Testicular hypotrophy in varicocele: pre and postoperative echographic follow-up in the pediatric age.

AIM: Varicocele is characterised by an anomalous tortuosity and dilation of the veins of the pampiniform plexus. The etiopathogenetic mechanisms are still unclear, but a correlation seems to exist between varicocele and testicular development, with possible repercussions on the testicle's functionality. The aim of this study is to evaluate gonadic trophism through echographic monitoring in the pre and postoperative phases in patients affected by idiopathic varicocele with testicular hypotrophy in order to evaluate the treatment's benefits. METHODS: Sixty-six patients (mean age 12,5; range 10-17) consecutively operated for left idiopathic varicocele were considered. Of these, 27 had ipsilateral testicular hypotrophy and thus they were included in the study. Fifteen were operated upon in videolaparoscopy (VLS), and 12 by the classic open inguinal access. The mean follow-up was 18 months (6-24 months). The data were analyzed by nonparametric Mann-Whitney U test. RESULTS: An increase in the testicular volume was observed clinically and by ultrasound in 13 of the 15 patients treated by VLS and in 9 of the 12 patients operated by traditional means. The nonparametric Mann-Whitney U test showed a significativity between pre and post-operative values. CONCLUSION: The testicular trophic healing observed in 81.5% of the operated patients leads to the belief that an early correction can allow a rapid volumetric increase and an improved function of the gonad.

[Treatment of varicocele in pediatric age with retroperitoneoscopic ''one trochar'' technique. Long term follow-up]. / Trattamento del varicocele in etá pediatrica in retroperitoneoscopia, con tecnica ''one trocar'' follow-up a lungo termine.

AIM: The incidence of varicocele varies from 6% to 16.2% in male children and adolescents. Various techniques were proposed to treat it. In the last years there was an increasing interest in the use of laparoscopy in pediatric urology. The authors reports their experience in the treatment of varicocele by retroperitoneoscopy with one trocar technique and the long-term follow-up in pediatric patients. METHODS: Fourty patients were treated for idiopathic Horner's degree III or less, but symptomatic, and type 1 according to Coolsaet varicocele. All patients underwent a clinical examination and echo-color Doppler before treatment and during the follow-up. RESULTS: The following parameters were evaluated: duration of the operation, intra and postoperative complications, duration of hospitalization and of antalgic therapy. Follow-up was at 6, 12, 24 and 36 months (mean 23.4 months). Testicles diameters, persistence/recurrence of varicocele and hydroceles were estimated. CONCLUSIONS: The retroperitoneoscopic approach in the treatment of varicocele is an effective technique because it implies a minor surgical trauma, a rapid postoperative recovery and a good cosmetic result.

[Treatment of varicocele in the pediatric age: videolaparoscopic versus "traditional" open techniques]. / Trattamento del varicocele in età pediatrica: tecnica VLS vs open.

AIM: Varicocele is determined by an ectasia of the veins of the pampinous plexus, and its incidence ranges from 2% to 16% in the different ages. Etiology and pathogenic mechanism are not clear; on the other hand it is absolutely certain that an early onset of varicocele in the pre-puberal age can heavily condition testicular development and function, with a condition of hypo-infertility which will be irreversible in the adult age. Up to date, there are not clear data allowing to state a "gold standard" therapy, although there is a general goodwill in affirming the usefulness of an early operation to prevent a gonadic damage. The aim of our study was to carry out an accurate analysis of post-operative clinical and instrumental data and to point out advantages and disadvantages of the traditional surgical technique versus the more recent videolaparoscopic technique (VLS). METHODS: Twenty-eight patients were consecutively treated for hydiopathic, III Horner degree, I Coolsaet degree left varicocele. In the first 15 patients an "open" operation was performed, while in the other 13 VLS technique according to Palomo was used. RESULTS: Follow-up, based on 9 different parameters, such as duration of hospitalisation and postoperative recovery was continued for a mean period of 18,67 months. CONCLUSIONS: An analysis of the results showed that both techniques are effective, although VLS can offer advantages as far as reduction of hospitalisation, reduction of duration of operation and postoperative recovery are concerned, as well as an increasing of compliance due to a better cosmetic result.

An extensively hydrolysed cow's milk formula improves clinical symptoms of gastroesophageal reflux and reduces the gastric emptying time in infants.

BACKGROUND: About 20 % of infants fed with breast-milk substitutes suffer from Gastro Esophageal Reflux (GER) and 1/3 of them also show Cow's Milk Allergy (CMA) symptoms. METHODS: We planned this study to assess by dynamic echography the usefulness of an Extensively Hydrolysed Cow's Milk Formula (eHF) in infants suffering from GER. Ten infants showing GER symptoms and 10 normal babies, all fed with breast-milk substitutes, were enrolled. Clinical symptom scores related to GER were assessed for one week. The Gastric Emptying Time (GET) was determined by means of dynamic echography after feeding with cow's milk-derived formulae and again after a week feeding with eHF in subjects previously showing GER symptoms. RESULTS: All infants with a clinical diagnosis for GER showed an abnormally high average GET in comparison to normal subjects (205 vs 124 min, p = 0.000). Switching to the eHF led to a significant clinical improvement (p = 0.0039) especially in babies skin-test and RAST positive to cow's milk, and to a significant decrease toward the normal value of the GET (167 min, p < 0.001). CONCLUSIONS: The eHF tested improves GER symptoms in infants suffering from this disease. Our experience confirms and supports the use of dynamic echography as a reliable, simple, and non-invasive diagnostic method for infants with an increased GET associated with clinical symptoms of GER.

An extensively hydrolysed cow's milk formula improves clinical symptoms of gastroesophageal reflux and reduces the gastric emptying time in infants

Background: About 20 % of infants fed with breast-milk substitutes suffer from Gastro Esophageal Reflux (GER) and 1/3 of them also show Cow's Milk Allergy (CMA) symptoms. Methods: We planned this study to assess by dynamic echography the usefulness of an Extensively Hydrolysed Cow's Milk Formula (eHF) in infants suffering from GER. Ten infants showing GER symptoms and 10 normal babies, all fed with breast-milk substitutes, were enrolled. Clinical symptom scores related to GER were assessed for one week. The Gastric Emptying Time (GET) was determined by means of dynamic echography after feeding with cow's milk-derived formulae and again after a week feeding with eHF in subjects previously showing GER symptoms. Results: All infants with a clinical diagnosis for GER showed an abnormally high average GET in comparison to normal subjects (205 vs 124 min, p = 0.000). Switching to the eHF led to a significant clinical improvement (p = 0.0039) especially in babies skin-test and RAST positive to cow's milk, and to a significant decrease toward the normal value of the GET (167 min, p < 0.001). Conclusions: The eHF tested improves GER symptoms in infants suffering from this disease. Our experience confirms and supports the use of dynamic echography as a reliable, simple, and non-invasive diagnostic method for infants with an increased GET associated with clinical symptoms of GER (AU)

Antecedentes: Alrededor del 20 por ciento de los niños alimentados con sustitutivos de leche materna padecen reflujo gastroesogáfico (GER) y un tercio de ellos además muestran síntomas de alergia a la leche de vaca (CMA). El estudio fue diseñado para, mediante ecografía dinámica, evaluar la utilidad de la fórmula de leche de vaca ampliamente hidrolizada (eHF) en niños que padecen GER. Métodos: Fueron reclutados 10 pacientes que mostraban síntomas de GER y 10 bebés normales, todos ellos alimentados con sustitutivos de leche materna. Los valores de síntomas clínicos relacionados con el GER fueron evaluados durante una semana. El tiempo de vaciamiento gástrico (GET) fue determinado mediante ecografía dinámica después de alimentar con fórmula derivada de leche de vaca a pacientes que mostraban previamente GER, y otra vez después de una semana, en pacientes alimentados con eHF. Resultados: Todos los niños con diagnóstico clínico de GER mostraron un nivel anormalmente alto de GET en comparación con los niños normales (205 vs 124 min, p = 0,000). El cambio a la alimentación con eHF indujo a una mejora clínicamente significativa (p = 0,0039) especialmente en bebés con pruebas cutáneas y RAST positivo a leche de vaca y un descenso significativo a valores normales del GET (167 min, p < 0,001).Conclusiones: El eHF estudiado mejora los síntomas de GER en niños que padecen dicha enfermedad. Nuestra experiencia confirma y apoya el uso de la ecografía dinámica como un método de diagnóstico fidedigno, simple y no invasivo para niños con un aumento del GET asociado a síntomas clínicos del GER (AU)

Hypoplastic or absent mandibular frenulum: a new predictive sign of infantile hypertrophic pyloric stenosis.

Among 25 patients with hypertrophic pyloric stenosis, a hypoplastic or absent mandibular frenulum was noted in 92%, compared with 1.6% of 319 control infants (P <.001). This previously unrecognized sign may prove helpful in identifying newborns at risk of developing the disorder.

[Varicocelectomy by an inguinal approach. Our experience]. / Varicocelectomia per via inguinale. Nostra esperienza.

Varicocele is a dilatation of the spermatic plexus due to a pathologic venous reflux in the testes. It affects about 15-18% of adolescents. The modern diagnostic tools allow an early identification and a thorough staging. Surgical treatment in this phase seems to be useful for the preservation of gonad integrity. Recently, the interest in varicocele in pediatric surgery has increased because of the close relationship of this disease to male infertility. We performed a diagnostic-therapeutic protocol with a follow-up to evaluate the trophism and functional state of testes and to identify early recurrence of venous reflux. In our Institute, the surgical treatment usually performed is resection of spermatic plexus through an inguinal approach. This technique is simple, yields good outcome and has no morbidity.

[Epididymitis in children: cause of acute scrotum]. / Epididimite in età pediatrica: una causa di scroto acuto.

The acute epididymitis in children is an uncommon disease which occurs mainly in adolescents. The pediatric surgeon must remember this illness whenever he observes a child with acute scrotum. The aim of this study is to review our experience at the Pediatric Surgery Department in Siena with 17 children (mean age: 7.53 years) underwent to surgery for acute scrotum and affected by primitive acute epididymitis without any other local or systemic associated disease. Our study shows that in children the acute epididymitis is more common than testicular torsion. It is often quite difficult to find the origin of epididymitis in children with no genito-urinary anomalies; so the acute scrotum and in particular the epididymitis require a standardized diagnostic and therapeutic approach based on an accurate physical exam, quickly feasible diagnostic procedures and a prompt surgical exploration of the scrotum.