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Background: The acquisition of proper and relevant pediatric clinical data is essential to ensure tolerable and effective pediatric drug therapies. In the field of pharmacological treatment of neuropsychiatric disorders, the lack of sufficient high quality scientific evidence for pediatric age results in the frequent need to prescribe off-label drugs. With the aim of improving knowledge about safety profile of off-label drug prescription in children and adolescent with neurological and/or psychiatric disorders, we realized a multidisciplinary pharmacovigilance study.Materials and methods: An observational retrospective study was conducted to assess the safety of off-label pharmacological therapies in patients aged 0–18 years, admitted to the Neuropsychiatry Unit of the Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” between January 2016 and December 2018. Prescription patterns and adverse drug reactions were evaluated by a multidisciplinary team.Results: Overall, 230 patients were enrolled, 48% boys (N = 111), 52% girls (N = 119), average age of 10 years, and a total of 534 prescriptions was analyzed. 54.5% (N = 125) of patients had epilepsy, 37.5% (N = 86) suffered from psychiatric disorders, 8% (N = 19) had other neurological disorders. The prevalence of off-label prescriptions was 32% and 50% of the study population received at least one off-label drug. A total of 106 ADRs was detected: 57% of ADRs were due to drug-drug interactions, 30% were due to off-label prescriptions, 10% were due to overdose and 3% were due to improper use. No significant association between emerged ADRs and off label prescriptions was found (Fisher’s exact two-tailed test, p = 1.000). There was significant association between increasing number of administrated drugs and risk of ADRs (OR 1.99; IC95% 1.58–2.5; p = 0.000). Psychiatric disorders were associated with at least three times higher risk to be treated with an off-label drug (OR 3.30; IC95% 2.26–4.83; p = 0.000).Conclusions: This study shows that off-label prescribing in neuropsychiatric disorders does not pose a greater risk of ADRs than on-label prescribing and highlights unmet clinical needs in pediatric neuropsychopharmacology. The multidisciplinary approach can provide important contributions to improve therapeutic path of these already complex pathologies by careful monitoring of therapeutic appropriateness and drug interactions.

Background Wounds of the finger nail bed represent a frequent injury, especially in children. Residents often learn nail bed repair on patients without prior training. We aimed to develop and evaluate a “low-fidelity” simulation model of nail bed repair. Methods The model consists of a false nail on a plastic finger and a hydrocolloid dressing, which is pasted on the nail bed site and cut horizontally. This model allows nail bed suture and nail fixation. The cost of each model is about $1. Thirty-three doctors evaluated this model on 10 items, rated out of five, concerning the realism, the difficulty of the procedure, and the educational value. The duration of the procedure was also noted. We evaluated the clinical effectiveness by comparing through Fisher's exact test the ratio of unsuitable events (revision surgeries, surgical site infections, and complaint letters) on two periods—3 y before and 18 mo after the implementation of this model in our institution, respectively. Results Average mark was 4.16/5. The model was considered reliable, reproducible, and realistic. All the testers recognized a big educational value. The overall duration of the procedure averaged 23 min for residents and 11 min for surgeons. We collected 17 unsuitable events out of 84 patients from the period “before” and 2 out of 54 patients from the period “after” (P = 0.005). Revision surgeries were 10/84 from the period before and 2/54 from the period after (P = 0.04). Conclusions The results of the internal and clinical evaluations are encouraging. We suggest integration of this model into the training program of residents.

Background/Purpose: Laparoscopic fundoplication (LF) represents the gold standard for surgical treatment for pediatric patients with gastroesophageal reflux disease (GERD). Methods: We report the results of long-term outcome of 36 patients who had undergone LF from January to December 1998, with a follow-up longer than 10 years (range 11–12 years). The patients were invited, by phone, to undergo a clinical follow-up. All patients underwent the modified European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN)’s Roma III questionnaire; however, only 22 out of 36 patients accepted to be controlled in a day hospital setting, and 10 out of 36 accepted to undergo a telephonic questionnaire. Our study is focused on the data of these 32 patients. Results: Twenty-eight out of 32 (87.5%) patients had completely recovered; 4 out of 32 patients (12.5%) had a mild persistent GER; 9 out of 32 patients (28%) referred a mild dysphagia; 21 out of 32 (66%) patients could burp; and only 9 out of 32 (28%) patients could vomit. The cosmetic result was good in 30 out of 32 (94%) patients. The weight/height ratio was satisfactory in 28 out of 32 (87.5%) patients. The quality of life was good in 28 out of 32 (87.5%) patients. Conclusions: Our experience shows that the long-term follow-up after LF produces a good clinical result and a good quality of life. The modified ESPGHAN’s Roma III questionnaire seems an effective way to check the longterm results, because it avoids submitting patients to long and not well tolerated instrumental exams.

PURPOSE: This retrospective study aims to evaluate the feasibility, safety and complication rate of laparoscopic inguinal hernia repair for small babies weighing 3 kg or less. METHODS: A retrospective analysis was performed on the surgical charts of 67 infants (47 boys and 20 girls) weighing 3 kg or less who underwent laparoscopic hernia repair in a 3-year period. A regular 5-mm scope was used for visualization, and 2 or 3-mm instruments were used for the closure of the inner inguinal ring using 3/0 non-absorbable suture. The median weight at surgery was 2,600 g (range 1,450-3,000 g). All except three were premature. RESULTS: Of the 67 infants, 15 (22.3 %) presented with an irreducible hernia. In three cases of irreducible hernias, we also performed a transumbilical appendectomy at the end of the hernia repair. Minor problems related with anesthesia were noted in four cases. Hernia recurrence was observed in three patients (4.4 %). No cases of testicular atrophy occurred. In 10 boys, we observed 12 cases of high testes, only 4 testes requiring subsequent orchiopexy. CONCLUSIONS: Laparoscopic inguinal hernia repair for babies weighing 3 kg or less is feasible, safe and perhaps even less technically demanding than open inguinal herniotomy.

Minimally invasive approach to the adrenal gland was first reported in 1992. Since then, the experience with the laparoscopic technique for adrenal disease in children has been limited. We report our experience with minimally invasive adrenal surgery in children. Two young girls (2 and 4 years old) with a left adrenal mass were operated using minimally invasive surgery (MIS) in our Unit. Ultrasonography and MRI showed in the oldest a 2 x 3 cm adrenal mass, while in the youngest a 5.5 x 5 cm adrenal tumor was found. According to the pre-existing literature, we approached the smallest lesion via retroperitoneoscopy, and the largest one laparoscopically. The operating time was 110 minutes for retroperitoneoscopy and 75 minutes for laparoscopy. No major intra or postoperative complications occurred. There were no conversions to open surgery. Postoperative hospital stay was 5 days for both patients. In both cases, the anatomo-pathological result was an adenoma. Minimally invasive adrenalectomy is a safe and feasible procedure in children with good results. For lesions smaller than 3-4 cm retroperitonescopy is feasible, while for tumors larger than 5 cm, due to malignancy risk, the laparoscopic approach is indicated. To keep oncologic criteria it is important to avoid tumor rupture and to extract the specimen in an endobag.

The management of the contralateral region in a child with a known unilateral inguinal hernia is a debated issue among paediatric surgeons. The available literature indicates that the perspective of the child's parents is seldom. This study was performed to evaluate parents' views on this topic. After the Ethical Committee's approval, 100 consecutive patients under 12 years of age with a unilateral inguinal hernia were studied prospectively from March 2010 to September 2010. After an oral interview, a study form was given to the parents about the nature of an inguinal hernia, the incidence of 20 to 90% of a contralateral patency of the peritoneal-vaginal duct and the possible surgical options (inguinal repair or laparoscopic repair). The parents' decision and surgical results were analyzed. Eighty-nine parents chose laparoscopic approach, and 11 parents preferred inguinal exploration. Regarding their motives, all 89 parents requesting laparoscopic approach indicated that the convenience and risk to have a second anaesthesia was the primary reason of their decision. The 11 parents who preferred inguinal approach indicated that the fear of a new surgical technology was their primary reason. Conclusion There is no consensus about the management of paediatric patients with a unilateral inguinal hernia. We believe that a correct decision-making strategy for parents' choice is to propose them the both procedures. Our study shows that parents prefer laparoscopic inspection and repair in the vast majority of cases.

Objective Perineal groove is an uncommon congenital anomaly of the perineum, affecting young girls. We report our experience in the treatment of this pathology. Design Retrospective review of patients operated in our institution for a perineal groove between 1999 and 2007. Setting Multidisciplinary clinic for young girls with perineal groove at the Department of Pediatrics, “Federico II” University, Naples, Italy. Participants Six young girls (aged between 2 and 7 years) with perineal groove. Interventions In the first three patients, who were operated on before 2004, the procedure consisted in resecting the groove and closing the perineal defect using interrupted sutures; in the last three, the skin was closed with similar approach and then covered with a chemical glue to impermeabilize and protect the suture. Results At a long-term follow-up, two of the three patients operated before 2004 experienced dehiscence of the perineal skin due to urine and feces contamination; in the last three patients in whom the sutures were covered with glue there was no skin dehiscence, and the postoperative course was uneventful. Conclusions A perineal groove is a rare anomaly in young girls. Treatment consists in the surgical excision of the groove, generally after two years of age. On the basis of our experience it is preferable to cover the suture with a chemical glue to impermeabilize the suture line and protect the skin from infections.

BACKGROUND: An acute scrotum concerns endoscrotal organs (testicles, spermatic cord, tunica vaginalis) and is characterized by pain, swelling and hyperemia of the hemi-scrotum. It represents one of the most common surgical emergencies in children often caused by testicular torsion; the diagnosis is mostly clinical but must be supported by ultrasonographic examination of the scrotal region in association with a colour Doppler study of the spermatic cord vessels and glandular parenchyma. An idiopathic scrotal hematoma is a very rare condition that can simulate it. CASE REPORT: A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle was located in the internal inguinal canal. Surgical intervention confirmed the sonographic diagnosis of left testicular hematoma and of the right cryptorchidism. CONCLUSIONS: Although testicular torsion is the most frequent cause of acute scrotum, the possibility of a persistent idiopathic scrotal haematoma and/or haematoma secondary to a trauma of the inguino-scrotal region, must be always taken into account. US diagnosis can avoid unnecessary emergency surgical treatment, required in case of testicular torsion.

Introduction Les traumatismes de l’appareil ungueal des doigts (doigt de porte) representent un motif frequent de consultation aux urgences traumatologiques pediatriques, souvent traites par des medecins juniors. Les lesions sont le plus souvent benignes, mais une prise en charge initiale inadaptee peut entrainer des sequelles esthetiques et fonctionnelles. A notre connaissance, il n’existe pas de formation specifique dans le cursus des internes francais. La simulation s’impose progressivement comme mode de formation privilegiee en chirurgie. C’est pour ameliorer l’apprentissage de la suture et du repositionnement de l’ongle que nous proposons un modele de simulation « basse fidelite », reproductible et peu onereux. Materiel et methodes Le modele est constitue d’un kit de suture standard, un faux ongle et un faux doigt sur lequel est fixe un pansement de type Duoderm®. Nous avons teste ce modele aupres de 23 medecins, internes de chirurgie (n = 3), pediatres urgentistes (n = 12) et internes de pediatrie (n = 8), dont l’experience en termes de nombre de plaies pulpo-ungueales deja suturees en circonstances cliniques reelles etait notee. L’evaluation a ete faite au moyen d’un questionnaire anonyme, portant sur le realisme global, le realisme de la sensation de la suture, la difficulte de la procedure (50 points au total) et l’interet pedagogique (5 points). L’analyse des resultats a ete faite en fonction des 2 groupes d’operateurs, experimentes (> 20 procedures deja realisees) ou non experimentes ( Resultats Dans les 2 groupes, le modele propose a ete considere comme fiable, reproductible et offrant un tres bon degre de realisme dans la realisation des differentes etapes de la reparation du doigt de porte (en moyenne : 41/50). Tous les medecins testeurs ont reconnu un grand interet pedagogique (5/5). Conclusion Nos resultats nous conduisent a proposer d’integrer ce modele de doigt de porte dans le cursus de formation des internes lors du stage en chirurgie infantile ou aux urgences pediatriques.

Objective Most surgical procedures for correction of hypospadias involve the removal of foreskin resulting in a circumcised penis. We report our experience and the medium-term results in the reconstruction of the foreskin during the correction of distal hypospadias. Materials and methods Between January 2007 and December 2011, 445 patients aged between 8 and 120 months underwent surgical correction of hypospadias. In 354 out of 445 patients, we performed the reconstruction of the foreskin. Urethroplasty was performed according to either the TIPU (tubularized incised urethral plate urethroplasty; Snodgrass) technique (233/354, 66%) or MAGPI (meatal advancement glanduloplasty incorporated) procedure (121/354, 34%). In 91 out of 445 patients urethroplasty was performed using classic TIPU technique and they were circumcised. The cosmetic and functional results were evaluated using the Hypospadias Objective Penile Evaluation (HOPE) scoring system. Results At a 12 months follow-up, 300 patients (84.7%) had retractable foreskin while 54 patients (15.3%) required postoperative steroid application. We had a total complication rate of 8.7%. As for preputioplasty, 16 patients (4.5%) had partial or total dehiscence of the reconstructed foreskin, one patient was circumcised for persistent phimosis (0.2%). As for urethroplasty complications, we recorded 11 fistulas (3.1%) and three stenosis (0.9%). The complication rate of the control group of circumcised patients was of 3.3% (2 fistulas [2.1%] and 1 stenosis [1.2%]). Conclusions Our experience shows that foreskin reconstruction can be performed successfully in selected patients with distal hypospadias. However, preputioplasty add an additional 4.7% complication rate. As for the complications of urethroplasty, it seems that preputioplasty does not increase the incidence of complications on the urethra reconstruction. We propose a new objective scoring system (modified HOPE score) for evaluation of esthetic and functional outcome.

Hypospadias is the most common malformation of the penis. Sometimes it fits into the overall scheme of disorders of sexual differentiation (DSD), field difficult, especially if the genital ambiguity is serious. Several genetic and environmental factors have been studied as determinants in the etiopathogenesis of the malformation. In the international literature more than 300 surgical techniques adopted for hypospadias correction can be found. In distal hypospadias, the TIPU repair according to Snodgrass is the preferred technique. In proximal hypospadias the use of flaps or buccal and lingual graft are most commonly adopted. Modern microsurgical instrumentation, micro-sutures, materials for the dressing such as the recent use of glue based on cyanoacrylate have improved clinical outcomes and reduced the incidence of post-operative complications. The future perspective is based on the use of tissue engineering and stem cell technology as a promising therapeutic resource for the reconstruction of urethral tissue.

Purpose: Laparoscopic varicocelectomy according to the Palomo technique is the most common procedure adopted in children with testicular varicocele. This procedure involves the ligation of the internal spermatic cord and is associated with a 3%-5% incidence of recurrence and up to 30% incidence of hydroceles. We sought to determine the impact of lymphatic preservation on hydrocele formation and the success of varicocelectomy. Patients and Methods: We retrospectively evaluated 396 patients with a mean age of 13.2 years who underwent laparoscopic varicocelectomy. Patients were divided into two groups: those who underwent a lymphatic-sparing (LS) procedure using isosulfan blue scrotal intra-dartoic injection and those who underwent a non-LS (NLS) technique. The incidences of recurrence/persistence and postoperative hydrocele formation requiring surgery or aspiration were analyzed statistically using the chi-squared test. Results: Of 396 patients, 244 received a laparoscopic LS procedure, and 152 received an NLS operation. The LS patients in whom the lymphatic vessels were not identified (26/244 [10.6%]) were considered NLS repairs. The follow-up was at least 12 months. LS surgery (218 patients) was associated with a decreased incidence of postoperative hydrocele (0/218 [0%] versus 18/178 [10.1%]; chi-squared test=25.84, difference statistically significant). There was no significant difference in incidence of persistent or recurrent varicocele requiring reoperation following the initial procedure (5/218 [2.2%] versus 5/178 [2.8%]; chi-squared test=0.41, difference statistically not significant). Conclusions: Laparoscopic LS varicocelectomy using isosulfan blue is preferable to laparoscopic Palomo repair that does not preserve the lymphatics. It has a significantly lower incidence of postoperative hydroceles and still maintains a low incidence of persistence/recurrence.

Background: The aim of this article is to standardize the laparoscopic technique to treat direct inguinal hernia in pediatric patients. Patients and Methods: In the last 3 years we treated laparoscopically 163 patients with a diagnosis of inguinal hernia. In 7 patients we discovered laparoscopically a direct inguinal hernia. This study is focused on the management of these 7 cases (4 girls and 3 boys; median age 4.6 years). They presented a right defect in 4 cases and a left defect in 3 cases. Six of 7 patients had been already operated for an inguinal hernia and presented a recurrence of the hernia. We used three trocars, 5-mm 0 degree optic, and two 3-mm instruments. In each case, after the resection of the lipoma using the hook cautery, the defect was closed by means of separated stitches. In every case we used the vesical ligament as an autologous patch to reinforce the closure of the defect. Results: The average operative time was 35 minutes. All the procedures were performed in a day-hospital setting. We had neither conversions nor complications in our series. With a minimum follow-up of 1 year, we had no recurrence. Conclusions: Laparoscopic identification and repair of direct inguinal hernia in children is a safe and effective procedure to adopt. The key points of the technique are the resection of the lipoma, the closure of the defect using separated, nonabsorbable sutures, and the use of the vesical ligament to reinforce the suture. We believe that in case of recurrence of inguinal hernias after inguinal approach, laparoscopy is the gold standard technique to identify and treat the cause of the recurrence itself.

La malattia da reflusso gastroesofageo (MRGE) in eta pediatrica puo essere associata a complicanze potenzialmente serie quali crisi di apnea e aspirazione del contenuto gastrico nelle vie aeree. Mentre la terapia medica dell’MRGE puo essere efficace, non elimina la malattia nella sua componente anatomica, modificando solamente la qualita del refluito ed eventualmente riducendo il tempo di contatto rendendo la mucosa esofagea piu resistente all’insulto chimico, il trattamento chirurgico dell’MRGE mira alla ricostruzione dei meccanismi anatomici che si oppongono al reflusso. Tale correzione deve essere quanto piu fisiologica possibile consentendo, soprattutto in eta pediatrica, fenomeni fisiologici come l’eruttazione o parafisiologici come il vomito.

L’ostruzione intestinale da fenomeni aderenziali e un problema di rilevante importanza nei bambini. La maggior parte delle ostruzioni da aderenze insorge in seguito a interventi per appendicectomia ed e fondamentale intraprendere misure preventive per ridurne l’incidenza. Rispetto alla chirurgia “open”, l’approccio laparoscopico apporta sostanziali vantaggi. I reinterventi in “open surgery” aumentano la probabilita di sviluppare una recidiva dell’ostruzione, mentre con l’approccio laparoscopico l’incidenza di riostruzione e inferiore rispetto alla chirurgia “open”. Altri indiscutibili vantaggi della laparoscopia sono il miglior risultato estetico e la piu rapida ripresa funzionale.

BACKGROUND: Laparoscopic cholecystectomy (LC) is a frequent operation in adults but is seldom performed in children. A retrospective review of 109 consecutive patients who underwent LC over an 11-year period was performed to see what lessons were learned from this experience. METHODS: From January 1996 to January 2007, a total of 109 patients were referred to our unit to undergo LC. Nine adult patients were excluded from the analysis. The remaining 100 pediatric patients form the basis of this report. Isolated cholecystectomies were performed using a four-trocar technique, with a fifth trocar added for cases in which splenectomy was required. One patient with main bile duct dilatation at preoperative echography underwent peroperative cholangiography. RESULTS: We recorded three anatomic anomalies (3%), two involving the bile duct and one the cystic artery. We recorded four minor problems during surgery: In one case there was failure of the tip of reusable scissors, and in three cases there was a small perforation of the gallbladder during the dissection step. We recorded four (4%) postoperative complications, which required redo surgery: one patient with bleeding from the cystic artery; one case of dislocation of clips positioned on the cystic duct; and two patients with lesions of the main bile duct that had not been detected during surgery. The treatment consisted in choledojejunostomy on postoperative day 7 in one case and suture of the choledocus on a stent positioned using endoscopic retrograde cholangiopancreatography on postoperative day 5 in the second case. Both biliary complications occurred in patients more than 14 years of age. We also recorded one umbilical granuloma. CONCLUSIONS: LC is an effective procedure in children. On the basis of our experience, it seems that major complications can occur even with experienced surgeons, and they are more frequent in teenagers. Biliary or vascular anomalies of the gallbladder are encountered in about 3% of patients

The blue rubber bleb nevus syndrome or Bean syndrome is a rare disorder characterized by cutaneous and gastrointestinal vascular malformations. A 5-year-old girl with Bean syndrome hospitalized in a pediatric unit came under our observation with abdominal pain and vomiting. An X-ray of the abdomen showed an intestinal occlusion and an ultrasonography showed a suspected intestinal invagination. She underwent emergency laparoscopic surgery using three trocars. Laparoscopy revealed a huge ascitis and multiple vascular lesions located on the loops and on the parietal peritoneum, and we identified also an ileo-ileal invagination. We performed a laparoscopic disinvagination that showed one huge vascular lesion producing the invagination and causing a stenosis of intestinal lumen. We performed an intestinal resection after exteriorizing the loops through the umbilicus as well as a termino-terminal ileal anastomosis. Conclusions: Our case shows that an intestinal invagination due to Bean syndrome is extremely rare in pediatric patients but possible. In the emergency, laparoscopy seems to be a safe and effective procedure to confirm the diagnosis and to perform the disinvagination mini-invasivally. In addition, laparoscopy permits to have a clear picture of other intra-abdominal lesions linked to Bean syndrome.

The effects on mitochondrial respiratory parameters of heavy metals, such as Cu, Ni, Pb, Cd, Zn, Ag, Hg, were recorded by using thein vitro response of submitochondrial particles (SMP) from beef heart mitochondria.

Meckel’s diverticulum has varied presentations in children and often becomes a diagnostic challenge. The authors present a 10-year-old boy with abdominal pain and one episode of melena. His symptoms were undervalued during two previous hospitalizations in pediatric units until his hemoglobin level dropped from 8.2 to 3.5 g/dL. The laparoscopic intervention performed in emergency identified a bleeding Meckel’s diverticulum that was resected after being exteriorized from the umbilicus. Our observation shows that severe hemorrhage due to a Meckel’s diverticulum is possible albeit exceptional.

La videochirurgia richiede da parte del chirurgo una particolare abilita, cioe quella di operare non guardando direttamente le proprie mani come avviene in chirurgia “open”, ma guardando direttamente il monitor che trasmette le immagini della telecamera.

Laparoscopic cholecystectomy (LC) is a frequent operation in adults but is seldom performed in children. A retrospective review of 109 consecutive patients who underwent LC over an 11-year period was performed to see what lessons were learned from this experience. From January 1996 to January 2007, a total of 109 patients were referred to our unit to undergo LC. Nine adult patients were excluded from the analysis. The remaining 100 pediatric patients form the basis of this report. Isolated cholecystectomies were performed using a four-trocar technique, with a fifth trocar added for cases in which splenectomy was required. One patient with main bile duct dilatation at preoperative echography underwent peroperative cholangiography. We recorded three anatomic anomalies (3%), two involving the bile duct and one the cystic artery. We recorded four minor problems during surgery: In one case there was failure of the tip of reusable scissors, and in three cases there was a small perforation of the gallbladder during the dissection step. We recorded four (4%) postoperative complications, which required redo surgery: one patient with bleeding from the cystic artery; one case of dislocation of clips positioned on the cystic duct; and two patients with lesions of the main bile duct that had not been detected during surgery. The treatment consisted in choledojejunostomy on postoperative day 7 in one case and suture of the choledocus on a stent positioned using endoscopic retrograde cholangiopancreatography on postoperative day 5 in the second case. Both biliary complications occurred in patients more than 14 years of age. We also recorded one umbilical granuloma. LC is an effective procedure in children. On the basis of our experience, it seems that major complications can occur even with experienced surgeons, and they are more frequent in teenagers. Biliary or vascular anomalies of the gallbladder are encountered in about 3% of patients.

New 3-dimensional molecular indices (WHIM descriptors) contain information about the whole molecular structure in terms of size, shape, symmetry and atom distribution. These indices are calculated from (x,y,z)-coordinates of a molecule within different weighting schemes in a straightforward manner and represent a very general approach to describe molecules in a unitary conceptual framework. The obtained models confirm the high modeling power of the WHIM descriptors. In this work WHIM descriptors are used for modeling chlorophenols toxicity measured by other not previously considered biosensors. In particular, the attention is stressed on submitochondral particles (SMP) as toxicity biosensors recently proposed and their relationships with other biosensors are further investigated.

Introduction notre experience dans la cure d’hernie inguinale par voie laparoscopique dans la premiere annee de vie, pour souligner les avantages de la procedure dans cet âge. Methodes Dans une periode de 2 ans, nous avons traites 315 patients avec hernie inguinale unilaterale par vois laparoscopique et 50 avaient moins de 1 annee. Notre attention sera concentree sur ce groupe de 50 enfants. Le rang d’âge etait de 1 jusqu’ a 12 mois avec un poids median de 5,5 kg. 5/50 patients ont presente une hernie incarceree. Nous avons utilise la technique de Montupet modifie. Resultats temps operatoire : 22 minutes. 35 procedures effectuees en hopital de jour, 15 patients dechargees le jour apres le procede. Dans 22 patients on a trouve une perviete contralateral et on a realise une herniorraphie bilateral. Dans une fille il y avait la coexistence d’une hernie oblique externe, une hernie directe du cote droit et les deux orifices ont ete sutures en laparoscopie. Au follow up minimum de 1 an il y avait 1 recidive sur 73 herniorraphies. Conclusions dans notre experience la reparation laparoscopique de l’hernie inguinale dans les enfants au dessous de 1 an par les mains expertes est une procedure efficace, qui permet de soigner au meme temps toutes les formes d’hernies inguinales.

The toxicity of a series of chlorophenols, determined by a short-term in vitro assay utilizing mammalian submitochondrial particles, was related to the physicochemical and structural properties of these compounds. Quantitative Structure-Activity Relationships were defined by correlating EC50 values with six molecular descriptors, chosen to represent lipophilic, electronic and steric effects: the n-octanol/water partition coefficient (log Kow), the constant of Hammett (sigma sigma), the acid dissociation constant (pKa), the first order valence molecular connectivity index (1 chi v), the perimeter of the efficacious section (sigma D) and the melting point (m.p.). The results of regression analysis showed that log Kow is the most successful descriptor, indicating that the ability of chlorophenols to partition into the lipid bilayer of the mitochondrial membrane has an important role in determining their toxic effects. These results are consistent with a molecular mechanism of uncoupling action based on the chemiosmotic theory and on the protonophoric properties of chlorophenols. The quality of the QSAR models confirms the suitability of the SMP assay as a short-term prediction tool for aquatic toxicity of environmental pollutants acting on respiratory functions.

In the present paper we investigate the Rayleigh-Benard convection in rarefied gases and demonstrate by numerical experiments the transition from purely thermal conduction to a natural convective flow for a large range of Knudsen numbers from 0.02 downto 0.001. We address to the problem how the critical value for the Rayleigh number defined for incompressible vsicous flows may be translated to rarefied gas flows. Moreover, the simulations obtained for a Knudsen number Kn=0.001 and Froude number Fr=1 show a further transition from regular Rayleigh-Benard cells to a pure unsteady behavious with moving vortices.

The toxicity of 14 organotin compounds was investigated by means of two short-term in vitro bioassays, the submitochondrial particle (SMP) test and the Microtox® test. The first bioassay makes use of SMPs and is based on the effects of toxicants on reverse electron transport, which is induced by adenosine triphosphate and succinate at the first site level of the respiratory chain. Microtox is a well known test system that uses marine luminescent bacteria and quantifies toxicity by measuring the reduction of luminescence caused by toxic chemicals. Very good agreement was observed between the median effective concentration (EC50) values determined for organotin compounds by means of the two bioassays. Toxicity depended on both the number and kind of organic substituents bound to the tin atom. It followed the order triorganotins > diorganotins ≈ tetraorganotins > monoorganotins. Within each series, butyltin and phenyltin compounds exhibited the highest toxicity. Microtox and SMP EC50 values were successfully correlated with toxicity data for aquatic organisms, demonstrating the usefulness of these bioassays as prescreening or complementary tools for monitoring aquatic toxicity. Moreover, to investigate the suitability of the two assays in providing information on the mechanism of toxic action of organotins, EC50 values were correlated with various physicochemical and structural parameters of the tested compounds. The results obtained showed that these parameters are poor descriptors of organotin toxicity; in particular, the poor correlations found between EC50 values and log Kow could be ascribed to the fact that different modes of action govern the biological activity of mono-, di-, tri-, and tetraorganotin compounds, respectively.