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The quality of life of the HIV-infected population in developed countries has substantially improved over the years. Accordingly, the clinical limitations in the surgical treatment of the HIV-infected patients are becoming fewer, and the number of HIV-infected patients undergoing surgical interventions of all types is increasing. However, available data on the incidence and risk factors for post-surgical complications, such as surgical site infections (SSI), in HIV-infected patients are still limited and often controversial. The aim of this study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients.A 1-year observational prospective multicenter surveillance study was conducted in 11 Italian Infectious Diseases Clinical Centers from which 305 consecutive HIV-infected patients undergoing different surgical procedures were enrolled. Postdischarge surveillance was conducted within 30 days after surgery. A number of variables were included in a multivariate analysis aimed at assessing potential risk factors for SSI, including body mass index, diabetes, Hepatitis C (HCV) and hepatitis B virus infection, lipodistrophy, HIV viral load, CD4 cell count and white blood cell count, preoperative hospital stay, National Nosocomial Infection Surveillance (NNIS) risk score, and any antimicrobial prophylaxis.SSI occurred in 29 of 305 (9.5%) patients, of which 17 (58.6%) SSI occurred during hospital stay, and 12 (41.4%) occurred during the postdischarge period. The SSI of the 29 patients were classified as superficial (21, 72.4%), deep (four, 13.8%), organ/space (one, 3.4%), and sepsis (three, 10.3%). Nearly 50% of the superficial and 50% of the deep SSI occurred during the postdischarge period. Organ/space infection and sepsis accounted for 13.7% of all SSI and were observed during the in-hospital stay. The multivariate analysis revealed that HCV co-infection was significantly associated to SSI occurrence. Total hospital stay was longer among patients with SSI than among those without SSI (p = 0.041).Although 92.5% of our HIV-infected patients presented a NNIS scoreor = 1, the SSI rate was twofold higher than that reported in Italian and European studies for the general population, with more severe clinical presentations. This is the first report of an association between HCV-HIV co-infection and SSI occurrence. Additionally, the viro-immunological status of our patients was not related to SSI occurrence, which suggests the need for further research for other potential risk factors that may be implicated in the occurrence of SSI.

A study was started aiming at assessing the pedogenic potential of zeolitized tuffs as possible substrates to soil formation, especially for soil rebuilding in degraded lands. This paper deals with Ca, Al, Mg and Fe distribution in leachates obtained by a sequence of experimental weathering cycles of Campanian Ignimbrite (yellow facies) by water (W) and Na-humate (Na-Hu). The cation amounts were Al>Ca>Mg>Fe in W and Ca>Al>Mg>Fe in Na-Hu extracts, the latter being more efficient. © 2008 Elsevier B.V. All rights reserved.

G. Kirov, L. Filizova, O. Petrov (Eds.), Pensoft, Sofia

An experimental pedology research program was started aiming at modeling the potential pedogenization of zeolitized tuffs. The present study deals with a medium-term weathering of Phlegraean Yellow Tuff (PYT, with phillipsite>chabazite) and Red Tuff with Black Scoriae (RTBS, with chabazite>phillipsite) under discontinuous treatment by water (W) and by humic acids (HA). Significant amounts of cations, increasing in the sequence Al

A study was performed to evaluate the suitability of zeolitized tuffs to restore degraded soils. Ca-saturated Neapolitan yellow tuff or clinoptilolite-rich tuff from Turkey were mixed with organic matter either as humic matter (tannic acid, humic acids) or non-humic matter (polygalacturonic acid). Organic matter was strongly stabilized in clinoptilolite-rich tuff aggregates based on humic matter, whereas it was more easily oxidized in models with nonhumic matter. Cation exchange capacity (CEC) was determined according to Ba/Mg-TEA method and by ammonium acetate procedure. The former method underestimated the CEC of the zeolitized tuffs, but was able to detect the contribution of organic matter to the CEC of aggregates. The latter method provided consistent CEC values for the zeolitized tuffs, but underestimated the exchange activity of the organic components of aggregates. CEC of aggregates including tannic acid was practically nil. Binding tannic acid to zeolite via Cabridges, results evidently in occlusion of zeolite pores. © 2007 Elsevier B.V. All rights reserved. A study was performed to evaluate the suitability of zeolitized tuffs to restore degraded soils. Ca-saturated Neapolitan yellow tuff or clinoptilolite-rich tuff from Turkey were mixed with organic matter either as humic matter (tannic acid, humic acids) or non-humic matter (polygalacturonic acid). Organic matter was strongly stabilized in clinoptilolite-rich tuff aggregates based on humic matter, whereas it was more easily oxidized in models with non-humic matter. Cation exchange capacity (CEC) was determined according to Ba/Mg-TEA method and by ammonium acetate procedure. The former method underestimated the CEC of the zeolitized tuffs, but was able to detect the contribution of organic matter to the CEC of aggregates. The latter method provided consistent CEC values for the zeolitized tuffs, but underestimated the exchange activity of the organic components of aggregates. CEC of aggregates including tannic acid was practically nil. Binding tannic acid to zeolite via Ca-bridges, results evidently in occlusion of zeolite pores.

Objectives To quantify colorectal neurogenic dysfunction in children with spina bifida and to evaluate the clinical efficacy of appropriate rehabilitation performed by the coloproctologist in the spina bifida team. Patients and methods The bowel function of 73 patients with congenital (67) and acquired (six) spinal lesions (age 7–25 years) was evaluated by one physician. Evacuation habit was classified as full bowel control, mild and severe constipation or incontinence. Fifty-two children had mild or severe incontinence or constipation, 22 of whom were treated by the coloproctologist using biofeedback or conventional therapy; 30 were not treated. The outcome was compared between the groups Results Bowel constipation remained stable in 90% and was complicated in 10% of the untreated patients, while it ameliorated in 59% of patients who received specialist treatment. Conclusion Neurogenic bowel dysfunction needs specialist management to achieve better results, using the concept of controlled incontinence. There was no significant difference between conventional therapy and biofeedback methods.

From 1976 to 1994, we followed 55 children with occult spinal dysraphism (OSD). The average age at diagnosis was 4.5 years (range: 24 days–21 years). In 13 cases the OSD was associated with anorectal anomalies. Urologic symptoms were present at diagnosis in 24 children (43%), but urinary incontinence affected all patients in the evolution of the OSD. At diagnosis, all children underwent complete neurourologic and urodynamic evaluation. Nine required early neurosurgical correction, before 3 years of age. During follow-up, intermittent clean catheterization was started in all patients. Vesicoureteral reflux was present or developed in 17 patients: 15 underwent endoscopic procedures and 2 required bladder augmentation because of upper-tract and renal-function deterioration. Endoscopic treatment for urinary incontinence was performed in 3 children. At long-term follow-up (6 to 18 years), socially acceptable continence was achieved in 78% of the children; renal failure occurred in 8. The long-term results were analyzed in order to compare the evolution of urinary continence and renal function in children with OSD with or without neurosurgery.

OBJECTIVE To evaluate and define the risk factors predictive of chronic renal failure (CRF) in children with severe bilateral primary vesico-ureteric reflux (VUR), observed within the first year of life and with a long follow-up. PATIENTS AND METHODS The study comprised 50 patients presenting with grade 3–5 bilateral VUR diagnosed in the first year of life; 12 were suspected prenatally and confirmed shortly after birth, before any urinary tract infection (UTI). The mean (range) follow-up was 6.3 (1–16) years. The variables considered within the first year of life were: gender, prenatal diagnosis with no UTI, number of febrile UTIs, serum creatinine and urea nitrogen levels, metabolic acidosis, proteinuria, 24-h urine output, hypertension, bilateral renal length on ultrasonography and renal scarring on renal scintigraphy. CRF was defined as a creatinine clearance of 6 mg/L before 1 year old was the most significant risk factor for CRF (P 6 mg/L in the first year of life have a significant risk of developing CRF in the long-term. Prenatal diagnosis and postnatal febrile UTI do not modify the outcome for renal function.

Though the concept of caudal regression, suggested in 1961 by Duhamel, could explain the association between anorectal anomalies (ARA) and spinal dysraphism (SD), its real incidence may be underestimated and its clinical significance is debatable. From 1988 to 1993, 111 patients with ARA were treated at the authors' institution. Associated anomalies were present in 36% of cases, with the exception of vesicoureteral reflux, which was considered functional rather than anatomical. In view of the late (1 to 2 years after surgical treatment) onset of vesical dysfunction and/or orthopaedic symptoms in some of these patients, a screening protocol was started in 1991, using magnetic resonance imaging (MRI) in all patients with ARA. Fifty patients, 29 boys and 21 girls, underwent a spinal cord MRI, with pathological findings in 25 cases (50%), 13 boys and 12 girls. The authors did not find any significant difference in incidence with respect to high, low, or cloacal malformations. A thickened filum, with or without fibrolipoma, was the most frequent finding, but even tethered cord, syringomyelia, and sac morphological alterations were present. MRI was also able to detect osteoarticular and/or muscular anomalies. Even when a urodynamic study and a neurological and orthopaedic workup were performed in 20 patients undergoing MRI, the clinical significance of these findings remained unclear. However, accurate follow-up of these patients is mandatory in order to detect early neurological symptoms, because currently it is not advisable to refer for neurosurgery all the patients with ARA presenting with anomalies of the spinal cord.

Treatment of varicocele using a microsurgical vein ligation approach is a successful procedure when applied to adult patients. We performed this procedure in prepubertal and pubertal patients in order to verify its feasibility and effectiveness in a younger population.Between January 1998 and December 1999, 46 patients (average age 13 years) were operated on for a left varicocele using a microsurgical selective vein ligation procedure. All patients were evaluated clinically and using color Doppler ultrasound (CDUS): 34/46 patients were classified clinically as grade III and the remaining 12 as grade II. We used a magnification loupe (x3) in 34/46 patients and an operating microscope (x 10-16) in the remaining 12.The procedure was successful in all but one patient (2.1%) who showed recurrence of the disease at the time of the first postoperative follow-up CDUS scan and required a repeat procedure. The average operative times were 45 and 60 min for loupe and microscopic procedures, respectively. In three cases (6.5%), early postoperative complications (wound infection and transient hydrocele) occurred and quickly resolved. All the patients were discharged within 24 h, returned to normal daily life within 2 days and resumed physical and sporting activities within 1 week.Subinguinal "artery- and lymphatic-sparing" microsurgical varicocelectomy, considered the gold standard treatment in adults, also proved to be successful in this preliminary experience with pediatric patients. The minimally invasive approach ensures the prevention of recurrences and/or postoperative complications, and is associated with a very low morbidity rate.

An attempt to correlate differnt facies of an important volcaniclastic formation of southern Italy, the Campanian Ignimbrite, with their zeolite content and physico-mechanical properties was carried out. The following parameters were measured: total zeolite content, solid unit weight (γ s ), porosity, and uniaxial compressive strength. Samples were formerly grouped on the basis of the displayed colour in four categories each of them characterized by a different zeolite grade. An increase of zeolite content determines a decrease of porosity and a good positive correlation with UCS values. The relationship existing between zeolite grade and UCS becomes less pronounced or even lost, when zeolite content reaches about 50% wt. Here, UCS values scatter in a quite wide range (3–6 MPa). It is hypothesized that the lithification of zeolite-bearing rocks is the result of two combined effects playing a different role during the zeolitization process: the transformation of the amorphous fraction in zeolite and the rock texture. In the first stage of the zeolitization process the role played by the rock texture (clasts/matrix ratio, pumice concentration, fractures, etc.) is totally masked by the overwhelming behaviour of zeolite itself up to that threshold value, above which the influence of these two leading parameters is inverted.

Study received institutional review board approval. Supported by the Italian Ministry of Health. * Correspondence: Department of NephroUrology and NeuroUrology Unit, Bambino Gesu Pediatric Hospital, Piazza S Onofrio 4, 00165 Rome, Italy (telephone: 0039.06.68592643; FAX: 0039.06.68592518; e-mail: mosiello@opbg.net). Purpose: Botulinum toxin type A has gained popularity in urology. Most reported studies have been in adults at urology centers and most have addressed long-term safety. Since botulinum toxin type A treatment for neurogenic bladder dysfunction requires repeat injections, verifying that such treatment does not induce fibrosis in children seems essential. Materials and Methods: The study was approved by the institutional review board and patients were enrolled after we obtained written consent. Patients with neurogenic bladder dysfunction not responding to conventional treatment (anticholinergics and clean intermittent catheterization) were treated with 10 IU/kg botulinum toxin type A up to a maximum of 300 IU. Endoscopic cold cup biopsies were obtained from the posterolateral bladder wall 1.5 to 2 cm above the ureteral orifice. Bladder wall findings were categorized into 3 groups, including inflammatory infiltration, edema and fibrosis. Each criterion was then graded as mild or severe and analyzed by Fisher’s exact test (p 0.05). Results: A total of 46 bladder wall biopsies were obtained from 40 patients 2 to 18 years old. Biopsies were evaluated in groups 1 and 2, including group 1—20 from patients with no botulinum toxin type A injection and group 2—20 after botulinum toxin type A injection. Group 2 was subdivided into group 3—10 biopsies after 1 injection and group 4—10 after multiple injections. Six patients underwent biopsy twice, that is before the first and second treatments. Histological changes were present in all biopsies. When comparing groups 1 and 2, there was no statistically significant difference in inflammation and edema. However, there was a significant difference in fibrosis between groups 1 and 4 (p 0.05) with apparently decreased fibrosis after multiple injections. Conclusions: In our experience repeat botulinum toxin type A injections into the detrusor in children do not lead to increased fibrosis in the bladder wall. This study confirms the long-term safety of botulinum toxin type A in the pediatric population.

The understanding of pathophysiology of obstructed uropathy has been facilitated by animal models with partial ureteric obstruction. Some studies on partially obstructed adult rats have drawn attention to a biphasic pattern of obstructive uropathy: an initial 'destructive' phase and a 'steady' phase in which renal deterioration no longer occurs and in which relief of obstruction would be of no advantage. We aimed to verify if this pattern applies also to younger (weanling) rats with more immature kidneys, resembling those of the human fetus. We measured the NAG-values in the urine samples of partially obstructed animals at different intervals of obstruction and in those of controls. The biphasic pattern proved to be the same as in adult rats as was previously documented, but the turning point occurred earlier (between 10 and 15 days of obstruction). Furthermore, there is evidence of low level values of N-Acetyl-Glucosaminidase (NAG) in the early phase of obstruction (5 days), demonstrating that the increase of tubular enzyme is not due to the operation itself. There is evidence that, if the 'destructive' phase can be precisely identified by biochemical studies, this could help identifying those subjects who could benefit from relief of obstruction.

Publisher Summary This chapter discusses the natural zeolites mineralization in the oligocene–miocene volcano-sedimentary succession of Central Sardinia. The investigations performed on the Cenozoic volcano-sedimentary sequence of Central Sardinia recognize widespread secondary mineralization processes, differently affecting the volcanic and sedimentary units cropping out in the region. Mineralogical studies confirm zeolite mineral association consisting of clinoptilolite and mordenite, locally attaining economic concentrations. Chemical composition of mordenite and clinoptilolite is strongly correlated with the rhyodacitic glassy precursor. Secondary mineralization process, which affects the volcaniclastic and epiclastic deposits, enables to identify the most interesting areas, as far as zeolite grade is concerned.

STUDIES IN SURFACE SCIENCE AND CATALYSIS 135

Publisher Summary This chapter discusses the ion-exchange features of intermediate-silica sedimentary phillipsite. Equilibrium ion-exchange data for intermediate-silica sodium (Na)-exchanged phillipsite at 25°C, in the presence of cation pairs Na/X, where X is barium (Ba), cobalt (Co), potassium (K), or calcium (Ca), are collected, and the relevant thermodynamic parameters are computed. Phillipsite is found very selective for Ba, K, and ammonium (NH 4 ), unselective for Co, whereas only about 50% Na could be readily replaced by Ca. This behavior is interpreted in terms of phillipsite's structural features.

Peritoneal dialysis has become an effective and widely used technique for the treatment of patients with end-stage renal disease. Peritoneal dialysis has become more practical for use in pediatric patients since equipment and techniques have been adapted for smaller patients. In the present work we describe the surgical technique that we currently use at our institution for surgical placement of peritoneal dialysis catheter. From January 1985 to January 1992, 19 peritoneal catheters were placed in 17 children, at the Bambino Gesù Children's Hospital. At the time of catheter insertion the average weight of the children was 14.2 kg., and the average age was 4 y. 10m. Peritoneal dialysis catheters were always placed under sterile conditions, in an operating room or in a pediatric ICU, with surgical technique. Regarding our surgical technique we recommend: 1) to use Tenckhoff catheter, 2 cuffs pigtail (curled) type; 2) to perform a minilaparatomy with lateral surgical approach and a routine omentectomy; 3) to create a submuscular tunnel (rectus abdominis) to reduce the leakaqe of peritoneal dialysis fluid. Furthermore the various clinical problems encountered in our experience and some surgical guidelines for the prevention of complications are reviewed.

Objectif: Examiner les differences par sexe, l'âge a la presentation et la severite des dysfonctions vesicales chez les enfants ayant un reflux vesico-uretral. Patients et Methodes: Une cystometrie etait obtenue chez 37 enfants (24 garcons et 13 filles) âges de 2 a 24 mois ayant un reflux vesico-uretral de stage II a IV. La presence d'une elevation de la pression maximale du detrusor a la miction (definie comme augmentee a partir de 90 cm H 2 O) ou d'une instabilite etaient considerees comme l'expression d'une hypercontractilite. Resultats: La prevalence de l'hypercontractilite etait de 75% (18/24) chez les garcons et de 46% (6/13) chez les filles (p

Surgery on the pyelo-ureteric junction obstruction (PUJO) has long been thought to affect postoperative renal function. However, preoperative assessment of which kidneys will benefit from such surgery remains unreliable.Pre- and postoperative data relating to renal function were obtained by renal scan for 69 patients who were operated upon for PUJO. These patients were divided into two groups: group A (improved differential renal function) and group B (unimproved or decreased differential renal function). The two groups were then compared with regard to age at operation and presence or absence of clinical symptoms. Ultrasound (anteroposterior diameter of the pelvis, parenchymal thickness) and renal scan (glomerular filtration rate, differential renal function of the affected kidney, obstructive pattern) parameters were also taken into consideration. Some variables were also made dichotomous (pelvic diameteror15 mm, parenchymal thicknessor5 mm, differential renal functionor40%). Statistical correlation was sought with parametric and non-parametric tests.No correlation whatsoever was found between the two groups for any of the parameters under consideration, so that any attempt at logistical regression analysis failed.None of the currently adopted diagnostic tests can be used to indicate which renal units will benefit from surgery through an improved renal function. The presence or absence of clinical symptoms does not appear to affect renal function either. There is evidence that parents should be provided with such information when giving their informed consent to pyeloplasty.

To determine whether bladder dysfunction in boys with posterior urethral valves (PUV) changes from a uniform pattern of hypercontractility during infancy to the hypocontractility found in adolescence, by reviewing serial urodynamic studies.Thirty boys with PUV and no voiding symptoms underwent a total of 86 urodynamic tests (mean 2.8 each). The first urodynamic study was undertaken at 1-4 years of age in 15 boys and at 5-13 years in 15. They were re-evaluated at least 3 years later; 15 patients underwent the first and last urodynamic study, respectively, at a mean age of 2.8 and 7.7 years (group A), 10 boys at 6.2 and 8. 8 years (group B) and five at 9.4 and 15.2 years (group C). In 10 boys aged5 years the first and last pressure-flow studies (PFS) were analysed using an advanced analysis (PFA) to better identify hypocontractility.Bladder dysfunction was found in 21 of 30 (70%) boys at the first evaluation and in 18 (60%) at the last. In 25 boys the urodynamic pattern changed. Of the 15 boys in group A, 10 of 12 who had hypercontractility changed to normal (seven), low compliance (one) or hypocontractility (two), and two remained stable; two of the remaining three with normal urodynamic studies changed to hypocontractility, while one was unchanged. Among the 10 boys in group B, six with hypercontractility changed to normal (three) or hypocontractility (three); two with normal urodynamic findings and one with low compliance changed to hypocontractility. Of the five boys in group C who showed severe hypocontractility after puberty, three had a normal pattern, one low compliance and one hypercontractility before puberty. The PFA showed a 'weak' detrusor in four of the seven boys who were considered normal on standard PFS. At the urodynamic follow-up, the PFA pattern changed to a 'weak' detrusor in four boys who had a normal (two) or strong (two) detrusor at the first evaluation.Bladder dysfunction in boys with PUV changes during childhood and through adolescence. The urodynamic pattern of hypercontractility generally found soon after valve ablation gradually changes to hypocontractility in many boys and this pattern seems to be the rule after puberty. The evidence from this series supports the hypothesis that long-term detrusor hyperactivity in boys with PUV leads to detrusor failure, but a longitudinal 15-year follow-up from birth to puberty is needed to validate this concept.

The Malone surgical procedure for antegrade continence enema (ACE) greatly improves the quality of life of many patients with fecal incontinence but has several complications. This report describes a technique of percutaneous endoscopic cecostomy (PEC) which was applied in three children with fecal incontinence secondary to anorectal malformation or spina bifida. Using a pediatric fiberscope, a colonoscopy was done which reached the right colon. An intraoperative ultrasound examination confirmed the position of the cecum just below the layers of the abdominal wall. The cecostomy tube was then percutaneously inserted, imitating the steps of percutaneous endoscopic gastrostomy (PEG) using the pull technique. The preliminary results are very encouraging: there are no procedure-related complications in this small series; all the patients are able to carry out the antegrade enema by themselves; and complete control of defecation has been obtained.

The Campi Flegrei volcanic field, Southern Italy, is composed of a large variety of pyroclastic deposits related to both magmatic and hydromagmatic activity. In spite of similarities of composition, grain size, age and pre-eruptive environment, the various deposits exhibit great differences in terms of degree and type of alteration of the juvenile components. In particular, detailed analyses of pyroclasts collected in the numerous monogenetic volcanic cones show the broad range of alteration, from fresh glass to complete replacement of the glass by the zeolites. The comparative analysis of 17 different deposits has allowed us to conclude that the eruptive and emplacement conditions were the major controls on the zeolitization processes. The relationships between volcanological features of deposits and secondary mineralization are consistent with the glass-fluid phase reaction in a near-closed post-depositional system. Eruptions characterised by separation of water vapour from the pyroclastic particles produce unaltered or poorly altered deposits. In contrast, eruptions characterised by mechanisms that permit the capture and retention of pore water and water vapour produce zeolitized deposits. According to these lines of evidence the zeolitization of pyroclastic products of Campi Flegrei took place immediately after emplacement, during the cooling of wet deposits.

Volcaniclastic products of Northern Sardinia (Italy) turned out to be affected by diffuse zeolitisation processes. About 130 samples, representative of the identified formations (pyroclastic flows and epiclastic deposits), were collected in order to evaluate the distribution of zeolitic phases. Clinoptilolite was the most widespread zeolite, whereas mordenite and chabazite rarely occured. A quantitative evaluation performed by the Reference Intensity Ratio (RIR) and Rietveld methods indicated that about 30% and 44% of samples from pyroclastic flows and epiclastic deposits, respectively, have a zeolite content higher than 50%.

The endoscopic incision of ureterocele in children is still a controversial procedure. In two Departments of Pediatric Surgery, between January 1990 and December 1994, 47 patients (34 females, 13 males), for a total of 53 ureteroceles, underwent endoscopic incision of the ureterocele as the primary form of treatment; 41 ureteroceles were in duplex kidney. In 33 cases (70%) the prenatal ultrasound had observed hydronephrosis or duplex kidney or the presence of the ureterocele; these babies were free of urinary infection before treatment. 45 of the 47 babies were less than 6 months old at the time of the endoscopic incision. Vesico-ureteral reflux developed in none of the single systems, and in 32% of the duplex systems; however a preexisting reflux spontaneously disappeared in 41%. At 1 year follow-up the mean increase in renal parenchyma as evaluated at ultrasound was from 6.4 to 11.1 mm in single systems, and from 3.4 to 6.3 mm in duplex kidneys. Scintigraphy or urography showed a stable or improved renal function in all previously functioning units; 40% of the non-functioning units before section showed signs of function at 1 year follow-up. One to 3 years after section, 14 children underwent open surgery for persisting vesico-ureteral reflux, urinary infections or non-functioning unit: 9 ureteroneocystostomies and 5 heminephrectomies were performed. The endoscopic incision is proposed as the early first treatment of ureteroceles, mainly in cases of prenatal diagnosis, possibly performed in the neonatal age. In the Authors' experience it has been effective in preventing sepsis in all patients and in preserving the renal function of the involved unit; surgery has been avoided in over 60% of cases and when necessary it has been safely postponed after more than 1 year of age.

Urinary incontinence following Posterior Urethral Valves (PUV) ablation has been attributed in the past to sphincter injury, but it is nowadays accepted that bladder dysfunction (BD) plays a determinant role. In order to assess BD evolution, we have evaluated, from 1982 to 1994, 48 boys with PUV by urodynamics (UD) studies. Age of the patients ranged from 10 months to 15 years. A total of 65 examinations were performed. We considered four groups: 0-3 years; 4-7 years; 8-12 years and > 12 years. Uninhibited detrusor contractions (instability), end filling pressure (EFP), bladder capacity and voiding detrusor pressure were evaluated in order to assess the presence of BD distinguishing it in: hypercontractility, hypocontractility and low-compliant bladder. The results collected confirm a high percentage of BD in PUV boys (71%) and the evolution of hypercontractility versus hypocontractility in 60% of patients considered.

Objective: Treatment of varicocele using a microsurgical vein ligation approach is a successful procedure when applied to adult patients. We performed this procedure in prepubertal and pubertal patients in order to verify its feasibility and effectiveness in a younger population. Material and Methods: Between January 1998 and December 1999, 46 patients (average age 13 years) were operated on for a left varicocele using a microsurgical selective vein ligation procedure. All patients were evaluated clinically and using color Doppler ultrasound (CDUS): 34/46 patients were classified clinically as grade III and the remaining 12 as grade II. We used a magnification loupe ( &#50 3) in 34/46 patients and an operating microscope ( &#50 10-16) in the remaining 12. Results: The procedure was successful in all but one patient (2.1%) who showed recurrence of the disease at the time of the first postoperative follow-up CDUS scan and required a repeat procedure. The average operative times were 45 and 60 &#114 min for ...

The urological malformations associated with anorectal anomalies (ARA) are not only anatomical, but also functional, the latter being related to congenital neurovesical dysfunction (NVD). The true incidence of spinal dysraphism (SD) in these children is still unclear and is probably underestimated. The concept of caudal regression could explain its association with the anorectal anomalies. Because of awareness of the late onset of neurovesical dysfunction and/or orthopaedic symptoms in some of our patients, in 1991 we started to screen with magnetic resonance imaging (MRI) the spinal cord of all patients with ARA. Eighteen (44%) out of 41 patients without neurological or orthopaedic symptoms and 7 (78%) of 9 children with neurological or orthopaedics symptoms screened by MRI showed pathological findings. The overall incidence of spinal dysraphism in ARA was 50%, without any great difference with respect to the type of the anomaly (high, low, cloacal). The pathological MRI findings encountered were: fibrolipoma (with or without a thickened filum terminale), tethering of the cord and syringomyelia, and sac anomalies. In order to check the onset of NVD in these children, we performed urodynamic studies with external sphincter electromyography in 24. Grouped by age: 14 were between 5 and 18 months and ten were 4 to 13 years old. Ten patients (71%) out of the first group and 3 (30%) out of the second had a normal urodynamic pattern. A total of 11 children had pathological findings; of these, 4 infants had a hyperreflexic bladder (one with detrusor-sphincter dyssynergia) suggesting upper motor neuron (UMN) lesion. Of the 7 older patients, two had UMN and 3 lower motor neuron (LMN) lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Continence is the main goal in the treatment of patients with bladder exstrophy and prognosis is necessarily long-term. Over an 8-year period, 44 patients presented with bladder exstrophy and/or incontinent epispadias. Twenty-five bladder closures (7 secondary), 23 male urethroplasties, 19 bladder neck (BN) reconstructions and 6 bladder augmentations were performed in these patients. In 18 children 2 additional procedures were employed in the last 3 years: female genito-urethroplasty (15) and submucosal periurethral collagen injection (11). Eight children underwent both procedures. Genito-urethroplasty and collagen injection were performed before BN reconstruction in 6 and 5 cases respectively, in order to increase bladder outlet resistance. The submucosal injection was performed at 3, 9 and 12 o'clock in the BN or sphincteric urethra, using 0.75 to 2.5 ml of cross-linked bovine collagen. Continence in the children who underwent the complete staged reconstruction was good in 58%, fair in 32% and poor in 11%. Following female genito-urethroplasty and periurethral collagen injection, bladder capacities increased by 25%. These complementary procedures are effective in increasing outlet resistance and bladder capacity in patients with exstrophy and/or epispadias; they may improve continence and lessen the need for further bladder augmentation.

During the period from March to September 1989, 40 children suffering from primary nocturnal enuresis, aged between 5 and 14 years, were included in a study to assess the comparative therapeutical efficacy of DDAVP and acupuncture. Children were divided into four groups of 10: group A was treated with DDAVP, group B was treated with acupuncture, group C was treated with DDAVP and acupuncture and group D was treated with placebo (control). The trial design included 3 periods: observation (2 weeks), treatment (8 weeks) and follow-up (4 weeks). Nineteen children completed the study. The efficacy of treatment, which was expressed as a percentage of dry nights, was high in both the DDAVP and acupuncture groups, when used separately. The combined treatment of DDAVP and acupuncture appeared to be the most efficacious both in terms of the percentage of dry nights at the end of treatment and in relation to the stability of results, even after the end of the study. The paper gives a detailed analysis of correlations between type of treatment and urinary osmolarity.

The possible use of Neapolitan yellow tuff, a widespread zeolitic rock containing phillipsite and chabazite, in the removal of chromium from wastes has been evaluated, either in static experiments or testing fixed beds eluted by solutions of the pollutant in the presence or lack of interfering cations. Results not entirely positive have been collected, because of the moderate selectivity displayed by both zeolites for Cr3+ and of the gradual structure breakdown resulting from the ion exchange process. Nevertheless a profitable employment has been suggested in the decontamination of waters with low chromium content and not too high salinity.

Methods 107 HIV-infected, ARV-naive patients were prospectively enrolled and treated with TVD (300 mg TDF + 200 mg FTC QD) or CBV (300 mg AZT + 150 mg 3TC BID) in combination with EFV (600 mg QD) or a PI (LPV/r, ATV/ r, fAPV/r and SQV/r). Twenty-seven patients received TVD-EFV, 33 received TVD-PI, 24 received CBV-EFV, and 23 received CBV-PI. Fifty-one of these patients have, so far, reached 12 months of therapy. Clinical, immunological and virologic parameters at baseline and after 12 months of therapy are presented.

To date, rigid operative ureterorenoscopy with ultrasound lithotripsy for the treatment of ureteral calculi has been performed only in adults or older children. The size of the instrument with the working channel for the ultrasound probe has been considered unsuitable for delicate anatomical structures, such as those of children younger than 4 years. We performed 8 ureterorenoscopic examinations in 7 patients (3 boys) 3 to 8 years old and have demonstrated that the 11.5F ureteroscope can be inserted without difficulty into the ureteral meatus of a 3-year-old boy. Introduction of the instrument is facilitated by the use of the Perez-Castro irrigation pump. This procedure does not lead to any urethral or ureteral damage, nor is vesicoureteral reflux shown on a postoperative cystogram. This technique allows extracorporeal shock wave lithotripsy to be extended also to small children, offering the possibility of easy and successful management of any residual steinstrasse.

Treatment regimens for 278 paediatric female patients with anatomical and dysfanctional incontinence are discussed including drug therapy, surgery and bladder training protocols.

The Authors describe the case of an acute brucellosis in a young veterinarian due to accidental injection of animal vaccine. The past history of the patient and the serological follow-up of the animals contacted by the professional did not evidence other risk contacts. The case evidence the real possibility that attenuated Brucella melitensis strains used in animal's vaccination can represent a source of occupational risk for this infection. In addition, it is important to notify similar cases to monitor the real extent of this phenomenon.

The authors report the results of a study on 20 children suffering from a particular type of enuresis, associated with bladder instability, characterized by uninhibited contractions of the detrusor muscle. The children selected showed symptoms of enuresis, frequency, urinary urgency and a positive urodynamic test. This test was performed on 11 patients before and after acupuncture. In 16 out of 20 children, the authors observed a net increase in the intensity and frequency of uninhibited bladder contractions 30 minutes after acupuncture. At 60 minutes the contractions decreased and at 24 hours they had practically disappeared. Clinically, a gradual elimination of enuresis has been observed in 11 cases and an improvement in the other 7. From these early observations, the efficiency of acupuncture in suppressing uninhibited bladder contractions seems to be proved, even though the therapeutic mechanism has yet to be clarified.

Background The objectives were: 1. to investigate the major topics on the Quality of Life (QOL) of Spina Bifida patients; 2. to evaluate attitudes, the experienced and the behaviours concerning everyday activities, social life participation and familial relationship; 3. to evaluate the information needs; 4. to evaluate the physical and psychological problems related to vesical and intestinal management.

The authors report on the management of 15 patients with vesicoureteral reflux secondary to neuropathic bladder treated by endoscopic subureteral injection of polytef paste (Teflon) in the first 9 cases and collagen (Zyplast) in the last 6 cases. Their ages ranged from 18 months to 12 years. The degree of reflux ranged from grade II to grade V. The amount of paste injected varied from 0.2 to 1 ml Teflon and from 0.75 to 1.5 ml Zyplast. The endoscopic treatment was completely successful in 12 cases. The risks and benefits of endoscopic treatment versus medical and traditional surgical management are discussed. The endoscopic approach could be a valuable alternative to open surgical repair in vesicoureteral reflux secondary to neuropathic bladder.

Cloacal malformations are rare and can present in variable aspects. The importance of ultrasound in detecting these anomalies is well known. Sonographic features vary in accordance with the type of malformation and the gestational age. A positive diagnosis is not possible because of the lack of specific ultrasound findings, which can show similar aspects to other abnormalities. We present 3 cases of prenatal diagnosis of this malformation, emphasizing that in the presence of a plurilobed cystic pelvic fetal mass with associated malformations, such as cardiac, renal, and vertebral anomalies, a persistent cloaca can reasonably be suspected.

We report a case of severe obstructive uropathy due to posterior urethral valves detected in a male fetus at 17 weeks’ gestation. The severe oligohydramnios, bladder dilation, kidney hyperechogenicity, and early gestational age at detection predicted a poor prognosis. However, the ultrasound findings subsequently revealed spontaneous improvement during pregnancy. The undistended, funnel-shaped aspect presented by the bladder since 18 weeks’ gestation and the appearance at 29 weeks of a urachal cyst and its subsequent disappearance suggest patent urachus and rupture of both the urachus and umbilical cord wall as a vent of the obstructed urinary tract. Postnatally, the outcome after valve ablation was good.

Prenatal ultrasound has set the stage for new trends in the diagnosis and treatment of many urinary tract malformations, in particular duplication of the renal collecting system with ureterocele. The authors have reviewed their experience with 41 ureteroceles in 7 years. The 36 patients were divided into two groups: those with prenatal diagnosis and subsequent early treatment (group A, 14 cases), and those with diagnosis later after birth (group B, 27 cases) showing various degrees of renal impairment as assessed by a 99Tc-diethylenetriamine pentaacetic acid scan. The surgical approach carried out on the patients of each group with particular regard to the endoscopic incision of the ureterocele as the treatment of choice, especially in neonatal period, is discussed.