Inflammatory pseudotumors of the lung in children: conservative or aggressive approach?

BACKGROUND: Inflammatory pseudotumors (inflammatory myofibroblastic tumors) of the lung are myofibroblastic lesions of controversial nosology. The concept that these are benign lesions has been recently questioned given their capacity for local invasion and recurrence. PROCEDURE AND RESULTS: We observed five children with inflammatory pseudotumors of the lung in whom the tumor was resected using the most limited excision possible. Unusually, in all five cases the tumor was localized in the right upper lobe: Three were parenchymal, and the others involved the bronchus. The three parenchymal masses underwent wedge resection, whereas the two bronchial lesions required ex-cision followed by a bronchoplasty and an up-per lobectomy, respectively. In all, the pathology showed a complete resection, and the patients had uneventful recoveries. Follow-ups, including CT and bronchoscopies, ranged from 4 to 8 years (mean of 6.4 years) with no signs of recurrence. CONCLUSIONS: Our limited experience supports the idea that excisional surgery is the treatment of choice for inflammatory pseudotumors of the lung. Such excisions, both diagnostic and curative, carry minimal risks and avoid unnecessary mutilation. Closely monitored follow-up is mandatory, as the natural history of this lesion is not yet well understood

Effectiveness and sustainability of an antimicrobial stewardship program for perioperative prophylaxis in pediatric surgery

Background\u2014Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim\u2014The aim of this study is to determine the effectiveness and long\u2010term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods\u2014We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women\u2019s and Children\u2019s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results\u20141771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post\u2010intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion\u2014The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP

Minimally invasive treatment of ventral incisional hernias: case series and technical notes.

An experience in laparoscopic prosthesic repair (LPR) of ventral incisional hernias (VIH) is reported,with 41% of cases treated using two ports. Aim of the present paper is to point out some technical aspects of the procedure.Methods.Between March 2006 and July 2011, 132 patients underwent VIH LPR.Mean age was 65.1 years (range 27-93);mean ASA score was 2.1;mean BMI was 30.2 (range 21-38);M/F ratio was 50/82.Different types of mesh have been used. Two trocars were used in 54 patients (41%),three in 74 (56%) and 4 in 4 (3%).Follow-up for complications and hernia recurrence was performed postoperatively.Results. Mean defect area was 148.75 cm2 (range 38-250 cm2);mean mesh area was 413 cm2 (range 100-750).Mean operative time was 76.1 minutes (range 20-150). Two trocars were used in 54 patients (41%),three in 74 (56%) and 4 in 4 (3%). In 7 patients (5.3%) a strangulated hernia was present,a recurrent hernia in 9 (6.8%)Mean hospital stay was 4.1 days (range 2-18).Conversion rate was 1.5% (2 patients).Complications occurred as follows:seroma in 4 patients (3%);prolonged ileus in 1 patient (0.75%);serious abdominal wall pain in 2 patients (1.5%); small bowel obstruction in 1 case (0.75%).One patient (0.75%) died within 30 days because of systemic sepsis [mortality (0.75%);reoperation rate (0.75%)].The number of trocars used did not affect morbidity. Recurrence rate was 2.3% (3 patients).Conclusions.VIH LPR is feasible and safe, with low recurrence and complication rates even with a “two-port” technique. As far as we are concerned, we report the largest subset of patients undergone VIH LPR using a two-port technique.Further studies need to be performed to establish its real impact on surgical practice

Impact of COVID-19 pandemic on pediatric endoscopy: A multicenter study on behalf of the SIGENP Endoscopy Working Group

Background: Aim of the present report was to investigate the repercussions of COVID-19 pandemic on the procedural volumes and on the main indications of pediatric digestive endoscopy in Italy. Methods: An online survey was distributed at the beginning of December 2020 to Italian digestive endoscopy centers. Data were collected comparing two selected time intervals: the first from 1st of February 2019 to 30th June 2019 and the second from 1st February 2020 to 30th June 2020. Results: Responses to the survey came from 24 pediatric endoscopy Units. Globally, a reduction of 37.2% was observed between 2019 and 2020 periods with a significant decrease in median number of procedures (111 vs 57, p &lt; 0.001). Both the median number of procedures performed for new diagnoses and those for follow-up purposes significantly decreased in 2020 (63 vs 36, p &lt; 0.001 and 42 vs 21, p&lt; 0.001, respectively). We reported a drastic reduction of procedures performed for suspected Celiac Disease and Functional Gastrointestinal Disorders (55.1% and 58.0%, respectively). Diagnostic endoscopies for suspected IBD decreased of 15.5%, whereas procedures for Mucosal Healing (MH) assessment reduced of 48.3%. Conclusions: Our study provides real-world data outlining the meaningful impact of COVID-19 on pediatric endoscopy practice in Italy

Effect of interferon-α on progression of cirrhosis to hepatocellular carcinoma: A retrospective cohort study

Background. There is debate about whether interferon-α treatment lowers the risk of progression to hepatocellular carcinoma in patients with chronic viral hepatitis and cirrhosis and whether any effect is limited to certain subgroups. We investigated these issues by retrospective analysis of data for 913 patients from Italy and Argentina. Methods. 21 centres reported patients from their records who had chronic viral hepatitis and Child's A cirrhosis, were positive for HBsAg or hepatitis-C-virus antibodies (anti-HCV), and had been screened yearly for at least 3 years by ultrasonography and α-1-fetoprotein testing. Prognostic risk factors for hepatocellular carcinoma defined by multivariate Cox regression analysis and individual observation time were used for group matching and conditional logistic regression analysis of the independent interferon-α treatment effect. Findings. After group matching, the number of patients was reduced to 637. Age, male sex, and portal hypertension were significant risk factors for hepatocellular carcinoma (each p &lt; 0.001); hepatic inflammation (p = 0.21) and iron storage (p = 0.18) were also included in the model. 66 (19%) of 356 untreated patients and 29 (10%) of 281 treated patients developed hepatocellular carcinoma (relative risk 1.99 [95% CI 1.09-3.64]); the corresponding proportions for anti-HCV-positive patients were 48 (18.5%) of 259 versus 21 (9.1%) of 232 (3.14 [1.46-6. 80]), and those for hepatitis-B-virus-infected (HBV) patients were 18 (10%) of 97 and eight (16%) of 49 (0.98 [0.33-2.92]). Among anti-HCV patients without HBV markers, 29 (20%) of 129 untreated and six (5%) of 116 treated patients developed hepatocellular carcinoma (6.28 [1.65-2.38]). Interpretation. Interferon treatment lowered the rate of progression to hepatocellular carcinoma two fold. The risk reduction was apparently greater for patients with chronic hepatitis C and no evidence of HBV infection. Future studies should stratify HCV-infected patients by HBV status