Search

In reporting 11 cases of Spigelian hernia observed, the Authors describe pathological findings of this rare disease. Aetiopathogenesis as well as indication for surgery and surgical technique are stressed.

"Acute scrotum" in infants and children is generally due to testicular torsion, torsion of the appendix of testis or acute orchiepididymitis. However they are other less frequent causes of "acute scrotum". The differential diagnosis is often very difficult. 265 consecutive cases of acute scrotum are reviewed. 47% of the all patients presented torsion of the appendix of testis, 26% torsion of testis and 26% acute orchiepididymitis. The torsion of testis was most frequent in children under 1 year (67%), in the older patients the torsion of appendix of testis was most frequent (46% in patients 1-6 years old, 57% in patients over 6 years). The value and limit of ultrasound, scrotal scintigraphy and doppler ultrasound are discussed and an algorithm for the diagnosis of causes of acute scrotum is presented. In equivocal cases, early surgical exploration may be necessary to exclude torsion of testis and to prevent testicular loss.

"Acute scrotum" in infants and children is generally due to testicular torsion, torsion of the appendix of testis or acute orchi-epididymitis. However they are other less frequent causes of "acute scrotum". The differential diagnosis is often very difficult. 265 consecutive cases of acute scrotum are reviewed. 47% of the all patients presented torsion of the appendix of testis, 26% torsion of testis and 26% acute orchi-epididymitis. The torsion of testis was most frequent in children under 1 year (67%), in the older patients the torsion of appendix of testis was most frequent (46% in patients 1-6 years old, 57% in patients over 6 years). The value and limit of ultrasound, scrotal scintigraphy and doppler ultrasound are discussed and an algorithm for the diagnosis of causes of acute scrotum is presented. In equivocal cases, early surgical exploration may be necessary to exsclude torsion of testis and to prevent testicular loss.

The authors report their anesthesiological experience in 88 cases of transluminal balloon dilatation of esophageal strictures in children. The most serious problems are caused by the need to repeat the dilatation process (up to a maximum of 24 times in one patient) and to the risk of extrinsic mechanical compression of the trachea with consequent transient anoxia. Good sedation was achieved using premedication with haloperidol and diazepam, but was not sufficient to avoid the child's anxiety on entering the operating theatre. Anesthesia using ketamine plus fentanyl, combined with tracheal intubation gave good results in almost all cases, but marked bradycardia was observed in several patients during balloon dilatation. In conclusion, although the technique itself is simple to perform, very careful anesthesia is required to avoid the risk of serious intraoperative complications.

The Authors report their experience in the treatment of 86 patients, in pediatric age, with Hirschsprung's disease: 40 with congenital rectosigmoid or subtotal megacolon, 8 with total colic or ileocolic aganglionosis and 38 with ultrashort aganglionic segment. Out of the patients 29% had necrotizing enterocolitis with 40% mortality rate in rectosigmoid or subtotal forms and with 75% mortality rate in total colic or ileocolic forms. In the last group the mortality was higher related also to difficulties and complications of surgical treatment. Necrotizing enterocolitis is the major cause of death in infants with Hirschsprung's disease. Early diagnosis and treatment can reduce the mortality rate.

Hydronephrosis in infancy and childhood is a frequent urinary malformation and is almost always congenital. In over 80% of the cases it is due to ureteropelvic junction obstruction; much less frequently it is due to anomalous renal vessels, sometimes associated to ureteropelvic junction obstruction. In this paper the Authors analyze their experience in the surgical treatment of this urinary malformation. 234 hydronephrosis out of 222 patients were operated on from January 1972 to June 1985. 61 hydronephrosis were operated on in 55 infants under 1 year. Primary nephrectomy was carried out only in 9 of the 234 hydronephrosis operated on (3.9%) and in 3 of the 61 hydronephrosis operated on in infants less than 1 year old (4.9%). All the 55 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants for a total of 30 hydronephrosis had a glomerular filtration rate determination during sequential scan for individual kidney function assessment. 90% of the kidneys operated on showed a normal or slightly reduced glomerular filtration rate. Recent advances in prenatal echographic diagnosis and relationship between obstructive uropathy, renal development and pulmonary hypoplasia are discussed. The Authors stress out the importance of early diagnosis to improve surgical results.

We believe this to be the third reported case of an unusual congenital sacral tumor-like lesion characterized histologically by the presence of dysplastic and immature renal-like tissue with a predominant glomerular and tubular structure. This lesion appears important in the differential diagnosis of extrarenal nephroblastoma, and should be regarded as a dysplastic overgrowth. An origin from mesonephric or metanephric remnants is suggested.

Authors describe importance of anatomical and functional factors in ethiopatogenesis of G.E.R., diagnostic iter and methods. Importance of 24-hour computerized pH-metry in pediatric age is particularly stressed out. Medical and surgical therapeutic procedures are emphasized.

Rebleeding, the long time high occurrence of encephalopathy and the impairment of hepatic function in the successful cases have led to increasing dissatisfaction in the last years with portasystemic shunt procedures. In the past 12 years we have operated on 14 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization); in two cases the entire procedure was performed through the thoracic approach. We had no mortality. Complications include bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Patient follow-up has been between 16 months and 11 1/2 years with an average of 6 1/2 years. The long term controls have been gratifying in 12 patients with disappearance of the varices and no evidence of rebleeding, esophageal strictures, gastroesophageal reflux, encephalopathy or impairment of the hepatic function; in two other patients the operations was unsuccessful. In our opinion the Sugiura procedure should be the elected operation in the surgical treatment of esophageal varices bleeding in pediatric age, after an attempt with sclerotherapy.

It is well known that closure of the cardia is incomplete in about 25-30% of all infants; the GER is a direct consequence. Roughly two-thirds of these infants do not show symptoms and only one-third become symptomatic. The symptoms are mild in about 75% of the symptomatic children; no treatment or medical treatment by pediatrician is required. In the remaining 25% the symptoms are moderate or severe and the clinical treatment is necessary. About the 85% of these children are cured with conservative treatment and only 15% of this small remaining group require surgery. In the paper the diagnostic problems and indications for surgery are considered. The Authors report the results of 66 children operated on for GER without (44 children) and with (22 children) hiatus hernia. The operative technique was gastropexy according to Boerema plus retroesophageal hiatopexy in the cases of important hiatus hernia. At the follow-up 61 children (92.5%) were completely asymptomatic and three showed mild symptoms without pathological radiological findings. Clinical and radiological recurrences occurred in two patients (4.5%) with severe brain damage. Two children were reoperated on postoperatively for an ileus due to adhesion. The mortality rate has been zero. In the author's opinion, the Boerema procedure is a simple, physiologic and fast technique, associated with very few complications and no mortality rate and should be considered the elective method in the surgical treatment of GER and hiatal hernia in pediatric patients.

Treatment of esophageal strictures is discussed. Authors describe technique and results of transluminal balloon dilatation in nine cases of esophageal stenosis.

Ureterocele is an unfrequent urinary malformation in pediatric age, but frequently it is clinically severe. Ureterocele in a double pyelo-ureteral system often presents very difficult treatment problems not uniformely dealt with. Authors report their experience with 66 ureteroceles observed in 60 children; more than a half of which were less than one year old. In the authors experience simple ureterocele does'nt give any surgical problem. On the contrary ectopic ureterocele, almost always associated with a pyeloureteral duplication, frequently gives some problems of surgical treatment. Treatment is always individualized but in our experience the best results have been achieved with unroofing of the ureterocele and upper heminephoureterectomy in one stage. This treatment can be used successfully in the majority of ectopic ureteroceles in pediatric age.

The Authors analyze the diagnostic contributions of echography and computer-assisted tomography in the diagnosis of duodenal hematoma in pediatric age.

The authors analyze the radiological aspects and the staging problems of the retroperitoneal lymphangioma, a rare neoplasma of infancy. Echography and computer-assisted tomography contributions are particularly emphasized.

Studied for measuring the peroxidase activity from thyroid gland have usually been achieved on the basis of the H2O2 oxidation of I- to I3- catalyzed by peroxidase. The activity assay has been found to depend on several factors such as the relative order of reagent addition, protein content of the enzyme preparation, presence of detergent and the pH of the reaction medium. At below 7.0 pH, the contribution of the non-enzymic transformation of I- to total activity became quite significant, to the extent that at below 6.5 pH, the chemical reaction predominates over the enzymic one. At values above 7.0 pH, a very rapid decomposition of the product was observed. Guaiacol oxidation has been considered to be a more reliable method than the iodide one, especially when the substrate concentration and temperature vary, and when the activity of relatively rich in protein samples, as well as of some other substances that might interfere with the I3- formation, are going to be measured.

Traditionally 3 mechanisms are responsible for the development of renal damage when primary vesico-renal reflux is present: reflux is a manifestation of abnormal embryological development of the ureteral bud, with subsequent dysplasia; sterile reflux damages the kidney, perhaps trough a mechanical or/and an immunological mechanism; renal damage occurs as a result of the reflux of infected urine into susceptible renal papilla (intrarenal reflux). Whatever the mechanism, it is apparent that reflux and renal damage are intimately related. It does appear that for the most part damage is done at an early age. Operative repair of vesico-renal reflux has been advocated as a reliable method to stop reflux, with attendant cessation of renal damage and improvement in renal function. However some recent prospective study found that the rate of continued renal scarring is independent of medical or surgical therapy. The aim of the present paper is to study the functional and radiological long-term results after successful antireflux surgery (mean follow-up 6 years 4/12). 90 patients for a total of 140 refluxing ureters were studied for assessment of urinary infection, blood pressure and renal function. 40 patients for a total of 62 refluxing ureters were evaluated for determination of renal parameters evolution. At follow-up from 3 to 14 years (mean 6 4/12 years), less than 10% of the patients showed pathological bacteriuria generally without episodes of acute pyelonephritis. Hypertension was present in 4 (4.4%) out of 90 patients, aged from 14 to 18 years. There was a significant improvement in renal function after operation, especially in infants operated on in the first two years of life. The postoperative radiological study showed a growing of affected kidneys in about 89%. In almost 47%, the affected kidneys showed an increased growth. Only about the 5% of the kidneys showed a decreased development with a final evolution toward a small pyelonephritic kidney. The best results were obtained in patients operated on very early in the life. Our greatest challenge is to prevent the early destruction of nephrons. This means an early diagnosis of urinary tract infection and detection of vesico-renal reflux with an early treatment. The administration of prophylactic antibiotics and, when indicated, an early surgical treatment can minimize, in our opinion, the magnitude of renal damage for the most part of patients.

We report an unusual case of right adrenal hemorrhage in which none of the clinical or familiar factors commonly associated with this situation were present. Diagnosis was made after sudden macroscopic hematuria, and was based on clinical and radiologic findings alone. The normal course of adrenal hemorrhage is also discussed.