Natural history of non-operative treatment for renal injuries in children.

AIM: Kidney is one of the solid organs injured in blunt abdominal traumas. Conservative management is well recognized in adults, but is still controversial in children. We performed a retrospective review regarding children with renal injuries observed at our Centre, analyzing the importance of a prompt diagnosis and the role of conservative treatment according to the degree of renal injury and natural history. METHODS: We reviewed 15 cases of blunt abdominal trauma with renal injuries observed during a period of 11 years. The diagnosis was confirmed by abdominal computed tomography (CT) scan and ultrasonography (US). Conservative treatment started monitoring the hemodynamic stability, the hematocrit value, the hemoglobin, the red cell count, the urine analysis. If necessary blood transfusion was performed. A follow-up from 1 month to 2 years monitored the lesions healing. RESULTS: Age of patients varied from 3 to 15 years (mean age = 6.3). Nine were males and six females. Two patients had an associated spleen lesion, thirteen had an isolated renal injury. Injury grades were classified as follows: grade I, 5 cases; grade II, 3 cases; grade III, 5 cases and grade IV, 2 cases. Non operative management was successful in 14 out of 15 cases; 1 patient with grade IV required a partial nephrectomy. At follow-up good healing of the lesions was observed. CONCLUSION: Most of renal injury related to abdominal trauma can be successfully and safely managed conservatively. Hemodynamic stability, a prompt clinical and instrumental diagnosis and grading of lesions by CT are necessary to start an effective non operative treatment.

Case report of congenital fistula of the penile urethra.

Isolated congenital fistula of the penile urethra is extremely rare. A case of congenital urethral fistula with an intact glandular urethra without chordee is reported with a discussion of the possible etiology and management.

An uncommon case of associate intrinsic and extrinsic stenosis of the duodenum in newborn.

The incidence of congenital combinations of extrinsic and intrinsic compression of duodenum is uncommon. The authors report a rare case of a neonate with a duodenal stenosis due to the contemporary presence of an annular pancreas and wind sock web. The diagnostic strategies and management will be discussed.

A case of bilateral prenatal testicular torsion: Ultrasonographic features, histopathological findings and management.

OBJECTIVES: The aim of this study was to demonstrate the ultrasonographic features of prenatal bilateral torsion of the testis, and its histological correlation and management. PATIENT: A newborn presented at delivery with both testes enlarged, swollen and tender. Prenatal ultrasound (US) showed enlarged, hyperechoic testes. Colour Doppler US examination was performed. RESULTS: US revealed both testes to be heterogeneous. Colour Doppler US did not reveal any flow signal. On inguinal exploration both testes appeared necrotic. Histology showed recognizable seminiferous tubules and Leydig cells. CONCLUSION: We believe that both testes should be left in situ after bilateral detorsion even if their macroscopic appearance is necrotic.

[Esophagoscopy in pediatric surgery]. / L'esofagoscopia in chirurgia pediatrica.

Esophagoscopy in pediatric surgery represents about 70% of examinations of upper digestive tract. The authors present their experience with pediatric surgical endoscopy. They show the importance of this procedure in pediatric population, which provides clear diagnostic answers and represents a good alternative to traditional surgical procedures.

[Acute urine retention: early clinical sign of a rhabdomyosarcoma of the bladder or prostate in children: report of three cases]. / Ritenzione acuta d'urina: primo segno di rabdomiosarcoma vescico-prostatico in età pediatrica: presentazione di tre casi.

Acute urine retention can be the first clinical sign of a rabdomyosarcoma (RMS) of bladder and prostate. This is particularly evident in the age group comprised between 2 and 4 years. The Authors report their experience on three cases of 2 years old males admitted for acute urine retention. One case was diagnosed to have an prostate RMS, the other two a RMS of the bladder. The prostate RMS refused the operation dying 2 years after operation. Of the two cases of RMS of the bladder, one was treated successfully by polychemotherapy treatment, the second, after polychemotherapy underwent a partial cystectomy. The Authors conclude affirming the importance of a ultrasonography of the lower urinary tract in all patients with acute retention of urine, since this could be the first sign of a RMS of prostate or bladder.

Gastric motility disorders in patients operated on for esophageal atresia and tracheoesophageal fistula: long-term evaluation.

BACKGROUND/PURPOSE: Disturbed peristalsis is reported frequently after successful repair of esophageal atresia (EA). Delayed gastric emptying could be considered a cause of symptoms of gastroesophageal reflux (GER) in patients with repaired EA. The aim of the current study was to evaluate the incidence of and to characterize gastric motility disorders in a long-term follow-up of patients operated on for EA-tracheoesophageal fistula (TEF) by studying gastric emptying with scintigraphic techniques and comparing the results with gastric manometric data. METHODS: Eleven patients, between 12 and 23 years of age (median, 17) operated on for EA-TEF between 1975 and 1985, were studied. The scinthigraphic study was undertaken using a standard solid meal. The manometric study was performed using a 2.3-mm probe with 3 solid-state transducers. RESULTS: Dysphagia was present in about 20% of patients. Dyspepsia was recorded in 40% of the patients. A pathological reflux was present in 2 patients. Delayed gastric emptying (T1/2 > 90') was present in 4 patients (36%). Manometric data showed alteration of gastric peristaltic activity in 5 patients (45%). CONCLUSIONS: Delayed gastric emptying is frequent in long-term follow-up of patients operated on for EA-TEF. In these patients antral hypomotility also is recorded manometrically. Abnormal gastric motility can be considered as an important factor predisposing to symptoms of GER. A thorough evaluation of gastric function is recommended in symptomatic patients after EA repair.

[McKusick-Kaufman syndrome: diagnostic and therapeutic problems]. / La sindrome di McKusick-Kaufman: problemi diagnostici e terapeutici.

Mc Kusick-Kaufman Syndrome (SMK) is an autosomal recessive multiple malformation Syndrome characterized by hydrometrocolpos and polydactyly. This Syndrome is more frequent in females, whose parents are first-degree cousins (frequency 1:8 liveborn). We describe two cases of SMK: a male and a female. Patients were siblings and their parents were first cousins. The first child presented postaxial hexadactily, of the hands and feet, cardiovascular malformation and Arnold-Chiari II malformation. The baby died on the 17th day of life, for neurosurgical complications. Second baby, in which a prenatal ultrasonography showed a large cystic dilatation in the pelvis, presented with urinary hydrometrocolpos associated with persistent urogenital sinus (UGS) and polydactyly. The patient was temporary treated with intermittent vaginal catheterization. At age of 6 months she underwent reconstructive surgery via the anterior sagittal transanorectal approach (ASTRA), previous creation of a colostomy. Thirty-two months of the operation, the patient is continent for stool and urine and the vagina looks normal.

Conservative treatment in primary neonatal megaureter.

The authors report their experience on 22 neonates (14 males and 8 females) with primary megaureter. In 18 patients a prenatal diagnosis was available, in the other four the diagnosis was suspected during a neonatal ultrasound screening. The dilatation involved the right ureter 7 times and the left 13 times, in 2 patients it was bilateral. Intravenous urography documented a type I ureteral dilatation in 2 renal units (8.3%), a type II in 9 (37.5%) and a type III dilatation in 13 (54.2%). Radionuclide scan (Tc99m DTPA) demonstrated in all the renal units with megaureter a stable function. From diuretic renal scan, non-obstruction appeared in 19 (83%), obstruction in 2 (8.5%) and an equivocal result in the remaining 2. Antibiotic prophylaxis was administered to all patients. Follow-up period ranged from 18 to 54 months. The 2 obstructed megaureter were surgically treated. Other 2 patients with type III dilatation and non-obstructing megaureter underwent surgery at 18 and 24 months of age respectively. The remaining 17 patients were all conservatively treated. The 2 patients with type I dilatation resolved spontaneously. Of 9 patients with type II megaureter the dilatation resolved in 6 patients and 3 patients had a good reduction. In the remaining 8 patients with type III megaureter, the dilatation resolved in 5 cases and 3 patients had only a fair reduction. The renal function (> 40%) remained stable in all the patients.