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Background: To describe the Sacral Hitch, vesical pexys to sacral promontory, an alternative technique to the Psoas Hitch when this is impossible to perform. We report intraoperative complications, and long-term functional results., Methods: From 1989 to date we performed 66 ureteroneocystostomies (UNCS) (transbladder technique and Politano-Leadbetter antireflux plasty): 51 with ancillary "Psoas Hitch" (11 Casati-Boari); 15 with "Sacral Hitch" because of the intraoperative finding of deficiency or lack of psoas tendon. Note of technique. Ureter and bladder are dissected as usual. Sacral Hitch: left lateralization of sigmoid and exposition of sacral promontory; longitudinal incision and divarication of peritoneum; smooth dissection of fat tissue, displacement of medium sacral vessels and visualization of neurovascular bundles. Direct fixation of the dome/posterior aspect of bladder to anterior longitudinal ligament above promontory., Results: Among the patients who underwent the Psoas Hitch technique, 3 (5.4%) showed hypoesthesia, acute pain and impossible flexion of the thigh on hip with EMG positive for femoral (1) and genito-femoral (2) neuropathy. The re-operation in 2 cases solved the symptoms. One case resolved conservatively with corticoids, tricyclic antidepressants (Amitriptyline) and antiepileptics (gabapentin). Mean follow-up was 115 months (8-252); two stenosis of anastomosis. Sacral Hitch: (15 pts), mean follow-up: 47 months (range 4-110), no stenosis of anastomosis 0%; transfusion rate 0%., Discussion: The psoas tendon deficiency or its congenital absence (children or women) requires the direct fixation to the muscle, an inadequate and weak target and housing of important sensitive-motor nerves (Genito-femoral, femoral and latero-cutaneous). A "Psoas-Syndrome" could be present in 5.1% and a re-operation could be necessary. The sacral promontory represents an affixation target already successfully adopted in other surgery specialties (Gynaecology, Orthopaedic and General Surgery) and gives to UNCS a stiffness plate and an effective bladder cranialization. CONCLUSIONS. Sacral Hitch Vesical Pexys represents an ancillary procedure to UNCS and surgeons should keep it in mind in cases of difficult finding of the psoas muscle tendon.

Spiral or volumetric computed tomography (CT) is a new scanning technique which allows the scanning of body regions with a continuously rotating system based on the slip ring technology; the patient is also moved continuously, synchronously with data acquisition. The physical characteristics of spiral CT image acquisition were compared with those of conventional CT images. The modulation transfer function (MTF) has the same values for medium-resolution filters, but lower values for spiral CT for high-resolution and frequency-enhancement filters. The slice sensitivity profile (SSP) describes the longitudinal image resolution for multiplanar reconstructions and was measured in terms of FWHM of the SSP curve. We obtained, for 10-mm slice thickness, a FWHM = 10.4 mm (conventional CT), versus 10.7 mm (Spiral CT), while, for 5-mm slice thickness, the corresponding values were 5.2 mm (conventional CT) and 5.5 mm (spiral CT). Noise was evaluated simply by measuring the standard deviation of the CT numbers, in a region of interest, of a uniform image and with the power spectrum or Wiener spectrum of the same image. To assess overall image quality and yield, the noise equivalent quanta (NEQ) value was also calculated. The values were a little lower for the spiral technique, particularly with high-resolution and enhancement or convolution filters. Dosimetric evaluation of the computed tomography dose index (CTDI) and of the multiple scan average dose (MSAD) was done using an acquisition protocol for average lung dose, in an anthropomorphic phantom and with TL dosimeters. The MSAD was 6.17 +/- 0.20 cGy for conventional CT and 5.98 +/- 0.23 cGy for Spiral CT, while lung dose was 3.25 +/- 0.12 cGy and 3.01 +/- 0.16 cGy, respectively.

This report takes into consideration the complications due to "body packers" cocaine absorption. In particular we report a clinical case in which severe dysrhythmias occurred. We think an early insertion of a pacemaker able to rid ectopic focus by overdriving is essential by comparison with an effective anti-dysrhythmic therapy. We also examine the cocaine metabolites values in the patient's serum and urine.

Diabetes mellitus is one of the main endocrinological disease complicating the course of thalassemia major. This study aimed evaluate beta-cell secretion in 24 patients with thalassemia major attending the hematological Day Hospital at the Pediatric Clinic in Modena where transfusion therapy is performed in all thalassemic patients so as to maintain minimum hemoglobin levels above 10.5 g/dl, together with intensive ferrochelating therapy (desferrioxamine 50-60 mg/kg/die s.c. 6 days a week). A C peptide challenge with glucagon was performed in three patients already receiving insulin therapy for diabetes mellitus; this unexpectedly revealed a slight residual beta-cell secretion. An intravenous glucose tolerance test (IVGTT) was performed in the remaining 21 non-diabetic patients, with widely varying findings regarding insulin secretion: from below 50 microUl/ml in 5 patients to above 200 microUl/ml in 5 patients, and between 50 and 150 microUl/ml in the remaining 11 patients. This study therefore confirmed that insulin secretion frequently alters in thalassemic patients. Moreover, insulin secretion is not correlated to ferritinemia or influenced by familiar diabetes or patient age.

We report a case of a man who died after ingestion of cantharidin as aphrodisiac. After evaluating the toxicology, we examined the development and therapeutic possibilities of handling the poisoning including charcoal hemoperfusion.

A chronic mucocutaneous infection due to yeasts to the Candida genus can be part of the autoimmune polyglandular syndrome, described as APECS, APECED, SPA type I, CES. The authors describe the case of a young patient affected by mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. Chronic mucocutaneous candidiasis was diagnosed first in early childhood and was followed by the development of hypoparathyroidism (4 yrs) and adrenal insufficiency (5 yrs). The initial lesion of this syndrome is still unknown as the reason of the marked susceptibility to mucocutaneous candidiasis without systemic candidiasis. The treatment of mucocutaneous candidiasis has been improved by the introduction of orally active antifungal drugs as Ketoconazole, first, and fluconazole now.

Two cases of Graves' (Basedow) dermopathy are reported. In one case pretibial myxoedema was localized on the external surface of the legs down to insteps. In the second case a diffuse form involved both legs and was characterized by wrinkles and peau d'orange appearance at the ankles. In both cases a biopsy confirmed the diagnosis of Graves' dermopathy, showing diffuse areas of amorphus substance infiltrating the derma and fragmentation of collagen fibers. According to the literature, the skin lesions were associated with ophtalmopathy. Thyrostatic therapy affected ophtalmopathy in one of the patients, while pretibial myxoedema regressed in both. The pathogenesis of pretibial myxoedema is not completely clear yet, although dermopathy, along with ophtalmopathy and acropachy, is considered to be an extrathyroidal manifestation of Graves' disease related to bioassayble antibodies anti-TSH receptor. A class of dermopathy-associated antibodies (DAAb) has been identified. It seems to be a reliable biological marker for pretibial myxoedema since it is nearly absent in patients with ophtalmopathy and without dermopathy. Since DAAb does not stimulate human fibroblasts in culture, the role of DAAb in the development of Graves' dermopathy is still to be found.

The aim of the present paper is to evidence whether a variation of activity of neutral proteases occurs during regeneration and neonatal growth in rat liver. Protease activity is assayed with a spectrophotometric method in total liver and hepatocyte homogenates using casein as substrate. Results show that the protease activity is Ca++-dependent; it is lower either in neonatal liver or in regenerating liver 4 hours after partial hepatectomy with respect to controls.

The total protein and glycoprotein in electrophoretic patterns of rat liver endoplasmic reticulum we studied in peculiar physiological conditions as perinatal development, pregnancy and liver rigeneration. Previous work in these experimental systems showed a changed microsome lipid composition and modified activities of some ER membrane bound enzymes. The microsomes obtained from foetal and neonatal liver show a modified electrophoretic pattern of both total protein and glycoprotein of low weight with respect to the adult animal. As to the microsomes of 8h and 12h regenerating liver modifications are observed only in the pattern of glycoprotein in the molecular weight range.

During hepatic regeneration a drop in the liver glycogen content along with a lower blood glucose level have been observed. These data are difficult to correlate with the rise of blood glucagon and the drop of insulin shown at the same times after partial hepatectomy. Therefore, liver glucose-6-phosphatase activity has been studied at 1.5, 4, 15 and 24 h, since that enzyme is involved in the release of glucose from the cell. 4 and 15 h after partial hepatectomy a remarkable decrease in glucose-6-phosphatase activity is observed. These results are discussed in view of the higher metabolic demand of regenerating liver.

We have examined the possible interferences with spectrophotometric protein determination of some detergents commonly used for the solubilization of membrane proteins. The results show that some mixtures of Triton X100 with SDS or DOC, at given concentrations, interfere with BSA determination by the method of Lowry.

Cholesterol and phospholipid content, and phospholipid composition (sphingomyelin, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidylethaolamine) were assayed in rat liver microsomes during regeneration, foetal development and pregnancy. Cholesterol was assayed using Liebermann-Buchard reagent; the phospholipid extract was separated by thin-layer chromatography. While in pregnancy no changes were observed, during foetal development and liver regeneration there was a significative decrease of cholesterol/phospholipid ratio, and of phosphatidylcholine content. Moreover, in developing liver microsomes, there is also a significative increase of sphingomyelin and phosphatidylserine + phosphatidylinositol.