Latex allergy in children with oesophageal atresia.

BACKGROUND: Latex allergy is frequently found in children and patients with spina bifida and urogenital abnormalities and have been considered at risk for latex sensitization. The aim of the study was to evaluate the incidence of latex sensitization in patients with oesophageal atresia and undergoing three or more surgical procedures and to identify possible risk factors in the process of latex sensitization. METHODS: A total of 20 patients were analysed: 19 boys and one girl. The oesophageal atresias were as follows: type I in three children, type II in two and type III in 15 children. Surgical and anaesthetic procedures, intensive care management, age, type of oesophageal atresia, associated congenital malformations, Waterston and Montreal prognostic classifications were considered as risk factors that may be implicated in the process of sensitization. RESULTS: Five patients (25%) were considered sensitized to latex (group 1) and 15 (75%) nonsensitized (group 2). Among the five sensitized patients, three reported clinical reactions to latex, while the other two presented only specific IgE sensitization. The number of operations, the total hours of surgery, the number of drainages, the total days of drainage, the total days of central venous catheter were significantly greater in group 1 than in group 2. Both of the highest risk oesophageal atresia classes (Waterston C and Montreal II) were related to latex allergy. CONCLUSIONS: Oesophageal atresia, especially in cases of prolonged management, must be considered as a risk for the development of latex allergy.

[Follow-up of residual renal function in patients with serious forms of posterior urethral valves]. / Valutazione a distanza della funzione renale residua (FRR) in portatori di forme gravi di valvole dell'uretra posteriore (VUP).

We report the results of the trend of the residual renal function (RRF) of 15 patients with serious forms of hind urethral valves (HUV) which agreed to be long term regularly controlled after surgical correction at the Children's Surgical Hospital of Bologna University. The nephrological follow-up started in 1985 is based on a periodical control at least once a year, of some indicatives parameters of the glomerulars activity (creatinine clearance according Schwartz and creatinine reciprocal), of the tubular activity (urinary flux ml/kg/h, per cent fraction of Na excretion) and the dynamical test of the RRF started in 1991. The results although the low cases studies, are not statistically significant, the Authors underline the validity of the adopted method. Although of the simplified and/or indirect type, this is able to give clinically reliable informations of the renal functionality evolution avoiding particularly complex or invasive analysis.

[Further experience with the use of gastrointestinal segments in bladder reconstruction in the complex of exstrophy-epispadias]. / Ulteriori esperienze sull'uso di segmenti gastro-intestinali nella ricostruzione vescicale del complesso estrofia-epispadia.

It is a matter of discussion if bladder augmentation should or should not utilize in the treatment of exstrophy-epispadias complex. When staged functional bladder reconstruction is adopted in the most difficult cases, or when one desires to avoid early and/or subsequent urinary diversions, sometimes a bladder enhancement could be necessary. The indications should be: a progressive damage to the upper urinary tract, after bladder closure at birth, due to a very small, no compliant detrusor plate (this is a rare condition: only one case in our series); a bladder capacity < or = 80 mls at the time of bladder neck reconstruction (this is a frequent but questionable condition: three cases in our series); a progressive damage of the upper urinary tract after bladder neck reconstruction (this is an unexpected, but not rare condition: 3 cases in our series); during every undiversion procedure (bladder augmentation is nearly mandatory during undiversion in cloacal or bladder exstrophies previously diverted: 4 cases in our series). In our experience, 12 bladder augmentations (in 11 patients, over 85 cases we observed) were done at median age of 8 years and 5 months. Different intestinal segments have been used: the sigmoid colon, the ileo-cecal portion, an ileal tract and the stomach. Follow-up ranges from 11 years to 12 months; until now, we observed few surgical complications: a bowel obstruction in one patient, a left ureteral partial stenosis at level of the anastomosis with the gastric patch wall in another patient and bladder lithiasis in 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ureteral ectopy. The residual stump syndrome]. / Ectopia ureterale. La sindrome del moncone residuo.

Anatomy and symptoms of ureteral ectopy in childhood can greatly vary. In most cases the site of ectopies in the urethral tract, so that a complete excision of the distal ureter is difficult and may cause damage to the sphincteric structures. When lower ureterectomy is performed below iliac vessels, symptoms secondary to residual ectopic ureter are rare. In our experience, residual ureteral stumps were symptomatic in two cases, with continence and micturation disturbances, which were codified as "residual ureteral stump syndrome". Clinical features and treatment are herein reported.

[Valves of the anterior urethra without diverticulum. Description of 3 cases]. / Valvole dell'uretra anteriore senza diverticolo. Descrizione di tre casi.

Anterior urethral valves are rare entities, especially in case they are not associated to urethral diverticulum. Because of their obstructive effects on the urinary tract, they must be searched in case of clinical evidence of lower obstructive uropathy. Three cases of anterior urethral valves without urethral diverticulum are herein reported. Differential diagnosis with urethral diverticula, endoscopic features and treatment are discussed and emphasized.