Cloacal exstrophy associated with gastroschisis: Case report of a rare association with favorable outcome

AbstractAbdominal wall defects are congenital malformations representing a challenge for pediatric surgeons. This paper presents a rare case of difficult surgical decision and clinical management, leading to a favorable outcome brought about by the multidisciplinary treatment of a patient with cloacal exstrophy associated with gastroschisis

Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis

Objective: Gastroschisis is a defect of the abdominal wall, resulting in congenital evisceration and requiring neonatal intensive care, early surgical correction, and parenteral nutrition. This study evaluated newborns with gastroschisis, seeking to associate nutritional characteristics with time of hospital stay. Methods: This was a retrospective cohort study of 49 newborns undergoing primary repair of gastroschisis between January 1995 and December 2010. The newborns’ characteristics were described with emphasis on nutritional aspects, correlating them with length of hospital stay. Results: The characteristics that influenced length of hospital stay were: 1) newborn small for gestational age (SGA); 2) use of antibiotics; 3) day of life when enteral feeding was started; 4) day of life when full diet was reached. SGA infants had longer length of hospital stay (24.2%) than other newborns. The length of hospital stay was increased by 2.1% for each additional day taken to introduce enteral feeding. However, slower onset of full enteral feeding acted as a protective factor, decreasing length of stay by 3.6%. The volume of waste drained by the stomach catheter in the 24 hours prior the start of enteral feeding was not associated with the timing of diet introduction or length of hospital stay. Conclusion: Early start of enteral feeding and small, gradual increase of volume can shorten the use of parenteral nutrition. This management strategy contributes to reduce the incidence of infection and length of hospital stay of newborns with gastroschisis

Body stalk anomaly: Three months of survival. Case report and literature review

Body stalk anomaly is composed of a set of genetic component abnormalities that are still rather unknown. This anomaly consists of a large defect in the abdominal wall closure, anatomical defects of the pelvis and lower limbs, severe scoliosis, and pulmonary hypoplasia. In addition to these deformities are heart disease and neural tube closure defects. Because of the association of these severe deformities, the cases described in the literature have proven to be almost entirely incompatible with life, resulting in abortion and stillborn fetuses. Therefore, the present article describes a case of body stalk anomaly that survived for nearly three months, the first of its kind in Latin America

Liver damage in schistosomiasis is reduced by adipose tissue-derived stem cell therapy after praziquantel treatment.

BackgroundIn view of the potential immunosuppressive and regenerative properties of mesenchymal stem cells (MSC), we investigated whether transplantation of adipose tissue-derived stem cells (ASC) could be used to control the granulomatous reaction in the liver of mice infected with Schistosoma mansoni after Praziquantel (PZQ) treatment.Methodology/prinicpal findingsC57BL/6 mice infected with S. mansoni were treated with PZQ and transplanted intravenously with ASC from uninfected mice. Liver morpho-physiological and immunological analyses were performed. The combined PZQ/ASC therapy significantly reduced the volume of hepatic granulomas, as well as liver damage as measured by ALT levels. We also observed that ASC accelerated the progression of the granulomatous inflammation to the advanced/curative phase. The faster healing interfered with the expression of CD28 and CTLA-4 molecules in CD4+ T lymphocytes, and the levels of IL-10 and IL-17 cytokines, mainly in the livers of PZQ/ASC-treated mice.ConclusionsOur results show that ASC therapy after PZQ treatment results in smaller granulomas with little tissue damage, suggesting the potential of ASC for the development of novel therapeutic approaches to minimize hepatic lesions as well as a granulomatous reaction following S. mansoni infection. Further studies using the chronic model of schistosomiasis are required to corroborate the therapeutic use of ASC for schistosomiasis

Metástases pulmonares em crianças: estamos operando desnecessariamente?

RESUMO Objetivo: determinar, em pacientes pediátricos portadores de neoplasias malignas, as características de nódulos pulmonares identificados à tomografia computadorizada, capazes de diferenciar nódulos benignos de metástases. Métodos: estudo retrospectivo de pacientes submetidos a ressecções pulmonares de nódulos diagnosticados como metástases em um período de sete anos. Achados de tomografia e da cirurgia, assim como resultados dos exames anatomopatológicos foram comparados. Resultados: nove pacientes, submetidos a 11 intervenções cirúrgicas, foram estudados. Entre as variáveis estudadas, apenas o tamanho do nódulo, maior do que 12,5mm provou ser estatisticamente significante para predizer malignidade. Conclusão: esse estudo sugere que, entre as características tomográficas de nódulos pulmonares de crianças portadoras de neoplasias malignas, apenas o tamanho da lesão foi preditor de malignidade

Pulmonary metastases in children: are we operating unnecessarily?

<p></p><p>ABSTRACT Objective: to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. Methods: we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. Results: we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. Conclusion: among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.</p><p></p