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Objectives: to evaluate the risk profile of hypospadias in Gela, an Italian National Priority Contaminated Site (NPCS) located in Sicily Region (Southern Italy), characterized by a significant excess of hypospadias in newborn residents compared to data from reference on regional, national, and international basis and, until 2014, by the presence of a petrochemical plant., Design: geographical analyses were conducted by comparing the prevalence of the Gela municipality to prevalence found in Sicily, in a territorial area bordering Gela (ALG), and in the NPCSs of Milazzo and Priolo. The geographical comparisons were conducted for the period 2010-2020, the trend within the Gela NPCS was evaluated by comparing two subperiods (2010-2014 and 2015-2020)., Setting and Participants: children up to 1 year of age with hypospadias resident in the municipality of Gela in the period 2010-2020., Main Outcomes Measures: crude odds ratios (OR) and respective 95% confidence intervals (95%CI) were used to compare the prevalence observed in Gela and that detected in the comparison areas., Results: excess risk for hypospadias was highlighted in 2010-2020 in Gela vs Sicily (OR 4.45; 95%CI 3.45-5.75), vs ALG (OR 4.29; 95%CI 3.02-6.10), and vs the NPCSs of Milazzo (OR 2.32; 95%CI 1.32-4.07) and Priolo (OR 2.37; 95%CI 1.55-3.62). The between-period comparisons in Gela did not show an important difference between 2010-2014 and 2015-2020 (OR 1.37; 95%CI 0.83-2.24), with a prevalence of 98.9 and 72.4 per 10,000, respectively., Conclusions: the prevalence of hypospadias in 2015-2020 remains very high, although decreasing when compared to 2010-2014 period. The Gela data, despite the refinery being closed after 2014, suggest a complex situation in which multiple risk factors may play a role.

Objectives: to evaluate and validate the adoption of an algorithm for the identification of cases of congenital anomalies (CAs) to improve the performance of the Congenital Malformations Registry of Sicily Region (Southern Italy)., Design: an algorithm was used to identify congenital anomalies on a sample of hospital discharge records (SDO) with ICD-9-CM code between 740-759 on any of the diagnoses within the first year of life, together with a sample of healthy births equal to 5% of total births for the same period. The identified cases were evaluated through the clinical record analysis., Setting and Participants: the analysed sample was composed of 4,271 cases identified between June 2013 and December 2014 along with 3,993 SDO without any code of MC (5% of the total volume of births in the same period)., Main Outcome Measures: positive predictive value (VPP) and negative predictive value (VPN) were computed by means of the comparison between the algorithm outcomes and the clinical record verification., Results: 4,271 potentially malformed records involving 3,381 subjects born in the Sicilian territory have been identified. Among the hospital discharge records that it was possible to verify, the application of the algorithm led to the exclusion of 924 cases: of these, 62 proved to be false negatives (VPN: 93.3). The valid cases were 1,179, while the cases to be evaluated 617: the comparison between algorithm and clinical record analysis led to a VPP of 91.7 and 72.1, respectively, for valid and to be evaluated., Conclusions: the tested algorithm proved to be a useful tool for identifying SDO potentially related to congenital anomalies. In the overall sample, the algorithm provided an outcome consistent with the clinical record assessment in 87.4% (2,379) of cases.

Introduction: The unusual anatomical position of the organ, generally suspended by a mesentery, allows the rare possibility of its torsion with necrosis and even perforation., Case Report: A woman, aged 78, who presented signs and symptoms similar to those of severe acute cholecystitis: abrupt onset of pain and a large palpable mass below the right costal margin. Immediate laparotomy with detorsion and easy cholecystectomy was performed., Conclusions: Should a greatly enlarged mass be palpable below the right costal margin within a few hours from the abrupt onset of unremittant abdominal pain the possibility of torsion should come to mind not to delay operation in the supposition of acute cholecystitis.

Diverticulum of the right colon is a rare disease which is often wrongly diagnosed and asymptomatic. It affects young individuals and is manifested by symptoms similar to appendicitis. The paper reports a case of a young man with an isolated perforated diverticulum of the right colon which was clinically manifested as acute appendicitis with peritoneal reaction. It is extremely difficult to make a preoperative diagnosis of cecal diverticulitis. Even the anatomosurgical appearance sometimes makes it difficult to distinguish from neoplasia. For this reason the most frequent operation is right hemicolectomy which is however well tolerated by young patients.

Vesicovaginal fistulas are commonly seen as a complication of abdominal (or vaginal) Hysterectomy. The signs and symptoms of a vesicovaginal fistula depend upon its size and location. Identification of a vesicovaginal fistula includes an intravenous urogram; cystoscopy may be performed in order to evaluate the possibility of immediate or delayed repair. Case report. Principles of surgical repair. The principles of surgical closure are similar: 1) total separation of the tissues comprising the wall of the vagina and the wall of the bladder; 2) sharp excision of the fistulous tract between to two structures; 3) closure of the defects with non-overlapping suture lines; 4) where possible, interposition of alternative tissue between the two suture lines. The intervention proposed by Legueu allows an abdominal transperitoneal approach to the fistula and is comprehensive of these principles. With such a procedure we have treated successfully two cases which required surgical closure. CONCLUSIONS. In patients who develop vesicovaginal fistulas as a complication of abdominal hysterectomy, we have applied the intervention proposed be Legueu, which allows closure of the fistula via a transperitoneal route. Preliminar diagnostic evaluation and following of the foundamental principles of correct surgical closure are indispensable to accomplish a successful intervention.

In order to define the validity of a screening program for hypertension in schools, aiming to prevent an hypertensive status in adult age, we screened 861 children from schools on the area of our Medical District (U.S.L. 22--Vittoria--Sicily). The object of our study is to search for risk factors of hypertension, detectable at school age and, if existing, which age is more suitable for a screening program. We randomly sampled 861 children from different schools, aging 6, 10 and 13 years. The first step was to define the prevalence of hypertension and obesity in the sample, and the correlation between the two factors (transversal study). We found an overall prevalence of obesity at 6, 10, and 13 years of 6.69%, 18.22% and 17.7% respectively. The prevalence of hypertension was 4.01%, 11.4%, and 6.98% at 6, 10 and 13 years respectively. The second step is to create a personal record of each child, which will be followed up to the age of 18 years, containing familial and nutritional informations, periodic evaluations of height, weight, blood pressure and biologic sampling (longitudinal study). Our preliminary results confirmed the correlation between obesity and hypertension, although they do not help to clarify why the prevalence of hypertension decreases from 10 to 13 years whereas obesity maintains the same prevalence at the mentioned ages.

Introduction: Laparoscopic cholecystectomy now represents a valid alternative to traditional surgery in the treatment of gallstone diseases. For the past twenty years laparotomic cholecystectomy has represented the golden standard of gallstone treatment given its extremely low mortality rate (0.5%) and equally acceptable morbidity rate. Laparoscopic cholecystectomy now appears to have taken over the position of elective treatment. Sophisticated techniques, such as ultrasound scalpels make this form of surgery particularly safe., Materials and Methods: The authors report a series of 50 patients who underwent laparoscopic cholecystectomy in which ultrasound surgery was used in 40 cases using the CUSA system. The gallbladder hilus is prepared using ultrasound manipulation following the secure identification, respect and clipping of the cystic artery and duct., Discussion and Conclusions: Laparoscopic cholecystectomy appears to be the ideal treatment for gallstone diseases. In the series reported here the use of the ultrasound scalpel allowed the gallbladder hilus to be reach skeletization, preserving the main structures and keeping the operating field clean and blood-free, without increasing operating times. The possibility of severe accidents, such as vascular lesions to the hepatic artery or vena portae, or damage to the common bile duct or other abdominal organs are reduced using this technique.

The authors report their finding concerning the frequency of postoperative pulmonary thromboembolism in an autopsy series of subjects who had died with 15 days of surgery. In all cases the relationship was evaluated between death and age, sex, the underlying pathology and the type of surgery.

The authors explain the clinical and anatomical features of retroperitoneal abscesses, which occur less commonly than peritoneal infections. Retroperitoneal abscesses arise chiefly from injuries in adjacent structures, but they may be primary when caused by hematogenous bacterial spread. The pyogenic bacteria have replaced Mycobacterium tuberculosis as the major causative organism. Retroperitoneal abscesses may be symptomless, but fever and abdominal pain are prominent features. The differential diagnosis includes retroperitoneal tumors and hematomas. These lesions are best delimited by CT scanning which localizes them accurately. The treatment consists in a prompt and adequate drainage and systemic antibiotics therapy. Drainage by catheter, however, has a lower success rate than the surgical approach. The surgical mortality rate is about 25%.

The paper reports a case of intestinal occlusion due to adenocarcinoma of the large intestine as a sequel to ureterosigmoidostomy for exstrophy of the bladder which was subsequently converted to ureteroileocutaneostomy. Inadequate follow-up did not allow an early diagnosis to be made. The authors underline the need for annual colonoscopy in all patients suffering from or with previous ureterosigmoidostomy given the high incidence of malignant transformation of the colon.

The authors report their experience of the use of mechanical staplers in total gastrectomy. The advantages of their use can above all be seen in anastomosis, in particular in high-risk areas like esophago-jejunal anastomosis, in which there is a lower incidence of dehiscence and mortality than when manual suturing techniques are used.

The authors describe a case of intraperitoneal anorectal injury. Such injuries now have an improved survival rate as a result undoubtedly of superior resuscitation, early operative management and early use of antibiotics. Civilian life rectal wounds are usually of the penetrating type. Major complications, both of intra and extraperitoneal injuries, are related to infection. The surgical management of these lesions is primarily a proximal diversion of the fecal stream. This is accomplished by a divided--end colostomy. Local wound care must be given for the inevitable infected foreign tract. When sepsis occurs, the surgeon must be prepared to handle it adequately by appropriate incision and drainage.

The authors report a rare case of jejunal Schwannoma which appeared as hematemesis and melaena. No preoperative test, even selective angiography, enabled a correct clinical diagnosis to be made. Only after explorative laparotomy and careful palpation of the small intestine was the bleeding lesion located. Resection and termino-terminal anastomosis were then performed. The preparation of immunohistochemical reactions now allow forms which were previously diagnosed in different terms to be precisely classified.

An essential introduction for a campaign of health education, to take preventive measures against caries, is to have knowledge of the prevailing situation of the pathology. The research analysed a sample consisting of 1371 pupils attending the "scuole elementari" and the "scuole medie" in the municipal districts of Vittoria, Acate and Scoglitti. The methodological statement consist of an analysis regarding experimental epidemiology. The emerged data, proposed in diagrams and tables, show that caries frequency increases in the pupils' ages, going from a value of 57.7% at the age of 6 to a value of 75.2% at the age of 13; besides, it is statistically meaningful the caries difference with regard to the sex at the age of 13. So the DMF and dmf values, although not alarming point out the necessity of a preventive intervention.

The Authors propose the use of intraoperative colon irrigation in emergency surgery of left-sided lesions of the colon. This technique allows the colon to be decompressed and cleaned at the same time with the possibility of performing a resection or hemicolectomy without having to resort to protective colostomy and its related problems of morbidity.

In view of the proteiform symptoms of duodenal diverticula, the Authors underline the diagnostic precision and surgical value of e.g.d. scopy. Indications for surgery in cases of symptomatic or complicated diverticula are also stressed, and the value of mechanical suturing is confirmed.

The authors propose a method of suturing the wound caused by the removal of pilonidal cysts and fistulas. The technique is noninvasive, uses a minimum amount of foreign material, and places the margins of the wound under very slight tension.

The flexible colonoscope has brought considerable advantages to the diagnosis and nonsurgical treatment of volvulus. In the case of repeated recurrences that make surgery vital because of the onset of signs of vascular trouble on the twisted ansa, preoperative resolution permits correction of hydroelectrolytic imbalances and the preparation of the colon with the possibility of operating with no need for protective colostomy. It also allows resolution of the acute situation in the presence of contraindications to intervention.

The attention of all those having to deal in any way with diseases of the perianal region is called to a particular pyodermatitis known as suppurative hidradenitis, or Verneuil's disease, frequently confused with other inflammatory pathologies. A clinical case exemplifying the diagnosis and treatment of the disease is reported.

Following an aetiopathogenetic review of I.P.P., diagnostic and therapeutic possibilities are assessed. Medically, stress is laid on the value of orgotein, an SOD which, used in time, reduces pain and penis curving and permits satisfactory sexual activity. In the case of inveterate forms or of large plaques, the use of a silastic prosthesis is proposed. This support enables a normal sex life to be continued, so resolving psychological and family stress.

Choledochoscopy is complementary to peroperative cholangiography in exploration of the main biliary way. Transcystic access is proposed in choledocholithiasis. The cystic duct, in fact, is frequently transitable owing to the dilatation produced by the migration of gallstones and because of the increasing miniaturisation of instruments. This examination of the MBW is less traumatic and risky than transcholedochotomic choledochoscopy.

An account of the effects of recent influenza epidemics is given from the medical standpoint, and also with respect to their social and economic repercussions. The part played by air travel in the carriage of such epidemics is also examined. The immunity of the population of Rome towards an A strain swine fever (A/New Jersey 8/76) is assessed in the light of personal research.