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Nowadays, drug-induced sleep endoscopy (DISE) is performed widely and its validity and reliability has been demonstrated by several studies; in fact, it provides clinical information not available by routine clinical inspection alone. Its safety and utility are promising, but still needs to be improved to reach the level of excellence expected of gold standard tests used in clinical practice. Our study compares the results of clinical and diagnostic evaluation with those of sleep endoscopy, evaluating the correlation between clinical indexes of routine clinical diagnosis and sites of obstruction in terms of number of sites involved, entity of obstruction and pattern of closure. This study consists in a longitudinal prospective evaluation of 138 patients who successfully underwent sleep endoscopy at our institution. Patients were induced to sleep with a low dose of midazolam followed by titration with propofol. Sedation level was monitored using bispectral index monitoring. Our results suggest that the multilevel complete collapse was statistically significantly associated with higher apnoea hypopnea index values. By including partial sites of obstruction greater than 50%, our results also suggest that multilevel collapse remains statistically and significantly associated with higher apnoea hypopnoea index values. Analyzing BMI distribution based on number of sites with complete and partial obstruction there was no significant difference. Finally, analyzing Epworth Sleepiness Score distribution based on number of sites with complete obstruction, there was a statistically significant difference between patients with 3-4 sites of obstruction compared to those with two sites or uni-level obstruction. In conclusion, our data suggest that DISE is safe, easy to perform, valid and reliable, as previously reported. Furthermore, we found a good correlation between DISE findings and clinical characteristics such as AHI and EPS. Consequently, adequate assessment by DISE of all sites of obstruction is very important, not only in patients with low-moderate AHI and EPS, but also in patients with a high AHI or/and high EPS, in particular to plan multilevel surgery that in these latter situations is more demanding since success may be harder to achieve.Attualmente, la sleep endoscopy indotta per via farmacologica (DISE) è ampiamente eseguita e la validità ed affidabilità di tale metodica sono state dimostrate in numerosi studi. La sua sicurezza e utilità sono promettenti, tuttavia, tale esame necessita di essere migliorato per raggiungere il livello di eccellenza tipico di un test gold standard utilizzato nella pratica clinica. Obiettivo del nostro studio è stato paragonare i risultati della valutazione clinica e diagnostica tradizionale con quelli della sleep endoscopy, mettendo a confronto i parametri clinici con i siti di ostruzione, ed in particolare prendendo in considerazione il numero di siti implicati, il livello di ostruzione e il pattern di chiusura. In questo studio abbiamo effettuato una valutazione prospettica longitudinale di 138 pazienti che sono stati sottoposti a sleep endoscopy con induzione farmacologica del sonno presso la nostra clinica. Ai pazienti è stato indotto il sonno mediante un basso dosaggio di propofol seguito da una somministrazione di boli progressivi. La profondità della sedazione è stata monitorata mediante il monitoraggio BIS. Sulla base dei risultati ottenuti è stato possibile stabilire che l'ostruzione completa multilivello si associa in modo statisticamente significativo ad un indice più elevato di apnea/ipopnea (AHI). Includendo nell'analisi anche i siti di ostruzione parziale con chiusuradel 50% abbiamo potuto dimostrare che l'associazione fra il collasso multilivello ed un valore di indice apnea/ipopnea più elevato rimane statisticamente significativa. Per quanto riguarda il BMI invece non sono state riscontrate correlazioni significative con il numero di siti di ostruzione completi o parziali. Infine, analizzando la scala della sonnolenza di Epworth e correlandola con il numero di siti con ostruzione completa abbiamo trovato una differenza statisticamente significativa tra i paziente con 3-4 siti di ostruzione rispetto ai pazienti con 2 o 1 livello di ostruzione. In conclusione, i nostri dati suggeriscono che la sleep endoscopy indotta per via farmacologica (DISE) costituisce una procedura sicura, di facile esecuzione, valida ed affidabile, come già descritto in altri studi. Inoltre abbiamo dimostrato una buona correlazione e coerenza tra i risultati della sleep endoscopy e gli indici di AHI e di Epworth. Concludendo riteniamo che un'adeguata valutazione dei siti di ostruzione mediante sleep endoscopy sia molto importante non solo nei pazienti con AHI ed indice di Epworth lieve/moderato, ma anche in quelli con AHI e/o indice di Epworth elevati, soprattutto nella pianificazione di una chirurgia multilivello che in questi casi è più impegnativa con un indice di successo più difficile da raggiungere.

Volvulus is a very rare condition which consists of the rotation of the small intestine and the proximal colon around the superior mesenteric artery, leading to complete intestinal obstruction and ischemic vascular damage. The frequency of this condition is 1 in 6000 live births. We report a case of midgut vovulus with malrotation with a prenatal diagnosis at the end of the week 33. We describe the importance of prenatal echotomographic diagnosis which offers the possibility of performing differential diagnosis. Additionally, it is important to remember that the prognoses of these patients depend on the length of remaining intestine, the location of the intestinal obstruction, the presence of meconium peritonitis, the possibility of associated malformations, but above all, on birth weight and level of prematurity.

Laparoscopic surgical procedures, employed even in the paediatric age, bearing both diagnostic and therapeutic value, are currently used in the evaluation of peritoneal-vaginal duct patency during surgery for controlateral inguinal hernia or other diseases requiring opening of abdominal wall.From January 1996 to December 2000, at the Department of Pediatric Surgery of the University of Siena a prospective study protocol has been performed to evaluate the effectiveness of laparoscopy versus traditional surgery in showing patency of peritoneal-vaginal duct.From our study we have been able to see how this laparoscopic procedure is well tolerated by children and parents, and is lacking in clinical complications. Patency of peritoneal-vaginal duct has been pointed out in 21.73% of cases. This result is in line with the international literature; in fact, the majority of authors have found a negative controlateral exploration in 50-80% of patients examined, thus confirming the uselessness of routine surgical controlateral inguinal exploration in hernia cases.The use of diagnostic laparoscopy in the study of peritoneal duct patency is a rapid and relatively easy technique, practically without intra- and peri operative risks. It allows an easy solution of the diagnostic doubt, without the need to necessarily perform a traditional explorative surgical procedure.

Various percentage incidences (36-75%) of the duct system morphologic alterations in cryptorchidism syndrome have been reported in the literature. Etiopathogenic factors, responsible for this syndrome, are yet to be specified, as is their correlation with testicular descent in the scrotum and peritoneal-vaginal duct regression.In a prospective multicentric study we have documented seminal duct anatomy in 566 children, undergoing inguinal or scrotal surgical exploration due to acute scrotal syndrome (group A, "control group"), cryptorchidism (group B), and peritoneal-vaginal duct patency syndromes (group C), for a total of 726 testicles. On the basis of anatomical configurations, explored testicles have been subdivided into three groups: normal testicles (type I), suspension anomalies (type II), obstruction anomalies (type III). Prevalence of the above anatomical configurations in the various groups has been statistically evaluated by the chi 2 test.Results have highlighted a significant prevalence (por = 0.01) of severe duct system obstructive anomalies (type III) in children with cryptorchidism (group B) and in children with vaginal duct patency (group C). These results can justify the hypothesis of a close correlation between testicle embryologic migration process in the scrotal sac and seminal duct development; this latter seems furthermore correlated with peritoneal duct regression.The drawn conclusion is that duct system morphologic alterations in cryptorchidism, due to their seriousness and incidence, can condition final fertility capability.