Circular myotomy of the distal esophageal stump for long gap esophageal atresia.

PURPOSE: The aim of this work is to report the utility of the distal esophageal stump's circular myotomy in case of a long gap esophageal atresia repair. METHODS: Between 1972 and 1999 the authors treated 192 patients who had esophageal atresia (EA). Among them, 6 patients with EA long gap underwent both a distal and proximal stump circular myotomy. Five cases were Gross type C, and 1 case was Gross type A. The gap (average 4.5 cm) did not permit a simple and direct end-to-end anastomosis. RESULTS: One patient died 6 days after the operation because of a cardiac malformation. There was no mucosal tear during the myotomies or any anastomotic stricture later. Five patients survived. Three of them needed an antireflux procedure (60% of surviving patients). None of the 5 patients showed any mucosal outpouching, and their esophageal motility and swallowing were not different clinically compared with the patients who underwent an EA repair without a myotomy. CONCLUSIONS: Distal circular myotomy is a very useful, however, delicate, procedure that can help solve the problem given by long gap EA. It is mandatory not to tear the mucosa during the myotomy to avoid the shortening of the stump caused by its repair, which would lead to an increase in the size of the gap. J Pediatr Surg 36:855-857.

[Renal ectopia in childhood. Experience in 13 cases]. / Ectopia renale in età pediatrica. Esperienza su 13 casi.

Renal ectopy is a rare congenital malformation related to an abnormal migration of the kidney from the sacral to the lumbar region. Three possibilities are present: absent migration (pelvic ectopia), excessive (intrathoracic ectopia) or to the opposite side (crossed ectopia). During the last 10 years in the Department of Pediatric Surgery of the Niguarda Hospital 13 cases of renal ectopy have been observed. Five patients had a crossed ectopy (4 with fusion) and eight had a simple ectopy (1 intrathoracic, 7 pelvic). Female were more affected than males (9 cases) and the right side was involved in 8 cases, the left in 4 cases and both kidneys in 1 case. Associated anomalies were present in 7 patients: 6 cases with exclusively genito-urinary malformations while 1 patient only was polimalformed (cloacal exstrophy, MMC, bilateral TEV). Correct diagnosis was obtained during urologic screening in 5 cases (1 suspected antenatally), while in 7 cases was related to the associated symptoms (UTI, hematuria, abdominal pain). Seven patients were surgically treated for the associated urologic abnormalities while in the remaining six cases no treatment was required.

[Infections of the urinary tract persisting in successful outcome of vesico-ureteral reimplants for primary reflux]. / Infezioni delle vie urinarie persistenti in esiti favorevoli di reimpianto vescico-ureterale per reflusso primitivo.

Persistence of urinary tract infections after successful ureteric reimplantation for vesico-ureteric reflux has been reported with an incidence varying between 20-30% according to different series. The Authors analyze their own experience with 99 patients successfully operated for primary VUR during a five year period. In 22 patients (22.2%) there was evidence of persistent UTI, which were almost exclusively low and asymptomatic (91%) and occurring within 6-12 months after the antireflux surgery. A single UTI was documented in over 60% of the patients. There was strong female prevalence (21 patients) and 50% were more than 6 years old. No significant relationship was found between grade of VUR, renal scarring, type of germ and number of preoperative infections and incidence of post-operative UTI. On the other end, voiding and continence disorders and cystoscopic evidence of cystitis cystica would both indicate to be predisposing factors. In these specific cases it is mandatory an accurate pre-operative evaluation of the voiding habits, in order to better define the treatment strategy, not only limited to the surgical correction of the associated reflux.

[Perforated appendicitis in a newborn infant associated with Down's syndrome. Review of the literature]. / Appendicite perforata in un neonato con associata sindrome di Down. Revisione della letteratura.

A seven days old male newborn with associated Down's syndrome suddenly presented with symptoms suggestive of intestinal obstruction. At laparotomy a perforated appendix with generalized peritonitis was discovered. This is the first case reported in the literature in association with the Down's syndrome.

[Congenital intrapericardial diaphragmatic hernia associated with an omphalocele in a newborn infant]. / L'ernia diaframmatica intrapericardica congenita associata ad onfalocele nel neonato.

The authors present a case of congenital intraperichardic diaphragmatic hernia and omphalocele, diagnosed on post birth day 11. The patient underwent an emergency procedure with evidenced an abdomino-perichardic hernia with perichardic sca due to the presence of a "breach gap" in the central-anterior region of the diaphragm. This rare malformation could be related to a development anomaly of the septum trasversum.

[Are echographic and radioisotopic studies substitutive or complementary to radiology in renal pathology in childhood?]. / Le indagini ecografiche e radioisotopiche sono sostitutive o complementari alla radiologia nella patologia renale in età pediatrica?

The role of ultrasound on paediatric renal tract investigation has become established over the last 15 years, showing only with nuclear magnetic imaging the merit of being truly, non invasive and almost certainly free from biological hazards. The information obtained remains mainly static rather than dynamic, anatomical rather than functional. Conversely radioisotopic methods allow functional studies, mainly in cases in which separate functional are requested. Recently some Authors claimed that these two techniques could replace conventional x-ray investigations. Aim of this paper is to report the results of these techniques separately applied in urinary tract abnormalities in pediatric age. Reliability and utility in terms of diagnostic and therapeutic approach are discussed.

[Circular myotomy in primary anastomosis for the correction of esophageal atresia]. / La miotomia circolare nell'anastomosi primaria per la correzione dell'atresia esofagea.

The A. present their experience with the circular myotomy sec. Livaditis in the primary anastomosis of esophageal atresia. Six cases operated on from January 1980 to October 1982 and with a follow-up from 8 to 36 months are analysed. In all the cases there was a distal esophago-tracheal fistula. Gestational age ranged from 36 to 40 weeks and the body weight at birth from kg 1.5 to 3.9. Two patients died for reasons unrelated to the surgical correction of the esophagus (sub-arachnoid hemorrhage, VDS). Both cases at necroscopy revealed a normal esophageal anastomosis. Early an late complications of the remaining 4 cases and long term results are evaluated. In conclusion the A. support the Livaditis esophagomyotomy whenever possible and prefer this technique to the disadvantages of the two-staged esophageal repair.

[Perioperative water-electrolyte therapy in urologic surgery in childhood]. / Trattamento idroelettrolitico perioperatorio nella chirurgia urologica dell'età pediatrica.

Renal function was evaluated before and after introduction of different intraoperatory methods of hydroelectrolytic re-equilibrium in 172 children who underwent urological surgery. 24 h postoperatory renal function resulted not affected in the treated group, while significantly reduced in untreated patients.

[The Lester Martin operation in an infant]. / Intervento di Lester Martin in un lattante.

A case of Lester Martin repair for total colonic and distal ileal aganglionosis in an infant of 3.4 Kg is reported. The Authors consider and discuss the possibility of application of this operation at a younger age than normally performed considering the satisfactory result obtained in this case.

Prune-belly syndrome: report of three siblings.

The "Prune-Belly" syndrome is rare and sporadic. The authors describe three siblings of both sexes with the syndrome. Good results in two of the patients arouse new interest in surgery for this syndrome. The possibility of prenatal diagnosis is discussed.

[Rare case of intestinal malrotation: duodenal-jejunal stenosis caused by ileal hyperrotation (180 degrees) in a newborn (author's transl)]. / Rare cas de malrotation intestinale: sténose duodéno-jéjunale due à une hyperotation iléale (180 degrees) chez un nouveau-né.

The authors present a case of intestinal malrotation characterized by a hyperotation of ileal loops (180 degrees) causing a stenosis of the duodenal-jejunal junction. Some ileal loops were situated, through a defect of the ascendent mesocolon, behind the ascendent colon. The difference between the ileal volvulus and this malformation is: 1. There was no vascular sufference of hyperrotated ileum. 2. The ileal loops were fixed in that hyperrotated position. 3. Some loops were located behind the colon ascendent. 4. After the derotation of ileal loops the stenosis at the duodenal-jejunal level persisted and we proceded to surgery of the stenotic point.

Three years of bacteriological monitoring in the Department of Paediatric Surgery.

The results of three years of bacteriological monitoring in the Department of Paediatric Surgery at the Ospedale Maggiore Ca'Granda in Milan are reported. The tests carried out involved the patients (faeces, urine, and pus cultures), the environment (operating theatre, incubators), and healthy carriers (upper respiratory tract of nursing and paramedical staff). The aetiopathogenesis of the post-operative infectious complications that occurred in 1974-1975 was investigated with the aid of surveys of the causative pathogens, the type of the surgical interventions, the atmospheric pollution in the operating theatre (mean indicative values), the number of operations per month, and the frequency of positive findings among the carriers. As a parallel investigation, between 1971 and the time of writing of this report the authors monitored the resistance to gentamicin of bacteria belonging to the family Pseudomonadaceae isolated from patients, in view of the constant threat posed by the vicinity of the burns department.