Sodium hyaluronate in treatment of diffuse nephrogenic adenoma of the bladder in a child.

Nephrogenic adenoma is a rare, benign lesion of the bladder, occurring as an epithelial response to chronic infection or trauma, probably arising from nephrogenic metaplasia. In contrast to nephrogenic adenomas in adults, who present with this tumor in the entire ureteral tract, it has been observed exclusively in the bladder of children thus far. We report and discuss here the case of a 12-year-old boy with diffuse calculus-producing nephrogenic adenoma successfully treated with sodium hyaluronate.

The use of the Limberg skin flap for closure of large lumbosacral myelomeningoceles.

Closure of the skin defect in myelomeningocele repair is an essential step that determines the quality of the surgical result. In large myelomeningoceles, however, adequate skin coverage may not be accomplished by direct closure or skin undermining. In such cases, the skin defect is best repaired using flaps. To evaluate whether the Limberg skin flap is effective for the repair of large round or oval lumbosacral myelomeningoceles, we studied the records of 25 children. Surgical repair was carried out within 24-36 hours of birth in all 25 patients, with the defect size ranging from 36-72 cm(2). Durable, stable soft tissue coverage of the defect was obtained in 23 of 25 patients, with a postoperative follow-up of at least 2 years. Reoperation became necessary in the remaining two patients, but flap necrosis occurred in only one. We suggest that Limberg flap repair may have some advantages in patients with large round or oval lumbosacral myelomeningoceles, including minimal invasivity, short hospitalization, and improved cosmetic results.

[Antibiotic prophylaxys in pediatric surgery of genito-urinary abnormalities]. / La profilassi antibiotica nella chirurgia delle malformazioni genito-urinarie in et pediatrica.

Ninety-two patients in the age range of 2,5 and 16 years with hypospadias (28 cases), vescicorenal reflux (22 cases), hydronephrosis (16 cases) and a series of other congenital genitourinary abnormalities underwent one or more surgical interventions performed by an unique surgeon at the department of Pediatric Surgery, S. Bortolo Hospital, Vicenza. The more frequently performed interventions were the plastic of the urethra (28 pts, 30,4%), that of the pyeloureteral joint (15 pts, 16,3%) and the modelling and the reimplantation of the ureter/ureters (12 pts, 13%). The interventions were considered as clean-contaminated, because all patients had a temporary urinary derivation with vescical catheters, uretral or pyelovescical stents. An antimicrobial prophylaxis was undertaken in all cases in order to prevent postoperatory infections. Ceftriaxone at a mean dosage of 50 mg/kg was administered to all patient for a mean duration of 5,5 days, in 79 cases by the intravenous and in 13 cases by the intramuscular route. Three patients received also metronidazol because of a concomitant intestinal surgery. The objective of this retrospective trial is to evaluate the efficacy of an antibiotic prophylaxis in pediatric genitourinary surgery with temporary urinary drainage. Data analysis evidenced a very low incidence of postoperatory infections, that occurred only in 2 patient on 92. It can be therefore concluded that ceftriaxone is effective and well tolerated when administered for the prevention of postoperative infections in urological interventions.