Risk Factors of Cholelithiasis Unrelated to Hematological Disorders in Pediatric Patients Undergoing Cholecystectomy

Background: Pediatric cholelithiasis unrelated to hematological disorders is an increasing disease. We analyzed our experience in the surgical treatment of these cases to evaluate risk factors, clinical presentation, intervention and follow-up. Methods: From January 2010 to December 2016, we retrospectively recorded all data (hematological study, familiarity, use of lithogenic drugs and parenteral nutrition) of cholecystectomies for cholelithiasis not related to hematological diseases. The body mass index (BMI) was calculated (obesity if > 25), medical treatment, surgery and follow-up were evaluated. All patients underwent ultrasound for diagnosis and major biliary tract assessment prior to surgery. All patients had a 1-year follow-up. Results: There were twenty-four cases (eight males), with a median age of 11.2 years. Predisposing factors were familiarity in 19, use of lithogenic drugs in 5 and total parental nutrition (TPN) in 3. Median BMI was 19.8 kg/m2, with BMI > 25 kg/m2 in eight cases. Regarding the clinical presentation, 14 had acute pain in the right upper quadrant, 5 had cholecystitis and 5 had non-specific abdominal pain. The medical treatment lasted 6 months in all, except for five (three operated after 2 months and two after 12 months). Preoperative ultrasound did not show stones in the biliary tract. MRI was performed in three cases for suspected malformation of the biliary tract (negative). Laparoscopic cholecystectomy was performed in all cases: mean intervention time was 95 min. A case of postcolecystectomy syndrome was found. At follow-up, all were asymptomatic, except two (recurrent abdominal pain). Conclusion: Main predisposing factors are familiarity and obesity. Preoperative ultrasound in our series replaced the intraoperative study of the biliary tract. Laparoscopic cholecystectomy is the gold standard

Can Infant Dyschezia Be a Suspect of Rectosigmoid Redundancy?

Infant dyschezia is a functional gastrointestinal disorder that occurs in children less than nine months of age. This disorder causes much anxiety among parents who consult different physicians when suspecting major intestinal problems. The aim of this study is to verify whether infant dyschezia involves an anatomic abnormality (redundancy) of the colon. In this retrospective study (48 months) we analyzed all the children younger than 9 months who came to our attention through the suspicion of gastrointestinal abnormality (Hirschsprung’s disease, anorectal malformations, colonic disorders or constipation). They all had a complete medical history, clinical examination and diagnostic tests, such as blood samples, suction rectal biopsy, a study of stool characteristics and, finally, a contrast enema. In cases with infant dyschezia, different colonic sizes and rectosigmoid length were measured, which created a ratio with the diameter of the second lumbar vertebra. These values were compared with those reported in the literature as normal for the age of one year. Of the 24 patients evaluated (mean age 4 months), 9 were excluded for different diagnoses (aganglionic megacolon, hypothyroidism, constipation). The comparison of the ratios obtained in the remaining 15 cases showed a significantly higher rectosigmoid length (redundancy) in children with dyschezia, 18.47 vs. 9.75 (p < 0.001). The rectosigmoid redundancy, a congenital anomaly already reported as a cause of refractory constipation, may be present in children with infant dyschezia

What Is the Correct Way to Manage Children Requiring Gastrostomy? Single Center Experience

Children with complex medical issues often present different comorbidities that cause feeding difficulties. Gastrostomy is often helpful, and should be performed when nutritional supplementation is necessary for longer than 6 weeks. Recently, different techniques have been used for gastrostomy in children. The authors report on their experiences regarding the diagnostic and therapeutic management of children requiring gastrostomy. All patients managed in the last 10 years were reviewed, retrospectively. Everyone underwent investigation to exclude gastroesophageal reflux disease (GERD). A total of 148 patients: 111 cases (75%) were neurologically impaired patients, 18 (12%) had complex heart disease, 10 (6%) had metabolic diseases, 4 (3%) had fibrosis cystic, 4 (3%) had muscle disease, and one had chromosomopathy. After investigation, 49 patients had GERD. PEG was performed in 101 cases (68%), laparo-assisted gastrostomy was performed in 44 cases (29.7%), open gastrostomy was performed in three cases. At follow-up, all patients reported weight gain, but 13 cases had major complications. Currently, the surgeon has the possibility of choosing between several safe techniques for gastrostomy. In our experience, PEG is the most useful technique for patients without GERD, while a laparo-assisted technique is better for patients who require laparoscopic fundoplicatio

Tuning interchain ferromagnetic instability in A2Cr3As3 ternary arsenides by chemical pressure and uniaxial strain

We analyze the effects of chemical pressure induced by alkali metal substitution and uniaxial strain on magnetism in the A2Cr3As3 (A = Na, K, Rb, Cs) family of ternary arsenides with quasi-one dimensional structure. Within the framework of the density functional theory, we predict that the non-magnetic phase is very close to a 3D collinear ferrimagnetic state, which realizes in the regime of moderate correlations, such tendency being common to all the members of the family with very small variations due to the different interchain ferromagnetic coupling. We uncover that the stability of such interchain ferromagnetic coupling has a non-monotonic behavior with increasing the cation size, being critically related to the degree of structural distortions which is parametrized by the Cr-As-Cr bonding angles along the chain direction. In particular, we demonstrate that it is boosted in the case of the Rb, in agreement with recent experiments. We also show that uniaxial strain is a viable tool to tune the non-magnetic phase towards an interchain ferromagnetic instability. The modifcation of the shape of the Cr triangles within the unit cell favors the formation of a net magnetization within the chain and of a ferromagnetic coupling among the chains. This study can provide relevant insights about the interplay between superconductivity and magnetism in this class of materials.Comment: Accepted in Phys. Rev. Materials as a regular article. 13 pages, 23 figures, 3 table

Intra-chain collinear magnetism and inter-chain magnetic phases in Cr3As3-K-based materials

We perform a comparative study of the KCr3As3 and the K2Cr3As3 quasi 1D compounds, and show that the strong interplay between the lattice and the spin degrees of freedom promotes a new collinear ferrimagnetic ground state within the chains in presence of intrachain antiferromagnetic couplings. We propose that the interchain antiferromagnetic coupling in KCr3As3 plays a crucial role for the experimentally observed spin-glass phase with low critical temperature. In the same region of the parameter space, we predict K2Cr3As3 to be non-magnetic but on the verge of the magnetism, sustaining interchain ferromagnetic spin fluctuations while the intrachain spin fluctuations are antiferromagnetic.Comment: Accepted in Phys. Rev. B as a regular articl

In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?

Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. The main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. The patients’ mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler–Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the anatomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient

Clinical Study Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results)

L'ecologia torna a casa.

ItConsiderando la pandemia dovuta al Covid-19 come un'occasione per ripensare filosoficamente la casa e il rapporto con essa, questo testo propone un ribaltamento dell'analogia che fonda la parola "ecologia" e suggerisce un suo "ritorno a casa", riflettendo su come la casa sia arrivata a costituire effettivamente tutto il mondo percepito. Gli autori affrontano il problema considerando il rapporto dell'uomo con l'ambiente, le relazioni umane in società e, infine, il contesto domestico.EnConsidering the pandemic due to Covid-19 as an opportunity to philosophically rethink the home and our relationship with it, the text offers an overturning of the analogy that underlies the word "ecology" and suggests its "returning home". The authors reflect on how the house has actually come to be intended as the whole perceived world and they try to face the problem by considering the engagement between men and nature, human relations in society and, lastly, the domestic context

Local characterization of ferromagnetic properties in ferromagnet/superconductor bilayer by Point Contact Andreev Reflection Spectroscopy

We realized point contact spectroscopy experiment on ferromagnet/superconductor bilayers. Differential conductance curves show several features that we explained within Bogoliubov-de Gennes formalism considering the presence of two interfaces in the normal-metal-tip/ferromagnet/superconductor device. We demonstrate that such configuration is suitable as local probe of the spin polarization and thickness of ferromagnetic layer, directly on bilayer areas. This is due to the high sensitivity of the Andreev surface states to the physical properties of the ferromagnetic interlayer