample and voiding cystourethrogram were normal. The ultrasound scan showed a thickened urachal duct. After antibiotic and anti-inflammatory therapy for two weeks, we performed laparoscopic surgery. In the second postoperative day the patient showed abdominal pain and hematuria. An ultrasound scan and a voiding cystourethrogram showed a leak from the dome of bladder. We performed an open surgery to close the defect on the bladder’s dome. The patient was discharged in 10th postoperative day. Now he is healthy. Clinically manifest persistent urachal anomalies are rare, but they carry a risk of recurrent infection and subsequent malignant degeneration. For these reasons the radical excision of the remnant is suggested. Today, due to the large laparoscopic experience, all the reports showed that this technique can be used safely, but we have to pay attention to all steps of the procedure. This case is a paradigmatic situation and it illustrates the importance of a meticulous technique during the excision of urachal remnant. Indeed even if laparoscopic excision could be safe and effective, it is not free of complication

Congenital pouch colon associated to a cloaca malformation in a syndromic newborn: A case report

Introduction: Congenital pouch colon (CPC) is a rare intestinal anomaly usually associated with an anorectal malformation (ARM). Because of its low incidence, there are no guidelines on the correct treatment. We report the step-by-step management and challenging surgery of a newborn with CPC and cloaca to ensure the patient's best quality of life possible. Case presentation: We describe a case of type II CPC associated with a complex cloaca with a retrovesical didelphus uterus in a 1530g preterm syndromic female. A preoperative cystoscopy identified a urogenital sinus with an anterior bladder and a posterior vagina. The abdominal exploration done on day 1 showed a dilated CPC with the cecum ending in a large structure extending toward the bladder, and a proximal diverting ileostomy was created. Eight months later, the CPC was mobilized, and the common wall of the bladder and the pouch colon was excised. The 8-cm colonic pouch was tabularized by a triangle resection resulting in a colonic tube used to create a colostomy. Because of the syndromic nature of the patient, the consensus has been not to proceed with the urogenital reconstruction and the ileo-anal pull-through. Conclusion: CPC malformations should be suspected in the case of a single perineal orifice. There is no consensus about the best surgical approach to CPC. The operative reconstruction must be tailored to each patient in order to ensure the best possible quality of life

Missouri 2011 Corn Performance Tests

This report is published by the MU Variety Testing Program, Division of Plant Sciences, University of Missouri. The work was supported by fees provided by companies submitting hybrids for evaluation. The University of Missouri's hybrid performance testing program began in the mid-1930s, with results first published in 1937. The number of entries in the program has grown from fewer than 50 in the early years to more than 250 today. The large number of commercial hybrids available makes selection of a superior hybrid difficult. To select intelligently, producers need a reliable, unbiased, up-to-date source of information that will permit valid comparisons among available hybrids. The objective of the MU Variety Testing Program is to provide this information