Transumbilical laparo-assisted appendectomy: a safe operation for the whole spectrum of appendicitis in children-a single-centre experience.

The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52' Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings.

[Notes on cases of meningitis admitted to the Ospedale Cotugno of Naples in the period 1987-91]. / Note sui casi di meningite ricoverati presso l'Ospedale Cotugno di Napoli nel periodo 1987-91.

The notification of the cases of meningitis admitted to the Hospital Cotugno of Naples in the period 1987-91 were analyzed by a retrospective study: aim of the study was to outline the epidemiological trend of meningitis and to evaluate the quality of the data around the change of the reporting system, which took place in 1991. We examined 566 clinical charts, selecting only the cases whose agents were identified. Our data agree with the national and international literature, with the exception that the majority of cases were produced by S. pneumoniae. Moreover, the data about tuberculous meningitis still show that the highest incidence occur in youth, while other Authors noticed a trend toward older ages. Further studies are in progress to improve the knowledge of tuberculous meningitis in our Country.

[Hypertrophic stenosis of the pylorus. Correlations with allergy to milk proteins and atopy]. / Stenosi ipertrofica del piloro. Correlazioni con l'allergia alle proteine del latte e con l'atopia.

We performed a study concerning the relationship between hypertrophic pyloric stenosis (HPS), atopy and cow's milk protein allergy (CMPA). Familial history of atopy was documented in 17 (44.7%) of 38 infants having undergone Ramstedt pyloromyotomy for HPS, in 12 (23%) of 52 infants having undergone surgery for inguinal hernia and in 53 (26.9%) of 290 normal controls (significant differences between HPS and other groups). Moreover 9 (23.6%) of 38 infants with HPS presented personal history of eczema at follow-up compared with 3 (5.7%) infants having undergone surgery for inguinal hernia (p less than 0.01). A significant difference between HPS and other groups was also found when looking for familial history of CMPA: 26.3% vs % and 2.5% respectively (p less than 0.001). Eventually we discovered a higher than expected incidence of CMPA both in a retrospectively evaluated group of HPS and in 24 infants undergone Ramstedt pyloromyotomy and followed according to a standardized protocol for a mean period of 4 months (16.6%). The etiology of HPS remains obscure. Our data however suggest some relationship between HPS, atopy and particularly CMPA.

[Multiple splenic and renal abscesses caused by Candida albicans: a new diagnostic and therapeutic method using intraoperative echography and closure of the residual cavities with biological glue]. / Les abcès multiples spléniques et néphrétiques par Candida albicans: nouveau procédé diagnostique-thérapeutique par échographie intra-opératoire et fermeture des cavités restantes avec colle biologique.

The Candida albicans infection represents a rather frequent complication in immunodeficient patients, while the evolution towards the growth of multiple intraparenchymal abscesses constitutes a very rare event. The authors describe the diagnostic-therapeutic pathway chosen in a case regarding a young patient in treatment for leukemia , who was affected by multiple splenic and renal abscesses caused by Candida albicans. After a preoperative diagnosis through ultrasonography and C.A.T., a splenectomy was undertaken. Next the only healthy part of the spleen was removed and grafted into the omentum. By using the intraoperative ultrasonography on both kidneys, the abscess cavities were precisely located, aspirated and finally stuck with a human fibrin glue.