Robotic ureteral reimplantation and uretero-ureterostomy treating the ureterovesical junction pathologies in children: technical considerations and preliminary results.

Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR) and robotic ureteroureterostomy (RUU) are two mini-invasive surgical techniques that have begun to be performed in pediatric urology in recent years. RALUR has been employed especially for VUR treatment, while RUU is considered principally in case of complex doubled ureteral systems. Our aim is to discuss the safety and feasibility of these approaches in children, focusing on technical considerations and supporting their use in different anomalies and pathologies of the ureterovesical junction. We retrospectively collected data about 58 patients who underwent 44 dismembered RALUR (D-RALUR), 28 non-dismembered RALUR (ND-RALUR) and 5 RUU between May 2020 and December 2021. Indications for surgery were primary or secondary vesicoureteral reflux, megaureter, secondary UVJ obstructions, complicated doubled ureteral systems. Mean age was 3.5 years (range 0.6-12.9) and mean weight 17.1 (range 7.2-80). No intraoperative complications occurred nor conversion to open approach were reported. Major postoperative complications were reported in 11.7% of cases with a higher incidence for ND-RALUR. Mean hospital stay was 2.14 days (range 1-8). Success rate at the short-term follow-up was 91.9% for D-RALUR, 96.3% for ND-RALUR and 100% for RUU. RALUR and RUU are two feasible and safe procedures to perform in children. RALUR represents the most required and adequate technique in the treatment of UVJ pathologies, however, in selected cases RUU could represent an effective alternative that has to be considered.

Giant calcified thoracic herniated disc: considerations aiming a proper surgical strategy.

AIM: Giant herniated thoracic disc (HTD) is a rare disease that, unlike other thoracic disc herniations of different size, need a different surgical management. The copresence of ''giant'' volume and calcification of the herniated disc heavily affects the surgical difficulty and is not elsewhere described. METHODS: Seven cases of surgically treated giant calcified HTDs were considered in this study. Five of them were females and two males, age range 18-63 years. Before and after surgery, all patients underwent computed tomography myelography, magnetic resonance imaging or both pre-and postoperatively. Functional outcomes were assessed using the Asia grading system preoperatively, immediately after surgery, and at long-term follow-up examination. The mean overall follow-up period was 36 months. All patients presented with various grades of myelopathy: according to the Asia impairment scale, two were grade B, four were grade C and one were grade D. Six patients underwent an anterior approach, i.e. thoracotomy, and one patients underwent a posterolateral approach, i.e. peduncolocostotrasversectomy. RESULTS: Based on an analysis of the long-term follow-up data, the Asia grade improved in five patients (71.4%), stabilized (no grade change) in one (14.3%), and worsened in one (14.3%). CONCLUSIONS: Giant calcified HTDs are particularly challenging surgical lesions and their volume and consistency are additional elements of difficulty. This article presents authors' personal experience on a small but extraordinary series of giant and calcified thoracic herniated discs and the problems encountered in the management of this peculiar pathology since an accurate surgical planning leads to better clinical results.

Small intestinal motility: normal and abnormal function.

This review outlines the properties and function of intestinal smooth muscle and the mechanisms that underlie contraction and relaxation. Both tonic and phasic (rhythmic) contraction are mediated by an increase in intracellular calcium. Phasic contraction is paced electrically by rhythmic changes in membrane potential (slow waves) which, upon reaching a threshold, lead to opening of membrane calcium channels and the entry of calcium into muscle cells; this inwardly directed calcium current or spike initiates a cascade of events resulting in contraction. Slow waves and spike potentials and, thus, phasic contraction, are influenced by neurotransmitters, hormones, and drugs. In circular muscle, these agents can also increase calcium by releasing it from intracellular stores, thus inducing tonic contraction. Ingestion of food initiates peristaltic propulsive activity which, in its rhythm, is superimposed on spontaneous phasic activity. The peristaltic reflex consists of two successive phases: relation of circular muscle distal to the distending bolus (descending relaxation) and contraction proximal to the bolus (ascending contraction). In-between meals, a different, slower pattern of muscle activity prevails, known as the migrating motor complex, which helps to maintain the lumen of the intestine free of contents. Improved understanding of normal muscle function is beginning to reflect itself in improved management of patients with motility disorders.

Quantitative studies of the hepatitis B viral pre-S proteins: lack of correlation with the HBeAg status.

Radioimmunoassays for the determination of the relative amounts of hepatitus B viral pre-S proteins present in serum samples have been developed which utilize antibodies against synthetic peptides corresponding to the amino termini of these proteins. The assays were shown to be sensitive and specific. These assays have been used to examine hepatitis B surface antigen positive human plasma samples for the presence and relative amounts of pre-S proteins. Contrary to previously published data, it was found that there is no correlation between the presence of the pre-S proteins and the HBeAg status of the plasma, but that the ability to detect the pre-S proteins is only a function of the hepatitis surface antigen titre of the plasma. It is concluded that the pre-S proteins would not serve as a useful marker for active viral replication.