ABSTRACT
Introducción: La tasa de complicaciones a largo plazo tras la reparación del hipospadias distal puede ascender al 20%, y aún no disponemos de directrices sobre la colocación de la sonda en la uretroplastia distal. Hemos analizado de forma retrospectiva la tasa de reintervención de la uretroplastia a medio plazo y los resultados estéticos tras un estudio piloto de 2años sobre las uretroplastias distales con colocación de sonda o sin ella.Materiales y métodosUn cirujano pediátrico realizó 11 procedimientos con la técnica de Snodgrass con colocación de sonda (grupo A) y 17 sin colocación de sonda (grupo B) en nuestra institución (2011-2013). La mediana de edad de los pacientes en la cirugía fue de 2,1 años (rango 1-8,5).Los criterios de inclusión fueron: defecto distal primitivo, un único cirujano en ambos procedimientos y alta sin sonda.La mediana de seguimiento fue de 6,4 años (rango 1,5-8,1).Los resultados clínicos y estéticos postoperatorios fueron evaluados al menos una vez mediante la herramienta HOSE (Hypospadias Objective Scoring Evaluation).El objetivo de nuestro estudio fue comparar las complicaciones y las tasas de repetición de la uretroplastia a medio plazo antes de iniciar un estudio aleatorizado. Se hizo un análisis retrospectivo. Se utilizó la prueba exacta de Fisher (p <0,05) para el análisis estadístico.ResultadosDe los 28 del total, 5 complicaciones requirieron una segunda cirugía: 2/11 casos con sonda, 3/17 sin sonda. Los resultados estéticos fueron satisfactorios en ambos grupos. Los resultados no alcanzaron significación estadística (p=1.000). (AU)
Introduction: Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need of a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-year pilot study on stented/un-stented distal urethroplasties.Materials and methodsA total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by one pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5).Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge.The median follow-up was 6.4 years (range 1.5-8.1).All patients received at least one post-operative clinical-cosmetic examination (HOSE).The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P<0.05) for statistical analysis.ResultsOf 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P=1.000). (AU)
Subject(s)
Humans , Hypospadias , Treatment Outcome , Urologic Surgical Procedures , Retrospective StudiesABSTRACT
INTRODUCTION: Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need for a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-years pilot study on stented/un-stented distal urethroplasties. MATERIALS AND METHODS: A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by the same pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5-8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (Pâ¯<â¯0.05) for statistical analysis. RESULTS: Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (Pâ¯=â¯1.000). CONCLUSION: Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.
Subject(s)
Hypospadias , Urologic Surgical Procedures, Male , Child , Child, Preschool , Humans , Hypospadias/surgery , Infant , Male , Pilot Projects , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need of a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-year pilot study on stented/un-stented distal urethroplasties. MATERIALS AND METHODS: A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by one pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5-8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P<0.05) for statistical analysis. RESULTS: Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P=1.000). CONCLUSION: Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.
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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.
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The pseudopapillary pancreatic solid tumor (TPSP) is a rare malignancy typical of young adult women (only 12 pediatric cases from 2000 to 2009), it can recur and metastasize. The prognosis is usually good after radical surgical removal. We emphasize the importance of TPSP in differential diagnosis of retrogastric, peripancreatic masses especially in puberal females. We describe the case of an adolescent girl with an abdominal mass revealed as a rare pancreatic neoplasia.
Subject(s)
Carcinoma, Papillary , Pancreatic Neoplasms , Abdomen/pathology , Adolescent , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Female , Humans , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgeryABSTRACT
Gallbladder polypoid lesions are rare in the pediatric patient and sometimes represent an incidental finding. A 13 year old male was referred to the Padua Hospital Pediatric Department for an obesity. A routine abdominal ultrasound (US) detected a gallbladder polypoid lesion 6 mm in diameter, initially considered a gallbladder adenoma. Investigation did not detect any other biliary tract abnormality. After seven months, the asymptomatic patient underwent a follow-up US which revealed the disappearance of the polypoid mass. The following concerns are raised: what is the size of the polypoid mass that should be considered for surgery? How does the presence of symptoms worsen the diagnosis and lead to preferring a surgical approach (cholecystectomy) over an echographic follow-up?
Subject(s)
Gallbladder Diseases/diagnosis , Polyps/diagnosis , Adolescent , Adult , Diagnosis, Differential , Follow-Up Studies , Gallbladder Diseases/diagnostic imaging , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/diagnostic imaging , Humans , Male , Polyps/diagnostic imaging , Radiography, Abdominal , Remission, Spontaneous , Time Factors , UltrasonographyABSTRACT
Animal bite lesions in the pediatric patient are mainly accounted for by dog bites in 80% to 90% of the cases. They often present a favorable prognosis but serious lesions do account for 5% to 20% of the total incidence. We will present three particular clinical cases which required urgent surgical treatment as well as a review of the current literature to include both medical and surgical treatment methods for this kind of lesion.
Subject(s)
Bites and Stings/surgery , Dogs , Animals , Child , Child, Preschool , Humans , Infant , Injury Severity Score , MaleABSTRACT
PURPOSE The umbilical venous catheter (UVC) is routinely used in neonatal intensive care. Incorrect placement may expose the patient to some dangerous complications (i.e. thrombosis, abscesses, etc). We report a case of an hepatic abscess due to incorrect positioning of this device. We describe how the abscess was treated and we emphasize that one cannot be cavalier about proper positioning of the UVC.
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Occlusion of traditional sites for central venous cannulation is a challenging problem in patients that require a permanent central venous line for chronic administration of nutrients or drugs. In rare cases, extensive central venous thrombosis of the superior and inferior vena cava may preclude catheterization, and uncommon routes should be used. We describe our approach for placement of chronic central venous lines in two pediatric patients with short bowel syndrome and extensive caval occlusion.
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The aim of this study was to evaluate the problems induced by the use of a central venous catheter (CVC) in a series of patients with short bowel syndrome observed at the university of Padua (Italy) between January 1981 and June 1997. During this period, 14 patients required central venous access for parenteral nutrition (PN); 55 catheters were inserted, 6 with percutaneous and 49 with surgical techniques. We divided the patients into two groups according to PN duration. The first group includes 11 children with short/medium-term PN 8 are now eating, and 3 died from respiratory failure) while the second group includes 3 patients on home long-term PN. Thirteen catheters were placed in the first group, and the mean PN duration was 173 days; the three patients on home PN required 42 catheters. It is our experience that the use of catehters in patients requiring short/medium- term PN is a safe procedure with few complications; patients on home long-term PN present an increasing number of complications, and the vascular access could become a serious problem as the number of PN-dependent increases.
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Extremely low birthweight neonates often require total parenteral nutrition by central venous catheterization.The technique of choice is the percutaneous cannulation via the basilica or cephalic vein; in particular cases, these peculiar patients need a cut down catheterization. This paper describes some unusual complications of this surgical approach.
