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Background: The nose represents the port of entry, the first part of the upper airway and accounts for 50% of its total resistance. Many authors identified rhinitis as relevant factor affecting quality of life, and sleep habits of sufferers and their caregiver's, particularly between 4-17 years old children. Both allergic rhinitis and non-allergic rhinitis may represent an important risk for obstructive sleep apnea syndrome in children. We evaluated the quality of sleep and the role of nasal irrigations with saline solutions in children with sign and symptoms of rhinitis., Methods: An observational retrospective study was conducted on 58 children aged 3-6 years old receiving diagnosis of rhinitis according to clinical and amnestic evaluation. All recruited children were screened before medical topic treatment with the Pediatric Sleep Questionnaire test in order to evaluate the sleep habits and after isotonic and hypertonic saline nasal irrigation for six months. One-Way ANOVA was used for statistical analysis of the results., Results: Forty-nine of 58 recruited children reached the follow-up control after six months of medical treatment. Mean score at Pediatric Sleep Questionnaire before and after medical treatments was respectively 0.39 and 0.28. One-Way ANOVA test showed a significant statistical difference (P<0.05)., Conclusions: Nasal topic decongestant may be used only for short-term treatments, and they do not seem to have long-term results. Topic corticosteroids may be used for long term treatment and their correlations with OSA seem to have different results. This study aims to attracting the attention of pediatricians on the importance of nasal topic saline solutions irrigations in children with rhinitis in improving HRQoL decreasing snoring and apneas and so daytime symptoms.

Background: Breast reconstruction after a mastectomy, today is considered the best choice to improve the quality of life for the patient. The aim of the procedure is to consider the aesthetic results obtained and the various involvements, comparing them with those already reported in literature. METHODS. There is no certain data of the number of breast reconstructions performed in Italy in the few years. In 1999, in Veneto, reconstruction surgery after total breast removal, represented only 16% of the operations. In our surgery Division, from 1996 to 2000, there were breast reconstructions performed, either immediately or delayed on 87 patients out of 118 after mastectomy. 73.7% none over the age of 60 (range 27-60). The breast removal technique used is the Madden, while, for the reconstruction we have put into effect the submuscle prosthetic implant; 63 patients were subject to follow-up treatment during the period of 10 to 36 months., Results: Seventy-eight percent of the women have judged the final aesthetic results the same or better than expected. Based on reconstruction with prosthesis, is the preferred procedure, even with serious complications which do not always influence the final results. This preference is because of the reduced operation time and the psychological and physical benefits due to immediate restoral of the mammary volume and shape., Conclusions: Some problems (Garavaglia Law) have slowed down the diffusion in Italy of this type of treatment which is now receiving more and more request and approval by the women affected with breast cancer.

A fluorocarbonate emulsion was infused into 30 rabbits after the removal of varying amounts of blood. Parameters relating to the transport of respiratory gases and the fundamental features of the macrocirculation were monitored. The animals were sacrificed after 6 or 24 hr and the histological changes in the main parenchymas were assessed. The material injected displayed low toxicity, a good ability to act as a vehicle for oxygen and carbon dioxide, and no tendency to alter the macrocirculation. Numerous problems remain, however, with regard to the stability of fluorocarbonates over the course of time and the effect of their uptake by tissues.

A rare case of acutely thrombosed atherosclerotic aneurysm of the deep femoral artery is herein described. A review of the literature revealed 12 other reported cases of deep femoral aneurysm. However none were treated by resection and replacement using a human umbilical vein graft which was chosen in the present case because the autogenous saphenous vein was not available.

A new i.v., water-soluble aldosterone antagonist (potassium canrenoate) was employed for the first time in a series of patients operated for various forms of abdominal disease. The pharmacological and clinical effects of the drug were constantly reproduced and a marked anti-aldosterone activity was noted. The drug is felt to be specifically indicated in the management of secondary hyperaldosteronism typical of the immediate postoperative period.

The characteristic aspects of the year's course in Surgical Symptomatology included in the curriculum of the degree course in Medicine and Surgery are examined. The report covers the student's behaviour at the first contact with the patient, his initial reaction and subsequent professional acclimatization, the techniques of didactic simulation and the new diagnostic technologies that essentially follow the dialectic of the "electronic game". Direct personal evidence and selected technical documentation constitute the demonstrative back up for the various points under discussion.

Certain fluorinated carbonate compounds can carry O2 and CO2 in a physiological manner. This faculty was exploited in the elaboration of an experimental intra-alveolar oxygenating washing protocol employing such compounds as intrapulmonary oxygenating liquids conveyed by transtracheal flooding of the alveoli in 20 rabbits. AP, PaP, CVP and EP were monitored in accordance with a 35' protocol, during which the positive oxygenation and negative emptying phases of the washing process were repeated at an average 2 cycles/min. A respiratory exchange capable of keeping all the animals alive until the recommencement of spontaneous ventilation was noted, along with only slight changes in lung structure. Once an in-depth study is made of certain fundamental phenomena related to structure and lung function, it is felt that this washing method can be used clinically for the treatment of hypoxaemic situations in which normal alveocapillary exchange is impeded by extraneous material, as in desquamative interstitial pneumonia, pulmonary alveolar proteinosis, etc.

A retrospective analysis was performed on 22 patients (mean age 65) in whom preoperative rectosigmoidoscopy had diagnosed tubulovillous rectal polyp. In 12 cases the polyps were removed transanally and the remaining 10 were subjected to laparotomy. The incidence of error in the preoperative histological diagnosis was 18.2% (9% for the nature and 10% for degree of dysplasia of the polyp). There were 25% recurrences after transanal exeresis, 10% after laparotomy. Total survival at 42 months was 86.3%. The study confirms the validity of transanal exeresis of tubulovillous polyps of the rectum assuming careful preoperative patient selection.

Fluorocarbonates are organic compounds capable of carrying oxygen and surrendering it to tissues by means of biological sound modalities. Experimentation of an emulsion consisting of perfluorotripropylamine and perfluorodecaline (Fluosol DA 20%) as a blood substitute is reported. Acute (Ht less than 1%) and chronic morphological (Ht = 15%) studies were performed on rats, and a semi-acute biochemical and morphological protocol (Ht = 21%) was experimented in pigs. The first signs of altered cerebral electrical activity occurred at Ht = 2% in the acute experiments, and death due to respiratory arrest took pace at Ht = 0.5%. In the semiacute and chronic experiments, widespread infiltration of fluorocarbonic micelles was noted on histological and electron microscope lung and liver preparations.

The importance of exfoliative cytology in the diagnosis of cancer of the oesophagus is stressed. The examination uses a straightforward, economical technique and, in association with traditional investigations, offers diagnostic positivity of close to 100%. The interest in exfoliative oesophageal cytology does not derive solely from its confirmation of clinically certain oesophageal cancer, but from the fact that it offers early diagnosis outside of dysphagic symptomatology. Its field of use is thus extended and it proves to be a complementary but indubitably useful technique for diseases of the oesophago-gastric tract, particularly in those presenting high cancerization risk. Its use is therefore recommended for the screening of oesophageal cancer.

Two patients who received Human Umbilical Vein (H.U.V.) femoropopliteal by-passes to revascularize ischemic limbs, and later underwent emergency operations for acute graft thrombosis, developed H.U.V. graft sepsis. The patients presented with haemorrhage, fever, pain and a growing mass at the site of the previous emergency procedure, one and five months later. An attempt at limited H.U.V. segment substitution (case 1) failed. We then performed successful complete graft excisions combined with extra-anatomical H.U.V. revascularization. At present both patients are asymptomatic with well-functioning H.U.V. grafts, 7 and 13 months later. In both cases Light and Scanning Electron Microscopic studies were performed. Findings of these studies have been analyzed.

Personal clinical experience and the results obtained in the treatment of patients suffering from severe hepatic insufficiency observed in the last seven years, out of a total of some 200 cases, are reported. The modalities employed in the application of intensive basic care and special treatment in 50 cases of initial or clear hepatic coma of various aetiological origin are reviewed. Whereas basic treatment involves more purely medical measures, such as reintegrative and nutritional treatment by the venous route, activation of renal function, the prophylaxis of infectious complications and reinfusion of ascitic fluid, that applied to cases of clear coma involves a more properly surgical technique. It makes use of an original biological clarification technique in extracorporeal circulation by means of isolated and perfused heterologous liver, and an isovolaemic exsanguinotransfusion technique. Indications and features are illustrated in detail.

A clinical research was carried out on the rheological and haemodynamic effects of various drugs commonly employed in the treatment of certain disturbances of the microcirculation. In addition to low molecular weight dextrane, a comparison was also made of three other substances theoretically capable of interfering with the fundamental relationship between viscosity, volume and haemodynamics. Assessment of the clinical signs was made both via evaluation of the peripheral haemodynamics during rest and during post-ischaemic hyperaemia and through determination of changes in blood viscosity by means of an original capillary viscosimeter. Some conclusions of a certain speculative and practical interest are drawn from the research as a whole.

From 1977 through 1984, 58 arterial reconstructions using glutaraldehyde-tanned human umbilical vein (H.U.V.) grafts were carried out: 41 femoropopliteal, 4 composite aortopopliteal (a Dacron graft was inserted proximally), 5 femorotibial, 6 axillofemoral, 1 femorofemoral, and 1 iliofemoral bypass. Autogenous saphenous vein was absent or inadequate in all patients. Limb salvage was the primary indication for surgery (89.7%). Five and 8 years cumulative patency rates were 42.8% and 35.1% respectively for all H.U.V. by-passes and 52.4% and 41.9% respectively for femoropopliteal by-passes. Four out of the 5 femorotibial by-passes failed during the first month following surgery. Two of the 6 axillofemoral and 3 of the 4 composite aortopopliteal by-passes thrombosed within 1 and 3 years after surgery, respectively. Perioperative mortality was 5.1%, while overall mortality was 17.2%. The following conclusions can be drawn from these results: H.U.V. grafts did not achieve cumulative patency rates superior to those reported with autogenous saphenous vein, in limb salvage situations, when the saphenous vein is not available, the H.U.V. graft offers acceptable salvage rates, results from the 8-year follow-up period demonstrate the durability and long-term patency of H.U.V. grafts.

A new apparatus for the reinfusion of ascitic fluid, offering effective clarifying action as well as the typical concentration of this therapeutic technique is presented.

Structural changes of colonic patches implanted in rat stomachs for periods of 2 to 12 months were evaluated by standard light and scanning electron microscopy. Colonic patches were sutured on the posterior wall of 116 white rats stomach body according to the following models: 1) mucosal surface to gastric lumen (60 rats); one third of the animals were given chronic doses of histamine subcutaneously; 2) peritoneal surface to gastric lumen (28 rats); 3) leiomuscular layers to gastric lumen by removing of the colonic mucosa (20 rats). Eight rats were used as controls. The colonic mucosa was shown to be highly resistant to acid secretions; only minimal surface erosions were found in animals with gastric hypersecretion following histamine stimulation. In contrast both the peritoneal surface and the colonic leiomuscular components were completely destroyed by contact with the acid juice. Both these structures were subsequently and completely colonised by the gastric mucosa.

Results observed over a period of two years in the intensive care of hepatic coma at the University of Genova surgical pathology department are briefly surveyed. A set of practical suggestions is offered for the management of patients whose prognosis is not open to change by the administration of conventional forms of treatment. A critical appraisal of the results achieved is presented along with the general series.

The formation of multiple aneurysms in the midportion of Dacron grafts has been reported only twice in the surgical literature. In the present case, three aneurysmal dilatations developed 6 years following an orto-femoral Dacron graft implantation. Multiple structural defects in the Dacron prosthesis appear to be the most likely cause of the graft failure.