Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia.

Dysphagia, gastroesophageal reflux (GER) and esophageal metaplasia are reported with various incidence in the long term follow-up of patients treated at birth for esophageal atresia (EA). To evaluate the long term outcomes 26 patients treated at birth for EA with Tracheo Esophageal Fistula (TEF) were examined 8-28 (mean 15.8) years later by clinical evaluation, including barium meal, fiberoptic upper GI endoscopy, 24 hour ambulatory two-channel pH-monitoring and stationary esophageal manometry. 50% of patients complained of dysphagia. Mild esophagitis was found in 20% of patients but GER was detected in only 16.7% of the cases. By morphological X-ray, esophageal anomalies were detected in 31% of cases without significant functional relevance. Hundred percent of patients had a disorganized peristaltic esophageal activity and a low amplitude of the esophageal contractions was observed in 58% of them. In our series, esophageal dismotilty seems to be the main consequence of EA without any relevant disturbance of normal nutritional habit.

[True splenic cysts. Two clinical cases]. / Le cisti spleniche vere. Due casi clinici.

Two case reports of epidermoid cyst of the spleen are presented. Only 700 cases have been reported so far. Although splenic cysts are benign lesions and could involve spontaneously, the risk of rupture of a large cyst is high, so a diameter of 5 cm was suggested as the higher limit for nonsurgical treatment. For many years the surgical treatment of splenic epidermoid cysts was splenectomy: however recognition of the short and long-term complications of radical splenectomy had led to the practice of splenic preservation (partial splenectomy, total cystectomy, laparoscopic cyst decapsulation).

[Retrocaval ureter in children: a rare form of obstructive uropathy]. / L'uretere retrocavale nel bambino: una rara forma di uropatia ostruttiva.

Retrocaval ureter is a rare anomaly, often misdiagnosed for years, presenting with sign of urinary infections and obstruction. Recognition of this anomaly is rare in childhood. We report a case of a 9 years old boy, who was successfully treated by ureteral section, excision of the retrocaval segment and uretero-ureteral anastomosis. Current diagnostic procedures and different methods of treatment are reviewed.

[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.

[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.

[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.