Detection of crossing vessels at the ureteropelvic junction with fast MRI.

OBJECTIVE: Minimally invasive surgery is an alternative to open surgery in the treatment of ureteropelvic junction obstruction (UPJO) in selected pediatric patients. Anomalous crossing vessels represent a contraindication to endopyelotomy and may also interfere with the videosurgical pyeloplasty. We investigated the usefulness of magnetic resonance imaging (MRI) without contrast in the preoperative evaluation of anomalous crossing vessels in children. MATERIALS AND METHODS: From January 1999 to December 1999, 14 patients with diagnosis of hydronephrosis were prospectively evaluated with the aim of accurately plan the operative approach. The children underwent MRI study with HASTE sequences, heavily T2 weighted. Diagnosis was made without IV contrast material. No sedation was used. RESULTS: 4 out of the 14 patients studied were diagnosed as having anomalous crossing vessels at the ureteropelvic junction. They underwent open dismembered pyeloplasty and the diagnosis was confirmed at the operation. There was 1 false negative. CONCLUSIONS: The fast T2 weighted MRI allows a non invasive preoperative assessment of crossing vessels at the UPJO which is of paramount importance in the choice of the appropriate surgical approach. Nevertheless, the high cost and the low sensitivity (80%, 4/5) make this technique still not routinely applicable in the preoperative work-up of children with UPJO.

Results and complications of laparoscopic surgery for pediatric varicocele.

BACKGROUND: The aim of this study was to evaluate the results and complications of laparoscopic varicocelectomy in children. METHODS: Over a 36-month period, 211 children underwent laparoscopic treatment of varicocele. Their ages ranged between 6 and 17 years; the varicocele was located on the left side in 209 cases (99.1%) and was bilateral in 2 (0.9%). In 195 patients the laparoscopic transperitoneal approach was used and in 16 retroperitoneoscopy was used. Thirty children (14.2%) underwent ligation of the veins alone, and 181 (85.8%) underwent ligation of testicular veins and artery. In 15 (7.1%) cases an additional procedure was applied during the same operation. RESULTS: Average operating time was 30 minutes and hospitalization about 24 hours. At an average follow-up of 26 months, there were 19 (9%) postoperative complications: 14 children had a left hydrocele, 3 children a scrotal emphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicocele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo's. Testicular atrophy did not occur in any patient of this series. CONCLUSIONS: This preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. The ligation of testicular veins and artery is preferable to the ligation of the testicular veins alone. Hydrocele seems to be the most frequent postoperative complication and a potential problem, especially in children operated on with the Palomo procedure.

One-trocar surgery: a less invasive videosurgical approach in childhood.

BACKGROUND/PURPOSE: Laparoscopic techniques and instruments are evolving to lessen the invasiveness of this surgical approach. The authors present their experience with the videosurgical approach using only 1 trocar. METHODS: Between October 1997 and January 2000 the authors performed 59 videosurgical procedures using a 1-trocar approach (mean age, 11.5 years; range, 4 to 18 years). A 10-mm Hasson trocar was inserted in an "open" fashion either through the umbilicus (laparoscopy) or below the apex of the 12th rib (retroperitoneoscopy). An operative laparoscope was used in all cases. The operations were 18 retroperitoneoscopic Palomo varicocelectomies, 1 retroperitoneoscopic renal biopsy, 38 appendectomies, and 2 ileal resections (Meckel's diverticulum, duplication cyst). For appendectomies and ileal resections, the corresponding intestinal loop was grasped and exteriorized through the umbilicus to perform conventional surgery. RESULTS: Mean operating time was 50.9 minutes (range, 30 to 120) for laparoscopies and 44 minutes (range, 15 to 80) for retroperitoneoscopy. There were 11 conversions (8 appendectomies, 3 varicocelectomies) and no postoperative complications. CONCLUSIONS: "One-trocar surgery" is safe, effective, and fast with a low complication rate and excellent cosmetic results. The authors believe it is the least invasive as well as the most effective approach in the treatment of varicocele, appendicitis, and selected intestinal diseases.

Unusual clinical presentation of a rare case of phyllodes tumor of the breast in an adolescent girl.

Phyllodes tumor of the breast is a very rare neoplasm, particularly in adolescent girls and young women. It usually presents as unilateral palpable mass. The authors report the case of an adolescent girl who presented at the Emergency Department with bloody nipple discharge. Although the clinical signs suggested an intraductal tumor, the histologic examination showed a phyllodes tumor. The management and the biologic behavior of this uncommon tumor are discussed with particular regard to the very unusual clinical presentation in this patient. J Pediatr Surg 36:941-943.

Biofilm formation on the surface of ceramic tiles.

The aim of the study was to investigate the formation of biofilm on the surface of ceramic tiles, widely present in public and private buildings, using six parallel flow chambers. Our flow system was conceived and made to compare biofilm results by parallel distributed rectangular tiles. The tiles, divided into two identical A and B sections, were placed within the flow chambers. Biofilm formation was performed after 72 h and was quantified by viable counts of bacteria. Average viable counts ranged from 1.1x10(7) to 7.3x10(7) cfu cm(-2) and from 1.1x10(7) to 5.8x10(7) cfu cm(-2) respectively for biofilm A and B sections. As statistical analysis does not show significant differences, we can conclude that biofilms obtained were so similar to each other that they confirmed the system reproducibility. Our next step will be to use our system to study Legionella pneumophila and to evaluate the efficacy of antibacterial agents.

Amino acids counteract the inhibitory effect of fentanyl on hepatocyte oxidative metabolism.

BACKGROUND/PURPOSE: Hypothermia is common after major surgery in newborns and can be triggered by intraoperative fentanyl analgesia. Recent studies have found that fentanyl inhibits hepatocyte mitochondrial oxidative metabolism, which is proportional to thermogenesis. In adults it has been shown that amino acids have a thermogenic effect, although the biochemical basis of this phenomenon is not known. The aim of this study was to test the hypothesis that amino acids counteract the inhibition of neonatal hepatocyte oxygen consumption by fentanyl. METHODS: Hepatocytes were isolated from suckling rats, and O2 consumption was measured polarographically. In experiment A hepatocytes were incubated with (1) palmitate alone (control), (2) palmitate plus fentanyl, (3) palmitate plus fentanyl plus amino acids, and (4) palmitate plus amino acids. In experiment B the effects of essential and nonessential amino acids were tested separately. In experiment C, to investigate whether the effect of amino acids is intramitochondrial, hepatocytes were incubated with amino acids plus inhibitors of mitochondrial respiration. RESULTS: In experiment A, fentanyl significantly inhibited O2 consumption (P = .006). This inhibition was reversed by amino acids (P < .001). In experiment B, both essential and nonessential amino acids reversed the effect of fentanyl (P < .001). In experiment C, there was no difference in O2 consumption in the presence of myxothiazol among the groups indicating that amino acids affect intramitochondrial O2 consumption. CONCLUSIONS: (1) Amino acids abolish the inhibitory effect of fentanyl on hepatocyte oxidative metabolism. (2) Amino acids affect intramitochondrial O2 consumption and therefore thermogenesis. (3) Perioperative administration of amino acids in neonates may help to prevent hypothermia and its deleterious effects.

Analgesic doses of fentanyl impair oxidative metabolism of neonatal hepatocytes.

BACKGROUND/PURPOSE: Studies in human surgical neonates have shown that intraoperative fentanyl analgesia results in greater fall in perioperative body core temperature compared with morphine analgesia. The aim of the study was to compare in a neonatal animal model the biochemical effect of fentanyl and morphine on hepatocyte oxidative metabolism. METHODS: Hepatocytes were isolated from suckling rats and the oxygen consumption from palmitate was measured polarographically. In experiment A, fentanyl and morphine within the respective analgesic serum ranges were added to hepatocytes to assess the effect on oxygen consumption. In experiment B, fentanyl was added to hepatocytes in the presence of inhibitors of mitochondrial respiration to investigate its site of action. In experiment C, hepatocytes were incubated with either fentanyl or morphine, centrifuged, and then examined ultrastructurally by electron microscopy. RESULTS: In experiment A, fentanyl inhibited oxygen consumption by up to 40% (P < .01). Morphine inhibited oxygen consumption to a maximum of 25% (P < .01). In experiment B, in the presence of oligomycin, fentanyl increased the inhibition of oxygen consumption; however, in the presence of myxothiazol, no further inhibition by fentanyl occurred. In experiment C, mild ultrastructural alterations to hepatocytes were observed after incubation with fentanyl but not with morphine. CONCLUSIONS: This study demonstrates that therapeutic doses of two commonly used analgesic drugs impair neonatal hepatic oxidative metabolism. Fentanyl exerts a greater effect than morphine by diminishing liver oxygen consumption by up to 40%. The inhibitory effect of fentanyl occurs directly on the mitochondrial respiratory chain, either on substrate oxidation or on the thermogenic proton leak. The findings of this study are relevant to the perioperative management of surgical neonates.

[Value of uroflowmetry in a long-term follow-up study in hypospadias surgery]. / Il valore della uroflussometria nel follow-up a lungo termine della chirurgia dell'ipospadia.

BACKGROUND: Many authors have shown the role of uroflowmetry in the follow-up of patients operated on for hypospadias. This technique has also been used to assess the validity of the operative technique. METHODS: Sixty patients have been selected among those operated on for hypospadias from January 1990 till January 1996 at the Pediatric Surgery Department of the Second University of Naples, Italy. These patients underwent uroflowmetry with a rotating disk sensor at clinic. Postoperative time at uroflowmetry ranged between 6 months and 6 years. Flow pattern, maximum flow rate (Q max) and mean flow rate (Q ave) were measured. Results are expressed as percentiles and compared with those obtained from Toguri. Q max and Q ave greater than 25 degrees percentile were considered normal; Q max and Q ave between 25 degrees and 5 degrees percentile were considered query obstructed; Q max and Q ave below the 5 degrees percentile were considered obstructed. RESULTS: Forty-two patients (70%) presented values above the 25 degrees centile, 8 patients (13.4%) presented an obstructed-like flow and 10 children (16.6%) showed a query obstructed flow. Three patients from the latter group presented within three months an obstructed-like flow. CONCLUSIONS: Uroflowmetry is an important tool in the follow-up of patients operated on for hypospadias that are at risk for stenosis and then requiring a further treatment, either dilatation or surgery.

Catch-up growth in children with vesico-ureteric reflux.

A longitudinal retrospective study of height Z score (HZ score) and weight-for-height index (WHI) was performed on 94 pre-pubertal children with vesico-ureteric reflux (VUR) and normal creatinine clearance followed for 1-6.8 years (mean 3.1 years). Thirty patients had bilateral VUR with scintigraphic signs of renal scarring (B+), 17 had bilateral VUR without renal scarring (B-), 27 had unilateral VUR with (U+) and 20 unilateral VUR without (U-) renal scarring. Thirty-three patients received only antimicrobial medication and 61 underwent successful antireflux operation. The increase in HZ score and WHI during the 1st year of follow-up was significantly (P = 0.001 and 0.00003, respectively) higher than during the 2nd year. At first visit, B+ subjects had an average WHI and HZ score that were significantly (P = 0.02 and 0.04, respectively) lower than the other groups of patients together. At last visit this difference was not significant. In B+ subjects, the WHI and HZ score at last visit were significantly (P = 0.04 for both) higher than at the first visit. B+ patients fully recover their body growth deficit compared with other groups of VUR subjects after medical and/or surgical therapy.

Gaschromatography-mass spectrometry analysis of fatty acids in human milk from forty puerperae living in southern Italy.

Fatty acid (FA) composition of breast milk, an important factor in newborn nutrition, may change in relation to maternal diet and individual metabolic characteristics. This study was carried out on a group of 40 puerperae who lived in Southern Italy, delivered at term and feeded with common mediterranean diet. End-milk samples were collected between the 15th and 40th day (in mean at 27th day) after delivery. Analysis of fatty acids was performed using high resolution gaschromatography and mass spectrometry. It has been reported 37 different fatty acids including 6 branched chain fatty acids (BCFA).