Management of undescended testis: italian experience of a single center of pediatric surgery

Abstract The undescended testis (UDT) is a common male genital anomaly. Sub fertility and testicular hypotrophy are considered the principal long-term consequences of UDT. There are two modes of treatment of UDT: hormonal and surgical treatment surgical that can be used alone or as complementary methods. Testicular histology, testicular volume (TV) and hormonal evaluation are considered to be the most relevant measure to establish future potential fertility. During follow-up each patient undergoes physical and ultrasound examination after three, twelve months and then five years. Serum level of gonadal hormone (LH, FSH, Inhibin B, LDH, Free Testosterone and DHEA) is evaluated before surgery and six months after orchidopexy. We assumed that testis biopsy is more predictive about future potential fertility than TV. Our patients have been found to have higher levels of LH and FSH and lower levels of inhibin B. To discern the presence of an effect of hormonal treatment we decided to consider the Testicular Atrophy Index (TAI), which is applicable only in unilateral UDT. Due to the necessity to consider also the case of bilateral UDT, we have introduced the normalized Testicular Atrophy Index (TAIn). Through the performed management, it has been possible to provide an estimate of the future fertility of these children. We noted that the degree of reduction in testicular volume does not seem to correlate with the severity of histological findings, nor does it seem to affect future fertility. The patients with a TAIn ≥ 20 % treated with preoperative and post-operative GnRHa therapy have a significant increase in TV after 5 years of follow-up, as shown by the relative reduction of TAIn values. Immediate and delayed post-surgery complications have not occurred. In the cases treated with hormonal therapy, a slight accentuation of secondary sexual characteristics occurs but it is completely regressed after discontinuation of the treatment (one month post-surgery). There have been no recurrences UDT after orchidopexy

Acquired Carotid-Jugular Fistula: Its Changing History and Management

Abstract Purpose. To highlight the changes that have come about in recent years in the etiology, diagnosis, and treatment of acquired carotid-jugular fistulas. Methods. We present a review of the literature on acquired carotid-jugular fistulas (CJFs), which includes studies from World Wars I and II up to today and a retrospective analysis of the lesion reports published in the period 2000–2012, with an update of Talwar's table. The case study of one patient suffering from an untreated, long-standing CJF recently treated by us is also presented and included in the updated table. Results. Thanks to early treatment of acute lesions by reconstructive and endovascular surgery, incidence of posttraumatic carotid-jugular fistulas is decreasing, while the number of iatrogenic ones due to medical advances is concomitantly increasing, specifically because of the ever more widespread use of central venous catheters for venous pressure monitoring, parenteral nutrition, and hemodialysis. Conclusion. Although such lesions seem destined to diminish in the future thanks to the above-mentioned diagnostic and therapeutic advances, the increasing number of internal jugular vein catheterizations performed worldwide implies that physicians will still be dealing with carotid-jugular fistulas for many years to come

Spigelian Hernia in a 14-Year-Old Girl: A Case Report and Review of the Literature

Spigelian hernia (SH) is a surgical rarity in children, which occurs through slit-like defects in the anterior abdominal wall adjacent to the semilunar line, the convexity lateral line which joins the nine ribs to the pubic tubercle and signs the limit between the muscular and aponeurotic portion of transversus abdominis muscle. As there are no specific symptoms and signs, the diagnosis is difficult, especially in children. We report a case of SH that comes to our observation: a 14-year-old girl presented recurrent abdominal pain associated to intermittent palpable mass in the paraumbilical region. Starting from our case report, we review the literature of pediatric SH from 2000 to 2013 and we describe the anatomy, etiology, clinical presentation, instrumental diagnosis, and surgical technique of pediatric SH

An Unusual Evolution of Krukenberg Tumour: A Case Report

Krukenberg tumours are rare metastatic tumours of the ovaries characterized by the presence of mucin-producing neoplastic Signet Ring Cell Carcinoma (SRCC). At first glance, this tumour may be confused with a primary ovarian tumour. Surgery and chemotherapy combination have led to improvement in prognosis, but it still remains severe. We report the case of a 60-year-old woman with a Krukenberg tumour rising from a low differentiated gastric adenocarcinoma. The patient was clinically stable for 26 months after surgery until she experienced a prompt decline and died of cerebral haemorrhage within two weeks. The aim of this article was to give an overview of the Krukenberg tumour starting from our case report and comparing it with clinicopathological characteristics of this pathology derived from a review of recent literatur

Habitual Joint Dislocations and Recurrent Multiple Hernias: An Unusual Connective Tissue Disease?

Purpose: Joint laxity and hernia defects are two well-defined conditions that are rarely described in association in literature. The purpose of this study is to describe a peculiar case of connective tissue disorder, not yet defined, whose features are habitual joint dislocations associated with recurrent and multiple hernias. Methods: This is an unusual case regarding a 22 years old male adult, who presented shoulder, patellar, mandibular habitual joint dislocations associated with groin, femoral, epigastric, umbilical, spigelian and lumbar hernias. His phenotype, consisting of tall stature and joint laxity, recalls a similar-marfanoid habitus. Results: Marfan Syndrome, Ehlers-Danlos syndrome, MEN-2B were excluded by specific assessments. The aspecific clinical features of the patient do not consent the identification of an exact diagnosis. Conclusion: This medical case, characterized by joint hypermobility and multiple recurrent hernias, probably consists in an unacknowledged peculiar case of connective tissue disorder. Further investigations and identification of subjects with similar features could be surely useful to diagnostic research and definitive characterization of patient’s disease

Multiple pyogenic granuloma of the penis in a four-year-old child: a case report

Pyogenic granulomas are common, acquired, benign vascular lesions of the skin and mucous membranes that can develop both spontaneously and traumatically. We present a unique case of a four-year healthy, uncircumcised boy with multiple pyogenic granuloma on the mucous face of the penis foreskin. Although penile multiple pyogenic granulomas have previously been described in adults, there are no reports of similar problems in children. In this patient, the pathogenesis of the lesions is probably trauma related as reported in the anamnesis. Therapeutic options are discussed

A congenital anterior urethrocutaneous fistula in a boy whose mother was exposed to ionizing radiations: a case report and literature review

Anterior congenital urethrocutaneous fistula is a rare anomaly that may present in an isolated fashion or in association with other anomalies of the genital urinary tract or anorectal malformations. A case of congenital anterior urethrocutaneous fistula nonassociated with other congenital anomalies in a 3-year-old male whose mother has been exposed to Chernobyl's nuclear fallout is described. The patient was successfully operated with no recurrence. We report a review of the literature about etiology and surgical strategy including the role of ionizing radiations. The congenital anterior urethrocutaneous fistula represents a rare malformation. The etiopathogenesis is unknown

Glutamate/GABA co-release selectively influences postsynaptic glutamate receptors in mouse cortical neurons.

Abstract Cultured rat cortical neurons co-expressing VGLUT1 and VGAT (mixed synapses) co-release Glu and GABA. Here, mixed synapses were studied in cultured mouse cortical neurons to verify whether in mice mixed synapses co-release Glu and GABA, and to gain insight into how they may influence excitation/inhibition balance. Results showed the existence of synapses and autapses that co-release Glu and GABA in cultured mouse cortical neurons, and the ability of both neurotransmitters to evoke postsynaptic responses mediated by ionotropic receptors. We studied the short-term plasticity of glutamatergic, GABAergic, and mixed responses and we found that the kinetics of mixPSC amplitude depression was similar to that observed in EPSCs, but it was different from that of IPSCs. We found similar presynaptic release characteristics in glutamatergic and mixed synapses. Analysis of postsynaptic features, obtained by measuring AMPAR- and NMDAR-mediated currents, showed that AMPAR-mediated currents were significantly higher in pure glutamatergic than in mixed synapses, whereas NMDAR-mediated currents were not significantly different from those measured in mixed synapses. Overall, our findings demonstrate that glutamatergic and mixed synapses share similar electrophysiological properties. However, co-release of GABA and Glu influences postsynaptic ionotropic glutamatergic receptor subtypes, thus selectively influencing AMPAR-mediated currents. These findings strengthen the view that mixed neurons can play a key role in CNS development and in maintaining the excitation-inhibition balance

RFID Technologies: Emerging Issues, Challenges and Policy Options

Radio Frequency Identification (RFID) technology, an enabling technology for automatic identification based on radio waves, will impact the daily lives of European citizens in many different ways, as it is a bridge between the physical and the virtual world. RFID has enormous socio-economic potential but it also brings challenges, such as serious security threats and the potential danger of impinging on personal lives, which if not addressed properly may limit the foreseen benefits from the wide-spread deployment of this technology. This report gives an overview of established and emerging RFID technologies, RFID standards and spectrum allocation, presents RFID market parameters and forecast, privacy and security issues and social aspects of RFID. Five case studies from different application sectors (animal tracking, healthcare, ICT sector, identity cards and public transport) allow us to draw conclusions about both specific areas of development and the whole RFID market in Europe. In the final part, the likely role of Europe is presented, as are policy options for further initiatives.JRC.J.4-Information Societ

Electroencephalographic source imaging: a prospective study of 152 operated epileptic patients

Electroencephalography is mandatory to determine the epilepsy syndrome. However, for the precise localization of the irritative zone in patients with focal epilepsy, costly and sometimes cumbersome imaging techniques are used. Recent small studies using electric source imaging suggest that electroencephalography itself could be used to localize the focus. However, a large prospective validation study is missing. This study presents a cohort of 152 operated patients where electric source imaging was applied as part of the pre-surgical work-up allowing a comparison with the results from other methods. Patients (n = 152) with >1 year postoperative follow-up were studied prospectively. The sensitivity and specificity of each imaging method was defined by comparing the localization of the source maximum with the resected zone and surgical outcome. Electric source imaging had a sensitivity of 84% and a specificity of 88% if the electroencephalogram was recorded with a large number of electrodes (128-256 channels) and the individual magnetic resonance image was used as head model. These values compared favourably with those of structural magnetic resonance imaging (76% sensitivity, 53% specificity), positron emission tomography (69% sensitivity, 44% specificity) and ictal/interictal single-photon emission-computed tomography (58% sensitivity, 47% specificity). The sensitivity and specificity of electric source imaging decreased to 57% and 59%, respectively, with low number of electrodes (<32 channels) and a template head model. This study demonstrated the validity and clinical utility of electric source imaging in a large prospective study. Given the low cost and high flexibility of electroencephalographic systems even with high channel counts, we conclude that electric source imaging is a highly valuable tool in pre-surgical epilepsy evaluatio