Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration.

BACKGROUND/PURPOSE: Aim of this study was to present a series of neonates and ex-preterm babies who underwent inguinal hernia repair focusing on complications and possible indication to perform routine contralateral groin exploration. METHODS: This is a retrospective study of a series of consecutive patients weighing less than 5 kg who underwent inguinal hernia repair between January 2007 and December 2012. Only the affected side was treated. Patients have been routinely followed up postoperatively. We resorted to available outpatients' charts and admission notes to record demographic data, surgical details, complications and the occurrence of metachronous hernias. A questionnaire was administered to all patients' relatives to confirm the long-term outcome. RESULTS: One hundred fifty-four patients were operated for a total of 184 herniotomies (88 right sided, 36 left sided and 30 bilateral). Median length of follow-up was 42 months (range 6 months-7.5 years). Thirteen patients (13/124 = 10.5 %) developed metachronous hernia that proved to be significantly more frequent in patients weighing less than 1,500 g at birth (p < 0.05). We observed 10 % of complications, including 2.7 % testicular atrophy and 4.5 % recurrence. Atrophy proved to occur more frequently in patients who experienced preoperative incarceration (p < 0.05). No other risk factors were identified. CONCLUSIONS: The results of our series demonstrated that, though technically demanding, herniotomy in the neonate and ex-preterm is associated with a relatively low incidence of complications. Based on our results and in accordance with literature data, we do not advocate routine contralateral exploration in case of unilateral hernia but surgery to be performed only on the symptomatic side, as soon as possible after initial diagnosis. Very low birth weight patients should be followed with care in the early postoperative period due to the higher likelihood of developing a metachronous hernia.

Shifting from open surgical cut down to ultrasound-guided percutaneous central venous catheterization in children: learning curve and related complications.

PURPOSE: Tunneled indwelling central venous catheters (CVC) are essential in the management of children with cancer, hematological, nephrological disorders and for parenteral nutrition. The aim of this study is to present the experience of a single center of the transition from traditional open surgical cut down procedure (OSC) to ultrasound (US)-guided percutaneous CVC insertion, focusing on learning curve and related complications. METHODS: All CVCs inserted between April 2008 and November 2009 in children at the Gaslini Children Hospital were revised, and data on methods of cannulation, intraoperative and device-related complications and re-intervention were recorded. RESULTS: 194 CVCs were positioned in 188 patients. 128 out of 194 CVCs were positioned through an OSC technique, whereas the remaining 66 CVCs were inserted percutaneously with US guidance. Of the 27 recorded complications, 15 were mechanical events, 7 cases developed infection, whereas the remaining 5 (2.6%) were classified as intraoperative complications. A second surgical procedure was described in 23 (11.8%) cases. CONCLUSION: Shifting from OSC to US-guided percutaneous CVC insertion inevitably involves a challenging learning curve which is generally associated with high complication rates. Complications progressively decrease once a good experience in US guidance and percutaneous technique has been obtained.

[Abdominal pain and defecation disorders without a known organic origin: importance of the psychodiagnosis]. / Dolori addominali e turbe dell'alvo senza etiologia organica accertata. Importanza della valutazione psicodiagnostica.

The authors submitted some children examined in the Division of Pediatric Surgery of the Ospedali Galliera in Genoa to a psychodiagnostic evaluation. They presented abdominal pain and defecation disorders, whose organic etiology was not demonstrated. The psychodiagnostic evaluation, consisting in colloquia, tests, drawings and plays, was completed in 11 of the 28 patients referred. A profoundly disturbed and protagonist mother-child relationship and a frequent "border position" of the father was focused. The symptoms disappeared in 8 of the 11 patients during the diagnostic evaluation, that resulted, its own, therapeutic. 3 patients were treated with psychotherapy and a remarkable improvement at 6 months from the beginning of therapy was noticed. Seventeen patients were lost because they didn't come to the outpatient dates or because they were already followed by other specialists in their residential zones. The authors believe that a psychodiagnostic evaluation is important in children with abdominal pain and defecation disorders whose organic origin has not been demonstrated.

One-step treatment of proximal hypospadias by the autologous graft of cultured urethral epithelium.

Surgical management of severe proximal hypospadias or long strictures of the posterior urethra is a difficult clinical task. Often, the therapeutic approach involves the autologous graft of free flaps of bladder or oral mucosa. We recently reported the use of autologous graft of cultured squamous urethral epithelium during urethroplasty in patients with severe proximal hypospadias. The main limitation to the widespread use of cultured epithelium was the long hospitalization due to the requirement of 2 surgical steps. We now report a substantial modification of the surgical procedure which allows for rapid 1-step urethroplasty. Cultured squamous urethral epithelium is tubularized in vitro with the aid of a tubular polytetrafluoroethylene (Gore-Tex) support and 1-step urethroplasty is performed within 30 minutes. Results obtained in 8 patients are presented.

[OEIS complex. Description of a case associated with cardiopathy]. / Complesso OEIS. Descrizione di un caso associato con cardiopatia.

We describe a newborn affected by OEIS complex (Omphalocele--Exstrophy of bladder--Imperforate anus--Spinal defect) associated with atrial septal defect. Terminal ileostomy, closure of the abdominal wall defect and suture of the cecal and vesical plates were performed. The patient died at 5 months and four days.

Intraocular dapiprazole for the reversal of mydriasis after extracapsular cataract extraction with intraocular lens implantation. Part I: Dose-response correlation.

Dapiprazole, an alpha-blocking miotic drug, was used intracamerally at the end of extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation. The double-blind study included 120 patients divided into four groups of 30 eyes; the groups received balanced salt solution, 0.125%, 0.25%, or 0.5% intraocular dapiprazole after IOL implantation and before suturing. Pupillary diameter recordings were performed immediately before and a few minutes after drug injection and two, four, and eight hours after surgery. The results showed a significant reversal of mydriasis by intraocular dapiprazole, especially with the 0.25% and 0.5% concentrations which did not differ significantly in effectiveness and safety.

Intraocular dapiprazole for the reversal of mydriasis after extracapsular cataract extraction with intraocular lens implantation. Part II: Comparison with acetylcholine.

Intraocular dapiprazole for reversing mydriasis during extracapsular cataract extraction with intraocular lens (IOL) implantation has been compared to intraocular acetylcholine. Ninety patients were enrolled in a double-blind study and divided into three groups of 30 eyes; each group received balanced salt solution (control), 0.25% dapiprazole, or 1% acetylcholine. Pupillary diameter recordings were performed immediately before and a few minutes after drug injection, and two, four and eight hours after surgery. Goldmann tonometry was performed the day before and 6 and 24 hours after surgery. Contact endothelial cell count was performed before and one and four months after surgery. The results indicated a slower starting but longer lasting effect with dapiprazole than with acetylcholine and a significant reduction of the postoperative intraoperative pressure rise with both drugs. No significant difference in reduction in the endothelial cell count was seen between dapiprazole and acetylcholine groups and the control group.