Cyclic Vomiting Syndrome

Cyclic vomiting syndrome is a disorder characterized by recurrent episodes of nausea and vomiting with complete resolution of symptoms between attacks. Nitric oxide plays a critical role in regulating several components of gastrointestinal mucosal defense and injury. Interleukin-6 has a wide variety of actions in the gastrointestinal apparatus. The purpose of this study was to evaluate the synthesis and release of nitric oxide and interleukin-6 by the esophageal and gastric mucosa in 10 children with cyclic vomiting syndrome, during symptom-free periods, and in 10 controls. The nitric oxide and interleukin-6 release by esophageal mucosa cells obtained from cyclic vomiting patients was quite similar to that in controls, but the release of nitric oxide from gastric mucosa cells of patients was significantly higher than that of controls. Conversely, no interleukin-6 was detectable in gastric mucosa cell supernatants in any of the patients. Further studies are needed to evaluate the relationship between factors triggering cyclic vomiting syndrome and the release of nitric oxide and interleukin-6 by gastric mucosa.     

3-min step test and treadmill exercise for evaluating exercise-induced asthma.

A simple exercise test would be useful for detecting exercise-induced asthma, a common problem in asthmatic children. The current study compared the 3-min step test with treadmill exercise for evaluating exercise-induced asthma in asthmatic children and assessed whether responses to both tests are influenced by baseline lung function and habitual physical activity. A series of 154 asthmatic children (84 male children; mean age 12.9 +/- 0.9 yrs) underwent a 3-min step-test and treadmill testing on different days within a week at least 24 h apart. Before both tests each subject did spirometry to obtain the baseline forced expiratory volume in one second (FEV1). After both exercise challenges all subjects did serial spirometry and the lowest FEV1 recorded over time was used to calculate the fall in FEV1 expressed as a percentage of the measured pre-exercise (baseline) value (% fall in FEV1) and the area above the FEV1 curve (AAC0-30 min) expressed as a percentage of the pre-exercise value. Changes in both exercise variables were also analysed in percentile subgroups defined by questionnaire answers on habitual physical activity in hours. The mean % fall in FEV1 was significantly higher for treadmill exercise than for the step test (15.0 +/- 7.5 versus 11.7 +/- 5.9); and the AAC0-30 min was larger for treadmill than for the step test (-261.6 +/- 139.9% versus -197.3 +/- 105.0% min). In all subgroups defined by habitual physical activity the mean % fall in FEV1 decreased more after treadmill exercise than after the step test. After step test and treadmill exercise no significant correlation was found between % fall in FEV1 and baseline lung function, or between % fall in FEV1 among groups defined by habitual physical activity. Although the 3-min step test yields a lower % fall in forced expiratory volume in one second (FEV1) and a lower value of the area above the FEV1 curve than treadmill testing, it is a quick, economical, reproducible and portable alternative procedure for identifying exercise-induced asthma in outpatients and epidemiological studies. Baseline lung function and habitual physical activity have no influence on the amount or duration of exercise-induced asthma.     

Dermoid cyst of the head of the pancreas area

Summary We report a case of dermoid cyst of the head of the pancreas area in a 26-yr-old woman radically treated with pancreatoduodenectomy and alive with no recurrence at 6-yr follow-up. The diagnostic and surgical procedures are described, and the literature is reviewed.     

Vesicouterine fistulas following cesarean section Report on a case,review and update of the literature

Herein we report on 1 more case of vesicouterine fistula followingcesarean section with review and update of the literature concerningthis unusual topic. The disease presented with vaginal urinary leakage,cyclic hematuria and amenorrhea. The fistula was successfully repairedby delayed surgery. Actually, all over the world the prevalence of thedisease is increasing for the frequent use of the cesarean section.Fistulas may develop immediately after a cesarean section, manifest inthe late puerperium or occur after repeated procedures. Spontaneoushealing is reported in 5% of cases. Vesicouterine fistulaspresent with vaginal urinary leakage, cyclic hematuira (menouria),amenorrhea, infertility, and first trimester abortions. The diagnosis isruled out by showing the fistulous track between bladder and uterus aswell as by excluding other more frequent urogenital fistulas. Thedisease treatment options include conservative treatment as well assurgical repair. Rarely, patients refuse any kind of treatment becauseof the benignity of symptoms and prognosis of the disease. Conservativemanagement by bladder catheterization for at least 4–8 weeks isindicated when the fistula is discovered just after delivery since thereis good chance for spontaneous closure of the fistulous track. Hormonalmanagement should be tried in women presenting with Youssef's syndrome.Surgery is the maninstay and definitive treatment of vesicouterinefistulas after cesarean section. Patients scheduled for surgery shouldundergo pretreatment of urinary tract infections. Surgical repair ofvesico-uterine fistulas are performed by different approaches whichinclude the vaginal, transvesical-retroperitoneal and transperitonealaccess which is considered the most effective with the lowest relapserate. Recently, laparoscopy has been proposed as a valid option forrepairing vesicouterine fistulas. The endoscopic treatment may beeffective in treating small vesicouterine fistulas. The pregnancy rateafter repair is 31.25% with a rate of term deliveries of25%. The disease may be prevented by emptying the bladder as wellas by carefully dissecting the lower uterine segment. It is advisablethat after vesicouterine fistula repair delivery should be performed byrepeating a cesarean section since the risk of fistula recurrence.Usually, vesicouterine fistulas are diagnosed postoperatively. As aresult, at least 95% of patients will undergo another operationfor repairing the fistula. In the meantime they are bothered by relatedsymptoms which impair their quality of life. As far as we are concernedintraoperative diagnosis is the gold standard in detecting vesicouterinefistulas for allowing immediate repair. We propose intraoperativesonography by the transvaginal (or transrectal) route for the Foleytransurethral catheter producing bloody urine, for suspecting bladderinjury while dissecting the uterine lower segment and for monitoringpatients who already had had vesicouterine fistula repair. As a resultpatients will avoid the familial and social problems related to thedisease as well another operation. Moreover, ultrasound Dopplerexamination may help in better investigating and understanding thepathophysiology of vesicouterine fistulas.     

Neonatal necrotizing enterocolitis: a focus on

Necrotizing enterocolitis (NEC) is a multifactorial worldwide problem, representing the most frequent gastrointestinal emergency in neonates. Extremely common in preterm infants, it is also registered in fullterm low birth weight neonates. Despite extensive research, its etiopathogenesis is not completely understood and this neonatal disease remains associated with high morbidity and mortality rates. This review proposes an interdisciplinary focus on recent developments in NEC etiopathogenesis, diagnosis and management.     

Gestational diabetes: universal or selective screening?

OBJECTIVE: To evaluate the incidence of gestational diabetes in our population and verify costs of universal screening. To assess neonatal and obstetrical outcomes with respect to maternal epidemiological characteristics. METHODS: Eight hundred and fifty-six pregnant women between 24th and 28th weeks of gestation were examined in this observational study. Universal screening with glucose challenge test was used to screen the group for gestational diabetes. History, obstetrical and neonatal outcomes were collected and then analyzed. RESULTS: Gestational diabetes was diagnosed in 6.6% of cases. Patients with at least one risk factor had a cesarean section in 50% of cases and a spontaneous vaginal delivery in 23.59% of cases (p < 0.001). The absence of any risk factor was found in 73.7% of positive glucose tolerance test and in 62.5% of affected patients. The cost of universal screening in our study, was 57,60 Euros per case identified. CONCLUSIONS: Given the high prevalence of diabetes, the high proportion of patients potentially not identified with a selective screening in this study and the relatively low cost, universal screening for gestational diabetes seems the best way to identify patients and prevent adverse obstetrical and neonatal outcomes.     

Osteopathia striata-cranial sclerosis: otorhinolaryngologic clinical presentation and radiologic findings

BACKGROUND: Osteopathia striata with cranial sclerosis (OS-CS) is a rare bone dysplasia that presents with variable symptoms mainly due to the associated CS. METHODS: The otorhinolaryngologic clinical presentation and temporal bone computed tomography (CT) findings of a new case of OS-CS are presented. Differential diagnosis is also discussed. RESULTS: Our study confirms the typical appearance of the temporal bone reported in previous CT studies and the utility of CT for evaluating the various etiologies of conductive-mixed hearing loss present in OS-CS. Radiographs of the femur and pelvis revealed the typical striations of OS-CS and allowed us to diagnose this rare form of generalized skeletal dysplasia involving the skull base. CONCLUSIONS: To our knowledge, this is the third reported case of OS-CS in which temporal bone CT evaluation corroborated the smallness of the middle ear cavities, abnormal ossicular fixation, and bone sclerosis of the mastoid cells. Other radiographic studies regarding the whole skeleton may, in combination, be very helpful in the differential diagnosis between the different forms of generalized skeletal diseases with bone sclerosis involving the skull base.