Simplified video-assisted one-trocar diverting colostomy in pediatric patients

Background: In pediatric age colostomy is mainly temporary and totally diverting, the major indication being neonatal anorectal malformation for which a specific double separated stoma route has been widely popularized. Out of newborn age the reasons for colon diversion in children are less common and the procedures are quite similar to the techniques employed in adults. Laparoscopy for pediatric colostomy has a short history and the original recommended procedure for newborns has been achieved only very recently with a two-trocars technique. Methods: We describe an original one-trocar method to create a double or single totally diverting colostomy avoiding any other abdominal wound at risk for complications. The procedure has been performed on newborns with anorectal malformations as well as on a teenager through minor technical variants. Results: This one-trocar method allowed a quick and safe totally diverting colostomy in every treated patient. There was no complication during surgery and no skin infection in the whole postoperative period; at the end of treatment scars were minimal. Conclusions: This technique is suitable for the specific neonatal double separated colostomy and virtually for every indication of fecal stream diversion in any kind of patient

Correction of congenital chordee penis by "Ventral separation and outward rotation of corpora"

Background/Purpose: The formation of congenital chordee penis in patients with or without hypospadias is multifactorial and not completely clear. In most cases, after release of all known causes of chordee, “residual” penile curvature can persist. The authors discuss the etiopathogenetic mechanisms of congenital chordee penis and describe their experience in surgical correction of “residual” penile curvature by “ventral separation and outward rotation of corpora.” Methods: In 22 patients with congenital chordee penis with or without hypospadias, “residual” penile curvature was corrected by “ventral separation and outward rotation of corpora.” Results: Ventral separation and outward rotation of corpora resulted in satisfactory correction of penile curvature. In only 2 cases of chordee penis without hypospadias was further intervention necessary: a Nesbit’s plication was carried out in one and a neourethra placed in the other. At follow-up no residual penile curvature was observed. Conclusions: An arrest of development of the penis caused by failure of outward ventral rotation of the corpora, may contribute to the formation of chordee penis. When “residual” penile curvature persists, “ventral separation and outward rotation of corpora” can be used to correct this complex malformation.</br

Genetic polymorphisms of vitamin D receptor and calcium sensing receptor gene in uremic secondary hyperparathyroidism: a multicentric italian study

The pathophysiology of hyperparathyroidism (HPT) relates to the loss of normal feedback control of parathyroid hormone secretion by extracellular calcium. Why the parathyroid cell loses its normal sensivity to calcium is unknown. Consistent with the essential role of vitamin D in parathyroid cell regulation, restriction fragment length polymorphisms (RFLPs) at the vitamin D receptor (VDR) gene locus have been recently postulated to be responsible for differential VDR transcription and/or mRNA stability, contributing to the parathyroid tumorigenesis. Particularly, common VDR allelic variants have been related to differences in the incidence of both primary and secondary HPT, and in serum PTH levels as well as in calcium regulation of PTH release. However, agreement on these relationships is not universal among different populations. In this study we investigated the role of VDR and calcium sensing receptor (CaSR) gene RFLPs in 100 uremic secondary HPT patients (mean age 58.2±6.7 yrs; mean dialytic age 7.1±2.0 yrs) compared to 200 age and sex matched controls. Apa I, Bsm I, and Taq I RFLPs at the 3'-end of VDR gene locus as well as Fok I RFLP at the translation initiation codon of the VDR gene were determined after PCR amplification and indicated respectively as A-a, B-b, T-t, and F-f, uppercase letter signifying the absence and lowercase letter the presence of the restriction site. The 3 polymorphisms in exon 7 of the CaSR gene (T/G at codon 986, A/G at codon 990, and G/C at codon 1011) were evaluated by PCR amplification and direct sequencing. Chi squared analysis revealed no significant difference in the distribution of any of the VDR or CaSR genotypes in subjects with secondary HPT compared to controls. Secondary HPT patients were divided into two major groups according to serum PTH levels: group 1 with higher PTH levels, requiring parathyroidectomy, and group 2 with serum PTH levels below 120 pg/ml. Interestingly, a trend for a higher prevalence of VDR genotype aabbTT in group 1, with respect to group 2 was observed (P=0.07; Chi-squared test). Taken together, these results suggest that VDR and CaSR gene RFLPs are not directly involved in parathyroid tumorigenesis and in determining the incidence of secondary HPT. However, VDR gene RFLPs might be useful in predicting the progression of secondary HPT as well as the severity of the diseas

Management of cholelithiasis in Italian children: A national multicenter study

AIM: To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition

Cryptorchidism with short spermatic vessels: staged orchiopexy preserving spermatic vessels

Purpose. Patients with cryptorchidism can have such short spermatic vessels that it is impossible to place the testicle in a satisfactory scrotal position using conventional orchiopexy. In these cases the most commonly used operation is 1 to 2-stage Fowler-Stephens orchiopexy. We present our surgical experience using staged inguinal orchiopexy without section of the spermatic vessels in patients with short spermatic vessels. Materials and Methods. We used 2-stage inguinal orchiopexy in 38 children with intra-abdominal testis or testis peeping through the internal ring and short spermatic vessels (7 bilateral). Spermatic vessels were not sectioned, but were lengthened through progressive traction of the spermatic cord wrapped in polytetrafluoroethylene pericardial membrane (Preclude®). In the first stage we mobilized the spermatic cord in the retroperitoneal space and then wrapped it in the polytetrafluoroethylene membrane. We subsequently attached the testis to the invaginated scrotal bottom. At 9 to 12 months we performed the second stage, which involved removing the polytetrafluoroethylene membrane. Results. From the first to the second stage we observed progressive descent of the testicle toward the scrotum. At 1 to 8-year followup after the second stage all 45 testicles were palpable in a satisfactory scrotal position with stable or increased testicular volume. Conclusions. This technique represents an alternative to Fowler-Stephens orchiopexy, which can be associated with a greater risk of testicular ischemia

An immune-related gene expression atlas of the shrimp digestive system in response to two major pathogens brings insights into the involvement of hemocytes in gut immunity

International audienceMuch of our current knowledge on shrimp immune system is restricted to the defense reactions mediated by the hemocytes and little is known about gut immunity. Here, we have investigated the transcriptional profile of immune-related genes in different organs of the digestive system of the shrimp Litopenaeus vannamei. First, the tissue distribution of 52 well-known immunerelated genes has been assessed by semiquantitative analysis in the gastrointestinal tract (foregut, midgut and hindgut) and in the hepatopancreas and circulating hemocytes of shrimp stimulated or not with heat-killed bacteria. Then, the expression levels of 18 genes from key immune functional categories were quantified by fluorescence-based quantitative PCR in the midgut of animals experimentally infected with the Gramnegative Vibrio harveyi or the White spot syndrome virus (WSSV). Whereas the expression of some genes was induced at 48 h after the bacterial infection, any of the analyzed genes showed to be modulated in response to the virus. Whole-mount immunofluorescence assays confirmed the presence of infiltrating hemocytes in the intestines, indicating that the expression of some immune-related genes in gut is probably due to the migratory behavior of these circulating cells. This evidence suggests the participation of hemocytes in the delivery of antimicrobial molecules into different portions of the digestive system. Taken all together, our results revealed that gut is an important immune organ in L. vannamei with intimate association with hemocytes

Response to: Caustic ingestion in children: is endoscopyalways indicated? A perspective from a SierraLeone experience

We read with interest the letter of Dr Contini et al regarding a large experience of caustic ingestion in children carried out in Sierra Leone that reported important and unique information on the outcome of caustic soda ingestion in one of the poorest developing countries and confirming our finding that asymptomatic patients do not develop severe esophageal sequelae