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…

Il ruolo della laparoscopia negli stati intersessuali

Enuresi ed ipertiroidismo

INJECTION TECHNIQUE DOES NOT INFLUENCE RESOLUTION RATE IN HIGH-GRADE VESICO-URETERIC REFLUX IN CHILDREN. A SINGLE CENTRE PROSPECTIVE STUDY

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…

One-Trocar,viedo-assisted stripping technique for use in the treatment of large ovarian cysts in infants

Comprehensive laparoscopic approach to paediatric varicocele

CHIRURGIA LAPAROSCOPICA DEL VARICOCELE: STATO DELL'ARTE

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…

Indicazioni al trattamento del reflusso vescico-ureterale in età pediatrica

ONE-TROCAR VIDEO-ASSISTED STRIPPING TECHNIQUE FOR USE IN THE TREATMENT OF LARGE OVARIAN CYSTS IN INFANTS

Abstract Background Management of ovarian cysts in infants is controversial; it can be conservative or surgical, and the management is determined by the cyst's size and sonographic features. Methods A surgical approach using a 10-mm umbilically placed operative laparoscope was taken in 3 female infants with antenatally diagnosed large, simple ovarian cysts. The contents of the cysts were partially aspirated and the cyst walls were stripped off the remaining ovarian parenchyma. No intraoperative or postoperative complications were recorded. Conclusions The one-trocar video-assisted stripping technique for large ovarian cysts in infants appears to be an ovarian-tissue-preserving procedure, an…

Correzione laparoscopica del varicocele di 3° tipo sec.Coolsaet

PSEUDOIPOALDOSTERONISMO DI TIPO III IN NEONATO CON GRAVE REFLUSSO VESCICO‐URETERALE BILATERALE

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 …

CISTI CONGENITA DELLA TESTA DEL PANCREAS: DALLA DIAGNOSI PRENATALE ALL’INTERVENTO PRECOCE

Fetal unilateral urinoma in upper urinary tract obstruction: our experience and review of literature. Does it protect renal function?

Ernia diaframmatica congenita. Analisi dei fattori prognostici in 27 pazienti (2000-2006)

Unilateral multicystic dysplastic kidney in infants exposed to antiepileptic drugs during pregnancy

Prenatal exposure to antiepileptic drugs (AEDs) increases the risk of major congenital malformations (MCM) in the fetus. AED-related abnormalities include heart and neural tube defects, cleft palate, and urogenital abnormalities. Among the various congenital anomalies of the kidney and urinary tract (CAKUT), multicystic dysplastic kidney (MCDK) disease is one of the most severe expressions. Although prenatal ultrasound (US) examination has increased the prenatal diagnosis of MCDK, the pathogenesis is still unclear. We report on four cases of MCDK in infants of epileptic women treated with AEDs during pregnancy. From October 2003 to June 2006, we observed four infants with unilateral MCDK bo…

Re: A New Suture Material for Hypospadias Surgery: A Comparative Study

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…

Il C.'E.'..S.I...P.U.O.': una sperimentazione di comunità in pediatria attraverso il processo educativo-formativo

THE USE OF DOUBLE DARTOS FLAP VERSUS DORSAL PREPUCE FLAP IN REDUCING FISTULA RATE AFTER TIP URETHROPLASTY

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

Cisti congenita del surrene ad esordio intrauterino: dalla diagnosi prenatale all'intervento precoce

Malformazione Adenomatoide Cistica del polmone (CAM): il neonato asintomatico

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

TRATTAMENTO DELL'INCONTINENZA FECALE MEDIANTE BIO-FEEDBACK IN PAZIENTI TRATTATI PER MALFORMAZIONI ANO-RETTALI

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…

Authors' Reply

Policistosi ovarica e gonadoblastoma in sindrome di Turner SRY positiva

Re: A new suture material for hypospadias surgery: a comparative study: N. Guarino, S. A. Vallasciani and G. Marrocco

Sull'uso dello stent doppio J nel megauretere ostruttivo

Which non palpable testes truly need laparoscopic Fowler-Stephens orchidopexy?

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

Clinical diagnosis and evoluation

CONGENITAL UNILATERAL URETEROPELVIC JUNCTION OBSTRUCTION:RENAL DAMAGE EVALUATION AND CORRELATION BETWEEN RENAL BIOPSY AND PRE-POSTOPERATIVE RADIONUCLIDE SCAN

PURPOSE to correlate severity of UPJO with immunohistochemical findings and radionuclide renal scan split function (SF), to obtain indications and timing of surgical correction of congenital UPJO. MATERIAL AND METHODS 21 patients, 57-105 days old, were studied. UPJO was assessed by MAG 3 diuretic renography. Patients underwent biopsy at pyeloplasty. Histological and himmunoistochemical analysis for Bcl-KL, Bcl2, AKT-1, BAD, Bax, AIF, FAS FAS-L, H-TERT, Mib-1 and Nocth2 was performed. TUNEL technique was used to detect apoptotic nuclei. Severity of UPJO was assessed intraoperatively and histologically. Renography was repeated one year after surgery. RESULTS All patients showed half-time wash…

Materiali di sutura: influenzano l'incidenza delle fistole e/o stenosi nell'uretroplastica con uso di lembi?

Displasia multicistica renale in rene ectopico: descrizione di un caso con anamnesi positiva per assunzione di farmaci antiepilettici della madre in gravidanza

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

The aim of this study was to assess if discrepancy between power-Doppler voiding urosonography (PD-VUS) and voiding cystourethrography (VCUG) affects the management of patients with primary vesicoureteric reflux (VUR).Fifty-six children with suspected or known VUR were assessed both by PD-VUS and VCUG. Two independent observers, both pediatric surgeons, each aware of the results of only one imaging modality, advised children's management according to present care standards. Agreement between diagnostic findings at the two imaging modalities and between therapeutic advice of the two observers was evaluated using kappa statistics.PD-VUS diagnosed VUR in 3 patients and 6 ureteral units more th…

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)

Approccio laparoscopico al dolore pelvico in età puberale

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…

Impegno nella formazione per una medicina "umana"

Stenosi del giunto pielo-ureterale unilaterale: valutazione del danno renale correlando il dati clinico strumentale con quello istologico ed immunoistochimico

Anastomosi primaria nell'atresia esofagea: risultati del follow-up

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

Abstract Background Gastroesophageal reflux (GER) is frequently observed in children treated for congenital diaphragmatic hernia (CDH) at birth, as well as esophageal dysmotility, that has been hypothesized to be caused by innervatory anomalies. The aim of this study is to evaluate GER and dysmotility in young patients with CDH using pH-multichannel intraluminal impedance. Methods Thirty children (17 boys and 13 girls) who underwent repair for CDH between 2002 and 2007 with a median age of 5.2 years (range, 3-10 years) were included in the study. All patients were operated on with a subcostal laparotomy incision and had a left-sided diaphragmatic defect. The defect repair required an artifi…

Febbre mediterranea familiare: un caso atipico con esordio precoce.

Un nuovo approccio laparoscopico nel trattamento del varicocele di tipo misto (di 3° tipo sec. Coolsaet) nei bambini ed adolescenti

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…

Fetal meconium psedocyst spontaneosly disappeared after birth. A Case report

Reflusso e motilità esofagea in pazienti trattati per ernia diaframmatica congenita: valutazione a breve e lungo termine

Double-J stent insertion across vesicoureteral junction--is it a valuable initial approach in neonates and infants with severe primary nonrefluxing megaureter?

Abstract Objectives To evaluate the role of double- J stent insertion in perinatally detected primary nonrefluxing megaureters as a method to temporize treatment in patients with impaired renal function or to prevent function loss in patients treated expectantly, but deemed at high risk of deterioration. Methods Two neonates and 8 infants with a ureter greater than 10 mm and an obstructive excretion pattern, including 3 cases with renal function less than 40%, were selected to undergo double- J stent insertion for a 6-month period. Patients underwent surgery if the ureter redilated and the excretion pattern was obstructive at reassessment 3 months after stent removal. Results Stents were pl…

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…

Focus on pediatric and adolescent varicocele: a single institution experience

The aim of this study was to report our long-term diagnostic and surgical outcome during the last 18 years, in paediatric and adolescent management of varicocoele. The present retrospective study enrols 374 patients observed at our institution between 1994 and 2011. Patients were divided into three groups: Group A includes 142 youngsters and adolescents treated with open surgery for left varicocoele, in which a pre-operative CDUS was not performed; Group B includes 65 patients treated with open surgery in which a pre-operative CDUS evaluation was carried out, to assess varicocoele haemodynamic pattern and testicular volume. Group C includes 167 patients treated by laparoscopy and with pre-o…

Aspetti controversi nella patologia del giunto pielo ureterale

Significance of enlarged fetal bladder in males. The value of amniotic fluid. When to perform vesicostomy?.

The hemodynamic approach to evaluating adolescent varicocele

During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack…

SEPARAZIONE VENTRALE ED EXTRAROTAZIONE DEI CORPI CAVERNOSI NELLA CORREZIONE DELL’INCURVAMENTO DELL’ASTA CON O SENZA IPOSPADIA

Emorragie digestive in età pediatrica: aspetti chirurgici

Trattamento laparoscopico del varicocele di tipo misto (di 3° tipo sec.coolsaet)

Management of hydrocele in adolescent patients

Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open …

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…

Complicanze associate all'utilizzo dello stent nelle pieloplastiche open. Studio comparativo tra 2 centri.

Epispadia femminile:la ricerca della continenza

Varicocele

Absorbable suture materials for primary defect closure in congenital diaphragmatic hernia: long term outcome

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

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

Sub-inguinal interruption of dilated veins in adolescent varicocele: should it be considered a gold standard technique?

Surgeons of varicocele are at present still searching for a gold standard technique, which can correct varicocele without any recurrences, maintaining optimal testicular function, having got minimal current and future morbidity and being cost effective. We evaluated the presence of these criteria in the technique of sub-inguinal dilated vein interruption.Between 1994 and 2001, 142 youngsters and adolescents underwent surgery for varicocele repair at our hospital. Average patient age was 12.4 years (range 8 to 15). One-hundred-six cases (74.7%) were grade III varicocele, while 36 (25.5 ) were grade II. Grade II varicoceles underwent surgery only if associated with scrotal discomfort, testicu…

Unexpected complication of TIP urethroplasty: the diverticulum of neo-urethra

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

Diagnostic laparoscopy in a Gartner's duct cyst

Gartner's duct cysts associated with renal dysgenesis are rare malformations and represent a diagnostic challenge. We report on one such case in which final diagnosis was achieved by laparoscopy and discuss the possible role of minimally invasive surgery in the management of this condition.

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

Surgery for urethrocutaneous fistula following hypospadias repair. An overview

Oesophageal pH/impedance monitoring in children treated for oesophageal atresia

Cisti celomica fetale intra-addominale, causa di atresia intestinale

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…

Ectopia ureterale bilaterale in distretto singolo in paziente con sindrome da regressione caudale

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

The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents

In a study from Italy, colour-Doppler ultrasonography was a reliable diagnostic tool in the preoperative assessment of patients with varicocele. The authors also found that it helped to distinguish those who could be treated laparoscopically from those who should be treated by microsurgical subinguinal ligature. OBJECTIVE To investigate whether colour Doppler ultrasonography (CDUS) is a reliable diagnostic tool for selecting patients with varicocele to undergo either laparoscopy or open microsurgical subinguinal ligation. PATIENTS AND METHODS In a 3-year period, 42 boys affected by left varicocele were evaluated before surgery by inguinal and scrotal CDUS. Using this method it was possible …

Reverse rotation of the right kidney associated with vascular anomaly producing ipsilateral ureteropelvic junction obstruction.

Failed hypospadias in paediatric patients

Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (tech…

Ruolo della laparoscopia nel trattamento della componente deferenziale nel varicocele di tipo misto (3° tipo sec. Coolsaet) nei bambini e negli adolescenti

Ipospadia posteriore:quale tecnica ?

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

[Cystic dysplasia of rete testis associated with ipsilateral renal agenesis. Case report].

Cystic dysplasia of the rete testis is a rare abnormality often associated with the ipsilateral agenesis of kidney. This malformation is due to a development defect of the mesonephric duct which is the cause of both the dilation of the testicular rete testis and renal agenesis. A case of this rare malformation, showing all the peculiarities described in the medical literature, is presented. A 3 years-4 months boy was examined for an asymptomatic left scrotal mass; thus, he underwent ultrasonography, which showed a multiple tubular and cystic dilatation of left rete testis, associated with the absence of left kidney, afterward confirmed by MAG3-radionuclide scan. Diagnosis was also validated…

Early diagnosis of ureteropelvic junction obstruction in a solitary kidney: when to correctly perform pyeloplasty.

Clinical Diagnosis and Evaluation

Il C.’E.’..S.I...P.U.O.’ (Centro Educativo Sperimentale Interistituzionale Pediatrico Universitario Ospedaliero). Un percorso di sperimentazione per l’umanizzazione in ambito pediatrico