Anorectal Malformations: the Brooke Ileostomy Technique Moves to the Colon

Colostomy is considered by most authors the first step of treatment for neonates affected by high or intermediate anorectal malformations (ARMs). However, for this subset of patients, the debate between total diverting colostomy (TDC) and loop colostomy (LC) is still ongoing among the paediatric surgeons community. The aim of this paper is to present our experience consisting in applying the Brooke technique, until now used only for ileostomy, in order to perform a functionally diverting loop colostomy (FDLC) in patients with high or intermediate ARMs. At our institution, from January 2014 to December 2018, 12 patients (6 males and 6 females) with high or intermediate ARMs underwent colostomy according to the Brooke ileostomy technique. The only complication observed was mild proximal stoma prolapse in 1 patient. Creation and closure of the stomas were easy, and the final cosmetic result was very satisfying in all patients. We believe that this is a promising technique since it might overcome the drawbacks of a TDC as it is less invasive, easier, and quicker to perform. Furthermore, it guarantees final better cosmetic results, albeit functioning as a TDC

Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors

This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p=0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6±1.0 to 1.1±1.0; p=0.001) and fingers (from 1.2±1.1 to 0.7±0.9; p=0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123

Chronic Cough and Eosinophilic Esophagitis: An Uncommon Association

An increasing number of children, usually with gastrointestinal symptoms, is diagnosed with eosinophilic esophagitis (EE), and a particular subset of these patients complains of airway manifestations. We present the case of a 2-year-old child with chronic dry cough in whom EE was found after a first diagnosis of gastroesophageal reflux disease (GERD) due to pathological 24-hour esophageal pH monitoring. Traditional allergologic tests were negative, while patch tests were diagnostic for cow's milk allergy. We discuss the intriguing relationship between GERD and EE and the use of patch test for the allergologic screening of patients

Influenza di un pasto di carboidrati sulla prestazione motoria di sciatori

Obiettivo. Valutare l\u2019influenza di un pasto di carboidrati sulla prestazione motoria in soggetti praticanti attivit\ue0 sciisti- ca per l\u2019intera giornata. Metodi. Dieci sciatori amatoriali (et\ue0 25-39 anni) hanno partecipato allo studio. L\u2019elettromiogramma di superficie dal muscolo vasto laterale e l\u2019oscillazione di forza intorno al bersaglio di forza sono stati rilevati e analizzati nel dominio del tempo durante contrazioni isometriche di 15 s con modulazione di forza di tipo triangolare (0-100-0% della mas- sima contrazione volontaria, MCV) e con modulazione di forza sinusoidale (0,1, 0,3, 0,5 Hz nell\u2019ambito 30-40% MCV) della tensione degli estensori del ginocchio. Le registrazioni sono state eseguite dopo 3 ore di pratica sciistica a stomaco vuoto (condizione controllo, C) e dopo pasto di carboidrati (condizione AM). Risultati. La MCV non \ue8 stata influenzata dal pasto (C: 617\ub1158,8 N e AM: 587\ub1213,5 N). L\u2019elettromiogramma non ha mai presentato differenze durante gli esercizi in C e AM. L\u2019oscillazione di forza ha presentato un\u2019ampiezza minore nel- la condizione AM (differenza statisticamente significativa durante la modulazione triangolare e sinusoidale a 0,1 Hz). L\u2019errore relativo (% della differenza tra forza esercitata e quella richiesta dalla funzione target) ha mostrato una tendenza ad essere pi\uf9 piccola nella condizione AM. Conclusioni. I nostri risultati suggeriscono che la digestione di un pasto di carboidrati non influenza negativamente la qualit\ue0 della prestazione neuromuscolare. Infatti in questa condizione l\u2019ampiezza dell\u2019EMG o dell\u2019oscillazione di for- za non denunciano un maggior coinvolgimento o un peggior rendimento del sistema di controllo motorio ne durante l\u2019intero ambito della modulazione triangolare di forza ne durante la impegnativa modulazione sinusoidale della forza dalle basse alle alte frequenze. Una sostenuta attivit\ue0 fisica pu\uf2 determinare alterazioni della glicemia e delle scorte di glicogeno muscolare con specifiche manifestazioni di fatica. Il pasto che \ue8 stato somministrato nel nostro esperimen- to, dato che non ha interferito con la prestazione motoria, potrebbe essere un aiuto senza controindicazioni per limi- tare gli aspetti di fatica correlati con la pratica dell\u2019attivit\ue0 sciistica giornaliera

Influence of workload and posture on handcycling efficiency

Handbike (HB) is an arm propelled device of locomotion for subjects with lower limbs disabilities. Handcycling has become a Paralympics discipline, increasing the need to study how lesion level may influence posture on HB and energy cost during exercise. The aim was also to test how postures different from the free chosen one might influence functional parameters during exercise