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Background Follicular Unit Excision (FUE) is a popular hair transplant technique, but requires shaving the donor area. This is a deterrent for some patients wishing to keep their hair transplant discreet. The new Long Hair FUE technique avoids shaving the donor area, which appeals to a wider patient population; however, it has a reputation of being technically challenging and slow. Aims We review the tools and techniques developed for Long Hair FUE and present our experience using the Trivellini Long Hair System and Long Hair Punch. Discussion With the new advances in tools and techniques for Long Hair FUE, this method is gaining momentum and has the potential to be the next trend in the hair transplant industry. There are a few different punch designs marketed specifically for Long Hair FUE (window/slotted, Trivellini Long Hair, and bi-pronged). Although this technique is slower to perform than shaven FUE, graft survival and final outcome are comparable. Conclusions Innovations in technology have made the Long Hair FUE technique more accessible to hair transplant surgeons. It is important for hair restoration surgeons to keep knowledgeable about this technique in order to maintain a competitive business.

Background Early use of follicular unit excision (FUE) as a method of hair transplantation was limited by high rates of hair follicle transection. This hurdle has been overcome by innovative methods, punch shapes, and devices. With the vast array of tools available, it can be difficult for hair transplant surgeons to choose the best option for their practices. Aims To provide an in-depth review and comparison of currently available FUE methods, punch designs, and motorized devices, and discuss how these tools fit the unique skin and hair characteristics of patients. Methods A review of the literature and available information on FUE methods, punches, and devices, as well as the authors' experience in this area, is provided. Results Innovative FUE methods, punch shapes, and motorized devices have successfully minimized the rate of hair follicle transection. Methods include the use of sharp punches with depth control, and blunt rotating punches. Punch shapes such as flared, hybrid, and edge out have successfully reduced transections by keeping the cutting edge away from the follicles under the skin. The development of motorized devices using features including rotation, roto-oscillation, oscillation, vibration, suction, and hydration has also aided in achieving more successful graft excision. Conclusion Follicular unit excision is a widely used technique by hair restoration surgeons. Therefore, it is important for physicians to be aware of the array of punches and devices available and understand how these tools can be used to adapt to the unique skin and hair characteristics of individual patients to optimize successful graft harvesting.

Objective: Unhealthy lifestyle habits during adolescence are linked to a higher risk of chronic degenerative disease during adulthood. The aim of this study was to assess the lifestyle habits among Italian adolescents, considering the potential influence of sex. Methods: Data were collected from 1707 eligible students. Demographic, dietary, and lifestyle data were collected, by using KIDMED and PAQ-C instruments. Results: The overall population had a medium adherence to a Mediterranean diet (58%, KIDMED score: 2.11 ± 0.64). There was no statistically significant difference in adherence by sex. We found boys to be more physically active than girls (p < .001). Considering ponderal index status, boys had turned out to be more overweight and obese respectively (13% and 4% respect to 10% and 2% in female population, p < .05, respectively), due to the presence of only one risk factor (medium or low both in diet and in physical activity score). Conclusions: Our results showed that our population stands at average levels both for its adherence to the Mediterranean diet and for physical activity, with males having a higher percentage of overweight and obesity. Importantly, in contrast to girls, boys have a higher risk of obesity, also in the presence of a single risk factor.

Among the various factors that could influence health-related quality of life (HRQoL) in adolescence, body mass index (BMI) seems to play a key role as a main anthropometric parameter. The aim of this cross-sectional study was to determine, in a sample of Italian adolescents, whether HRQoL is associated with the different weight status categories (underweight, normal weight, overweight, obese), according to BMI cut-off points for children, even considering sex differences. Data were collected from 1707 adolescents (n = 828 males) in seven schools. HRQoL was analyzed using the Italian version of KIDSCREEN-52. Males were more overweight and obese than females (13% vs. 10% and 4% vs. 2%, p &lt, 0.05, respectively). In females, BMI categories are associated with physical well-being (p &lt, 0.05), emotion/mood (p &lt, 0.05), self-perception (p &lt, 0.001), financial resources (p &lt, 0.05), and bullying behavior (p &lt, 0.05). In males, weight status is linked to physical well-being dimension (p &lt, 0.001) and perception of self (p &lt, 0.05). Our results may suggest that there is an association between weight status categories and HRQoL, more pronounced in females than in males. Interestingly, the weight status correlated more with the psychological dimension mainly in females, whereas in males, a stronger association between weight and physical status was observed, suggesting that given the complex, multifaceted, and dynamic nature of relationship between health-related quality of life and weight status in adolescents, multiple factors must be considered.

Coronavirus disease 2019 (COVID-19) outbreak represented an experience of social isolation potentially leading to changes in the health quality of life. The aim of this study is to investigate the health-related quality of life during quarantine in early adolescents. Data were collected from 1,289 adolescents (mean age, 12.5; male, 622), at the beginning of the school year (September 2019, Standard Condition, SC) as part of the AVATAR project and during Phase 1 of the Italian lockdown (mid-late April 2020) (COVID-19 Quarantine, CQ) using an online questionnaire. In the CQ period, with respect to SC, adolescents showed lower perception in the dimensions, such as psychological (p = 0.001), physical well-being (p = 0.001), mood/emotion (p = 0.008), autonomy (p = 0.001), and financial resources (p = 0.018). Relationship with the family (p = 0.021) and peers (p = 0.001), as well as the perception of bullying (p = 0.001) were reduced. In lifestyle, adolescents developed higher adherence to the Mediterranean diet (p = 0.001). Adolescents living in the village had greater reduction in both autonomy (p = 0.002) and peer relationships (p = 0.002). Moreover, the perception of physical well-being was lower in those living in the city instead of those living in the countryside (p = 0.03), in an apartment instead of a detached house (p = 0.002), and in those who did not have green space (p = 0.001). Gender effect emerged for the psychological (p = 0.007) and physical well-being (p = 0.001), mood/emotion (p = 0.001), and self-perception (p = 0.001). The study showed that health-related quality of life during quarantine changed in its psychosocial dimensions, from mood and self-esteem to social relationships, helping to define the educational policies at multiple points in the promotion process of health.

Local anesthetics have been used since ancient times in medical surgeries and aesthetic procedures. Lidocaine is the most commonly used local anesthetic agent. The infiltration techniques include using small caliber needles and low-volume syringes. The conventional needles have three parts: the hub

Adolescence is a period characterized by rapid physical maturation, involving bodily changes that often necessitate a reorganization of self-perception. The current study investigated the impact of menarche on the determinants of quality of life in healthy female adolescents. Data were collected from 361 healthy female adolescents divided into two groups: pre- and post-menarcheal event. Participants, according the AVATAR project, completed Italian version of KIDSCREEN-52 questionnaires on health-related quality of life. Pre-menarcheal females had the higher score in psychological well-being and mood than post-menarcheal females. As concerns self-perception, post-menarcheal females exhibited lower score compared to pre-menarcheal females. In social context, pre-menarcheal females perceived a better school environment, also when we considered it in terms of social acceptance.Conclusion: Menarche event affects all the components of quality of life, from mood, self-esteem to social relationships, underlining how this hormonal variation is responsible of psychological and emotional changes, opening up the opportunity for preventive approaches aimed not only at traditional risk factors but according a more integrated perspective.What is Known:• Adolescence is a time of increasing behavioural divergence between males and females, probably due to the different hormonal development.• There is a possible link between menarche and the health-related quality of life variables.What is New:• Menarche condition affects all the components of quality of life, from mood to social relationships.• Post-menarcheal condition is associated to psychosocial and emotional changes, with possible multiple pathways to post-pubertal depressive symptoms.

Morphological variation provides a method for phenotypic stock differentiation at inter- and intra-specific levels. Various methods are used for the assessment of fishery stocks in mollusks; one of them is geometric morphometrics. We analyzed morphological variation in razor clams at ten fishing grounds, five from the Argentinean North Patagonian gulfs and five from Chile, and evaluated the occurrence of phenotypic stocks between Argentinean and Chilean fisheries, using geometric morphometrics methods. The Argentinean harvesting of Ensis macha is emerging, and represents a way to diversify the shellfisheries in north Patagonia. Nevertheless, fishing and aquaculture play important roles for the Chilean economy. Various multivariate methods were applied to describe the differences among and between fishing grounds. We found significant differences in the average shell shape of individuals from either ocean, and these differences principally describe changes in the robustness of the shell. The average shell shapes differed among sites from the Pacific while those from the Atlantic Ocean did not show statistical differences. This study shows that geometric morphometric techniques are appropriate for the identification of phenotypic stocks in E. macha. Our results could be used for future resource management and to determine the origin of the product in razor clams from South America. Fil: Marquez, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto de Biología de Organismos Marinos; Argentina. Universidad Nacional de la Patagonia; Argentina Fil: Trivellini, Maria Magdalena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto de Biología de Organismos Marinos; Argentina. Universidad Nacional de Córdoba; Argentina Fil: Van Der Molen, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto de Biología de Organismos Marinos; Argentina

1. Roberto Trivellini, MD (lrtrivellini{at}yahoo.com.ar) 1. Asuncion, Paraguay The excision of follicular units using conventional FUE techniques has challenges and requires certain skills on the part of the physician. The multiphasic suction-assisted FUE device, described below, allows us to

Adolescence is not only typically considered a time of good health but also characterized by an emergence of risk factors that may have long-term consequences for well-being that represents strong predictors of adverse health outcomes. The aim of the study is to assess adolescence well-being through the development of an integrated Well-Being Index (WBI) including variables of lifestyle habits, social context, emotional status, and mental skills. One thousand two hundred forty-eight healthy adolescents (Female 48%; Male 52%; mean age 13 years) were recruited from five Italian junior high schools, by KIDSCREEN-52 and cognitive processing using the Stroop Test. School performance was estimated by questions concerning the scholastic achievement. Social context was the most important predictor of perceived well-being (β = 0.972, SE = 0.014, p < 0.0001), with parent relation (p < 0.0001) as the most observed variable. Subsequently, WBI was strongly represented by lifestyle habits (β = 0.954, SE = 0.017, p < 0.000) with autonomy (p < 0.0001), and emotional status (β = 0.949, SE = 0.017, p < 0.000) with psychological well-being perception (p < 0.0001). Finally, mental skills (β= −0.1417, SE = 0.031, p < 0.0.00) was the least important predictor for the WBI index (p < 0.0001). Personalised (P) WBI was obtained by the sum of each centered and scaled WBI variable, weighted by the corresponding ratio between factor loading and residual variance. Social context was the more important predictor of WBI, followed by lifestyle, emotional factors, and lastly mental skills. PWBI provides an integrated and personalized perspective of adolescents' well-being, on the basis of a cooperation between school, family, and community with the common intent to promote and protect adolescent health.

The quality of horticultural products is the result of the interaction of different factors, including grower's crop management ability, genotype, and environment. Sub-optimal environmental conditions during plant growth can induce abiotic stresses and reduce the crop performance with yield reduction and quality losses. However, abiotic stresses can induce several physiological, biochemical, and molecular responses in plants, aiming to cope with the stressful conditions. It is well known that these abiotic stresses are also elicitors of the biosynthesis of many metabolites in plants, including a wide range of bioactive compounds, which firstly serve as functional molecules for crop adaptation, but they have also a great interest for their beneficial effects on human health. Nowadays, the consumer is oriented to low-energy foods with low fat content, but at the same time, growing attention is paid to the presence of bioactive molecules, which are recognized as health-related compounds and concur to the nutraceutical value of plant-derived foods. In this context, fruit and vegetables play an important role as sources of bioactive ingredients in the diet. At the cultivation level, the understanding of crop responses to abiotic stresses and how they act in the biosynthesis/accumulation of these bioactive compounds is crucial. In fact, controlled abiotic stresses can be used as tools for improving the nutraceutical value of fruit and vegetables. This review focuses on the quality of vegetables and fruits as affected by preharvest abiotic stressors, with particular attention to the effect on the nutraceutical aspects.

Climate change has increased the global environmental risks, especially the impacts of abiotic stresses on agriculture productivity. Among the abiotic stresses aggravated by climate change, flooding (complete submergence, stagnant flooding, soil waterlogging) has been identified as a major stress for plant growth and food production worldwide. Improving crop plants adaptation to flooding conditions is important to cope with increasing incidences and intensity of flooding, which could potentially be accomplished through manipulating adaptive physiological and molecular processes. Ethylene is a key plant hormone in plant adaptation to flooding, modulating signaling, and metabolic responses. Significant progress was made in understanding the basic physiological and molecular mechanisms associated with ethylene-mediated plant responses to flooding stress, though our knowledge in this field is still far from complete. This review provided (a) an overview of ethylene biosynthesis, signaling and its perception under flood condition in plants, with emphasis on rice; (b) assess the ethylene functions under flooding stress based on available evidences; (c) cross-talks of ethylene with other phytohormones and signaling molecules associated with ethylene-induced flooding responses; and (d) elucidate the role of ethylene mediated tolerance pathways with an aim of developing flood tolerant plants. The review represents a step forward to develop flood resilient crop plants by exploiting the knowledge of ethylene biology and functions.

The paper investigates the deforestation process in the Mau Forest (Kenya), highlighting the actors involved and the underlying relations of power. The proximate causes of the deforestation are three: agriculture, wood production and infrastructures. In this context of pressure on natural resources, local communities have developed different projects to reduce deforestation and promote alternative development strategies, especially through the Community Forest Associations (CFAs). These dynamics show that deforestation is a complex issue whose solutions lie primarily outside the forest itself and that it should be tackled with suitable policies on crucial issues such as land, agriculture, infrastructure and indigenous peoples. L’article analyse le processus de déforestation dans la Forêt Mau (Kenya) et met l’accent sur les acteurs impliqués et les relations de pouvoir sous-jacentes. Les causes directes de la déforestation sont trois : l'agriculture, la production de bois et les infrastructures. Dans ce contexte de pression sur les ressources naturelles, les communautés locales ont développé différents projets visant à réduire la déforestation et à promouvoir des stratégies de développement alternatives, en particulier à travers l’action des Associations Communautaires de gestion de la Forêt (CFAs). Ces dynamiques montrent que la déforestation est une question complexe dont les solutions se situent principalement en dehors de la forêt et devraient être abordées à travers des politiques appropriées sur des questions cruciales telles que la terre, l'agriculture, les infrastructures et les peuples autochtones.

Fruits and vegetables are highly perishable foods which usually undergo a gradual loss of nutraceuticals during storage. Chitosan-based edible coatings are extensively studied thanks to antimicrobial activity and great potential to extend the shelf life. However, little information is presently available on the nutraceutical quality of chitosan-coated products. The present study is addressed to evaluate accompanied by a delayed degradation of some phenolic compounds during storage. These results indicate that chitosan coating is effective in maintaining the quality parameters, the coated fruit showed less weight loss (−16%) and more firmer (+40%) than control fruit, chitosan-coated tomato emitted significantly lower ethylene (−41%) than control, and slowing down the nutraceutical loss occurring in postharvest, mainly of the lycopene, main carotenoid, found in tomato fruits. These results indicate that chitosan coating is effective in slowing down the nutraceutical loss occurring in postharvest, thus representing a promising tool to preserve bio-protective phytochemicals during fruit conservation. Practical applications During storage and domestic conservation, the nutraceutical quality of fruits and vegetables usually decreases and can undergo deterioration due to physiological disorders and mechanical damages. In the last decade, use of edible coatings has attracted interest as a promising technology to prolong the shelf life of particularly perishable foods. These coatings act as protective barriers decreasing transpiration rate and gas transfer across the product surface, thus promoting the maintenance of nutritional quality.

There is a tremendous growing interest both in various industrial sectors and among people worldwide, towards the use of natural compounds from plant origin. The natural compounds obtained from plants have been more and more employed by cosmetic, food and pharmaceutical industries and could represent potential alternatives to synthetic chemicals. In the Lamiaceae family there are herbs with enormous socio-economic value, including several species of horticultural and ornamental interest, many used as culinary herbs, and with diversified industrial applications essentially due to their high content in valuable phenolic compounds. This review focuses on the wide spectrum of bioactive phenolic compounds in several species in the Lamiaceae , which possess known pharmacological properties and are used by humans for therapeutic purposes. It also reports other challenging and innovative industrial applications of these compounds as potential alternatives to conventional synthetic chemicals, because natural phenols would have lesser environmental and human health impacts than most of the conventional ingredients used in cosmetic, pesticides and food additives-preservatives industries. Finally, the review considers how an enhanced understanding of the effects of elicitation could be applied to increase and/or modify tissue content of active principles. Chemical or physical elicitors can activate the stress-signaling pathways leading to enhance the content of bioactive secondary metabolites, thus representing a new perspective for sustainable production of industrial crops.

Agricultural growing practices have been evolving towards organic, sustainable or environmental friendly systems. The aim of modern agriculture is to reduce inputs without reducing the yield and quality. These goals can be achieved by breeding programmes but would be species specific and time consuming. The identification of organic molecules able to activate plant metabolism may allow an improvement in plant performance in a short period of time and in a cheaper way. Biostimulants are plant extracts and contain a wide range of bioactive compounds that are mostly still unknown. These products are usually able to improve the nutrient use efficiency of the plant and enhance tolerance to biotic and abiotic stresses. In this review, the state of the art and future prospects for biostimulants are reported and discussed. Moreover, particular attention has been paid to intensive agricultural systems such as horticultural and floricultural crops. In vegetables, the application of biostimulants allowed a reduction...

Background. The aim of this retrospective study is to verify whether some maternal features are related to pregnancy outcome in cases of emergency mid-trimester cerclage when membranes are protruding through the dilated cervix. Methods. Between 1988 and 1996 twenty-three pregnant patients with dilated cervix and protruding membranes were treated with emergency cerclage. At the time of cerclage, gestational age ranged from 17 to 27 weeks (median 22). Results. Pregnancy was prolonged from 0 to 20 weeks (median 4). Eleven living infants were born (46%); median gestational age at delivery was 25 weeks (range 21-39) and median birth weight 700 g (range 350-3980 g). Obstetric histories, white blood cell count, and vaginal-cervical and urine cultures obtained on admission were analyzed in the two following groups: data from patients with good pregnancy outcome (live births) versus those from patients with poor outcome (stillbirths and neonatal deaths). No significant difference was found between the groups for t...

Hernia repair is the most common surgical procedure in general surgery in Italy and in the Lombardy region. In the last decade, the use of mesh, the concept of a tension-free technique, and the postoperative rate of recurrences after Bassini or Shouldice operations have completely changed the surgical approach to hernia repair. For this reason, we sent a questionnaire to 148 surgical departments in the Lombardy region to investigate about total hernia operations performed in 2000 in Lombardy, the surgical approach, the surgical techniques used, the type of anesthesia and the hospital stay. One hundred five out of 148 surgical departments returned the questionnaire, and we collected information on a total of 16,935 surgical operations for hernia: 16,494 were performed using tension-free techniques. The inguinal anterior approach is the one of choice for primary and recurrent inguinal hernia, whereas the open preperitoneal and laparoscopic approaches are limited to bilateral and recurrent hernias. The majority of cases were treated under locoregional anesthesia and with a hospital stay of two nights.

Our objectives were to assess the plasma coenzyme Q10 (CoQ10) levels in normal pregnancy, in pregnancy with a spontaneous contractile event, in spontaneous abortion and in threatened abortion. Six hundred and fifteen CoQ10 levels were analyzed in 483 pregnant women: 350 patients were employed to design a normal curve; 66 patients with spontaneous contractile activity underwent two or more CoQ10 analyses in different trimesters; 49 patients presented spontaneous abortion, and 18 patients threatened abortion. The normal curve of plasma CoQ10 levels rises during each trimester of pregnancy, while there is a correspondence between a low CoQ10 level and spontaneous abortion. Furthermore we found a statistically significant difference between the plasma CoQ10 value in spontaneous contractile activity, mainly in the third trimester. We found an increase in the plasma CoQ10 level in relation to the contractile activity of the uterine muscle. Further studies are necessary to explain the involvement of this marker on pregnancy in clinical practice.

A multispecies GIS-based approach has been used to evaluate species richness from potential distribution maps, calculated for 58 bird species present in the study area. Species-level predictions agree with the recent Varese Province Bird Georeferenced Atlas data, not used in modeling, whereas biodiversity hotspots identified allowed a first evaluation of the efficiency of Natura 2000 sites in the area.

From January 1986 to December 1990 70 HIV-seropositive pregnant women were seen at the Department of Obstetrics and Gynecology, Rome, Italy. All of them delivered in our Hospital Center and their babies were enrolled in pediatric follow-up. Sixty-five patients (93%) were drug-addicted, only 6 of them showing signs of HIV infection (lymphoadenopathy). The authors report the results of a clinical study demonstrating that asymptomatic HIV infection did not affect the regular course of pregnancy. Moreover, they show that there was no progression of disease during pregnancy, vertical transmission was 24%, the infected babies were of low birth weight (2,586 +/- 527 vs. 3,100 +/- 470 g) and the incidence of premature delivery was higher (30 vs. 8%) than in noninfected controls.

In this retrospective study, we review our data on 203 drug-addicted pregnant patients, considering two different aspects of the question: maternal and fetal. We report the findings relative to maternal metabolic, endocrinological, neuroendocrinological and immunological studies performed in our department over the past 13 years. Moreover, we study fetal involvement in drug-addicted pregnancy and report the findings of our fetal behavior and urodynamic studies. The last section of this study deals with perinatal outcome. In particular, we report a high incidence of small-for-gestational-age fetuses and premature deliveries.

Giant incisional hernias with total loss of substance are an ominous pathological condition characterized by massive depletion of muscular and fascial tissue, by complete loss of the anatomical and physiological function of the abdominal wall and by severe respiratory and visceral involvement. Over a 10-year period we operated 270 patients with voluminous incisional hernias, 12 of which had a total loss of substance. There was no intraoperative mortality. One patient died of myocardial infarction on the fifth and one died of intestinal occlusion and peritonitis the 11th postoperative day. Early postoperative complications occurred in only one patient who had skin necrosis with an infection at the polypropylene mesh. This was successfully treated with systemic antibiotic therapy and topical medication of the wound. There was also one minor recurrence over the pubis 1 year after the operation that required a new operation to replace the mesh. No respiratory complications occurred and all patients were normally active. The good results reported in our series encourage us to continue in this direction even though these patients are at high risk.

The existence of polyester and polypropylene prosthetic meshes has provided a new dimension in the treatment of inguinal and incisional hernias. With the safety of these materials established, methods have been devised that would at last conquer pathology that was once thought untreatable. These methods have gained popularity in Europe and throughout the world, thanks to the efforts of the French authors Rives et al.1 and Stoppa and Warlaumont2 in particular. They and other authors3,4 have described operative techniques using prosthetic materials in preperitoneal sites.

When confronting a massive incisional hernia, a surgeon needs to know not only the particulars of the case before him, but also the characteristics and hazards of this class of disorder. A postoperative incisional hernia cannot be understood simply as a hole in an abdominal wall in need of suturing, but rather as a condition that Jean Rives identified in 1973 as “incisional hernia disease.” The implication is that the hernia itself is but one of many manifestations of that disease.

The aim of this retrospective study is to verify whether some maternal features are related to pregnancy outcome in cases of emergency mid-trimester cerclage when membranes are protruding through the dilated cervix.Between 1988 and 1996 twenty-three pregnant patients with dilated cervix and protruding membranes were treated with emergency cerclage. At the time of cerclage, gestational age ranged from 17 to 27 weeks (median 22).Pregnancy was prolonged from 0 to 20 weeks (median 4). Eleven living infants were born (46%); median gestational age at delivery was 25 weeks (range 21-39) and median birth weight 700 g (range 350-3980 g). Obstetric histories, white blood cell count, and vaginal-cervical and urine cultures obtained on admission were analyzed in the two following groups: data from patients with good pregnancy outcome (live births) versus those from patients with poor outcome (stillbirths and neonatal deaths). No significant difference was found between the groups for the above mentioned maternal features.The possibility of 46% live births is considered a good result for mid-trimester emergency cerclage when the membranes are protruding. Success of the procedure remains unpredictable on the basis of the maternal features investigated.

Women having recurrent miscarriages or intrauterine growth retardation could have subclinical coeliac disease, which can be detected by serological screening tests.

The surgical approach for the treatment of abdominal incisional hernias is a difficult problem. Only the use of prosthetic materials can provide a solution, yet their use in case of abundant loss of peritoneum can involve complications due to direct contact between the mesh and the intestine. The use of prosthetic materials in reconstruction of the abdominal wall highlights two closely connected problems: the kind of mesh to be used and the best implant site The prosthesis should be positioned only in the pre-peritoneal space or in the retromuscular prefascial plane. We report our experience with a surgical technique in which the peritoneum is integrated with an absorbable prosthesis and the nonabsorbable prosthesis is positioned in the neo-preperitoneal plane. From January 1992 to January 2000 65 patients underwent surgery for large incisional hernias. The follow-up period ranged from 6 to 60 months. There were 15 (23.1%) early complications (seromas, hematomas and infections) and 2 (3.1%) late complications: a fistula between the skin and the prosthesis and a subacute infection of the abdominal wall. No recurrence was noted. In patients with abundant loss of substance there is no real pre-peritoneal space; therefore a new one must be created to restore the mechanical and functional structure of the peritoneum. The prosthetic Vicryl® mesh permits good tissue repair with almost no involvement of the intestinal loop. Follow-up studies confirm the efficacy of this method.

Objective: We evaluated pregnancy outcome and fetal growth in women requiring total parenteral nutrition (TPN). Methods: Eleven malnourished pregnant women were treated with TPN in a single institution, starting at a mean gestational age of 20 ± 8 weeks (± SD). Serial ultrasound evaluations of fetal growth (biparietal diameter, femur length, abdominal circumference) were performed. The paired Student t test and Wilcoxon signed-rank test were used for the statistical analysis: p values Results: The duration of TPN ranged from 14 to 220 days. Maternal nutritional state was well preserved and no complications were related to treatment. A gestational age of 35 ± 3 weeks at delivery (mean ± SD), birth weight of 2,251 ± 670 g (mean ± SD) and birth percentile of 29 ± 16 (mean ± SD) were observed. One intrauterine death occurred. The comparison between the sonographic findings, before and 2 weeks after starting TPN, showed a fetal percentile gain with a statistically significant increase in the abdominal circumference percentile (p < 0.05) from a median percentile of 2 (range 2–32) to 33 (range 2–78). Conclusions: TPN proved to be helpful and lifesaving in malnourished pregnant women and promoted fetal growth, as shown by the longitudinal ultrasonographic evaluations.

This report describes a pregnant woman at 22 weeks of gestation examined for fetal bilateral dilated renal pelvis and oligohydramnios. Ultrasound evaluation confirmed the diagnosis of low-level obstructive uropathy. At 26 weeks of gestation, the increase in hydronephrosis prompted us to introduce a vesicoamnionic shunt. Because of unusual intraperitoneal dislocation of the shunt and an increase in ascites and hydronephrosis, we had to insert a peritoneoamnionic shunt at 30 weeks of gestation. The patient underwent cesarean section at 31 weeks for obstetric complications. The infant, at 15 months of age, showed mild renal failure.

Cholelithiasis is considered uncommon in infancy, childhood, and adolescence. We performed a prospective, controlled study showing that children with Down's syndrome have a significantly higher prevalence of cholelithiasis (4.7%) compared with controls (0.2%). Clinicians should be aware of the risk of gallstones in children with Down's syndrome.