46 research outputs found
Pediatric kidney transplantation: is it safe to perform during night-time or day-off?
Purpose: To investigate the impact of after-hours surgery on the outcomes of pediatric kidney transplantation (KT). Methods: Medical records of pediatric KTs performed at a single institution between 2013 and 2021 were retrospectively reviewed. The population was split into three groups according to the incision time and calendar: ordinary day (8.00 AM – 6.30 PM), day-off, and night-time (6.30 PM – 8.00 AM). The following endpoints were compared: ischemia times, length of surgery, complications, delayed graft function (DGF), primary graft non-function (PGNF), and eGFR at three-month follow-up. Results: Ninety-six non-living donor KTs were performed, median age 11 (IQR 4.3–14) years and median body weight 26 (IQR 13–50) kg. Forty-one (43%) were performed during night-time and 28 (29%) during day-off. Ischemia times were similar (p = 0.769, p = 0.536). Day-off KTs presented an extended length of surgery (p = 0.011). Thirty-two complications were reported in 31 KTs. No difference in the overall rate of complications, DGF, PNGF, and three-month eGFR was found (p = 0.669, p = 0.383, p = 0.949, p = 0.093). Post-operative bleedings were more common in days-off (p = 0.003). Conclusion: The number of pediatric KTs performed during after-hours was considerable. Even though similar outcomes were reported, more caution should be focused on the KTs performed in days-off to avoid severe complications
Percutaneous Trans-Thoracic Procedures in Children With Tumors of Thoracic Wall, Mediastinum and Lung. The Experience of a Single Institution
Background
While percutaneous trans-thoracic procedures (PTTP) are commonly performed in adults with
tumors of thoracic wall, mediastinum and lung, the experience is limited in children, in whom
however less invasive methods should be the choice for the diagnosis or the identification of
small pulmonary nodules that need to be removed, sparing lung tissue. The results of the PTTP
performed by the interventional radiologists in our Pediatric Surgery Department are analyzed.
Methods
CT-guided biopsies, utilizing a 64-slice CTscanner, with low-radiation dose, were performed
applying the coaxial technique with 16-18G needles with a single tissue path. For localization
of lung nodules before surgery, two 20G-hook wires were positioned beyond the nodule. CT
images after each manipulation of the needles were obtained. US-guided biopsies were
performed either with or without coaxial technique through a needle bracket. Younger patients
required sedation. All patients underwent a chest radiogram two hours after the procedure and
remained under observation for 24 hours.
Results
From January 2015 to March 2019, 23 procedures were performed in 22 patients (Age:16M-
19Y): 6 patients underwent CT-guided biopsy (4 lung nodules, 2 mediastinal mass); 3
underwent 4 CT-guided hook-wire localization of pulmonary nodules, just before surgery; 13
underwent US-guided biopsy (posterior mediastinum 2; anterior mediastinum 5,
thoracic/intrathoracic mass 5). Adequate core biopsies were obtained in all patients, except
three, who underwent thoracoscopy/thoracotomy. The hook-wires were successfully
positioned in all cases, as confirmed by histology. After the procedure, two patients presented
perilesional hemorrhage and one pneumothorax, but they did not required treatment.
Conclusion
PTTP were successful in most patients, without significant complications. These techniques
should be encouraged to avoid diagnostic aggressive surgical approaches in children with
cancer. For all cases a multidisciplinary team is essential to discuss the indications and planning
the procedures
Anatomy of the thorax
Typing \u201canatomy\u201d or \u201cinteractive anatomy\u201d into the search-window of any web browser elicits information on hundreds of potentially useful websites. Most are very helpful in learning what is needed to pass an examination or to prepare a surgical intervention accurately. However, accurate anatomical descriptions for any one approaching thoracic pediatric surgery are needed, and which are the basis of this chapter
Fimosi
In questa pubblicazione, indirizzata alla consultazione del pediatra \ue8 raccolta l'esperienza maturata nella gestione dei pazienti con fimosi. La fimosi \ue8 una patologia conosciuta da diverse migliaia di anni che presenta un\u2019elevata incidenza nella popolazione pediatrica. La gestione dei pazienti con fimosi \ue8 oggetto di discussione, per quanto riguarda l\u2019indicazione terapeutica (timing, finalit\ue0 e tipo di trattamento), per le ripercussioni psicologiche nell\u2019eventualit\ue0 di intervento chirurgico, per la definizione della patologia e per i preconcetti culturali esistenti nella nostra societ\ue0 riguardo le implicazioni psicologiche legate alla circoncisione, pratica molto diffusa nel mondo occidentale (la maggior parte della popolazione maschile negli Stati Uniti \ue8 circoncisa) che, diversamente da quanto si pensa non compromette la funzionalit\ue0 sessuale futura
Metachronous Bilateral Ovarian Teratoma: A Germ-line Familial Disorder andReview of Surgical Management Options
Background: Germ cell tumors in females are uncommon, and bilateral metachronous ovarian teratoma is even exceptional, with sporadic cases described in the literature. Case: We report on a girl in whom a metachronous ovarian teratoma occurred 6 years after the first. The simultaneous onset of germ-line anomalies in other members of the family supports the existence of genetic or environmental factors conferring susceptibility to germ cell lesions. Summary and conclusion: The case here illustrated reminds the issue of the appropriate follow-up of these patients and of their families
Congenital pouch colon: Case series and review of evidences for resection
Background: Congenital pouch colon (CPC) is a rare variant of anorectal malformations (ARM) with its highest reported incidence in India. We aimed to describe five patients affected by CPC, in which the tissue from the terminal dilated colon has been successfully used and to discuss our results on the light of an extended revision of the literature. Materials and Methods: The clinical details of five cases treated for CPC in two Italian Centers were retrospectively reviewed assessing the fate of the terminal dilated colon. Results: In all cases, the tissue from dilated colon has been used. The double vascular system of the dilated pouch allowed increasing bladder capacity (case 4), reconstruction of the vagina (case 3, 5), and lengthening of the colon (case 1, 2, 5). In our series, 3/5 have a good bowel control with daily bowel management after ARM correction. In literature, there are not differences in terms of dependence from bowel management in patients with pouch resected and in patients with pouch saved (P = 0.16). Conclusions: We acknowledge that the analysis of the available literature is limited by the absence of studies with high level of evidence and the removal or the preservation of the abnormal colon tissue seems to follow the surgeon preferences
Management of Congenital Urethral Strictures In Infants. Case Series
Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants