Conversational metrics,psychopathological dimensions and self-disturbances in patients with schizophrenia

European Archives of Psychiatry and Clinical Neuroscience - Difficulties in interpersonal communication, including conversational skill impairments, are core features of schizophrenia. However,...     

Classification and management of rectal prolapse after anorectoplasty for anorectal malformations

Purpose

To suggest a classification, describe the risk factors and management of rectal prolapse after anorectoplasty for anorectal malformations (ARMs).

Methods

We classified prolapse as minimal (rectal mucosa visible with Valsalva manoeuvre), moderate (prolapse <5 mm without Valsalva), evident (>5 mm without Valsalva) and compared patients with and without prolapse within our ARM-population.

Results

Among 150 patients, 40 (27 %) developed prolapse: 25 minimal, 6 moderate, 9 evident. Prolapse affected 33 % of males (9 % of perineal fistulas, 38 % of bulbar, 71 % of prostatic, 60 % of bladder neck and 13 % without fistula) and 21 % of females (9 % of perineal, 30 % of vestibular, 50 % of cloacas, and 25 % without fistula). Risk factors for prolapse were: tethered cord (40 vs 24 %), vertebral anomalies (39 vs 24 %), laparoscopic-assisted anorectoplasty (LAARP) (75 vs 25 %), and colostomy at birth (49 vs 9 %). Redo anorectoplasty was not associated with prolapse. Symptoms were present in 11 patients (28 %): in 7 % with minimal, 33 % with moderate and 77 % with evident prolapse. Nine patients (2 moderate, 7 evident) underwent surgical correction.

Conclusion

Severe ARMs, tethered cord, vertebral anomalies, colostomy, and LAARP predispose to rectal prolapse. Classifying prolapse allows to predict symptoms and need for surgical correction, and to compare outcomes among different centers.     

Fluorescence imaging in pediatric surgery: State-of-the-art and future perspectives

BackgroundThe employment of fluorescence imaging has gained popularity in many fields of adult surgery where it has demonstrated great potentials to improve both surgical and oncological outcomes while minimizing anesthetic time and lowering health-care costs. However, the clinical application of fluorescence-guided surgery (FGS) in pediatrics is just at the initial phase.Material and methodsA systematic review of current clinical uses of FGS in pediatric surgery was performed along with a discussion on its advantages, limitations and future developments.Results21 studies were included: 9 retrospective and 1 prospective study, 8 case reports, 2 case series and a review article reporting authors' institutional experience. Great emphasis was given to surgical resection of hepatoblastoma and its metastasis (n = 6), real-time imaging of the biliary tree (n = 3) and urogenital system (n = 2). Other current uses concern the assessment of blood perfusion (intestine, n = 3; myocutaneous flap, n = 1; transplanted liver, n = 1) and lymphatic flow imaging (n = 4).ConclusionDespite a paucity of clinical studies evaluating its role in pediatric surgery, FGS has shown promising results in helping guide tumor resection and improving the accuracy of anatomical delineation.Type of studyReview article.Level of confidenceLevel IV.     

Genetic background and risk of postpartum haemorrhage: results from an Italian cohort of 3219 women

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality, particularly in the developing countries, and of severe maternal morbidity worldwide. To investigate the impact of genetic influences on postpartum haemorrhage, in association with maternal and intrapartum risk factors, using a candidate gene approach. All women (n = 6694) who underwent a vaginal delivery at the Obstetric Unit of a large University hospital in Milan (Italy) between July 2007 and September 2009 were enrolled. The first consecutive 3219 women entered the genetic study. Postpartum haemorrhage was defined as ≥500 mL blood loss. Eight functional polymorphisms in seven candidate genes were chosen because of their potential role in predisposing to or protecting from haemorrhagic conditions: tissue factor (F3), factor V (F5), tissue factor pathway inhibitor (TFPI), platelet glycoprotein Ia/IIa (ITGA2), prothrombin (F2), platelet glycoproteins Ibα (GP1BA) and angiotensin‐converting enzyme (ACE). After correction for the already known PPH risk factors, only the promoter polymorphism of the tissue factor gene (F3 ‐603A>G) showed a significant association with PPH, the G allele exerting a protective effect (P = 0.00053; OR = 0.79, 95% CI = 0.69–0.90). The protective effect against PPH of the TF ‐603A>G polymorphism is biologically plausible since the G allele is associated with an increased protein expression and Tissue Factor is strongly represented in the placenta at term, particularly in decidual cells of maternal origin.     

Learning curve for robotic surgery in children: a systematic review of outcomes and fellowship programs

Journal of Robotic Surgery - The learning curve (LC) of a new technique is fundamental for its application and assessment, and for the training. Literature was analysed to define the LCs of...