A Structured Training for Trans Anal Irrigation in Pediatric Patients Improves Outcomes and Reduce Failures: Results of an Interventional Multicenter Prospective Study

BACKGROUND

Continence issues due to organic causes including previous colorectal surgery or neurological issues might benefit from Transanal irrigation (TAI) that proved to be highly effective but with a number of limitations including a relatively high discontinuation rates. Our study was aimed at evaluating the efficacy of an advanced protocol tailored to each patient to prevent dropout and increase satisfaction, independence, and quality of life.

MATERIALS AND METHODS

This was a prospective, interventional, multicenter, nonrandomized study involving children aged 4-18 years with bowel dysfunction unresponsive to conventional treatments who required TAI. TAI was performed in accordance to the best standards of care with a total irrigation volume that was determined based on low emission X-Ray barium enemas performed at the very beginning of the study. All patients underwent training and assessments of continence, patients' perspectives and quality of life were performed at different timepoints from enrollment (T0) up to 6 months since TAI was introduced (T3).

RESULTS

A total of 78 patients were enrolled. Male to female ratio was 1.4:1. Mean age at enrollment was 106.1 ± 42.8 months. Discontinuation was reported by 3 patients (3.8 %). Continence, satisfaction and a number of other outcome measures increased from baseline (T0) to the last visit (T3). In particular, mean Rintala total score increased linearly from 7.8 to 14.8 during the study period (T0 to T3 timepoints). On a multivariate analysis, the only parameter that proved to be inversely associated with continence as well as with other outcome measures was the use of laxatives at enrollment and during the study.

CONCLUSIONS

This study has demonstrated the high efficacy of this innovative patient-tailored TAI protocol across all assessed scores. Of note, given the negative impact of laxatives, our findings suggest limiting their use in this patient population to further increase the efficacy of the procedure.

Post-infarction ventricular septal defect surgery in Portugal

INTRODUCTION AND OBJECTIVE

We performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment.

METHODS

A descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented.

RESULTS

Median survival of the cohort (n=76) was 72 months (95% CI 4-144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01-1.15) and concomitant CABG (OR 0.23; 95% CI 0.06-0.90).

CONCLUSIONS

Our results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias.

Coronary artery bypass grafting in a child with Kawasaki disease

Kawasaki disease (KD) with cardiac involvement can result in the development of coronary aneurysm, stenosis or thrombosis with significant cardiovascular implications. We report the case of a 23-month-old male with a late diagnosis of KD, in whom intravenous immunoglobulin treatment was not feasible. The patient's course was assessed by routine echocardiography. At the age of five years, angiographic assessment revealed an aneurysm of the anterior descending coronary artery measuring 17 mm×7 mm involving the first diagonal branch, 90% post-aneurysmal stenosis, and an aneurysm of the right coronary artery measuring 32 mm×6 mm. Due to the critical anatomy of the anterior descending artery the revascularization method of choice was coronary artery bypass surgery with an internal mammary artery graft, under cardiopulmonary bypass. There were no significant intraoperative or postoperative complications. This confirms coronary artery bypass grafting as a reliable treatment option for patients who present with coronary sequelae from KD, even at a very young age.

Coronary artery bypass grafting in a child with Kawasaki disease

Kawasaki disease (KD) with cardiac involvement can result in the development of coronary aneurysm, stenosis or thrombosis with significant cardiovascular implications. We report the case of a 23-month-old male with a late diagnosis of KD, in whom intravenous immunoglobulin treatment was not feasible. The patient's course was assessed by routine echocardiography. At the age of five years, angiographic assessment revealed an aneurysm of the anterior descending coronary artery measuring 17 mm×7 mm involving the first diagonal branch, 90% post-aneurysmal stenosis, and an aneurysm of the right coronary artery measuring 32 mm×6 mm. Due to the critical anatomy of the anterior descending artery the revascularization method of choice was coronary artery bypass surgery with an internal mammary artery graft, under cardiopulmonary bypass. There were no significant intraoperative or postoperative complications. This confirms coronary artery bypass grafting as a reliable treatment option for patients who present with coronary sequelae from KD, even at a very young age.

Analysis of a 10-year period of lead removal in a referral centre

OBJECTIVES

Our goal was to analyse all lead extraction procedures (transvenous or open surgery) performed in our centre and the short- and long-term follow-up data from these patients.

METHODS

All lead extractions performed from 2008 to 2017 were retrospectively reviewed for patient characteristics and indications for device implantation; indications for lead extraction; techniques used; peri- and postprocedural complications and short- and long-term follow-up data.

RESULTS

A total of 159 patients (282 leads) were included [age 70 (62-78) years; 72% men]. The median follow-up time was 57 (25-90) months. Patients with lead explants were excluded. The most common indication for lead removal was infection (77%). A surgical approach was necessary in 14 patients (9%) owing to unsuccessful transvenous removal (n = 3), large vegetation in the lead (n = 4), concomitant valvular endocarditis (n = 2), other indications for open surgery (n = 4) and complicated transvenous removal (n = 1). Removal was tried for 282 leads. Of those, 256 were completely removed. Clinical success was achieved in 155 individual patients (98%). Complications occurred in 6 patients: 3 persistent infections, 1 stroke and 2 blood vessel ruptures. The procedure-related mortality rate was 2% (n = 3).

CONCLUSIONS

Lead removal was associated with a high success rate and low all-cause complication and mortality rates. Emergency surgery because of acute complications was rare, and open-heart surgery was most frequently elective and not associated with a worse outcome.

P1508A single center analysis of a 10-year period of lead removal

BACKGROUND

The number of lead removal of cardiac implantable electronic devices (CIED) has increased in recent years. The recent European registry (ELECTRa) did not include all European centers and not all lead extractions are possible to be performed transvenously.

AIMS

We aim to analyze all lead extraction procedures (transvenous or open surgery) performed in our center and the short- and long-term follow-up of these patients (pts).

METHODS

We retrospectively reviewed all lead extractions performed from 2008 to 2017. We analyzed pts´ characteristics (personal history, cardiovascular risk factors, indication for device implantation, laboratory tests); indications for extraction; techniques used and personnel that participate in the procedure, complications peri- and post-procedural and short and long-term follow-up.

RESULTS

A total of 189 pts (330 leads) were included (mean 69 ± 14 years, 73% male).  The follow-up was 54 (IQR 20-87) months. Median time after implant was 47 (IQR 19-98) months. Lead explant was performed in 30 patients (16%) and lead extraction (at least one lead implanted >1 year or a lead requiring assistance of specialized equipment) in 159 (84%). Indications for removal are presented in figure A. In those who were infected, isolation of the microorganism was possible in 35% and Staphylococcus aureus was the most common agent (51%). 101 procedures (53%) occurred in the operating room, while 89 (47%) were performed in the electrophysiology laboratory, but 47% of those with the participation of a surgeon. On the total, cardiac surgeons were responsible for 75% of the procedures. Removal was tried in 330 leads (98 atrium lead, 199 right ventricle lead (79 defibrillator lead) and 33 coronary sinus lead). Of those, 298 were completely removed, 14 were partially removed (<4cm of a lead remained in the patient body) and 18 were not removed (radiologic failure). On an individual patient basis, clinical success was achieved in 185 patients (97%). Techniques used in the 330 leads were distributed in figure B.  Surgical approach was necessary in 14 pts due to unsuccessful transvenous removal (n = 3), large vegetation in the lead (n = 4), concomitant valvular endocarditis (n = 2), other indication for open surgery (n = 4) and complicated transvenous removal (n = 1). Complications occurred in 6 patients: 3 persistent infections, 1 stroke, 2 vessel rupture. Related-procedural mortality was 1.5% (n = 3). The long-term survival of pts who performed open heart surgery was not different from those who underwent transvenous lead removal (logrank, p = 0.27) (figure C).

CONCLUSION

Although being a low volume center (19 procedures/year) and including pts with transvenous and open surgery, lead removal was associated with a high success rate with low all cause complication and mortality rates. Emergent surgery due to acute complications was very rare (0.5%) and open heart surgery was mostly programmed and not associated with a worse outcome.

Abstract Figure.

CABG: To CBP or Not To CBP - A Propensity Score Matched Survival

INTRODUCTION

Over the past 3 decades two main strategies have been employed for surgical coronary revascularization (CABG): on- pump CABG with cardioplegia (ONCAB) and off-pump CABG (OPCAB). The objective of this study is to evaluate the short-term and long-term survival of the two strategies.

METHODS

This study consists of 8-year cohort, retrospective single-center analysis with an intention-to-treat design. 2954 patients underwent CABG (OPCAB n=2123; ONCAB= 831) for CAD. As these two groups were statistically different regarding several parameters, a propensity score model was applied and a more homogeneous cohort (n= 1441; OPCAB= 885; ONCAB=556) was analyzed. Univariate analysis, Kaplan-Meier curves and when appropriate a multivariate analysis was applied to the overall group and 6 subgroups: 2 vessel disease, 3 vessel disease, left stem disease, diabetic patients; patients with creatinin clearance bellow 50ml/min; and patients with body mass index above 30 kg/m2.

RESULTS

Our study show: No difference in 30-days mortality, long-term survival (mean 71 months follow-up), AKY and stroke rates; Higher rates of bypass per patient (2.3% vs 2.8%, p<0,001) and complete revascularization (76% vs 83%) in the ONCAB group; Fewer re-operation for bleeding (0.8 vs 3.8%, p<0.001), fewer peak troponin>19mg/ dl (4.7% vs 9.9%, p<0,001), and fewer IABP use (1.5% vs 3.3%, p=0,027) in the OPCAB group. Sub-group analysis showed no difference between the two groups with exception of a higher rate of troponin peak >19mg/dl adjusted for CAD extension in the left-main stem disease group undergoing ONCAB (OR=2,3 +-0.8 p=0,018).

CONCLUSION

The major randomized controlled trials comparing the two strategies show: No difference in 30-days mortality, 1-year survival, AKY and stroke rates; Less re-revascularization rates and higher bypass per patient and bypass patency with ONCAB. Despite the large volume of evidence generated around both on-pump and off-pump CABG strategies, studies fail to demonstrate clear benefit of either strategy regarding mortality and most common complications. Our results are similar of those found in the literature as neither strategy has unequivocal superior results. ONCAB shows consistently higher rates of complete revascularization and higher number of grafts. OPCAB shows lesser troponin levels suggestive of less myocardial damage. Major limitations include: analysis not matched for surgeon performance; cardiac related events, re-revascularization need and graft patency not evaluated; isolated use of troponin levels for evaluation myocardial damage.

David Operation in the Bicuspid Aortic Valve Population

INTRODUCTION

Bicuspid aortic valve (BAV) is the single most common cardiac congenital mal-formation with a prevalence of 1-2%. It is frequently associated with aortic disease including annular ectasia. Increasing evidence suggests that valve-sparing root re-implantation surgery combined with primary aortic valve repair can be performed with good midterm results in patients with BAV.

METHODS

Our objective is to compare the short and long term results of David procedure in BAV patients with aortic root ectasia. Retrospective analysis of our institution's database retrieved 42 patients with aortic annular ectasia who underwent valve-sparing root re-implantation surgery with David technic from 2007 to 2015. This cohort included 11 patients with BAV and 31 with tricuspid aortic valve (TAV). Pre, intra and post-operative variables of these two groups were statistically analyzed using univariate analysis. Continuous variables are expressed as means+-standard deviation. Categorical variables are expressed as percentages. Univariate analysis was performed using students t-test for continuous variables and x2 for categorical variables. Long-term survival and freedom from re-intervention was analyzed using Kaplan-Meier curves.

RESULTS

Follow-up was achieved in 100% of cases with an average follow-up of 60 months. Mean age of the studied population was 50 years. Comorbidities and demographics were similar in the BAV and TAV groups with the exception of a younger operative age in the BAV group (p=0,028). Mean cardiopulmonary bypass time and mean ischemic time was 162' and 133' respectively. Combined procedures were performed in 3 (7,1%) of patients. The BAV group showed longer cardio- pulmonary bypass e aortic cross-clamp times (p=0,024; p=0,022) and a universal need for aortic plasty. Short-term results and complications were similar in the two groups with the exception of a higher need for pacemaker implantation in the BAV group (p<0,001). Post-operative results including in-hospital mortality, stroke, AMI, pre-discharge echocardiographic evaluation and long-term survival and freedom from re-intervention were similar between the two groups.

CONCLUSION

Our experience reinforces the idea that, however challenging, the aortic valve sparing re-implantation procedure in the setting of BAV, has acceptable short and long-term results, similar to those observed in TAV patients. The pitfalls of this setting are the universal need for aortic valve plasty and higher risk for AV block. A more significant cohort of patients; echocardiographic long-term evaluation and long-term comparison with the gold-standard technic (Bentall procedure) may further clarify the benefits of this approach in BAV patients.

Bilateral Internal Thoracic Artery Grafting in Patients with Diabetes Mellitus

INTRODUCTION

Bilateral internal thoracic artery (BITA) grafting in patients with diabetes mellitus is controversial due to a higher risk for sternal infection. The purpose of this study is to compare the rates of mediastinitis as well as mortality rates of BITA grafting to that of single internal thoracic artery (SITA) grafting and saphenous vein grafts in patients with diabetes.

METHODS

Between 2007 and 2015 all consecutive diabetic patients with multivessel disease who underwent primary coronary artery bypass graft surgery with BITA were compared with patients who underwent coronary artery bypass graft surgery with SITA and saphenous vein grafts (the control group). Patients submitted to single grafts were excluded from the analysis. Propensity score matching was used to account for differences between groups in preoperative characteristics. The frequency of peri-operative mediastinitis was compared between BITA and control group. Mortality rates between were compared between groups at 1-month post-surgery and 2-year post-surgery.

RESULTS

A total of 1005 patients were included in our sample in which 188 (19%) patients performed BITA grafting. BITA patients were younger (BITA group mean age 60.0 years vs control group 69.9 years; p<0.001), less often female (BITA group 11.7% vs control group 28.2%; p<0.001), and less often insulin treated (BITA group 9.6% vs control group 18.8%; p=0.002) compared to the control group. All other characteristics were not statistically different between groups, namely CCS, NYHA score, three vessel coronary artery disease, left main disease, previous myocardial infarction, hypertension, COPD and body mass index. After propensity score matching, 344 patients were included in the analysis, 138 in the BITA group and 206 in the control group. In this analysis both groups were not statistically different in every characteristic evaluated including age, sex and insulin-treated diabetic patients. The rate of peri-operative mediastinitis in matched groups was comparable (BITA group 2.3% vs control group 1.5; p=0.605). Mortality rates were comparable between groups at 1-month post-surgery (BITA group 1.4% vs control group 0.5%; p=0.346) and 2-year post- -surgery (BITA group 3% vs control group 2%; p=0.557).

CONCLUSION

The findings of this sample suggest that the short and mid-term outcomes of patients with diabetes and multivessel disease who undergo BITA grafting is similar to other grafting procedures. BITA grafting in diabetic patients seems to be safe in terms of sternal wound problems. Longer term follow-up is required to determine BITA grafting survival improvement.

Extracorporeal membrane oxygenator assistance as bridge to recovery in a case of tachycardiomyopathy

Sustained tachycardia is a rare, usually reversible, cause of dilated cardiomyopathy. Extracorporeal membrane oxygenation (ECMO) is a useful method for cardiopulmonary resuscitation and short-term support for reversible cardiac failure refractory to conventional therapy. The present case consists of a 17-years-old male who presented with symptoms of cardiac insufficiency and tachycardia. Timely extracorporeal circulatory assistance with venous-arterial ECMO was essential to patient stabilization, tachycardia control as well as recognition and ablation of culprit ventricular-atrial posterior-septal accessory pathway. The patient's steady hemodynamic and left ventricular function improvement was documented and extracorporeal circulatory assistance was discontinued 1 week after implantation.

[Conservative treatment of children constipation with Macrogol 4,000]

AIM

Macrogol 4,000 is one of the new generation's osmotic laxatives. It is constituted by a heavy molecular weight polymer without additional salts. In most of patients Macrogol 4,000 shows its efficacy in 48 hours from the beginning of treatment. Daily evacuations has been reported after first week therapy with an improvement in quality of life. The aim of this observational study was to demonstrate the efficacy of Macrogol 4,000 in the treatment of constipation in children.

METHODS

The effect of Macrogol 4,000 was assessed in 120 children affected by constipation treated with therapeutic doses of Macrogol 4,000. The study period ranged from September 2006 to March 2007. The data analysis was collected with the evaluations concerning clinical examination and the consultation of daily diaries assembled by parents, tracking stooling pattern; in case of loosing contacts with the patient, a telephonic survey has been carried out. The child with symptoms improvement, i.e. reduction of the pain during defecation, daily spontaneous evacuations and better stool consistence, were considered ''normal''.

RESULTS

Of the 120 patients, 89 returned to the clinical follow-up, while the remaining 31, who missed the follow-up, has been contacted by telephone. To the final analysis, 103 patients (85.8%) have had a normalization of the clinical symptoms, 9 patients (7.5%) have refused Macrogol 4,000 for the unpleasant flavour, 8 patients (6.7%) did not have any improvement from the treatment.

CONCLUSION

The results of this observational study suggest that Macrogol 4,000 could be very useful to treat pediatric patients with constipation, also those affected by neuronal intestinal displasia (NID) type B.

[Association of tracheobronchopathia osteochondroplastica and ozène]

INTRODUCTION

We report a case of tracheobronchopathia osteochondroplastica associated with Ozena (atrophic rhinitis).

OBSERVATION

Fibreoptic bonchoscopy showed irregular tracheal stenosis and histopathological examination displayed zones of bone metaplasia in the tracheal submucosa. We isolated the bacteria Klebsiella pneumoniae sp ozaenae from bronchial aspirate.

CONCLUSION

This organism is frequently isolated in both conditions suggesting some link between the two diseases.

A basic peroxidase from wheat kernel with antifungal activity

A basic heme-peroxidase (WP1) was purified to homogeneity from wheat (Triticum aestivum) kernels. The protein was not glycosylated and exhibited a molecular mass of 36 kDa and a pI of 8.0. The N-terminal amino acid sequence revealed a very high similarity with a wheat flour peroxidase allergen associated with baker's asthma. WPI showed indole-3-acetic acid oxidase activity in the presence of Mn2+ and phenolic cofactors. Antifungal assays performed in vitro towards phytopathogenic fungi indicated that WP1 was active in inhibiting germ tube elongation. This first report on antifungal properties of a heme-peroxidase gives experimental support to the idea that peroxidases play a defensive role against invading pathogens.

Testicular function in men treated in childhood for undescended testes

PURPOSE

The aim of the study was to evaluate testicular hormones and sperm counts of young men treated in childhood for cryptorchidism

METHODS

Testicular volume, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone as well as semen specimens were evaluated in 57 men (mean age, 19 years; range, 18 to 27 years) treated in childhood for unilateral (n = 47) and bilateral (n = 10) cryptorchidism. In 3 unilateral cases monorchidism was found. Thirty-seven patients underwent orchiopexy after hormonal treatment (luteinizing hormone releasing factor, 1.2 mg/d for 28 days followed by human chorionic gonadotropin, 500 IU intramuscularly 3 times a week for 3 weeks). The remainder underwent surgery. Mean age at surgical treatment was 5.4 years (range, 2 to 12 years). These patients were examinated again after a mean period of 13.3 years (range, 10 to 19 years).

RESULTS

Reduced testicular volume (<12 mL) was found in 6 of 64 testes (9.3%). LH, FSH, and testosterone levels were found within the normal range in all patients. With linear regression, inverse relations were found between FSH and, respectively, testicular volume (P =.002), sperm concentration (P =.013), sperm motility (P =.023), and normally shaped sperms (P =.019). There were direct relations between testicular volume and sperm concentration (P =.02), sperm motility (P =.000), and normally shaped sperms (P =.001). We did not find any statistical correlation between age at surgery and semen quality. Significantly better results in terms of sperm counts were found in patients directly operated on in comparison to those treated with hormones before orchiopexy.

CONCLUSIONS

Presented data indicate tubular impairment in young men operated on in childhood for cryptorchidism; FSH values increase and testicular volume decrease are related to sperm deterioration. Studies on children treated in the first 2 years of life are required to clarify the usefulness of early treatment of cryptorchidism.

[Congenital cysts of the pancreas. A case report]

The authors report a clinical case of congenital cyst of the pancreas occurred in a female aged 15 months. They stress how this pathology is particularly rare in pediatric age (only 22 cases in the literature) and how it is extremely difficult to formulate a preoperative diagnosis. The young patient was in good general condition with an enormous abdominal tumefaction and without alterations of hematochemical markers. Echographic and tomographic patterns led to four diagnostic hypotheses: a) mesenteric cyst; b) left ovarian cyst or compound ovarian tumor; c) intestinal duplication; d) pancreatic cyst. Only after surgery a correct diagnosis was formulated (on the basis of the topographic position and the intracystic content of amylase and lipase) and a complete resolution of this pathology was obtained. Surgery therefore has the double function of formulating a correct diagnosis and allowing the complete resolution of this pathology. The complete surgical removal of the mass, in view of the benignity of this lesion, is the therapeutic goal.

A pre- and postsynaptic modulatory action of 5-HT and the 5-HT2A, 2C receptor agonist DOB on NMDA-evoked responses in the rat medial prefrontal cortex

Intracellular recordings were made from pyramidal neurons in layers V and VI of the rat medial prefrontal cortex in slice preparations to investigate the effect of the serotonin 5-HT2A,2C receptor agonist (-)-1-2,5-dimethoxy-4-bromophenol-2-aminopropane (DOB) and 5-hydroxytryptamine (5-HT) on N-methyl-D-aspartate (NMDA)-induced responses. Bath application of either DOB or 5-HT [in the presence of antagonists to 5-HT1A, 5-HT3 and gamma-aminobutytric acid (GABA) receptors] produced a concentration-dependent biphasic modulation of the NMDA responses. They facilitated and inhibited NMDA responses at low (</= 1 microM DOB and </= 50 microM 5-HT) and higher concentrations, respectively. Both the facilitating and inhibitory action were blocked by the highly selective 5-HT2A receptor antagonist R-(+)-alpha-(2, 3-dimethoxyphenil)-1-[4-fluorophenylethyl]-4-piperidineme thanol (M100907) and the 5-HT2 receptor antagonist ketanserin, thus indicating that both facilitation and inhibition were mediated by the activation of the 5-HT2A receptor subtype. However, the facilitating, but not inhibitory, action of DOB showed a marked desensitization, suggesting that the facilitation and inhibition of NMDA responses resulted from activation of different 5-HT2A receptor subtypes and/or signal-transduction pathways. Indeed, the selective PKC inhibitor chelerythrine and the Ca2+/CaM-KII inhibitor KN-93 prevented the facilitating and inhibitory action of DOB, respectively. We have generated several lines of evidence to indicate the following scenario. Low concentrations of DOB, at presynaptic nerve terminals, markedly enhance NMDA-induced release of excitatory amino acids (EAAs), which then act upon both NMDA and non-NMDA receptors to elicit inward current. The massive inward current masks the postsynaptic inhibitory action of DOB. At higher concentrations, DOB inhibits the release of EAAs and discloses the postsynaptic inhibitory action.

Cryptorchidism: medical and surgical treatment in the 1st year of life

Since cryptorchidism can cause infertility and early orchiopexy can improve fertility, we tried to determine whether medical and surgical treatment in the 1st year of life can improve testicular fertility. We concluded that this is the best time to treat cryptorchid tests.

[An unusual case of macroscopic hematuria in pediatric age]

An unusual case of macroscopic hematuria in a 14 year old boy is presented. At the time of the first hospital admission, no urinary tract infection could be demonstrated, in spite of the associated symptoms of stranguria and dysuria. At ultrasound examination, only a mild thickening of the upper bladder wall was detected, and cystoscopy showed a huge oedema and inflammation of the mucosal layer. The biopsy of the bladder was characterized by a definite eosinophilic infiltration; due to this particular hystologic pattern, the diagnosis of eosinophilic cystitis was made. In the following months, the boy did not improve. Recurrent hematuria occurred, and a pseudo-polypoid mass in the inner bladder wall was detected at ultrasonography. A limited resection of the vesical dome was performed, to remove completely the mass. The hystologic examination showed Schistosoma Haematobium eggs in the bladder wall, with a typical granulomatous reaction. The post-operative course was uneventful, and the child was completely cured after Praziquantel treatment. The Authors underline the need to take into account Schistosomiasis in cases of hematuria, particularly when this symptom affects boys coming from countries where Bilharziasis is endemic.

Structural and antifungal properties of a pathogenesis-related protein from wheat kernel

We have purified and characterized a protein from the water-soluble fraction of wheat kernel (Triticum aestivum cv. S. Pastore) consisting of a single polypeptide chain blocked at its N-terminus by a pyroglutamate residue; the complete amino acid sequence has been determined by automated sequence analysis performed on peptide fragments obtained by enzymatic hydrolyses of the protein. Homology studies have shown that this protein is very similar (97% sequence identity) to the previously characterized wheatwin1 as well as to other members of the pathogenesis-related (PR) proteins of class 4; in analogy with wheatwin1, we have termed this protein wheatwin2. Both wheatwin1 and wheatwin2 have specific antifugal activity toward the wide-host-range pathogen Botrytis cinerea and the wheat-specific pathogenic fungi of wheat Fusarium culmorum and Fusarium graminearum of groups 1 and 2. On the basis of their structural and functional properties, wheatwin1 and wheatwin2 can be classified as members of the PR4 protein family; this represents the first report concerning the presence of this kind of protein in wheat.