A case of diffuse persistent pulmonary emphysema: When is difficult the diagnosis?

AbstractPersistent pulmonary interstitial emphysema (PPIE) is a rare condition that occurs in both preterm and term infants. It is thought to arise from a disruption of the basement membrane of the alveolar wall allowing air entry into the interstitial space. The characteristic CT scan appearance of PPIE can be used to differentiate it from other congenital cystic lesions that may present similarly. The management of infants suffering from diffuse persistent interstitial pulmonary emphysema varies according to severity and stability of the patient, being either conservative treatment or aggressive surgical treatment by pneumonectomy. We report a case of an unstable patient with diffuse persistent interstitial pulmonary emphysema successfully treated by lobectomy as a form of conservative surgical approach

Split-appendix technique: Alternative urinary diversion for pediatric complete incontinence

We report our series of selected patients with complete incontinence in whom the appendix was divided and utilized for creating two continent catheterizable stomas. All patients were treated for urinary and fecal incontinence by split appendix technique. The appendix was divided into two different parts preserving adequate perfusion and used for creating an appendicocecostomy (ACE) and an appendicovesicostomy at the same time. After a clinical and radiological follow up, our patients referred a good acceptance and an easily management of the stomas in order to stay dry for all day from urine and feces with improving of their quality of life. The combination of ACE and Mitrofanoff principle have revolutionized the management of urinary and fecal incontinence in patients who are unable to utilize their urethra to keep themselves dry

Prenatal Diagnosis of Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. The pathophysiology of CDH is a combination of lung hypoplasia and immaturity associated with persistent pulmonary hypertension of newborn (PPHN) and cardiac dysfunction. Prenatal assessment of lung to head ratio (LHR) and position of the liver by ultrasound are used to diagnose and predict outcomes. However, fetal therapy is indicated in cases where negative prognostic factors are detected in screening investigations (liver herniation, LHR  2 kg with CDH and no associated major lethal anomalies. Prematurity, associated abnormalities, severity of PPHN, type of repair and need for ECMO can affect the survival of an infant with CDH. With advances in the management of CDH, the overall survival has improved

Congenital pouch colon associated with anorectal malformation: A rare anomaly of Asian Region-experience of Kurdish centre

Background: Congenital pouch colon (CPC) is an unusual malformation associated with anorectal malformations (ARMs) that are seen especially in Asia. The aim of this study was to analyse our series of CPC associated with ARM in our centre and report our experience based on the rarity of pathology. Materials and Methods: This is a retrospective study conducted at the Department of Paediatric Surgery in North Iraq. We identified patients from a prospectively kept database, including all patients managed between 1997 and 2014. Results: In total, 17 patients (3 females and 14 males) were included; all had CPC and high ARM; male:female ratio was 5.6:1. Two females had colo-vestibular fistula, 1 had a colo-cloacal fistula, all males had imperforate anus with colovesical fistula. Pre-operative diagnosis of CPC was made in eight patients (47%). Four patients (23.5%) had an incomplete pouch colon (Type III and IV), and 13 (76%) had complete pouch colon (Type I and II). All patients were managed with staged surgery. Mortality rate was 17.6% (3/17). Conclusions: CPC associated with ARM can be defined as 'Asian' complex malformation. Few cases are reported in Literature from Europe and USA. However, it is known that it is ever more frequent the collaboration between Asian and European surgeons (as in our study), so the suspicion should be considered in all patient high ARM who come from Asian region. We reviewed literature and report our experience of 15 years, after a retrospectively analysis, to share it and add our data to their reported

Sistema de Gestión de Informes

A fin de contribuir y brindar apoyo a las medidas que se vienen adoptando en materia de seguridad se está llevando a cabo el Proyecto denominado Sistema de Gestión de Informes (SGI), una Solución Web desarrollada en su totalidad por la Dirección Provincial de Informática dependiente de la Subsecretaría de Modernización del Estado de la Secretaría General de la Gobernación de la Provincia de Buenos Aires, que hace uso de la tecnología de Firma Digital y cuyo principal objetivo es optimizar el intercambio de documentación crítica interviniente en los procesos judiciales entre las Unidades Funcionales de Instrucción y Juicio, pertenecientes a la Procuración General de la Suprema Corte de Justicia de la Provincia de Buenos Aires y la Dirección de Registro de Antecedentes del Ministerio de Justicia y Seguridad de la Provincia de Buenos Aires. El SGI permite realizar solicitudes y envíos de informes de antecedentes y, altas y bajas de capturas y secuestros a través de una aplicación WEB valiéndose del uso de Firma Digital, lo cual permite garantizar la integridad, autenticidad y no repudio de los documentos firmados. Asimismo el SGI brinda una interfaz simple que permite a los usuarios administrar los documentos de manera práctica, confiable y segura. La firma digital es una tecnología que se utiliza ampliamente en varios países avanzados y ya ha demostrado impactar en la optimización y transparencia de aquellos procesos en los que ha sido implementada. Es por esto que creemos firmemente que el SGI, al hacer uso de esta tecnología, además de solucionar los inconvenientes antes mencionados, fomentará el uso de la Firma Digital en el Sector Público y dará apertura a un cambio cultural necesario e imprescindible, brindando de esta manera, beneficios a la sociedad en su conjunto.Sociedad Argentina de Informática e Investigación Operativ

Retroperitoneoscopic Varicocelectomy in Adolescents: Long-term Follow-up in Two Italian Centres

Background: The varicocele is the most commonly diagnosed pre-pubertal andrological condition with an incidence of 10%-15% between adolescents. The aim of this study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in two Italian centres with particular attention to post-operative testicular volume and semen analysis after 18 years of life. Materials and Methods: From 1999 to 2010, 286 adolescents underwent retroperitoneoscopic left varicocelectomy. Of these patients, 67 were evaluated by clinical examination, ultrasound and semen analysis, allowing an adequate long-term follow-up. Results: Surgery was performed at a mean age of 13 years (range 10-17) without intraoperative complications. There were two recurrences (3%), two left testis hypotrophy (3%) and four hydroceles (6%), not yet undergone surgery because asymptomatic or without tension. Currently, 44 patients accepted to perform semen analysis which showed a reduction in sperm motility in 12 cases, with associated morphological alterations in 3 and reducing number of spermatozoa in one case. Conclusions: In consideration of morphological and biomolecular spermatic alterations reported in adolescent varicocele that could interfere with cellular migration, differentiation and nutrition, it is fundamental to consider the correction of varicocele, not only for the classical indications, but also as a choice for arresting the progressive damage that inevitably acts for several years on the adolescent testis. The RV in adolescents is a safe and feasible procedure for experienced paediatric laparoscopic surgeons with early good clinical outcomes, but more studies occur to understand the real impact of adolescent varicocelectomy on testicular function

Nuevas perspectivas de las psicoterapias con gays y lesbianas

INTRODUÇÃO: O estigma que gays e lésbicas sofrem configura uma questão de saúde pública. Frequentemente, a procura de psicoterapia por esses pacientes é motivada por fatores relacionados a dificuldades de relacionamento com o meio. Dessa forma, a psicoterapia é uma ferramenta valiosa para mitigar os efeitos deletérios do estresse de minorias e dos novos impactos psicossociais advindos da pandemia. MÉTODO: Foi realizada uma revisão narrativa da literatura indexada em bases de dados utilizando palavras-chaves obtidas a partir de vocabulários controlados e sinônimos. A amostragem foi por conveniência. RESULTADOS: Diferentes modelos de psicoterapias foram adaptados às necessidades das minorias sexuais, como protocolos baseados nas terapias interpessoal, psicodinâmica e cognitivo-comportamental. Os modelos atuais da identidade sexual incorporam conceitos como homonegatividade internalizada e estresse de minorias, com conflitos que podem ser descritos em estágios passíveis de intervenções psicoterápicas específicas. Adicionalmente, a pandemia de COVID-19 pareceu trazer à tona uma série de novos possíveis estressores para indivíduos pertencentes a minorias sexuais, como o isolamento social e o aumento no consumo de álcool. DISCUSSÃO: Diversos modelos de psicoterapia mostram resultados satisfatórios em gays e lésbicas. Os principais fatores relacionados ao êxito terapêutico são a adoção de uma postura não julgadora e em uma aliança terapêutica sólida. CONCLUSÃO: A psicoterapia apresenta-se como um tratamento de notável valor ao atenuar o possível sofrimento psíquico de gays e lésbicas, principalmente diante da intensificação do estresse de minorias durante a pandemia de COVID-19.INTRODUCTION: The stigma suffered by gays and lesbians is a public health issue. Frequently, the demand of psychotherapy by these patients is motivated by factors related to relationship difficulties with the environment, which makes psychotherapy a valuable instrument to reduce the deleterious effects of minority stress and the new psychosocial impacts resulting from the pandemic. METHOD: A narrative review of literature indexed in databases was conducted using keywords obtained from controlled vocabularies and synonyms. The sampling was by convenience. RESULTS: Different models of psychotherapies have been adapted to the needs of sexual minorities, such as protocols based on interpersonal, psychodynamic and cognitive-behavioral therapies. Current models of sexual identity include concepts such as internalized homonegativity and minority stressors, with conflicts that can be described in stages amenable to specific psychotherapeutic interventions. The pandemic of COVID-19 seemed to bring out a number of new potential stressors for individuals belonging to sexual minorities, for exemple social isolation and increased alcohol consumption. DISCUSSION: Several models of psychotherapy demonstrate satisfactory results in gays and lesbians. The main factors related to therapeutic success are the adoption of a non-judgmental stance and in a solid therapeutic alliance. Minority stress, intensified during the COVID-19 pandemic, contributes to negative mental health outcomes. CONCLUSION: Psychotherapy presents itself as a treatment of notable value in alleviating the psychological suffering of gays and lesbians, especially in the face of intensified minority stress during the COVID-19 pandemic.INTRODUCCIÓN: El estigma que sufren gays y lesbianas es un problema de salud pública. A menudo, la demanda de psicoterapia por parte de estos pacientes está motivada por factores relacionados con las dificultades de relación con el entorno, lo que convierte a la psicoterapia en un valioso instrumento para reducir los efectos deletéreos del estrés minoritario y los nuevos impactos psicosociales derivados de la pandemia. MÉTODO: Se realizó una revisión narrativa de la literatura indexada en bases de datos utilizando palabras clave obtenidas de vocabularios controlados y sinónimos. El muestreo fue por conveniencia. RESULTADOS: Se han adaptado diferentes modelos de psicoterapias a las necesidades de las minorías sexuales, como protocolos basados en terapias interpersonales, psicodinámicas y cognitivo-conductuales. Así, la psicoterapia afirmativa emerge como un modelo transteórico asociado a mejores resultados en salud mental que auxilia en la expresión de la identidad sexual de los individuos, aunque no se ajuste a la norma social. La pandemia de COVID-19 pareció generar una serie de nuevos factores estresantes para las personas pertenecientes a minorías sexuales. DISCUSIÓN: Varios modelos de psicoterapia demuestran resultados satisfactorios en gays y lesbianas. Los principales factores relacionados con el éxito terapéutico son la adopción de una postura libre de juicios y en una sólida alianza terapéutica. El estrés de las minorías, intensificado durante la pandemia de COVID-19, contribuye a los resultados negativos de salud mental. CONCLUSIÓN: La psicoterapia se presenta como un tratamiento de notable valor para aliviar el sufrimiento psicológico de gays y lesbianas, especialmente ante el estrés de las minorías intensificado durante la pandemia de COVID-19

Health-related quality of life of children and adolescents with osteogenesis imperfecta: a cross-sectional study using PedsQL

Background: Osteogenesis imperfecta (OI) is a disorder of bone formation leading to low mineral density and fractures. Children and adolescents with OI require periodic medical follow up, corrective surgery, drug therapy and physical therapy, as well as specific daily care practices. In addition, they have an increased incidence of fractures, which require immobilization and cause severe discomfort and short-term disability. This study evaluated the health-related quality of life of children and adolescents with OI in two reference centers for OI treatment in southern Brazil. Methods: In this prospective cross-sectional study, the Pediatric Quality of Life Inventory (PedsQLTM) was applied in two university-affiliated reference centers for OI treatment in southern Brazil. Children and adolescents aged ≥ 5 years with clinical diagnoses of OI were included. Clinical data and socioeconomic status was evaluated. Results: The sample consisted of 52 children and adolescents with OI (aged 5-17 years); 26 (50%) participants with type I OI, 13 (25%) type IV, 12 (23.1 %) type III, and 1 (1.9%) type V OI. Physical and social functioning domains differed significantly according to clinical presentation of OI with lowest scores in the severe type (OI type III). Pain seems to be the variable that is most associated with impact on the PedsQL domains. Conclusions: Overall, this study revealed differences in physical functioning and social functioning in relation to OI clinical presentation. These results reinforcing the importance of the clinical management of these patients with the aim of functional improvement and importance of pain control

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

<p>Abstract</p> <p>Background</p> <p>Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.</p> <p>Methods</p> <p>A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO₂insufflation at the 10 cm of water. TIR was evaluated at the 24^th, 72^nd, 120^thand 168^thhour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.</p> <p>Results</p> <p>More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24^thand 72^nd; p < 0.01 - 120^thand p < 0.001 - 168^thhrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.</p> <p>Conclusions</p> <p>MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO₂insufflation however, led to moderate inflammation and less adhesion formation.</p