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Acute respiratory tract infections (ARTIs) are the main reason for antibiotic prescription in children. In 2005, the French Drug Agency published guidelines to minimise inappropriate use of antibiotics for ARTI. The purpose of this study was to assess the impact of implementing these guidelines in a paediatric emergency department. We retrospectively analysed data collected prospectively in a French paediatric emergency department from November 2005 (date of guideline implementation) to October 2009. For each child diagnosed with ARTI, we collected age, diagnosis, and prescribed antibiotics. We computed antibiotic prescription rates in the study population. During the study period, 53,055 children were diagnosed with ARTI and 59% of the 22,198 antibiotic prescriptions given at discharge were related to ARTI. The proportion of ARTI patients given antibiotic prescriptions fell from 32.1% during the first year to 21% in year 4 (p<10(-4), Cochran-Armitage test). Amoxicillin-clavulanic acid and amoxicillin accounted for 50% and 34% of antibiotic prescriptions for ARTI, respectively. French antibiotic guidelines led to significant decreases in antibiotic prescription for ARTI in our paediatric emergency department.

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Systematic uncertainties in the crayfish Austropotamobius pallipes are well grounded by the number of species and subspecies described using different approaches, causing scientists to define this taxon as "complex". However, a key task that conservation programmes are facing regarding the recent and drastic decline of European populations, is the coherent systematic classification of this threatened species. Here we present results obtained by coupling mtDNA and genome analysis suggestive of a novel evolutionary framework to explain the relationships among phylogenetic lineages of A. pallipes. The direct sequencing of mtDNA COI gene fragment revealed a strong geographic structure with four distinct haplogroups separated by a range of 5-25 mutations. However, mitochondrial data were not supported by genomic fingerprinting based on 535 AFLP polymorphisms. Nuclear markers showed an unexpected moderate level of genetic differentiation and the absence of any geographic structure. Consequently, this study proposes that the taxonomic hypothesis of a single species of A. pallipes settling the Italian continental waters, is affected by complex evolutionary events. To solve the paradox, we hypothesized an evolutive scenario in which the separation of ancient mtDNA lineages likely occurred before the latest glacial periods. However, the speciation process remained incomplete due to secondary intensive postglacial contacts that forced the mingling of the genomes, and confounds the phylogeographic signature still detectable within mtDNA. Postglacial dispersion and the following demographic events, such as founder effects, drift and bottlenecks, abruptly depleted the local mtDNA variation, and shaped the current genetic population structure of white-clawed crayfish.

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BACKGROUND: The aim of this retrospective study is to verify the progress of the results in 827 patients submitted to videolaparoscopic treatment for cholecysto-choledochus lithiasis during the period >March 1994 - September 2000. METHODS: All the patients had recurring biliary colic, dyspepsia and pain in the upper abdominal quadrants. All clinical forms of cholecystitis were treated. RESULTS: The laparotomic conversions in the case of lithiasis of the gallbladder alone were 8 (0.9%) and 13 (1.5%) as it occured simultaneously with lithiasis of the common bile duct. Mortality was null and morbidity was found in 4 cases, equal to 0.4%. CONCLUSIONS: On the basis of the results obtained cholecystectomy can be implemented on a large scale to include patients of all ages and those in the high risk groups provided that the operating team include expert and skilled surgeons in the laparoscopic method as well as the conventional methods.

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The authors describe their experience with three cases of toxic megacolon: two cases were complications of an ulcerative colitis and died after surgery; one case was a complication of Crohn's disease and recovered after medical resuscitation treatment. Diagnosis was based on clinical features and direct abdominal X-ray showing an evident dilatation of the colon. The authors think that intense medical treatment has to be carried out in all cases without urgent surgical indication: even if not always successful, a medical therapy will be an appropriate preparation for operation. The authors believe that the operation of choice is colectomy with ileo-rectal anastomosis plus upstream protective ileostomy or right terminal ileostomy plus left iliac sigmoidostomy with subsequent reconstruction of continuity.

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Acute necrotizing pancreatitis has been obtained in rats after experimental portal hypertension. On the onset has been observed lobular necrosis of the pancreas, then cytosteatonecrosis followed by fibrosis and, at the end, by glandular regeneration.

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In course of experimental pre-hepatic portal hypertension in the rat, the most important histological alterations in the spleen, are represented by pooling of blood in the red pulp, activation of the macrophagic system, with hyperplasia of the histiocytes, increase of reticular fibers and of subcapsular myo-fibroblasts, and finally by evolution towards a diffuse fibrosis all over the parenchyma.

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In a review of 70 cases of extra-hepatic cholestasis of different origin, the great diagnostic value of imaging techniques, echography and computed tomography, was demonstrated in distinguishing the type of jaundice, and in defining the cause and site of obstruction.

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The authors discuss a case of pneumomediastinum observed in the course of acute bronchitis and after an operation performed with general anesthesia and orotracheal intubation.

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An experimental model of acute pulmonary edema was obtained in the rat, with over-infusion of normal saline and of plasma: histology demonstrated essential differences between edema from crystalloids, developed in the interstitial space, and that from colloids, affecting the alveoli.

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An experimental model of pulmonary hypertension was obtained in the dog implanting the left main pulmonary artery in the descending thoracic aorta. The main histological lesions consisted in an increased muscularity of the pulmonary artery itself and of its lobar branches.

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The authors report a surgical technique for high approach to the common femoral artery, just below the inguinal ligament, which can be useful in cases of difficult dissection of the femoral region or those with diffuse fibrosis or multiple scars. It is also useful when there is a concomitant inguinal hernia to repair.

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The authors describe two cases of pseudomyxoma peritonei, one of which with a lengthy clinical course and the other with a rapidly fatal outcome. The clinical picture in pseudomyxoma peritonei is associated with a variety of benign or malignant mucus-secreting tumours, mainly originating in the appendix or ovaries. Survival is generally long owing to the lack of visceral invasion or metastases. An accurate prognostic assessment can only be achieved on the basis of identification of the primary tumours and its degree of malignancy.

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In course of acute bacterial peritonitis in rats, the authors observed an active role of the macrophages of the spleen, well explaining the important defensive function of this organ against infection.

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The authors report a case of a ruptured right subphrenic abscess causing a diffuse peritonitis complicating a chronic empyema. The authors recommend active treatment of purulent pleurisies, particularly when they are associated with a bronchopleural fistula.

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During acute experimental peritonitis in the rat, the main histological lesions in the liver are represented by venous stasis in the central lobular vein and in the sinusoids; by glycogen mobilization and intracytoplasmic accumulation of triglycerides in the hepatocytes; by activation and hypertrophy of Kupffer's cells.

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The authors report a rare case of abscess developed in a solitary renal cyst and observed just after the resolution of a bronchopneumonia. The modern imaging techniques, sonography and computed tomography, permitted an exact diagnosis, and subsequent surgical treatment brought to a complete recovery.

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