80 research outputs found
Thoracoscopic diagnosis and repair of central congenital diaphragmatic hernia in a neonate: A case report of a rare entity
Abstract Introduction Central congenital diaphragmatic hernia that involves a central tendon defect is a very rare form of diaphragmatic hernias. Experience in the thoracoscopic repair of congenital diaphragmatic hernia has expanded in recent years, but this expansion was mainly for the most common type; the posterolateral. We report a case of central congenital diaphragmatic hernia, which is supposed to be the case number seventeen of those reported in literature. And we report the first use of thoracoscopic repair in such rare entity. Case presentation We present a case report of a Bengali neonate who had a prenatal diagnosis of left congenital diaphragmatic hernia, which was supposed to be the usual posterolateral type. As we usually approach such cases by thoracoscopy, the patient had an intraoperative diagnosis of central congenital diaphragmatic hernia. The defect was amenable to a successful thoracoscopic repair. Conclusion The rare neonatal central congenital diaphragmatic hernia could present as a left sided herniation that clinically resembles the usual posterolateral congenital diaphragmatic hernia. Thoracoscopic approach offers a tremendous tool for diagnosis as well as the management of this kind of presentation of a central congenital diaphragmatic hernia
Thoracoscopic resection of a lung keratocyst associated with pulmonary sequestration in a neonate
Abstract Introduction Keratocyst is a cystic lesion that has distinctive histological features composed of an epithelial lining with surface keratinization that is corrugated and predominantly parakeratotic. Although rare, they present in human pathology mainly as odontogenic keratocysts and have occasional association with Gorlin-Goltz syndrome. Case report We present a neonate with an antenatal suspicion of congenital pulmonary airway malformation. While stable and imaging confirmation studies were accomplished, thoracoscopic exploration and excision of a bronchogenic-like lung cyst attached to an extralobar pulmonary sequestration supero-medial to the left upper lobe were performed successfully at day 44 of life. Histopathological study has revealed keratocystic features of the lung cyst attached to a pulmonary sequestration tissue. Discussion and conclusion Up to our knowledge and review of the literature, this is the first case and occurrence of Lung Keratocyst. Long-term follow up is needed to assess the outcome of the thoracoscopic management of such lesion, and its hypothetic relation with odontogenic keratocysts or any associated syndromes
Thoracoscopic Approach for Congenital Diaphragmatic Hernia: A Useful Tool in Diagnosis and Treatment of Unexpected Associated Lung Lesion
We report the case of a neonate affected by prenatally diagnosed congenital diaphragmatic hernia (CDH), treated by thoracoscopy. During the procedure, we detected an associated extralobar pulmonary sequestration (EPS), which was preoperatively undiagnosed, and we removed it. EPS has been shown to be associated with CDH in up to 15 to 40% of cases. A possible explanation hypothesized is that pulmonary sequestration, which develops at 4 to 5 weeks of gestation, can disturb the fusion of the diaphragm and closure of the pleuroperitoneal canal. The thoracoscopic approach permitted us to identify the thoracic EPS that probably would have been otherwise missed
Gallbladder polyps in association with metachromatic leukodystrophy
Polypoid lesions of the gallbladder (PLG) are rare in the paediatric population. Growth in technology with the availability of high-quality ultrasonography and in the experience of radiologists in detecting such lesions, has led to an increase in incidental detection of PLG. In children, the occur either as a primary disorder or in association with other conditions, including metachromatic leukodystrophy, Peutz- Jeghers syndrome, or pancreatobiliary malunion [1]. Due the rarity of these lesions in the paediatric age group, accurate management algorithms are inherited from the adult population. In these, PLG is a more common pathology, occurring in 4\u20137% of patients undergoing ultrasonography, with clinical significance relating largely to their malignant potential [2,3]
Peritoneal dialysis catheters in pediatric patients: 10 years of experience in a single centre
Peritoneal Dialysis (PD) is one of the numerous options for
chronic dialysis and in many cases when access for acute dialysis
is required early in a hospital course, at any age. PD catheter
can be inserted with an open or laparoscopic approach. The complication
rate after catheter insertion is still high, as reported in
published literature. We present the experience matured at our
Centre in the last 10 years on implantation of peritoneal dialysis
catheters in children, emphasising surgical complications. We
conducted a retrospective study on patients who underwent PD
at our Centre in a range period of 10 years. We analysed patients
\u2019demographic data, past and present medical, perioperative and
post-operative data, permanence of the catheter, duration of dialysis,
the gap between placement and use, outcomes and complications.
We compared the data, dividing patients in 2 groups:
patients operated with a traditional open technique and patients
operated laparoscopically. We retrospectively reviewed 29 children
with an average age of 3years and 6 months. Mean age was
42 months (1 month; 8 years) for the VLS group, 18 months (11
days, 4 years) for the OT group. Mean operative time was 106
min for the VLS group; 44 min for the OT group. The Catheter
permanence period was 17 days (12h-64 days). Duration of dialysis
was between 48 hours and 23 days (average 8 days). In the
total population, we registered 8 complications (5 minor, 3
major), the overall complication rate being 33 % (minor complication
rate 21%, major complication rate 12,5 %). 6 complications
occurred in patients operated laparoscopically (6/14 = 36
%); 2 complications in the OT group (2/10 = 20 %). The complication
rate after PD catheter insertion is still high. Advantages
and disadvantages of the open and laparoscopic approach must
be known. Both minor and major complications, such as bowel
perforations and occlusions, must be understood and differentiated
Robotic removal of MĂĽllerian duct remnants in pediatric patients: our experience and a review of the literature.
Persistent MĂĽllerian duct syndrome is a disorder of sexual development, which features a failure of involution of MĂĽllerian structures. An enlarged prostatic utricle is a kind of MĂĽllerian duct remnant (MDR) with a tubular shaped structure communicating with the prostatic urethra. Treatment is aimed at relieving symptoms when present, preserve fertility and prevent neoplastic degeneration. We describe 3 cases of successful robot assisted-removal of symptomatic MDRs. The first case came to our attention for pseudo-incontinence; the other two for recurrent urinary tract infections. The patients have not presented such symptoms anymore on follow-up. We then reviewed existent literature on authors who have recently investigated the main issues concerning MDRs and have attempted a roboticassisted approach on them. Robot-assisted laparoscopy can be considered a valid, safe and effective minimally-invasive technique for the primary treatment of prostatic utricle
A case of massive subcutaneous emphysema and transient ischemic attack due to argon plasma coagulation following endoscopic pilonidal sinus treatment
Pilonidalsinusisasmallholeaffectingtheskinandsubcutaneoustissue,whichusuallycontainshairandskindebris,resultinginthecreationoftheso-calledpilonidalcyst.Theendoscopicpilonidalsinustreatment(EPSiT)isaminimallyinvasiveprocedureconsistingoftheremovalofhairsandcauterizationofthecavityunderdirectendoscopicvision.Inourinstitution,weusedtoendthisprocedurewithargonplasmacoagulation(APC).Here,wediscussacaseof22-year-oldmanaffectedbypilonidaldisease,whodevelopedamassivesubcutaneousemphysemaandsuspectedtransientischemicattacksecondarytogasreabsorptionafteranEPSiTinwhichAPCwassedforthecoagulation
Paediatric surgery in the robotic era: early experience and comparative analysis
The aim of this study is to present our preliminary experience in robotics and a comparative analysis with conventional Minimally- Invasive Surgery (MIS). Cases operated by da Vinci Xi® System from February 2016 to October 2017 are reviewed retrospectively through demographics, diagnosis-procedure and short-term outcome parameters. A comparison with a matching conventional MIS population was also conducted. 40 robotic procedures were carried out and 112 (out of 3705) non-robotic procedures met inclusion criteria for comparison. Among robotic patients we observed: an average age of 143.5 months, weight of 42.9 Kg, operative and anaesthesia induction time respectively of 116.8 and 34.8 minutes. Furthermore, we observed a 6.1-day length of stay, 2.5% conversion rate and no complications. From the comparison between the groups, no statistical difference emerged in the length of stay, in conversion rates or in complications. A statistical significance was observed in terms of operative time in favour of non-Robotic- System. Our experience has meant to introduce the System in our surgical environment, comparing to the conventional MIS (an already established approach routinely performed at our center). Results have shown comparable safety and feasibility
Fish Skin Graft: Narrative Review and First Application for Abdominal Wall Dehiscence in Children
Summary: Acellular fish skin grafts (FSGs) are tissue-based products created by
minimally processing the skin of the Atlantic cod (Gadus morhua). The FSG is rich
in omega-3 and facilitates tissue regeneration by supporting revascularization and
ingrowth in the proliferation and remodeling phases of wound healing. FSG is structurally
more similar to human skin than antiviral-processed skin substitutes such
as amniotic membrane, and there are no known prion, bacterial, or viral diseases
that can be transmitted from North-Atlantic cod to humans. The FSG is processed
using a proprietary method that preserves the structure and lipid composition of
the skin. FSG is CE marked, and US Food and Drug Administration cleared for
multiple clinical applications in partial and full-thickness wounds. FSG is currently
the only acellular dermal matrix product that does not originate from mammalian
tissues. For this narrative review, Medline and UpToDate were used to include a
total of 21 articles published from 2015 to 2022 about fish skin graft use. We also
reported a case of a 7-year-old boy who underwent treatment with FSG for abdominal
wall dehiscence at our department of pediatric surgery, IRCCS Sant’Orsola-
Malpighi, Alma Mater Studiorum, University of Bologna, University Hospital of
Bologna. FSG provides a valuable and sustainable treatment that improves wound
healing in both adult and pediatric populations. We described the first application
of an FSG for wound dehiscence of the abdominal wall in a pediatric patient,
reporting how FSG was completely reabsorbed and improved the skin’s repai
Dirofilaria repens testicular infection in child, Italy
Testicular Dirofilaria repens infection was identified and confirmed by sequence analysis in a child in northeastern Italy. Because human dirofilariasis is emerging in southern and eastern Europe, this parasitic infection should be considered in the differential diagnosis of scrotal swelling in disease-endemic countries to avoid unnecessary interventions, such as orchiectomy
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