Benign blockage: gastric outlet obstruction due to a prolapsing gastric pedunculated polyp. Case report and literature review

NO ABSTRACT AVAILABLEAn 89-year-old woman was admitted to the emergency department at “Ospedale Civile Umberto I” in Lugo (Ravenna) for 1 month of vomiting, mild epigastric pain, and postprandial diarrhea without fever. Main comorbidities included chronic atrial fbrillation treated with a direct-acting oral anticoagulant, previous MI, hypertension, diabetes, and hypercholesterolemia, though despite her age the patient was autonomous in her daily activities. On admission, laboratory tests included normal WBC count, Hgb, and CRP. Abdominal X-ray demonstrated a stomach flled by ingested food (Fig. 1a) and difuse air–fuid levels accompanied by abdominal distension (Fig. 1b). A surgical consultation was requested; a CT scan was performed confrming gastric distension by ingested food (Fig. 2). Since gastric outlet obstruction was suspected, the patient was hospitalized in a medical unit, treated with NPO and IV fuids. After 2 weeks, a second surgical consultation was requested due to the recurrence of clinical symptoms with unchanged laboratory tests. An upper GI series reported normal gastric and duodenal transit (Fig. 3) while colonoscopy was negative. The patient underwent EGD that showed a 4-cm pedunculated polyp situated in the gastric antrum; the polyp prolapsed into the duodenal bulb creating a “ball valve”-type intermittent obstruction. Biopsy was consistent with a hyperplastic polyp which was endoscopically resected (Fig. 4a–c). The fnal histological report confrmed a benign lesion; the patient was discharged from the hospital without any further invasive treatment in good general condition

Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy.

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease

Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases

The role of preferential interactions between similar domains in determining the behavior of aqueous solutions of aminoalkanols. A microcalorimetric study

Enthalpies of dilution of binary aqueous solutions containing 1 mol kg-1 NaOH as cosolvent and the homologous series of α,ω-aminoalkanols and 2-amino-1-alkanols as solutes have been determined by flow microcalorimetry at 298 K. Enthalpic self and cross interaction coefficients of the virial expansion of the excess enthalpies were evaluated. These coefficients are positive and increase at increasing alkyl chain length. The difference between the coefficients of positional isomers of aminoalkanols resembles that shown by the corresponding diols in water. The cross interaction coefficient relative to the ternary system containing hexane-1,6-diamine and hexane-1,6-diol is smaller than those relative to the respective binary solutions. The coefficients were interpreted using the "preferential configuration" model: it is inferred that interactions between like hydrophilic groups are preferred when compared to the like-unlike ones

Transanal evisceration in a patient with rectal perforation and full thickness rectal prolapse: what has prolapsed into what?

These images show a 72-year-old female with full thickness rectal prolapse scheduled for surgery. She presented in the Emergency Room with irreducible prolapse, abdominal pain and signs of shock. Examination revealed the presence of small intestine prolapsing from the anus. Due to the presence of hemodynamic instability, the patient underwent emergency surgery without further diagnostic testing. At laparotomy, a perforation of the superior rectal wall was found with a 120 cm loop of small intestine prolapsing through it. The ileum was reduced in the abdomen with rapid resumption of perfusion and motility and a Hartmann procedure was performed. The postoperative course was uneventful and the patient was discharged after 6 day

Gas in the portal vein: an emergency or just hot air?

We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction

Impact of sleep respiratory disorders on endothelial function in children.

Obstructive sleep apnea syndrome (OSAS) in children can induce endothelial dysfunction, a well-known early marker of atherosclerosis. The study aimed to evaluate a link among endothelial function (measured by flow-mediated vasodilation (FMD)), obesity (evaluated by body mass index (BMI)), and sleep disordered breathing (SDB), assessed with apnoea/hypopnoea index (AHI), in a paediatric population. We demonstrated that our little OSAS patients showed an impaired endothelial function as compared to controls. In particular, the higher the AHI, the worst the FMD values and thus the endothelial function. Although the population sample is small, this study demonstrated that OSAS could impair endothelial function and worsen cardiovascular risk profile since childhood

Cochlear dysfunction in type 2 diabetes: a complication independent of neuropathy and acute hyperglycemia

The effects of type 2 diabetes on evoked otoacoustic emissions (e-OAEs) elicited by clicks in subjects with normal hearing and the involvement of the central (CNS) and peripheral nervous system and acute hyperglycemia were investigated. In study 1, 110 type 2 diabetic patients and 106 control subjects matched for age and gender were investigated by e-OAEs. Central and peripheral neuropathy were evaluated respectively by auditory brainstem responses {ABRs) and according to San Antonio Consensus Conference criteria. In study 2, 10 healthy and 10 type 2 diabetic men matched for age, all with normal e-OAEs, underwent a 5-hour hyperglycemic clamp study, e-OAE tests were performed before and during the hyperglycemic clamp. In study 1, e-OAEs were impaired in 51.8% (57 of 110) of the diabetic subjects, in comparison to 4.7% (five of 106) of the control group (P < .0001). Diabetics with impaired e-OAEs (e-OAEs-), in comparison to those with normal e-OAEs (e-OAEs+), were older (51.0 _+5.8 v 45.1 +- 6.0 years, P < .001), had diabetes longer {11.5 -+ 4.4 v 7.0 +- 3.9 years, P < .001), achieved poorer metabolic control as judged by hemoglobin Alc ([HbAlc] 6.9% -+ 0.4% v 6.5% -+ 0.3%, P < .001), and had more peripheral neuropathy (46% v 23%, P < .02). No difference was observed between e-OAEs- and e-OAEs+ subjects for retinopathy or nephropathy. Nevertheless, when the duration of diabetes was corrected by multiple regression analysis, the correlation between sensorineural damage and peripheral neuropathy lost significance (P = .12). Diabetic groups (e-OAEs+ and e-OAEs-) showed greater latency in waves I, III, and V and greater interwave latency for waves I to V than the control group, but there was no significant difference in ABRs between e-OAEs+ and e-OAEs- subjects. In study 2, there were no significant changes in e-OAE intensities compared with basal values during the entire hyperglycemic clamp in either type 2 diabetic or control subjects. No difference was observed between the two groups at each time of the clamp. Thus, type 2 diabetic subjects show a higher rate of compromised e-OAEs than healthy individuals. The e-OAE dysfunction does not associate with either an injury to the auditory nervous pathway or diabetic microvasculopathy. The apparent interference of peripheral neuropathy in e-OAEs loses significance when corrected for the duration of diabetes