URACHAL CYST: AN UNSPECTED COMPLICATION

The urachus is the remnant of the allantois, which usually becomes obliterated shortly after birth. Urachal remnants due to an incomplete obliteration of different portion of the urachus are rare, but they need to be treated surgically because of their potential for infectious complications and malignant degeneration. We present a case report with an unespected postoperative complication. M.E., a 10 years old boy, came to the Accident and Emergency Department for an acute abdominal pain, without other symptoms, twice in one year. The blood tests, urine sample and voiding cystourethrogram were normal. The ultrasound scan showed a thickened urachal duct. After antibiotic and anti-inflammatory therapy for two weeks, we performed laparoscopic surgery. In the second postoperative day the patient showed abdominal pain and hematuria. An ultrasound scan and a voiding cystourethrogram showed a leak from the dome of bladder. We performed an open surgery to close the defect on the bladder’s dome. The patient was discharged in 10th postoperative day. Now he is healthy. Clinically manifest persistent urachal anomalies are rare, but they carry a risk of recurrent infection and subsequent malignant degeneration. For these reasons the radical excision of the remnant is suggested. Today, due to the large laparoscopic experience, all the reports showed that this technique can be used safely, but we have to pay attention to all steps of the procedure. This case is a paradigmatic situation and it illustrates the importance of a meticulous technique during the excision of urachal remnant. Indeed even if laparoscopic excision could be safe and effective, it is not free of complication

Missouri 2011 Soft Red Winter Wheat Performance Tests

This report is published by the MU Variety Testing Program, Division of Plant Sciences, University of Missouri. The work was supported by fees from companies and organizations submitting varieties for evaluation. The large number of varieties available makes selection of a superior variety difficult. To select intelligently, producers need a reliable, unbiased, up-to-date source of information that will permit valid comparisons among available varieties. The objective of the MU Variety Testing Program is to provide this information. Tests are conducted under as close to uniform conditions as possible. Small plots are used to reduce the chance of soil and other variations occurring among variety plots. Results obtained should aid individual growers in judging the relative merits of many of the commercial wheat varieties available in Missouri

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

Traces of Fallback Breccia on the Rim of Barringer Meteorite Crater (a.k.a. Meteor Crater), Arizona

Barringer Meteorite Crater (a.k.a. Meteor Crater), Arizona, is one of the youngest and best preserved impact craters on Earth. For that rea-son, it provides a baseline for similar craters formed in the geologic past, formed elsewhere in the Solar Sys-tem, and illuminates the astronomical and geological processes that produce them. The crater has not, how-ever, escaped erosion completely. While Shoemaker [1] mapped a breccia with fallback components inside the crater, he did not locate it beyond the crater rim. He only found remnants of that type of debris in re-worked alluvium [1; see also 2]. Fallback breccia and any base-surge deposits have, thus, been missing components in studies of material ejected beyond the transient crater rim

Housing and health in an informal settlement upgrade in Cape Town, South Africa

Taking a socio-ecological perspective the World Health Organisation recognizes that housing comprises four interrelated dimensions—the physical structure of the house, the home, the neighbourhood infrastructure and the community. Housing related health vulnerability arises when residents are exposed to poor conditions in any one of these dimensions and augmented when two or more co-exists. Regardless the relationship between housing and health in the global south remains largely under explored; in particular there has been little focus on health outcomes resulting from upgrading of informal settlements. Applying this framework we report from an in situ upgrading of the informal settlement of Imizamo Yethu in Cape Town, South Africa. Data gathered from surveys are used to determine whether differences in each of these dimensions exist between housing type; both formal upgrades and shacks. Results show that whilst no significant differences exist in self-reported physical health, residents of formal housing are less likely to report mental health issues, have a stronger sense of belonging and report greater satisfaction with both neighbourhood and home than shack residents. However, these contested spaces are not easily interpreted and community tension, exclusion and disadvantage highlight the complex interactions between each of the interrelated dimensions and policies regarding housing intervention. The paper highlights the complex relationship between housing and health that is often lost in simplistic measures of housing when outcomes related to the indoor environment alone are considered

Pharmacologically active microcarriers influence VEGF-A effects on mesenchymal stem cell survival

Resistance of transplanted mesenchymal stem cells (MSCs) in post-ischemic heart is limited by their poor vitality. Vascular-endothelial-growth-factor-A (VEGF-A) as such or slowly released by fibronectin-coated pharmacologically-active-microcarriers (FN-PAM-VEGF) could differently affect survival kinases and anti-apoptotic mediator (e.g. Bcl-2). Therefore VEGF-A or FN-PAM-VEGF could differently enhance cell proliferation, and/or resistance to hypoxia/reoxygenation (H/R) of MSCs. To test these hypotheses MSCs were incubated for 6-days with VEGF-A alone or with FN-PAM-VEGF. In addition, MSCs pre-treated for 24-hrs with VEGF-A or FN-PAM-VEGF were subsequently exposed to H/R (72-hrs 3% O(2) and 3-hrs of reoxygenation). Cell-proliferation and post-hypoxic vitality were determined. Kinases were studied at 30-min., 1- and 3-days of treatment. Cell-proliferation increased about twofold (P < 0.01) 6-days after VEGF-A treatment, but by a lesser extent (55% increase) with FN-PAM-VEGF (P < 0.05). While MSC pre-treatment with VEGF-A confirmed cell-proliferation, pre-treatment with FN-PAM-VEGF protected MSCs against H/R. In the early phase of treatments, VEGF-A increased phospho-Akt, phospho-ERK-1/2 and phospho-PKCε compared to the untreated cells or FN-PAM-VEGF. Afterword, kinase phosphorylations were higher with VGEF, except for ERK-1/2, which was similarly increased by both treatments at 3 days. Only FN-PAM-VEGF significantly increased Bcl-2 levels. After H/R, lactate dehydrogenase release and cleaved Caspase-3 levels were mainly reduced by FN-PAM-VEGF. While VEGF-A enhances MSC proliferation in normoxia, FN-PAM-VEGF mainly hampers post-hypoxic MSC death. These different effects underscore the necessity of approaches suited to the various conditions. The use of FN-PAM-VEGF could be considered as a novel approach for enhancing MSC survival and regeneration in hostile environment of post-ischemic tissues

Persistent nonbilious vomiting in a child: Possible duodenal webbing

An association between malrotation and congenital duodenal webbing is rare. We present our experience with four patients at two centers, and a review of published reports. There are currently 94 reported cases of duodenal pathology associated with malrotation. However, only 15 of the 94 cases (15.9%) include patients with malrotation and a duodenal web. We suggest that nonbilious vomiting in a child must prompt the surgeon to consider duodenal pathology even in the presence of malrotation

Gastric transposition as a valid surgical option for esophageal replacement in pediatric patients: Experience from three Italian medical centers

Background: Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies (peptic or caustic ingestion). The purpose of our work was to describe the experience of gastric transposition in three Italian centers. Methods: This is a retrospective study. The data were extrapolated from a prospective database. We included all patients who had undergone gastric transposition in the last 15 years. Results: In the 15-year period, eight infants and children (3 males and 5 females) underwent gastric transposition for esophageal replacement. Six patients had long-gap esophageal atresia, and two had caustic esophageal stenosis. There were no deaths in the series. Three patients had an early postoperative complication: Two had a self-limited salivary fistula at three weeks, and one (a patient with jejunostomy) had a jejunal perforation treated surgically. One late complication, anastomotic stricture, was recorded that required two endoscopic dilatations. The median follow-up was 60 months (range: 18-144 months). At final clinical follow-up, six patients had no eating problems, and two patients had some difficulties with eating (jejunostomy in situ), but they underwent logopedic therapy with improved outcomes. All patients had an increase in body weight and height postoperatively. Conclusion: Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results, both in terms of surgical technique (simplicity, reproducibility, complication rate) and clinical follow-up (good oral feeding of young patients, normal social life and regular growth curves)