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Aim: To highlight the harmfulness and pervasive of early and repeated exposure to family violence from the theoretical perspective of complex trauma as a developmental disorder., Method: A study carried out on a sample of 22 adolescents between the ages of 15 and 18, who have been entrusted to Il Faro Bologna, a Specialist Centre for child abuse and neglect. Specific areas of psychological functioning were examined. According to the NCTSN these areas are considered vulnerable to violence in primary relationships and crucial for future mental health. They are attachment, self-concept, affect regulation, cognition and behavioural control. The data was correlated with the different forms of maltreatment and the main risk factors detected in the family environment and was collected by means of clinical interviews, family and social histories, structured interviews and self-reports recommended by the NASMHPD., Results: The data highlights a correlation between the psychic functions examined and exposure to family violence, distortion of parental empathy and parental responsibility failure., Conclusion: The study indicates the need: a) to raise clinical awareness of the consequences of complex trauma on development; b) to adopt specific diagnostic tools for evaluating post-traumatic outcomes; c) to carry out regular screening in order to explore histories of maltreatment in patients cared for by mental health services.

Restorative proctocolectomy with ileal pouch anal anastomosis is the first choice procedure for the treatment of ulcerative colitis and familial adenomatous polyposis. The introduction of the stapled technique has shortened the duration of the procedure and reduced the complication rates. Data on 335 consecutive patients undergoing ileal pouch anal anastomosis for ulcerative colitis (277 pts), Indeterminate colitis (20 pts) and familial adenomatous polyposis (38 pts) between 1984 and 1998 were prospectively collected. Parameters evaluated included diagnosis, surgical technique, functional outcome, early and late complications and their management and results. Twenty-nine patients (8.6%) presented with pelvic sepsis. Twelve patients (3.5%) experienced late perianal fistulas. The pouch failure rate was 3.4%. Six patients required a re-do pouch procedure, with 75.9% preservation of sphincter function. No correlation was found between complication rates and diagnosis. The mean number of stools was 5.2/24 h. The study confirmed the safety and effectiveness of the procedure. In particular, morbidity rates are comparable to those of major abdominal procedures and the long-term functional results are satisfactory. However, a number of technical aspects, such as the anastomosis technique, the need for temporary ileostomy and the treatment of indeterminate colitis, still remain controversial.

The exact role of 111In leukocyte scanning in the assessment of clinical activity of Crohn's disease (CD) is still a matter of controversy. In our center we studied 22 patients with CD (8 with active disease) with standard 111In labelled mixed leukocyte scans. We determined the extent of the lesion measured as lesion-occupied cells on scanned area and the degree of inflammatory activity assessed as count ratio between the involved region and the iliac crest. Particularly in delayed scans, these scintigraphic parameters showed good correlation with clinical and laboratory indices of disease activity. In our series, only 6 patients had completely negative scans. They were in clinical and laboratory remission, and 5 of them had undergone surgery for CD during the previous year, with no radiological and/or endoscopic findings of recurrence. Among the other 8 patients in clinical remission, 5 had positive early scans, while the rest showed persistent delayed images. Moreover both early and delayed leukocyte scans were positive in 8 cases in which disease was undoubtedly active. A 1-year follow-up was available for 14 patients in clinical remission when 111In-scan was performed. During this period, 3 patients, all of whom had had early and delayed positive 111In-scan, suffered from clinical relapse; no clinical relapses were documented in patients with only 4th hour positive scans. In conclusion, in our series, 111In-scan was also frequently positive in patients in clinical remission; in this patient subset persistent images on delayed scans might suggest the risk of clinical relapse.