26 research outputs found
Surgical vls therapy of oesophageal achalasia in pediatric age: four case reports
The Authors present a retrospective review of their record of cases, characterized by 4 cases of achalasia in which it was performed a Heller myotomy with front fundoplication (Thall) in laparoscopic approach in the period from 2012 to 2019.
In paediatric achalasia, the laparoscopic Heller myotomy seems to be the best treatment because of its multiple advantages offered by the minimally invasive technique. First of all, thanks to the video-technique, which allows a complete and extended myotomy, the accuracy of this operation is maximized; moreover, the post-operative pain is widely reduced, thanks to the minimal dissection and traction of the tissues; finally, but not negligible, this approach ensures a better aesthetic result than the classic open technique. With regard to the front fundoplication, the Authors suggest that it is mandatory because, even if it extends the operating time, it ensures a natural protection to the myotomy herniated mucosa and avoids gastro-oesophageal reflux, which often occurs after the surgical correction, thus obliging to perform a reoperation
Complications of the “nuss procedure” in pectus excavatum
During the pediatric age range, one
the most frequent deformities of the chest wall are
Pectus Excavatum (PE). Currently the treatment of
choice for PE is surgical intervention following the
Nuss procedure.
In this study, we present a description of the
complications associated with surgical treatment of PE
with the Nuss technique, in patients with symmetrical or
asymmetrical deformity, in different stages of disease
severity.
The study was conducted in collaboration with
the Pediatric Hospital “Istituto G. Gaslini” of Genoa.
We analyzed a cohort of 402 patients (334 males and 68
females), who underwent corrective surgery between
2005 and 2018. Within this group of patients, we
observed 82 cases with complications (20.39%), 20 of
which were intraoperative (4.98%) and 62 postoperative (15.42%). For the evaluation of
complications, this group was arbitrarily divided into
patients with symmetric and asymmetric Pectus and in
patients with mild, moderate and severe Pectus using
Haller's index.
Although a small group of patients presented
complications, overall results from data analysis show
that the Nuss technique represents the preferred surgical
procedure for the treatment of PE, in agreement with
literature. Furthermore, in our results show no
correlation between asymmetry or severity of PE with
complication related to the surgery
Papillary thyroid carcinoma in paediatric age
In children, differentiated thyroid
carcinoma is a rare condition. Early diagnosis is not
always easy, because of the lack of clinical symptoms,
but it has a pivotal role in performing a correct
therapeutic process.
The study describes three cases of papillary
thyroid carcinoma. None of the three patients had a
positive familiarity or exposure to risk factors. In two
cases, the tumor occurred as a non-injurious swelling in
the anterior cervical region, in the other case it
occurred with a latero-cervical lymphadenopathy that
had been persistent for a year. In the first two patients
we made a certain diagnosis by the needle aspiration of
the thyroid nodule; in the other case the diagnosis was
made by surgical exeresis and histological analysis of
the lymph nodes. We also performed blood chemistry
and hormonal tests, neck ultrasound, chest x-ray.
The three children underwent total
thyroidectomy and two of them also underwent rightsided cervical lymph node exeresis because there was
the presence of metastasis.
In our experience, the best therapeutic strategy
for children with differentiated thyroid carcinoma is the
total thyroidectomy, followed or not by latero-cervical
lymph node exeresis and radioiodiotherapy. The
removal of the whole gland reduces the risk of relapse
Minimally invasive treatment of urolithiasis in children: evaluation of the use of flexible ureterorenoscopy and laser lithotripsy
Urolithiasis is a multifactorial disease; in recent years, its incidence has gradually increased in pediatric age. Among the factors involved in urolithiasis pathophysiology, urinary tract anomalies and metabolic diseases are the most relevant, although ethnicity and environmental factors may have an important role.
The advances in technology and miniaturization of endoscopic devices have permitted the use of Retrograde Intrarenal Surgery (RIRS) to treat kidney and ureteral stones.
Nowadays, flexible ureterorenoscopy and laser lithotripsy, which are techniques that have been applied in the management of adult upper urinary tract disorders, are also used in children as a minimally invasive treatment of urolithiasis with encouraging, effective and safe results.
The Authors report a retrospective review of their record of cases considering 21 pediatric urolithiasis treatment procedures performed between October 2017 and April 2019 in a total of 17 patients (10 males and 7 females).
Six procedures involved the use of the flexible ureterorenoscope (FURS) while in 15 procedures the application of the laser fiber was used (FURSL). A case of laser lithotripsy for bladder stone was included. The average age of patients was 10.5 years (2-18 years). The renal pelvis dilatation pretreatment was evaluated in post-operative follow-up.
From the evaluation of the sample in analysis, the use of RIRS has good results in the treatment of paediatric urolithiasis, emerging as a valid option in the management of the paediatric population in terms of efficacy and safety, with an improvement in patient outcomes
Laparoscopic repair of paediatric indirect inguinal hernia: modified flip flap technique
In paediatric age, indirect inguinal
hernia represents more than 95% of the hernial disease.
It is a congenital type, in contrast with adulthood in
which acquired forms are more frequently found (1).
The laparoscopic correction of indirect inguinal hernia
is one of the most common surgeries performed in
paediatric age. In recent years, various techniques have
been introduced for the videolaparoscopic correction of
this disease.
The aim of this study is to provide an
assessment of the efficacy and safety of the execution
of a modified Flip-Flap technique, using tissue glue for
filling of Peritoneal-vaginal duct (DPV), performed in
order to ensure greater suture tightness and reduce the
incidence of postoperative hydrocele.
The Authors present a retrospective review of
their record of cases, considering a total of 187 patients
aged between 18 months and 14 years. For the
correction of the hernial defect, the modified VLS FlipFlap technique was carried out.
The evaluation of safety, efficacy, operating
time, relapse rate and development of short-term
complications (such as postoperative hydrocele, scrotal
hematoma or ecchymosis, atrophy or iatrogenic testicle
ascension) was considered in a mean follow-up of 6
months. The Authors suggest that this variant of the
peritoneal Flip-Flap technique is simple to perform; its
safety, reproducibility and effectiveness is proven and
has a percentage of relapses and complications
overlapping with the “open” approach and superior to
other laparoscopic techniques
Congenital cystic adenomatoid malformation of the lung tipe II: three cases report
Congenital cystic adenomatoid
malformation (CCAM) is a rare congenital lung
lesion. It may appear since birth (30-35%) with
difficulty breathing or may have a late onset (60-
65%) with recurring pulmonary infections or
growth failure; in a small percentage of cases, the
lesion can be completely asymptomatic.
Fetal or post-natal surgery can be used as
surgical treatment of these lesions. Postnatal
surgery consists of a lobectomy, bilobectomy or
pneumonectomy, based on the size of the lesion.
The best age to undergo this surgery is around 2
years, but only if the injury is stable and the child
has no complications.
The study describes three cases of CCAM,
observed at the Pediatric Surgery Section of the
University of Siena. We analyzed those 3 cases
whose approach was defined by the onset of
symptoms, age and clinical condition of patients. In
the first case the surgery was performed a few hours
after birth due to the worsening of the clinical
conditions; in the other two cases it was delayed
because the patients were asymptomatic.
The purpose of this study is to review the
management of patients with CCAM in relation to
clinical onset and the type of injury
Pre and post-operative ph-metry in videolaparoscopic surgery for gastro oesophageal reflux disease
Gastro-oesophageal reflux is
common in children, especially in the first year of life,
and it may be regarded as physiological. Good
functioning of the lower oesophageal sphincter depends
largely on the anatomical relationships between
oesophagus, stomach and diaphragm hiatus. Relative
immaturity of these structures in newborn babies and
young children is a risk factor in reflux disease, which
may result in a wide variety of typical and/or atypical
symptoms and, sometimes, serious complications such as
oesophagitis and stenosis.
Reflux disease may be diagnosed and studied,
basing on morphological and functional aspects and,
since the advent of pH-metry, it is possible to personalise
the therapeutic approach to children with reflux.
Surgical treatment of reflux disease in children
has recently been improved due to a mini-invasive
surgical approach. Absolute indications are recurrent
pneumonia, intractable pain due to oesophagitis and
retarded growth, often in association with neurological
impairment.
In the last three years, 18 children with reflux
disease underwent videolaparoscopic surgery in our
department, 14 by the Nissen and 4 by the Toupet
technique.
Post-operative pH-metry always showed a
reduction in exposure of the distal oesophagus to acid
(integral of H+) and an improvement in oesophageal
clearance (short refluxes percentage) indicative of good
functioning of the gastro-oesophageal junction.
PH-metry proved to be an invaluable technique
for planning therapeutic strategy. In follow-up
evaluations, it enabled us to monitor functioning of the
gastro-oesophageal junction and to avoid other more
difficult and invasive tests in patients with severe
neurological impairment
Neutralizing antibodies to Omicron after the fourth SARS-CoV-2 mRNA vaccine dose in immunocompromised patients highlight the need of additional boosters
IntroductionImmunocompromised patients have been shown to have an impaired immune response to COVID-19 vaccines.MethodsHere we compared the B-cell, T-cell and neutralizing antibody response to WT and Omicron BA.2 SARS-CoV-2 virus after the fourth dose of mRNA COVID-19 vaccines in patients with hematological malignancies (HM, n=71), solid tumors (ST, n=39) and immune-rheumatological (IR, n=25) diseases. The humoral and T-cell responses to SARS-CoV-2 vaccination were analyzed by quantifying the anti-RBD antibodies, their neutralization activity and the IFN-γ released after spike specific stimulation.ResultsWe show that the T-cell response is similarly boosted by the fourth dose across the different subgroups, while the antibody response is improved only in patients not receiving B-cell targeted therapies, independent on the pathology. However, 9% of patients with anti-RBD antibodies did not have neutralizing antibodies to either virus variants, while an additional 5.7% did not have neutralizing antibodies to Omicron BA.2, making these patients particularly vulnerable to SARS-CoV-2 infection. The increment of neutralizing antibodies was very similar towards Omicron BA.2 and WT virus after the third or fourth dose of vaccine, suggesting that there is no preferential skewing towards either virus variant with the booster dose. The only limited step is the amount of antibodies that are elicited after vaccination, thus increasing the probability of developing neutralizing antibodies to both variants of virus.DiscussionThese data support the recommendation of additional booster doses in frail patients to enhance the development of a B-cell response directed against Omicron and/or to enhance the T-cell response in patients treated with anti-CD20
Minimally invasive treatment of urolithiasis in children: evaluation of the use of flexible ureterorenoscopy and laser lithotripsy
Dall'archivio fotografico alla critica d'arte: L'ASAC di Venezia e Umbro Apollonio ai tempi della Guerra Fredda.
Sulla base dei recenti studi riguardanti le relazioni che negli anni sessanta intercorsero tra le cosiddette "nuove tendenze" in Europa e nell'ex Jugoslavia è possibile delineare i modi e i tempi degli sviluppi storici, politici e artistici avvenuti negli scambi ufficiali tra l'Archivio Storico delle Arti Contemporanee (ASAC) di Venezia e le istituzioni museali jugoslave. Umbro Apollonio è stata una figura cardine negli accordi bilaterali sulle attività artistiche tra i due paesi che ebbe un peso preponderante nel divenire di tali scambi sia attraverso il proprio pensiero critico sia attraverso le corrispondenze ufficiali e private con studiosi, direttori e curatori dei musei jugoslavi. La documentazione esaminata costituisce un bacino da cui attingere per fare luce sul ruolo svolto dalle fotografie non solo per il loro carattere documentario, ma anche come fonte iconografica per l'aggiornamento degli artisti est-europei e di supporto alle mostre d'arte che ufficialmente circolavano in quei paesi