Evaluation of Esophageal Motility Using Multichannel Intraluminal Impedance in Healthy Children and With Gastroesophageal Reflux

Abstract OBJECTIVE: : Multichannel intraluminal impedance (MII) directly evaluates esophageal bolus transport. There is a good correlation between MII and manometry in healthy adults, but there are no reports concerning children.The aim of the present study was to determine normal values of esophageal motility using only impedance measurements in healthy children and in a pediatric population with gastroesophageal reflux (GER). PATIENTS AND METHODS: : We described in the present study 60 children submitted to pH-MII for 24 hours for suspected GER. Patients were divided into 2 different groups on the basis of their pH-MII report. Group 1 patients showed acid GER, whereas group 2 patients had…

Enuresi ed ipertiroidismo

The inconspicuous penis in children

The term 'inconspicuous penis' refers to a group of anatomical abnormalities in which the penis looks smaller than is expected. Micropenis can be defined as 'true micropenis' - which results from a defect in the hypothalamic-pituitary-gonadal axis - and 'micropenis secondary to congenital anatomical anomalies of the surrounding and overlying structures' - also known as 'concealed penis'. The different forms of concealed penis include webbed penis, congenital megaprepuce and partially hidden penis caused by prepubic adiposity. This disorder can also have iatrogenic causes resulting from adhesions that are secondary to circumcision - this type of concealed penis is known as 'trapped penis'. H…

Ileocecal duplication cysts: is the loss of the valve always necessary?

Abstract Background Ileocecal (IC) duplication cysts are enteric duplications located at the IC junction, not clearly identified in all the published series. The reported treatment is IC resection and ileocolic anastomosis. It is well known that the loss of the IC valve has several adverse effects. This study is aimed at demonstrating that cyst removal together with the common ileal wall and following enterorrhaphy is possible, safe, and effective in preserving the IC region. Methods Medical records of 3 patients who underwent surgery for IC duplication between 2003 and 2013 were retrospectively reviewed evaluating follow-up results. Results All patients had an antenatal diagnosis of intraa…

Comprehensive laparoscopic approach to paediatric varicocele

A simple technique of oblique anastomosis can prevent stricture formation in primary repair of esophageal atresia

Abstract Background Anastomotic stricture is an important problem after esophageal atresia (EA) repair. This study evaluates a technique of oblique esophageal anastomosis without use of a flap in order to prevent stricture formation. Methods Medical records of 16 patients (14 with EA type III and 2 with EA type IV Ladd-Gross classification) who underwent primary repair of EA at birth without anastomotic tension were reviewed, evaluating long-term follow-up results. All patients were studied with esophageal contrast study, pH-multichannel intraluminal impedance, and endoscopy. The incidence of complications and their management were analysed. Results Contrast esophagogram and esophagoscopy a…

Correzione laparoscopica del varicocele di 3° tipo sec.Coolsaet

Different types of intestinal atresia in identical twins

The authors present a previously unreported association of different types of intestinal atresia in identical low-birth-weight twins. Both babies were affected by duodenal atresia, associated in the first case with a complete mucosal duodenal membrane and in the second one with an "apple-peel" jejunal atresia. These occurrences may suggest that they were either the consequence of linkage of 2 genes or a pleiotropic expression of a single gene responsible for such rare conditions.

Evolving management of adolescent varicocele

Abstract Objective To review the evolution in indications for treatment and treatment modalities for adolescent varicocele at our centre, and evaluate the impact of varicocelectomy on final outcome. Patients and methods Between 1995 and 2006, we treated 242 left varicoceles. Preoperative assessment included clinical evaluation, measurement of testicular volumes, and colour-Doppler ultrasound (CDUS). A subinguinal varicocelectomy was performed in 124 patients (group A), and a laparoscopic non-artery-sparing Palomo procedure in the remaining 118 (group B). In group B patients, CDUS was also used to investigate the functional anatomy of varicocele, and all the veins found to be refluxing were …

LA NUTRIZIONE PARENTERALE e L'INTESTINO RESIDUO: quale relazione nel decorso dei pazienti con Sindrome da Intestino Corto? Valutazione da una Casistica Nazionale Multicentrica

In età pediatrica la Sindrome da INtestino Corto (SIC), il più delle volte conseguenza di un intervento chirurgico di resezione intestinale massiva, è la più frequente causa di Insufficienza Intestinale (ID). L'esigenza di conoscere la realtà delle SIC ha promosso uno Studio Nazionale Multicentrico retrospettivo ("SIC 91" ) per valutare i casi di SIC osservati dal 1991 al 2001, avvalendosi inoltre dei dati del Network Italiano "Insufficienza Intestinale in Età Pediatrica". I dati preliminari sono già stati presenatti e pubblicati in altra sede ed hanno permesso di esprimere alcune considerazioni iniziali. Gli obiettivi di questo Studio sono quelli di valutare l'outcome dei pazienti in relaz…

Is rectal disimpact always necessary in children with chronic constipation? Evaluation with pelvic ultrasound

PURPOSE: The aim of study was to evaluate if pelvic ultrasound can be useful in managing children with chronic idiopathic constipation. METHODS: A total of 270 children with idiopathic chronic constipation were enrolled in the study. At baseline and at monthly checkups children were evaluated by clinical score and pelvic ultrasound (US). Patients have been divided in 2 groups, based on pelvic US results: group A with a rectal diameter >3 cm, group B with a rectal diameter <3 cm or rectum not visualized. Both groups were subsequently randomly divided in two subgroups (A1, A2, B1, B2) on the basis of the prescribed treatment (disimpaction for the first week and daily laxative or only daily la…

Approccio laparoscopico al testicolo ritenuto intraddominale non palpabile. L'esperienza di 2 centri Chirurgia Pediatrica

Le incongruenze tra cistografia e cistosonografia minzionale influiscono sul trattamento del reflusso vescico ureterale primitivo ?

Surgery of deferential reflux in pediatric varicocele based on preoperative color doppler ultrasound assessment

Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring.

Abstract Background Gastroesophageal reflux (GER) and dysmotility are frequent in patients treated for esophageal atresia (EA). This aim of this study is to evaluate GER and dysmotility in young EA patients using pH–multichannel intraluminal impedance (pH-MII). Methods Fifteen patients with a mean age of 7.5 years (group 1) have been studied and compared with 15 children without congenital malformation, submitted to pH-MII for suspected GER (group 2). These latter patients serve as a control group of healthy subjects. The following impedance reflux and motility parameters have been studied on 10 standardized swallows: number of reflux episodes, mean acid clearing time, median bolus clearing…

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Valutazione del dolore post-operatorio dopo infiltrazione locale e instillazione endoperitoneale di ropivacaina nella chirurgia laparoscopica in età pediatrica.

Uso del flap di muscolo retto nella derivazione continente sec.Mitrofanoff

Outcome dei pazienti con sindrome da intestino corto. valutazione da una casistica nazionale multicentrica

Gli Autori presentano i risultati di una ricerca nazionale multicentrica retrospettiva sulla Sindrome da Intestino Corto (SIC)

Gastroesophageal reflux in young children treated for esophageal atresia: evaluation with pH-multichannel intraluminal impedance

Objectives: Gastroesophageal reflux (GER) and dismotility occur frequently after repair of esophageal atresia (EA). GER-associated complications can manifest either early or later; then precocious diagnosis and treatment are essential. The aim of the study was to evaluate characteristics of GER and esophageal clearance in children treated for EA with distal tracheoesophageal fistula, using pH-multichannel intraluminal impedance (pH-MII). Patients and Methods: Twenty-two children (ages 3‐40 months) treated for EA at birth, and 20 normal children of similar age with suspected GER disease were included in the study. Impedance parameters were analyzed according to age and symptoms. Results: Ref…

Febbre mediterranea familiare: un caso atipico con esordio precoce.

Sulle complicanze della chirurgia laparoscopica nei primi 5 anni della learning curve

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation

Abstract Purpose Functional bowel outcome in patients with anorectal malformation often is poor. For fecal incontinence resulting from sphincter dysfunction, biofeedback (BFB) training appears to be effective. The aim of study was to investigate the bowel function in incontinent children treated for ARM, using a clinical score, a manometric and pelvic magnetic resonance evaluation, in order to establish predictive parameters of response after BFB. Methods 25 children (median age of 6.5years) with true fecal incontinence were evaluated by clinical score, anorectal manometry and magnetic resonance imaging (MRI). According to these evaluations patients were divided in 4 groups: group 1 (favora…

Il ruolo del color doppler nel determinare il trattamento appropriato nel varicocele in bambini ed adolescenti

Coverage of urethroplasty in pediatric hypospadias: Randomized comparison between different flaps

Objectives The use of covering urethroplasty with flaps in hypospadias surgery has been well recommended. Various techniques have been described for flap harvesting. The aim of the present study was to compare the outcome and complication rate of dorsal preputial flaps and ventral dartos flaps. Methods A total of 130 patients were prospectively evaluated from January 2008 to December 2011. Using the tubularized incised plate urethroplasty procedure, urethroplasty was carried out by a single surgeon. Patients were randomly divided in two groups: group A (57 patients), in which a preputial flap was carried out using three different techniques; and group B (73 patients), in which a single or a…

Utilità dell'ecografia nei pazienti con stipsi cronica idiopatica

Efficacy of Periportal Infiltration and Intraperitoneal Instillation of Ropivacaine After Laparoscopic Surgery in Children

Postoperative pain is less intense after laparoscopic than after open surgery. However, minimally invasive surgery is not a a pain-free procedure. Many trials have been done in adults using intraperitoneal and/or incisional local anesthetic, but similar studies have not yet been reported in the literature in children. Aim: The aim of this study was to evaluate the analgesic effect of periportal infiltration and intraperitoneal instillation of ropivacaine in children undergoing laparoscopic surgery. Materials and Methods: Thirty patients who underwent laparoscopic surgery were randomly allocated to one of three groups. Group A (n 10) received local infiltration of port sites with 10 mL of ro…

Emorragie digestive in età pediatrica: aspetti chirurgici

Efficacia del blocco penieno nell'ipospadia

Laparoscopic surgery of deferential reflux in pediatric and adolescent varicocele

BACKGROUND: This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically. MATERIALS AND METHODS: Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively,all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS)to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of ref…

Displasia multicistica monolaterale in due neonati esposti in utero a farmaci antiepilettici

Valutazione della motilità esofagea in età pediatrica attraverso la pH-impedenzometria 24h.

Valutazione del reflusso gastroeofageo associato ad atresia dell'esofago con fistola distale mediante ph-impedenzometria 24h

Approccio laparoscopico al testicolo non palpabile. E' necessaria l'esplorazione "open" nel vanishing testis intracanalicolare?

Evaluation of esophageal motility using multichannel intraluminal impedance in healthy children and children with gastroesophageal reflux: comments

Laparoscopic Treatment of Deferential Reflux in Pediatric Varicocele Based on Preoperative Color Doppler Ultrasound Assessment

Oesophageal pH/impedance monitoring in children treated for oesophageal atresia

Preemptive hydrocelectomy in subinguinal varicocelectomy

&lt;i&gt;Background/Aims:&lt;/i&gt; The hydrocele rate is very low after microsurgical subinguinal varicocelectomy, but microsurgical expertise is not always available in pediatric centers. We describe a modified technique to reduce the hydrocele rate after subinguinal varicocelectomy performed without an operating microscope. &lt;i&gt;Methods:&lt;/i&gt; A retrospective review was performed of 142 non-microsurgical subinguinal varicocelectomies performed at a single pediatric center. In 96 patients, varicocelectomy was combined with the excision and eversion of the tunica vaginalis (‘pre-emptive hydrocelectomy’) while in the remaining 46 cases the vaginalis was left untouched. &lt;i&gt;Resu…

Gastroesophageal reflux in patients treated for congenital diaphragmatic hernia: short- and long-term evaluation with multichannel intraluminal impedance.

The incidence of GER, related symptoms and complications in patients treated for congenital diaphragmatic hernia (CDH) are poorly defined. The aim was to evaluate incidence and development of GER in children treated for CDH in a short- and long-term follow-up period, identifying potential risk factors of morbidity. Thirty-six patients were evaluated with pH-MII at a median age of 6 months (T1) and re-evaluated with pH-MII and endoscopy at a median age of 5 years (T2). The incidence of reflux was 83 % in T1 and 61 % in T2; the incidence of symptoms was 62 % in T1 and 38 % in T2. In both groups the reflux was mainly non-acidic. Patch, intrathoracic stomach and esophageal dysmotility were risk…

Stripping della parete cistica, un'alternativa all'ovariectomia nelle grosse cisti ovariche congenite? A case report.

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

Abstract: Background This study aimed to assess whether laparoscopic treatment for any kind of varicocele is possible after preoperative identification of refluxing veins by color Doppler ultrasound (CDUS). Methods At the authors'' institution, 98 patients with a median age of 11.3 years (range, 7.1-16 years) were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and CDUS to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. In all the patients, laparoscopic division of the spermatic artery and veins was performed as close as possible to the internal inguinal ring. The other…

Coverage of urethroplasty in pediatric hypospadias: Randomized comparison between different flaps

LAPAROSCOPIC LEFT LIVER SECTIONECTOMY (LLLS) FOR PEDIATRIC LIVING RELATED LIVER TRANSPLANTATION (LRLT)

PURPOSE: LRLT in children is a method to provide organs for transplantation. We report 2 cases of LLLS for pediatric LRLT. METHOD: Donor position: lithotomy with surgeon in French position. Trocars: three 12 mm, placed 2 cm upper the supra-umbilical mid-line and sub-costal bi-lateral on the nipple lines; one 5 mm in epigastrium. Special instrumentation: harmonic scissor, ligasure®, Hem-O-Lock clips, and Endo Catch-II® bag. Main steps: division of round, falciform, left triangular ligaments and of lesser omentum; inspection of anatomy; hepatic hilum dissection with exposure of the left hepatic artery; dissection of the right side of the falciform ligament with exposure of the left branch of …

Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence

Background: Transanal irrigation (TAI) is employed for children with fecal incontinence, but it can present several problems which require a study of their outcomes among different pathologies and without a tailored work up. The aim of our study was to evaluate the effectiveness of an advanced protocol in order to tailor TAI, prevent complications, and evaluate outcomes. Methods: We included 70 patients (14 anorectal malformation, 12 Hirschsprung’s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen®: fecal score, volumetric enema, rectal ultrasound, anorectal 3D manometry, and diary for testing and parameter adjustment. Resu…

Un caso di due gemelle monocoriali con una differente doppia atresia intestinale

APPENDICECTOMIA VIDEOASSISTITA IN ETA' PEDIATRICA. NOSTRA ESPERIENZA.