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The impact of perioperative care interventions on postreconstructive complications and short-term colorectal outcome in patients with anorectal malformation (ARM) type rectovestibular fistula is unknown. An ARM-Net consortium multicenter retrospective cohort study was performed including 165 patients with a rectovestibular fistula. Patient characteristics, perioperative care interventions, timing of reconstruction, postreconstructive complications and the colorectal outcome at one year of follow-up were registered. Overall complications were seen in 26.8% of the patients, of which 41% were regarded major. Differences in presence of enterostomy, timing of reconstruction, mechanical bowel preparation, antibiotic prophylaxis and postoperative feeding regimen had no impact on the occurrence of overall complications. However, mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h and postoperative nil by mouth showed a significant reduction in major complications. The lowest rate of major complications was found in the group having these three interventions combined (5.9%). Multivariate analyses did not show independent significant results of any of the perioperative care interventions owing to center-specific combinations. At one year follow-up, half of the patients experienced constipation and this was significantly higher among those with preoperative mechanical bowel preparation. Differences in perioperative care interventions do not seem to impact the incidence of overall complications in a large cohort of European rectovestibular fistula-patients. Mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h, and postoperative nil by mouth showed the least major complications. Independency could not be established owing to center-specific combinations of interventions. Treatment study. III [ABSTRACT FROM AUTHOR]

Ti–6Al–4V parts obtained by selective laser melting typically have an acicular α′ martensitic microstructure whose ductility is low. Thus, post-heat treatments are useful for increasing ductility. In this work, the effects of sub-β- transus heat treatments on the mechanical properties of Ti–6Al–4V parts with porous structures are correlated with martensite α′ phase decomposition. The precipitation of β phase and the gradual transformation of α′ into α phase by the diffusion of excess vanadium from α′ to β phase are proposed to be the main events of martensite α′ phase decomposition in parts fabricated by selective laser melting. The heat treatment performed at 650 °C for 1 h produced no microstructural changes, but the samples treated for at the same temperature 2 h showed a fine precipitation of β phase along the α′ needle boundaries. The heat treatment performed at 800 °C for 1 or 2 h produced a fine α+β microstructure, in which β phase are present as particles fewer in number and larger in size, when compared with the ones present in the sample heat-treated at 650 °C for 2 h. Heat-treatment of the parts at 800 °C for 2 h proved to be the best condition, which improved the ductility of the samples while only slightly reducing their strength. [ABSTRACT FROM AUTHOR]

Background Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. Methods A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). Results A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. Conclusions This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients. [ABSTRACT FROM AUTHOR]

Abstract: Rapid prototyping allows titanium porous parts with mechanical properties close to that of bone tissue to be obtained. In this article, porous parts of the Ti–6Al–4V alloy with three levels of porosity were obtained by selective laser melting with two different energy inputs. Thermal treatments were performed to determine the influence of the microstructure on the mechanical properties. The porous parts were characterized by both optical and scanning electron microscopy. The effective modulus, yield and ultimate compressive strength were determined by compressive tests. The martensitic α′ microstructure was observed in all of the as-processed parts. The struts resulting from the processing conditions investigated were thinner than those defined by CAD models, and consequently, larger pores and a higher experimental porosity were achieved. The use of the high-energy input parameters produced parts with higher oxygen and nitrogen content, their struts that were even thinner and contained a homogeneous porosity distribution. Greater mechanical properties for a given relative density were obtained using the high-energy input parameters. The as-quenched martensitic parts showed yield and ultimate compressive strengths similar to the as-processed parts, and these were greater than those observed for the fully annealed samples that had the lamellar microstructure of the equilibrium α+β phases. The effective modulus was not significantly influenced by the thermal treatments. A comparison between these results and those of porous parts with similar geometry obtained by selective electron beam melting shows that the use of a laser allows parts with higher mechanical properties for a given relative density to be obtained. [Copyright &y& Elsevier]

The article discusses the clinical cases of four patients who developed completely isolated enteric duplication cysts (CIDC). Enteric duplication cysts are rare congenital abnormalities attached to a portion of the gastrointestinal tract and are located on the mesenteric site of the digestive tract. They are diagnosed through computed tomography and magnetic resonance imaging. The cases presented here involve children who were diagnosed with CIDC associated with bowel malformation, such as ileal atresia, Mekel's diverticulum and enteric duplication. The treatment administered to each patient is described, along with their clinical outcomes.