Daniela Codrich

Raman and FTIR microscopic imaging of colon tissue: a comparative study.

Colon tissue constitutes a valid model for the comparative analysis of soft tissue by Raman and Fourier transform infrared (FTIR) imaging because it contains four major tissue types such as muscle tissue, connective tissue, epithelium and nerve cells. Raman microscopic images were recorded in the mapping mode using 785 nm laser excitation and a step size of 10 microm from three regions within a thin section that encompassed mucus, mucosa, submucosa, and longitudinal and circular muscle layers. FTIR microscopic images that were composed of 4, 8 and 9 individual images of 4096 spectra each were recorded from the same regions using a FTIR spectrometer coupled to a microscope with a focal plane array detector. Furthermore, Raman microscopic images were recorded at a step size of 2.5 microm from three ganglia that belong to the myenteric plexus. The results are discussed with respect to lateral resolution, spectral resolution, acquisition time and sensitivity of both modalities.

Raman mapping and FTIR imaging of lung tissue: congenital cystic adenomatoid malformation

Congenital cystic adenomatoid malformations (CCAMs) are benign masses of non-functional lung tissue developing from an overgrowth of the terminal bronchioles with subsequent suppressing of alveolar growth. For the first time CCAMs are studied by Raman mapping and Fourier transform infrared (FTIR) imaging. Both vibrational spectroscopic methods are able to analyze the biochemical composition of tissues and their pathological changes at the molecular level. Cryosections were prepared on calcium fluoride substrates from CCAMs and from normal lung tissue of two infant patients who underwent surgery. Raman maps were collected at a step size of 100 microm in order to assess the whole tissue section and at a smaller step size of 10 microm in order to resolve details in selected areas. FTIR images were collected in the macroscopic and microscopic modes. Data sets were segmented by cluster analysis and the mean spectra of each cluster were compared. At low lateral resolution a lower red blood cell content and higher lipid content were found in CCAMs than in normal lung tissue. At higher lateral resolution, accumulations of lipids and glycogen were identified in CCAMs. The lipid aggregates contain a high concentration of phosphatidylcholine. It is discussed how the combined application of Raman mapping and FTIR imaging might improve the differential diagnosis of lung malformations and how both modalities might be applied to other bioanalytical and biomedical problems in the future.

The treatment of internal anal sphincter achalasia with botulinum toxin.

Abstract. Internal anal sphincter (IAS) achalasia is a disorder of defecation in which the IAS fails to relax. Botulinum toxin (BT), which has been successfully used to relax the anal and lower esophageal sphincters, was injected twice into the IAS of one adolescent and three infants with manometric, radiologic, and in 2 cases histochemical diagnosis of anal achalasia; in the adolescent a third injection was necessary. Spontaneous defecation was achieved in all patients following the second injection. In one case a diagnosis of short-segment Hirschsprungs disease was obtained after the second injection. Local infiltration of BT into the IAS proved effective in the treatment of IAS achalasia. Double-blind studies and longer follow-up periods are needed to better evaluate these preliminary results and define the limits of this promising therapy.

Chronic inflammation in congenital cystic adenomatoid malformations. An underestimated risk factor

PURPOSE Congenital cystic malformations of the lung are more frequently diagnosed before birth, but guidelines for surgical management of asymptomatic cases are lacking. The aim of this article is to review our 10-year results with antenatally diagnosed congenital cystic adenomatoid malformations (CCAMs) to debate indications for early postnatal surgical management in asymptomatic patients. METHOD Twenty-four cases were reviewed; of these, 18 were operated on before 15 days of life for respiratory distress or mediastinal shift, whereas 6 were submitted to elective surgery at 3 months of age. RESULTS Twenty lobectomies and 4 atypical resections were performed. Two of the latter required a second surgery for incomplete primary perinatal resection. No postsurgical complications were reported. Nineteen (19/24) of the resected specimens showed signs of chronic inflammation. In the perinatal period, 100% (8 cases) of CCAM type II and 50% (8 cases) of CCAM type I resulted to be inflamed. Of the asymptomatic cases, 50% (3/6) were also found to be affected. No infections were detected at bacteriologic culture and bacterial debris was stained in 3 specimens. CONCLUSION In this series, a 79% incidence of pulmonary inflammation was detected. The CCAM type II resulted to be always involved in this process of inflammation. This was an unexpected finding, particularly in cases without mediastinal shift or respiratory distress. In light of these results, early postnatal treatment, at around 3 to 6 months of age, could be considered even in asymptomatic patients.

Acute abdomen: the presenting sign of systemic lupus erythematosus in childhood.

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease characterized by deposition of auto-antibodies and immune complexes in tissues and cells. Onset of the disease in childhood can be insidious with nonspecific symptoms such as fever, malaise, and weight loss or it can be acute with involvement of one or more organs or systems (e.g., kidney, skin, central nervous system, joints, or blood). Gastrointestinal symptoms appear in one third of patients with known SLE during their lifetime but very rarely does the condition present with acute abdomen as the only sign. Differentiating a patient with an acute abdomen secondary to SLE is therefore a real challenge and may be associated with a delay in the correct diagnosis. We describe two pediatric cases of SLE with acute abdomen as the sole presenting sign of the disease.

Perforated appendix with abscess: Immediate or interval appendectomy? Some examples to explain our choice

Highlights • There are no clear guidelines in the treatment of a perforated appendicitis associated with localized abscess.• Our team’s therapeutic choice, also with presence of coprolith, is the initial conservative case management followed by a routine interval appendectomy.• Interval appendectomy should be performed not later than 4 months after discharge.

Still toddler: A clinical clue for acute appendicitis: Still toddler

A previously healthy 30-month-old boy presented to the emergency department with a 2-days history of repeated non-bilious vomiting, low-grade fever and refusal to stand or walk. The day before admission, he had been evaluated by his general practitioner and a viral intestinal infection was suspected. The re-evaluation was prompt by the fact that in the next hours at home he was continuously lying in his bed, refusing to walk or play. On examination, he was alert, vital signs were normal, body temperature was 37.5 C and no signs of dehydration were noted. He was apparently not suffering, calm while lying on the table, trying to limit movements and to keep a still body position. He started crying after palpation of the right lower abdominal quadrant. No guarding or rebound tenderness were noted. Bowel sounds were present. An acute appendicitis was suspected and a diagnostic work-up was performed. Blood tests showed an increased white blood count (20.4 × 10/L) with neutrophilia (17.4 × 10/L) and an elevated C-reactive protein 5.26 mg/dL. Abdominal ultrasonography revealed a hypoanechoic dilated appendix (>1 cm) with peripheral hypervascularity at colour-Doppler analysis with a visible appendicolith (Fig. 1). The patient was admitted to the surgical department and an appendectomy was performed. He recovered without complications.

Voiceless disability: A worth case of bilateral infrainguinal testicular torsion in a patient with cerebropalsy

Introduction A fast surgical treatment is the gold standard when a testicular torsion is diagnosed. However, an early diagnosis of torsion may not be feasible in case of torsion associated with undescended testis in the patients affected by cerebropalsy. Case presentation A Bolivian 16 year old male with acquired cerebropalsy and spastic neuromuscular disease was admitted to our Institute for a right inguinal swelling observed by the father in the morning. Indeed, the father had reported that the swelling had may be started two days before without pain or any other symptoms apparently. Two episodes of vomiting were only reported. At the general examination the patient, apparently, seemed to laugh repeatedly and a spastic movements increase were observed. The child had an infrainguinal bilateral cryptorchidism. An urgent left infrainguinal orchyectomy had been performed in the past and controlateral cryptorchidism was not corrected. At the right inguinal exploration, a complete twist of the spermatic chord was observed and a right orchyectomy was then performed. Discussion Testicular torsion in the inguinal canal is a rare reported condition that usually can involve patients with spastic neuromuscular disease. Processing, communication and verbalization of a chronic or acute pain seems to be different in a child with or without intellectual disability. It could be a lot more difficult to correct pain interpretation, with an important repercussion on pain accurate assessment and management. Conclusion In the patients with intellectual disability, a control of the testicles, it should always be done, mostly in case of atypical behaviour.

Surgery for distal hypospadias: what about the catheter?

No agreed recommendations exist for timing of urethral stent removal, after distal hypospadias surgery. We compared our preliminary case series with outcomes from literature: 18/44 patients were treated with catheter and 26/44 without it. The surgical outcome was comparable in the two groups. After hypospadias surgery, the main advantage of the immediate postoperative catheter removal was the shorter hospital stay without negatively affecting the care and home management.

More than (Double) Bubble.

A woman in her third trimester of pregnancy was referred to our prenatal diagnosis unit because of identification of double-bubble sign in the fetus and severe polyhydramnios. There were no other fetal malformation, and, thus, the diagnosis of lower duodenal tract atresia was postulated. Because of worsening polyhydramnios and threatened preterm labor, 2 procedures of amnioreduction were performed. During ultrasound evaluation, repetitive fetal vomiting was observed (Figure 1 and Video; available at www.jpeds.com). At 34 gestational weeks, the woman delivered vaginally a neonate with birthweight of 2330 g and Apgar score of 7-10. There were no complications in adaptation to postnatal life. A bilious fluid was drained by nasogastric tube, and meconium was regularly emitted. A venous umbilical catheter was placed, and antibiotic therapy and fluid infusion started.