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

Robotic removal of Müllerian duct remnants in pediatric patients: our experience and a review of the literature.

Persistent Müllerian duct syndrome is a disorder of sexual development, which features a failure of involution of Müllerian structures. An enlarged prostatic utricle is a kind of Müllerian 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

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

Ovarian tissue cryopreservation and transplantation: 20 years experience in Bologna University

Objective: To report the 20-year experience in ovarian tissue cryopreservation (OTC) and ovarian tissue transplantation (OTT) of the Bologna clinical center (Bologna, Italy). Design: Retrospective cohort study. Patients: 1026 pediatrics and women aged between 2 and 38 years who underwent OTC and OTT between January 2002 to January 2022. Results: Of the 1026 patients, 238 (22.8%) were pediatrics (≤ 17 years, Group 1) and 788 (77.2%) were adult women (range 18-38 years, Group 2). In Group 1, 184 (77.3%) patients had malignant diseases and 54 (22.7%) had non-malignant diseases. In Group 2, 746 (94.7%) patients had malignant diseases and 42 (5.3%) had non-malignant diseases. No real complications were observed during surgery. In all the samples analyzed most of the follicles were in the resting stage, while only a few follicles were growing. In both fresh and thawed samples, follicular density was higher in Group 1 than in Group 2 (p < 0.01). Regardless of age, good preservation of follicles and stroma was observed in fresh and thawed ovarian tissue by histological and immunohistochemical analyses (estrogen and progesterone receptors; Ki67 and Bcl2 markers; TUNEL). To date, out of 1026 total women, 812 (79.1%) had their tissue stored. Sixty-eight (6.6%) patients died from their primary disease. Twentyfour (2.3%) women performed 33 OTTs between December 2011 and January 2022. Restoration of menstruation was observed in 15 out of 17 menopausal women. Six pregnancies were achieved, two hesitated in abortion and four in the birth of healthy babies. Conclusion: OTC is the only fertility preservation technique applicable in prepubertal/ pediatrics and in adult patients when stimulation for oocytes/embryos cryopreservation is not possible. The reported data can help future patients and physicians in their discussions and decisions about the need and possibilities of preserving ovarian function

Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children

Abstract: Background: Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI’s management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. Materials and methods: The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. Results: An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. Conclusion: We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way

Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study

open15noAbstract Background: The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature. Methods: We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019. Results: We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%). Conclusions: Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.openAngotti, Rossella; Raffaele, Alessandro; Molinaro, Francesco; Riccipetitoni, Giovanna; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Mattioli, Girolamo; Alberti, Daniele; Boroni, Giovanni; Mariscoli, Francesca; Martino, Ascanio; Pelizzo, Gloria; Maffi, Michela; Messina, Mario; Lima, MarioAngotti, Rossella; Raffaele, Alessandro; Molinaro, Francesco; Riccipetitoni, Giovanna; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Mattioli, Girolamo; Alberti, Daniele; Boroni, Giovanni; Mariscoli, Francesca; Martino, Ascanio; Pelizzo, Gloria; Maffi, Michela; Messina, Mario; Lima, Mari

The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis

Our aim was to develop an APpendictis-PEdiatric score (APPE score) in quantifying risk of acute appendicitis based on combination of clinical and laboratory markers. 1025 patients were classified in: acute appendicitis (AA) and non-appendicitis. Demographic/clinical features, and laboratory were collected. They were compared for quantitative-variables and categorical-variables. Significant predictors (P=<0,05) were included in logistic regression model. Based on regression-coefficients, a diagnostic score was tested by calculating the area under the ROC curve. Two cut-offs were established to define classes of risk of AA. 9 variables were identified as potentially predictors for AA. Those underwent logistic regression and a score was assigned, for maximum 21-points. The score showed an area under the curve: 0.831 and a linear proportion with the state of appendicular inflammation (R20.85). Patients with a score ≤8 were at low risk of AA (sensitivity 94%); those with a score ≥15 were at high risk for AA (specificity 93%). Those between 8 and 15 were defined at intermediate risk class. APPE-score guides clinicians in classifying patients with suspected-AA according to clinical and laboratory findings in order to improve their management

Anomalie renali congenite e rene multicistico

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