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Savanelli A, Alicchio F, Esposito C, De Marco M, Settimi A. A modified approach for feminizing genitoplasty. World J Urol 2008; 26:517-20. [DOI: 10.1007/s00345-008-0298-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022] Open
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Esposito C, Settimi A, Centonze A, Savanelli A, Ascione G, De Marco M, De Fazio C, Esposito G. Bochdaleck diaphragmatic hernia, complicated by an antenatal gastric perforation, presenting as a pneumothorax and a perforative peritonitis. Pediatr Surg Int 2008; 24:365-9. [PMID: 17726610 DOI: 10.1007/s00383-007-2000-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 07/30/2007] [Indexed: 11/28/2022]
Abstract
The presentation of congenital diaphragmatic hernia (CDH) at birth may fall outside the typical features (cyanosis, tachypnea and respiratory failure), manifesting, instead, also with others pictures that make the diagnosis difficult or even impossible. We report a case of CDH presenting as a pneumothorax and a perforative peritonitis due to an antenatal gastric perforation.
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Cavagna L, Caporali R, Esposito C, Augetti C, Epis O, Montecucco C. Clinical features of ANCA-positive systemic lupus erythematosus: report of two cases. Scand J Rheumatol 2007; 36:74-6. [PMID: 17454941 DOI: 10.1080/03009740600844738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Esposito C, Lima M, Mattioli G, Mastroianni L, Riccipetitoni G, Monguzzi G, Zanon G, Cecchetto G, Settimi A, Jasonni V. Thoracoscopic surgery in the management of pediatric malignancies: a multicentric survey of the Italian Society of Videosurgery in Infancy. Surg Endosc 2007; 21:1772-5. [PMID: 17356939 DOI: 10.1007/s00464-007-9246-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 10/11/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few reports have elucidated the role of minimally invasive surgery (MIS) for pediatric malignancies. This study aimed to review the results of a multicenter study on the management of thoracic tumors in children using MIS. METHODS A 5-year retrospective review of all MIS procedures for the treatment of pediatric malignancies performed in seven centers belonging to the Italian Society of Videosurgey in Infancy is reported. The data from 145 pediatric oncologic patients (80 girls and 65 boys) ages 30 days to 17 years (median, 7.2 years) were analyzed. Of the procedures performed, 87 were laparoscopies (60%), 55 were thoracoscopies (38%), and 3 were lumboscopies (2%). This study focused only on the results of the 55 thoracoscopic procedures performed for diagnostic purposes in 19 cases (34.6%) and for therapeutic purposes in 36 cases (65.4%). RESULTS The duration of surgery was 15 to 180 min (median, 65 min). Metastasectomies were performed for various etiologies in 31 of the 55 cases. Of the 55 patients, 5 underwent resection of a mediastinal tumor, and 19 underwent a diagnostic thoracoscopy. During a mean follow-up period of 25.6 months, 2 (3.6%) of the 55 patients experienced perioperative complications. CONCLUSIONS The role of MIS in tumor resection for children is currently limited, but may be used in individual cases when the preoperative workup shows it to be feasible. Its indication is strictly dependent on the thoracoscopic experience of the surgeon and the tumor site for preoperative imaging techniques. When the indication for thoracoscopy is correct, this approach has high therapeutic applicability (65.4% in our series). Our preliminary experience shows that careful patient selection and an appropriate level of technical skill make thoracoscopy a reasonable and safe option for the treatment of pediatric malignancies.
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Mattioli G, Pini Prato A, Cheli M, Esposito C, Garzi A, LiVoti G, Mastroianni L, Porreca A, Riccipetitoni G, Scalisi F, Buluggiu A, Avanzini S, Rizzo A, Boeri E, Jasonni V. Italian multicentric survey on laparoscopic spleen surgery in the pediatric population. Surg Endosc 2007; 21:527-31. [PMID: 17287922 DOI: 10.1007/s00464-006-9035-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 03/28/2006] [Accepted: 04/20/2006] [Indexed: 12/31/2022]
Abstract
BACKGROUND Some technical aspects of laparoscopic spleen surgery still are debated, although efforts have been made to standardize them. The position of the patient, the approach to the spleen, vessel identification and division, and spleen extraction can vary from center to center. METHODS This retrospective muticentric study led by the Società Italiana di Videochirurgia Infantile (SIVI) examined indications, surgical details, and complications of laparoscopic spleen surgery in the pediatric population during a 5-year period. RESULTS The study period from January 1999 to December 2003 (5 years) involved nine centers and included 85 patients with a mean age of 10 years (range, 2-17 years). Hypersplenism or severe hemolysis in cases of hematologic disorders represented the most important indications. More than 90% of the patients underwent total laparoscopic splenectomy. Specific technical details from each center were collected. Intraoperative complications occurred in 19% of the patients (hemorrhage in 8% and technical problems in 14%), and 6% of the patients required conversion to the open approach. No deaths occurred, and no reoperations were required. Postoperative complications were experienced by 2% of the patients. CONCLUSION Laparoscopic spleen surgery is safe, reliable, and effective in the pediatric population. On the basis of the results, some technical details for laparoscopic spleen surgery can be suggested. The patient is preferably kept supine or lateral, approaching the spleen anteriorly. Moreover, the ilar vessels should be identified selectively and individually, with initial artery division performed to achieve spleen shrinking. Any hemostatic device proved to be effective in experienced hands. Once freed, the spleen is preferably extracted via a suprapubic cosmetic transverse incision (faster, easier, and safer), although a bag can be used. Finally, the size of the spleen does not represent a contraindication for a trained and experienced surgeon. Nevertheless, this parameter must be considered when laparoscopic spleen surgery is planned.
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Valle L, Amicizia D, Bacilieri S, Banfi F, Riente R, Durando P, Sticchi L, Gasparini R, Esposito C, Icardi G, Ansaldi F. Performance testing of two new one-step real time PCR assays for detection of human influenza and avian influenza viruses isolated in humans and respiratory syncytial virus. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2006; 47:127-33. [PMID: 17263157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION AND METHODS Two real time one-step RT-PCR assays were developed for simultaneous detection and typing of influenza A and B viruses and detection of Respiratory Syncytial Virus (RSV). As regard influenza, primers were designed to amplify specific sequences of gene M of A/H1N1, A/H3N2, A/H5N1, A/H7N7 and A/H9N2 viruses and of gene NP of type B viruses belonging both Yamagata and Victoria lineage. Specificity, analytical and clinical sensitivity, dynamic range, linearity of the new assays were evaluated. RESULTS Dynamic ranges for Influenza A and B, and RSV were at least five logs and linearity was conserved. In order to evaluate the specificity, 80 nasopharyngeal swabs resulting Influenza and RSV negative by multiplex nested PCR and cell culture, were tested and 79 resulted negative. The detection limits for influenza A and B, calculated by 95% probit, was 0.008 and 0.09 PFU, respectively, resulting more sensible than nested PCR. A total of 75 specimens (10 A/H1N1, 3 A/H1N2, 8 A/H3N2 Johannesburg/94-like, 10 A/H3N2 Panama/2007/99-like, 10 A/H3N2 Fuijian/411/02-like, 2 A/H5N1, 2 A/H7N7 and 2 A/H9N2, 15 B/Yamagata-like and 13 B/Victoria-like) collected between 1994 and 2004 or received by WHO Influenza Centre, London, were chosen as representative of the circulating strains and tested. All samples resulted positive although one B/Victoria sample was not clear typed. Thirty swabs nested RT-PCR positive for RSV collected during the four seasons, were also analysed by realtime PCR, resulting positive. To evaluate the performance of the new assay on fresh material, 250 specimens, collected during the 2004/05 seasons, were tested by nested-PCR, cell culture and real-time PCR. DISCUSSION AND CONCLUSION The new assays provide accurate and sensitive diagnosis of influenza and RSV infection and they represent a sensitive tool for virological surveillance and management of patient with ILI.
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MESH Headings
- Animals
- Antiviral Agents/chemical synthesis
- Antiviral Agents/therapeutic use
- Birds
- Cell Culture Techniques
- Communicable Diseases, Emerging/prevention & control
- Communicable Diseases, Emerging/virology
- Humans
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza A virus/drug effects
- Influenza A virus/genetics
- Influenza A virus/isolation & purification
- Influenza in Birds/epidemiology
- Influenza in Birds/virology
- Influenza, Human/epidemiology
- Influenza, Human/virology
- Phylogeny
- RNA, Viral/analysis
- RNA, Viral/genetics
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Virus Infections/virology
- Respiratory Syncytial Viruses/drug effects
- Respiratory Syncytial Viruses/genetics
- Respiratory Syncytial Viruses/isolation & purification
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Reverse Transcriptase Polymerase Chain Reaction/standards
- Sensitivity and Specificity
- Sentinel Surveillance
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Esposito C, Fasoli G, Rampino T, Dal Canton A. [Hepatocyte growth factor and kidney]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2006; 23:381-8. [PMID: 17063438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
HGF is a multifunctional polypeptide with mitogenic, motogenic and morphogenic effects. These effects are mediated by c-met, a specific receptor of HGF and a member of the receptor tyrosine kinase superfamily, virtually expressed in every type of kidney cell. HGF has a central role during embryogenesis since it stimulates epithelial differentiation of metanephric mesenchymal cells and induces branching tubules, as experiments in epithelial cells cultures demonstrated. Several studies have shown also that HGF accelerates the recovery from toxic-ischemic acute renal failure. This effect seems to be mediated by the inhibition of programmed cell death and an increased cell survival. HGF inhibits apoptosis by upregulating the protooncogene Bcl-2 and downregulating Bax. Since HGF can modulate extracellular matrix turnover, authors suggest its beneficial role in tissue remodelling and particularly in chronic renal diseases. Several studies reported a key role for HGF in reducing interstitial fibrosis and glomerular sclerosis, both in in vivo and in vitro models. This protective effect is secondary to HGF antagonizing the profibrotic action of TGF-beta. HGF modulates the balance between synthesis and degradation of extracellular matrix, increasing the expression of metalloproteases and reducing the production of their specific inhibitors TIMPs. Furthermore HGF suppresses the effect of TGF-beta by blocking the axis TGF-beta/Smad. Last, the antifibrotic effect of HGF might be modulated by the proliferative status of target cells. To sum up, the supplementation of exogenous HGF or the induction of endogenous HGF expression may provide an effective therapeutic strategy for combating chronic renal diseases.
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Esposito C, Montupet P, van Der Zee D, Settimi A, Paye-Jaouen A, Centonze A, Bax NKM. Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc 2006; 20:855-8. [PMID: 16738969 DOI: 10.1007/s00464-005-0501-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 01/20/2006] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nissen fundoplication is the most popular laparoscopic operation for the management of gastroesophageal reflux disease (GERD). Partial fundoplications seem to be associated with a lower incidence of postoperative dysphagia, and thus a better quality of life for patients. The aim of this study was to compare the long-term outcome in neurologically normal children who underwent laparoscopic Nissen, Toupet, or Thal procedures in three European centers with a large experience in laparoscopic antireflux procedures. METHODS This study retrospectively analyzed the data of 300 consecutive patients with GERD who underwent laparoscopic surgery. The first 100 cases were recorded for each team, with the first team using the Toupet, the second team using the Thal, and the third team using the Nissen procedure. The only exclusion criteria for this study was neurologic impairment. For this reason, 66 neurologically impaired children (52 Thal, 10 Nissen, 4 Toupet) were excluded from the study. This evaluation focuses on the data for the remaining 238 neurologically normal children. The patients varied in age from 5 months to 16 years (median, 58 months). The median weight was 20 kg. All the children underwent a complete preoperative workup, and all had well-documented GERD. The position of the trocars and the dissection phase were similar in all the procedures, as was the posterior approximation of the crura. The short gastric vessels were divided in only six patients (2.5%). The only difference in the surgical procedures was the type of antireflux valve created. RESULTS The median duration of surgery was 70 min. There was no mortality and no conversion in this series. A total of 12 (5%) intraoperative complications (5 Nissen, 5 Toupet, 2 Thal) and 13 (5.4%) postoperative complications (3 Toupet, 4 Nissen, 6 Thal) were recorded. Only six (2.5%) redo procedures (2 Thal, 2 Toupet, 2 Nissen) were performed. After a minimum follow-up period of 5 years, all the children were free of symptoms except nine (3.7%), who sometimes still require medication. The incidence of complications and redo surgery for the three procedures analyzed with the Mann-Whitney U test are not statistically significant. CONCLUSIONS For pediatric patients with GERD, laparoscopic Nissen, Toupet, and Thal antireflux procedures yielded satisfactory results, and none of the approaches led to increased dysphagia. The 5% rate for intraoperative complications seems linked to the learning curve period. The authors consider the three procedures as extremely effective for the treatment of children with GERD, and they believe that the choice of one procedure over the other depends only on the surgeon's experience. Parental satisfaction with laparoscopic treatment was very high in all the three series.
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Mattioli G, Bax K, Becmeur F, Esposito C, Heloury Y, Podevin G, Lima M, MacKinlay GA, Goessler A, Tovar JA, Valla J, Tuo P, Nahum L, Ottonello G, Sacco O, Gentilino V, Pini-Prato A, Caponcelli E, Jasonni V. European multicenter survey on the laparoscopic treatment of gastroesophageal reflux in patients aged less than 12 months with supraesophageal symptoms. Surg Endosc 2005; 19:1309-14. [PMID: 16151683 DOI: 10.1007/s00464-004-2279-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 04/07/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND This multicenter survey includes neonates and infants who underwent surgery for primary gastroesophageal reflux (GER) who presented with supraesophageal symptoms of unknown origin with a minimum of 12 months postoperative follow-up. METHODS A total of 726 patients underwent GER surgery in 10 European Centers in the period 1998-2002. Respiratory symptoms were present in 204 patients (28%); 135 patients (17%) had surgery under 1 year of age, and 46 of them (6.3%) because of respiratory symptoms. Surgery was performed without any previous medical treatment in 10 cases (21%). The type of procedure included 37 complete 360 degrees wraps (80%) (Nissen, 12, and Rossetti, 25) and nine partial wraps (20%) (Thal five, Lortat Jacob one, Toupet one, others two). Gastrostomy was associated in 17 cases (37%) (6 PEG and 11 modified Stamm). No gastric emptying procedures were recorded. RESULTS No major intraoperative complications were reported. Six patients developed complications (13%) and a redo operation was performed in three (6.5%). Respiratory outcome after antireflux surgery was good in 35 patients (76%) and fair with significantly improved respiratory symptoms in 11 (24%). CONCLUSIONS This multicenter survey underlines that GER has to be suspected and aggressively treated in infants with difficult-to-treat supraesophageal symptoms, and also in high-risk cases, in order to prevent major complications.
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Quaglietta L, Mastroianni R, Miele E, Esposito C, Terracciano LM, Vallone G, Staiano A. Cystic lymphangioma associated with enteric duplication as a cause of recurrent vomiting. Dig Liver Dis 2005; 37:533-6. [PMID: 15975542 DOI: 10.1016/j.dld.2004.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 07/14/2004] [Indexed: 12/11/2022]
Abstract
We describe a case report of a 6-year-old boy with a 4-year history of recurrent vomiting with a cyclical vomiting pattern. Although initially labelled with and treated for Cyclical Vomiting Syndrome the cause was subsequently found to be an enteric duplication associated with cystic lymphangioma, an association not previously described.
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Esposito C, Settimi A, Centonze A, Damiano R, Maglio P, Esposito G. Enlarged wandering spleen treated with hemisplenectomy and fixation of the residual spleen. Pediatr Surg Int 2005; 21:488-90. [PMID: 15803335 DOI: 10.1007/s00383-005-1403-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2004] [Indexed: 10/25/2022]
Abstract
A case of enlarged wandering spleen presenting as an abdominal mass in a 7-year-old girl is reported. The diagnosis was performed by ultrasonography and confirmed by aortography. Treatment consisted of an elective partial splenectomy and fixation of the residual spleen to the left hemidiaphragm. The patient's symptoms regressed, and now, after more than 2 years, she is doing well. Two years postoperatively scintigraphy demonstrated a good captation of radionuclide by a normal-sized spleen at the left hypochondrium. The results obtained with the procedure that was adopted for treating this case of wandering spleen allow the authors to state that hemispleen fixation is a valid option for treating symptomatic enlarged wandering spleen.
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Esposito C, Bellotti N, Fasoli G, Foschi A, Plati AR, Dal Canton A. Hyperkalemia-induced ECG abnormalities in patients with reduced renal function. Clin Nephrol 2005; 62:465-8. [PMID: 15630907 DOI: 10.5414/cnp62465] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hyperkalemia is a potentially lethal condition to be aware of in the presence of ECG abnormalities especially in patients with reduced renal function. However, ECG abnormalities are not always dependent on the degree ofhyperkalemia but may be aggravated by the rapidity of the development of hyperkalemia and by associated electrolyte disorders. We describe 3 patients with renal failure and different ECG changes induced by hyperkalemia. More severe changes were observed when hyperkalemia developed rapidly, but not in presence of electrolyte disorders. Even minor ECG abnormalities must alarm physicians in patients with renal failure since severe hyperkalemia is not always associated with critical ECG changes.
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113
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Esposito C, Settimi A, Centonze A, Capano G, Ascione G. Laparoscopic-assisted jejunostomy. Surg Endosc 2005; 19:501-4. [PMID: 15959713 DOI: 10.1007/s00464-004-9016-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Accepted: 10/08/2004] [Indexed: 01/14/2023]
Abstract
BACKGROUND Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients. METHODS Since January 2002, seven patients (age range, 5-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using two 10-mm trocars. The technique consists of identifying the first jejunal loop, grasping it 20-30 cm away from the Treitz ligament with fenestrated atraumatic forceps, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct positions of the intestinal loop and feeding tube were evaluated via laparoscopy. RESULTS Surgery lasted 40 min on average, the laparoscopic portion only 5 min. There were no perioperative complications; hospital stay was 3 or 4 days for all patients. At the longest follow-up (18 months), all patients had experienced a significant weight gain, with a high level of parental satisfaction. One patient died 1 year after the procedure of unknown causes. All the others are well, without complications or problems, and their parents are extremely satisfied with the improved quality of life of their children. CONCLUSIONS Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. This procedure solves these patients' feeding problems even if the reflux is not completely eliminated. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. This technique is extremely safe because the surgeon is able to verify, at the end of procedure, the status of the jejunostomy from outside and inside the abdominal cavity. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure.
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Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, Pirozzi F, Caiazzo P. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 2004; 19:117-9. [PMID: 15549629 DOI: 10.1007/s00464-004-9004-9] [Citation(s) in RCA: 185] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Accepted: 04/22/2004] [Indexed: 01/19/2023]
Abstract
BACKGROUND In the last few years, robotics has been applied in clinical practice for a variety of laparoscopic procedures. This study reports our preliminary experience using robotics in the field of general surgery to evaluate the advantages and limitations of robot-assisted laparoscopy. METHODS Thirty-two consecutive patients were scheduled to undergo robot-assisted laparoscopic surgery in our units from March 2002 to July 2003. The indications were cholecystectomy, 20 patients; right adrenalectomy, two points; bilateral varicocelectomy, two points; Heller's cardiomyotomy, two points; Nissen's fundoplication, two points; total splenectomy, one point; right colectomy, one point; left colectomy, 1 point; and bilateral inguinal hernia repair, one point. In all cases, we used the da Vinci surgical system, with the surgeon at the robotic work station and an assistant by the operating table. RESULTS Twenty-nine of 32 procedures (90.6%) were completed robotically, whereas three were converted to laparoscopic surgery. Conversion to laparoscopy was due in two patients to minor bleeding that could not be managed robotically and to robot malfunction in the third patient. There were no deaths. Median hospital stay was 2.2 days (range, 2-8). CONCLUSIONS The main advantages of robot-assisted laparoscopic surgery are the availability of three-dimensional vision and easier instrument manipulation than can be obtain with standard laparoscopy. The learning curve to master the robot was >or= 10 robotic procedures. The main limitations are the large diameter of the instruments (8 mm) and the limited number of robotic arms (maximum, three). We consider these technical shortcomings to be the cause for our conversions, because it is difficult to manage bleeding episodes with only two operating instruments. The benefit to the patient must be evaluated carefully and proven before this technology can become widely accepted in general surgery.
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Barbieri C, Costa S, Bellazzi R, Nai M, Villa G, Montagna G, De Mauri A, Esposito C, Dal Canton A. [Diffusive and convective treatments in the clinical practice: observation study of the Pavia district nephrology group]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2004; 21 Suppl 30:S153-6. [PMID: 15750975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED PURPOSE. Although convective treatments are widely used, there is no evidence that they can improve patient survival or hospitalizations nor clinical criteria indicating which patients could benefit from them. This study was carried out to evaluate the dialysis modality distribution and the clinical criteria used in choosing the dialysis therapy by the four dialysis Centers in the district of Pavia, a district characterized by a quite homogeneous population. METHODS We evaluated age, gender, body mass index (BMI), time on dialysis, number of sessions per week, dialysis duration, dialysis modality, criteria used in choosing dialysis therapy, vascular access (VA), Kt/V, and the number of hypotensive episodes. RESULTS Two hundred and seventy-two patients were enrolled in the study. Mean age was 67.3 +/- 12 yrs, BMI was 26.3 +/- 6.1, dialytic age was 5.49 +/- 5.5 yrs, Kt/V was 1.4 +/- 0.3, mean session time was 238 min. Fifty-two patients (19.2%) were on a convective treatment. Age, BMI, time on dialysis, dialysis duration and number of sessions per week were no different between convective treatment patients and diffusive treatment patients. Kt/V was significantly different between convective and diffusive methods (1.55 +/- 0.37 vs 1.4 +/- 0.28, p<0.05). Convective treatments were prescribed for cardiovascular (CV) instability by the nephrologists from the Pavia district in the majority of patients (90.9%). There was no difference in hypotensive episodes between convective and diffusive methods. CONCLUSIONS Our study demonstrated that lacking clinical evidence indicating an improvement in the long-term outcome with convective techniques, nephrologists in the Pavia district choose this type of dialysis treatment to ameliorate CV stability in uremic patients.
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Esposito C, Valla JS, Yeung CK. Current indications for laparoscopy and retroperitoneoscopy in pediatric urology. Surg Endosc 2004; 18:1559-64. [PMID: 15931494 DOI: 10.1007/s00464-003-8272-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Accepted: 03/30/2004] [Indexed: 10/26/2022]
Abstract
Laparoscopy has raised great interest in the past few years in the field of pediatric urology. It has evolved from a simple diagnostic maneuver to complex operative procedures. The aim of this study was to review urologic laparoscopy literature and provide a critical review of this field to establish current indications for videosurgery in pediatric urology. In general, from an anatomic point of view, retroperitoneoscopy seems to be more suitable than the transperitoneal laparoscopic approach for reaching the upper urinary tract. It also is less invasive and complies with the criteria for open renal surgery. With respect to current indications for videosurgery in pediatric urology, the authors have identified several well-established clinical procedures, although no large series have been published for any of the procedures, except for the treatment of varicocele, nonpalpable testis, and nephrectomy. In conclusion, the data reviewed suggest that videosurgery is a safe and feasible technique in pediatric urology if performed by expert surgeons, and that it certainly will develop further in the next few years.
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Damiano R, Autorino R, Perdonà S, De Sio M, Oliva A, Esposito C, Cantiello F, Di Lorenzo G, Sacco R, D'Armiento M. Are extended biopsies really necessary to improve prostate cancer detection? Prostate Cancer Prostatic Dis 2004; 6:250-5. [PMID: 12970731 DOI: 10.1038/sj.pcan.4500671] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study is to understand the value of specific sites in extended peripheral and transition zone biopsy schemes in order to define the optimal systematic biopsy regimen correlated with the percentage of positivity of each single bioptic site. A total of 165 consecutive patients underwent transrectal ultrasonography examination to detect prostate cancer followed by a lesion-directed and systematic 14-step biopsy scheme. The detection rate was examined for the lesion-directed and for each zone region biopsy. The frequency of positive biopsies in the various prostate regions was determined to evaluate the diagnostic yield of each biopsy site. Analysis was stratified for prostate-specific antigen (PSA), free-to-total PSA ratio, age, prostate size and digital rectal examination. The biopsy protocol detected 40% of patients (66/165) as positive and 55.1% (91/165) as negative for cancer. Standard sextant biopsy was expected to detect only 51 cancer on 66, lateral peripheral (PZ), transition (TZ) and central zone (CZ) biopsies only 56 cancer on 66, while the combination of sextant, PZ, TZ and CZ biopsies, for a total of 14 zone biopsies, detected 64 on 66 patients with cancer (97%) at recruitment. Sampling only the eight prostate regions with higher frequency of positive cancer biopsy was expected to detect 61 cancer patients against the 64 found with the 14-step scheme. This eight-biopsy regimen outperforms the conventional sextant regimen in cancer detection rate (93 vs 77%) and has an overall detection rate lower by only 3.1% (36.9 vs 40%) compared to the 14-biopsy regimen. This difference in detection rate is even smaller in patients with PSA values <10 ng/ml, age <70 y and prostate size <50 ml. This eight-biopsy scheme, including sampling in PZ and TZ toward the base, should be considered in an initial biopsy scheme to maintain a similar detection rate of an extensive biopsy scheme reducing the number of biopsies.
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Caputo I, D'Amato A, Troncone R, Auricchio S, Esposito C. Transglutaminase 2 in celiac disease: Minireview article. Amino Acids 2004; 26:381-6. [PMID: 15290344 DOI: 10.1007/s00726-004-0083-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Accepted: 01/15/2004] [Indexed: 11/26/2022]
Abstract
Celiac disease (CD) is an autoimmune pathology of the small intestine triggered, in genetically predisposed patients, by the exposition to gliadin, a flour protein, thus evoking local immune reactions and mucosal atrophy. The discovery that type 2 transglutaminase (TG2) is the main, if not the sole, target of the endomysium CD-specific autoantibodies assigned to this enzyme a master regulator role of CD. Two separated events, both based on the finding that gliadin is able to act as a TG2 substrate, have been described to indicate that TG2 is involved in both the humoral and cellular immune responses. In this paper we review the novel insights on the localization and enzymatic activity of TG2 in the small intestinal mucosa. Moreover, we report on the capability of gliadin and its peptides to act as TG2 substrates.
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Esposito C, Foschi A, Parrilla B, Cornacchia F, Fasoli G, Plati AR, De Mauri A, Mazzullo T, Scudellaro R, Dal Canton A. Effect of calcineurin inhibitors on extracellular matrix turnover in isolated human glomeruli. Transplant Proc 2004; 36:695-7. [PMID: 15110634 DOI: 10.1016/j.transproceed.2004.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although chronic cyclosporine toxicity is mainly characterized by tubular atrophy and interstitial fibrosis, glomerular injury with expansion of mesangial matrix and sclerosis is not uncommon. Tacrolimus is a newer calcineurin inhibitor that has been used in renal transplant recipients as primary or rescue therapy. Clinical trials suggest an improved long-term graft survival among patients treated with tacrolimus. Recently we have shown that tacrolimus and cyclosporine have similar effects on extracellular matrix turnover in cultured cells. The present study was performed to investigate the effects of the calcineurin inhibitors on whole glomeruli extracellular matrix turnover. METHODS Human glomeruli isolated from kidney biopsies just before transplantation were incubated with culture media containing either cyclosporine (200 ng/mL) or tacrolimus (10 ng/mL) for 24 hours. Glomeruli incubated only with culture medium were used as control. RESULTS The expressions of (alpha2)IV collagen, metalloprotease 9 (MMP9), tissue inhibitors of metalloproteases 2 (TIMP-2), and TGFbeta were evaluated by in situ reverse transcription and polymerase chain reactions (RT-PCR). beta-actin was used as a control gene. Cyclosporine (but not tacrolimus) increased the expression of (alpha2)IV collagen and TIMP2 in isolated glomeruli. TGF-beta was markedly increased by cyclosporine. MMP9 expression was not affected by the calcineurin inhibitors. By light microscopy kidney biopsies did not show pathologic changes. CONCLUSION Cyclosporine treatment modulates extracellular matrix turnover in isolated human glomeruli, inducing an imbalance between synthesis and degradation. This effect, not observed in tacrolimus-treated human glomeruli, may induce the extracellular matrix deposition and sclerosis characteristic of chronic cyclosporine toxicity.
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Cigliano B, Cipolletta L, Baltogiannis N, Esposito C, Settimi A. Endoscopic fibrin sealing of congenital pyriform sinus fistula. Surg Endosc 2004; 18:554-6. [PMID: 15115008 DOI: 10.1007/s00464-003-4253-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pyriform sinus fistula is a very rare branchial apparatus malformation, often appearing in the form of a cervical inflammatory process (abscess or suppurative thyroiditis), especially in infants. Failure to diagnose this lesion may result in unexpected recurrence. A case of recurrent suppurative thyroiditis caused by pyriform sinus fistula in a 9-year-old girl is reported. In the latency period of infection, the fistula tract was identified by a barium meal contrast study. Direct endoscopy showed the fistula internal orifice at the apex of the left pyriform fossa. The fistula was completely obliterated by injection of fibrin glue. Suppurative thyroiditis is reported mainly in the pediatric literature, and the reported case is the first to be managed endoscopically by injection of fibrin adhesive.
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Esposito C, Damiano R, Settimi A, De Marco M, Maglio P, Centonze A. Experience with the use of tissue adhesives in pediatric endoscopic surgery. Surg Endosc 2004; 18:290-2. [PMID: 14691695 DOI: 10.1007/s00464-003-9032-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2003] [Accepted: 07/23/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Due to technological improvements, the use of tissue adhesives and glues for tissue approximation and hemostasis in surgery has increased. We report our preliminary experience with this technology in pediatric endosurgery. METHODS Between 1997 and 2000, we employed tissue adhesives in 48 pediatric patients during laparoscopic procedures. In 25 patients, the glue was adopted for the hemostasis of parenchimal organs (liver in 24 cases and spleen in one). In three cases, the glue was used to repair organ perforation, in 19 it was used to close the distal part of a patent processus vaginalis in case of congenital inguinal hernia. In the final case, the glue was adopted to achieve optimal airtightness in case of pulmonary biopsy. The glue was injected with the aid of a needle positioned transparietally. RESULTS The procedure was easy and rapid in all cases, and there were no problems or complications related to glue positioning at a mean follow up of 51 months. CONCLUSION Tissue adhesives are a very versatile product for use in pediatric laparoscopic surgery. It is likely that their usage will increase as the technology improves and more effective products are developed.
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Littger R, Alke A, Tewes B, Gropp F, Asai T, Watanabe K, Kuromi K, Kurohane K, Ogino K, Taki T, Tsukada H, Nakayama J, Oku N, Babai I, Matyas G, Baranji L, Milosevits J, Alving CR, Bendas G, Rothe U, Scherphof GL, Kamps JAAM, Kessner S, Rothe U, Bendas G, Carafa M, Di Stefano A, Sozio P, Cacciatore I, Mosciatti B, Santucci E, Choice E, Harvie P, Galbraith T, Zunder E, Dutzar B, Anklesaria P, Paul R, Cocquyt J, De Cuyper M, Van der Meeren P, Cruz MEM, Gaspar MM, Silva MT, Dathe M, Nikolenko H, Wessolowski A, Schmieder P, Beyermann M, Bienert M, Santos ND, Cox KA, Allen C, Gallagher RC, Ickenstein L, Mayer LD, Bally MB, Fischer S, Margalit R, Freisleben HJ, Garidel P, Chen HC, Moore D, Mendelsohn R, Garidel P, Keller M, Hildebrand A, Blume A, Girão da Cruz MT, Simões S, Pedroso de Lima MC, Graser A, Nahde T, Fahr A, Müller R, Müller-Brüsselbach S, Harvie P, Dutzar B, Choice E, Cudmore S, O'Mahony D, Anklesaria P, Paul R, Hoving S, van Tiel ST, Seynhaeve ALB, Ambagtsheer G, Eggermont AMM, ten Hagen TLM, Høyrup P, Jensen SS, Jørgensen K, Iden D, Kuang H, Mullen P, Jacobs C, Roben P, Stevens T, Lollo C, Ishida T, Maeda R, Masuda K, Ichihara M, Kiwada H, Jung K, Reszka R, Kaiser N, Ohloff I, Linser-Haar S, Massing U, Schubert R, Kan P, Tsao CW, Chen WK, Wang AJ, Kimpfler A, Gerber C, Wieschollek A, Bruchelt G, Schubert R, Kobayashi T, Okada Y, Ishida T, Sone S, Harashima H, Maruyama K, Kiwada H, Kondo M, Lee CM, Tanaka T, Su W, Kitagawa T, Ito T, Matsuda H, Murai T, Miyasaka M, Junji K, Kondo M, Asai T, Ogino K, Taki T, Tsukada H, Baba K, Oku N, Koning GA, Wauben MHM, ten Hagen TLM, Vestweber D, Everts M, Kok RJ, Schraa AJ, Molema G, Schiffelers RM, Storm G, Kristl J, Šentjurc M, Abramović Z, Landry S, Perron S, Bestman-Smith J, Désormeaux A, Tremblay MJ, Bergeron MG, Madeira C, Loura LMS, Fedorov A, Prieto M, Aires-Barros MR, Marques CM, Simões SI, Cruz ME, Cevc G, Martins MB, Moreira JN, Gaspar R, Allen TM, Esposito C, Ortaggi G, Bianco A, Bonadies F, Malizia D, Napolitano R, Cametti C, Mossa G, Endert G, Essler F, Lutz S, Panzner S, Pastorino F, Brignole C, Pagnan G, Moase EH, Allen TM, Ponzoni M, Pavelic Z, Škalko-Basnet N, Jalšenjak I, Penacho N, Simões S, Pedroso de Lima MC, Pisano C, Bucci F, Serafini S, Martinelli R, Cupelli A, Marconi A, Ferrara FF, Santaniello M, Critelli L, Tinti O, Luisi P, Carminati P, Santaniello M, Bucci F, Tinti O, Pisano C, Critelli L, Galletti B, Luisi P, Carminati P, Sauer I, Nikolenko H, Dathe M, Schleef M, Voß C, Schmidt T, Flaschel E, König S, Wenger T, Dumond J, Bogetto N, Reboud-Ravaux M, Schramm HJ, Schramm W, Sheynis T, Rozner S, Kolusheva S, Satchell D, Jelnik R, Shigeta Y, Imanaka H, Ando H, Makino T, Kurohane K, Oku N, Baba N, Shimizu K, Asai T, Takada M, Baba K, Namba Y, Oku N, Simberg D, Danino D, Talmon Y, Minsky A, Ferrari ME, Wheeler CJ, Barenholz Y, Takada M, Shimizu K, Kuromi K, Asai T, Baba K, Oku N, Takeuchi Y, Kurohane K, North JR, Namba Y, Nango M, Oku N, Tewes B, Köchling T, Deissler M, Kühl C, Marx U, Strote G, Gropp F, Qualls MM, Kim JM, Thompson DH, Zhang ZY, Shum P, Collier JH, Hu BH, Ruberti JW, Messersmith PB, Thompson DH, Tsuruda T, Nakade A, Sadzuka Y, Hirota S, Sonobe T, Vorauer-Uhl K, Wagner A, Katinger H, Wagner A, Vorauer-Uhl K, Katinger H, Weeke-Klimp AH, Bartsch M, Meijer DKF, Scherphof GL, Kamps JAAM, Zeisig R, Walther W, Reß A, Fichtner I, Zschörnig O, Schiller J, Süß M, Bergmeier C, Arnold K, Nchinda G, Überla K, Zschörnig O. Poster Abstracts. J Liposome Res 2003. [DOI: 10.1081/lpr-120017490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Savanelli A, Esposito C, Tilemis S, Franzese A, Guys J, Settimi A. Persistent urogenital sinus with bladder agenesis and absence of vagina. BJU Int 2003; 92 Suppl 3:e48-e49. [PMID: 19127645 DOI: 10.1111/j.1464-410x.2003.04190.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mattioli G, Esposito C, Pini Prato A, Doldo P, Castagnetti M, Barabino A, Gandullia P, Staiano AM, Settimi A, Cucchiara S, Montobbio G, Jasonni V. Results of the laparoscopic Heller-Dor procedure for pediatric esophageal achalasia. Surg Endosc 2003; 17:1650-2. [PMID: 12915969 DOI: 10.1007/s00464-002-9257-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 03/27/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Esophageal achalasia is not a frequent disorder in children and different treatments have been proposed during past decades. This study reviews the results of the laparoscopic Heller-Dor procedure performed in pediatric patients in two different surgical units. METHODS We included the patients aged <14 years with a minimum follow-up of 6 months operated on in the period 1994-2001. A single longitudinal anterior esophageal myotomy (Heller) and a 180 degrees anterior gastropexy (Dor) were laparoscopically performed. The patients were checked to detect intra- or postoperative complications and recurrence. RESULTS Twenty children were operated on. Mean follow-up was 45 months (range 6-102). Postoperative clinical score was Visick 1 in 15 cases and Visick 2 in five. CONCLUSIONS As complication and recurrence rates are very low we consider modified Heller myotomy and Dor gastropexy through a laparoscopic approach our first choice to treat esophageal achalasia in the pediatric population.
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Esposito C, Cardona R, Centonze A, Damiano R, Colace R, Rotondo C, Settimi A, Bolognini S, Sacco R. Impact of laparoscopy on the management of an unusual case of nonpalpable testis in an adult patient. Surg Endosc 2003; 17:1324. [PMID: 12739128 DOI: 10.1007/s00464-002-4283-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2002] [Accepted: 11/21/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the past decade, cryptorchidism has generally been treated in the first 36 months of life using an inguinal approach, in the case of palpable testis, or using laparoscopy, in the case of nonpalpable testis. Nevertheless, before this period some children were managed incorrectly. This case report shows how laparoscopy and the collaboration between pediatric surgeons and urologists may lead to optimal results. CASE REPORT A 19-year-old male was referred to our unit following routine medical examination for enrollment in the military service with a diagnosis of right cryptorchidism. The clinical history showed the anamnesis of right cryptorchidism diagnosed at birth as a right nonpalpable testis, confirmed at 2 years of age with clinical examination and computer tomography. The patient came to our attention to again undergo a clinical examination, ultrasonography, computed tomography, and magnetic resonance imaging. We found a left, well-positioned testis of 20 ml in volume and an empty right scrotum; all the instrumental examinations were negative. The patient was thus scheduled for a diagnostic laparoscopy. A pediatric surgeon with extensive experience in this pathology performed the procedure. The 10-mm 30 degrees optics introduced through the umbilicus showed a closed right inguinal ring, with no evidence of either vas deferens or inner spermatic vessels at the level of the inguinal region or pelvis. Two more trocars were introduced and a testis of 15 ml in volume was found under the ascending colon 10 cm away from the cecum. An orchiectomy was performed via laparoscopy. CONCLUSION This case clearly shows that some males with nonpalpable testis may have been treated incorrectly in the prelaparoscopic era and may now have an intraabdominal testis. In addition, our experience shows that intraabdominal testis may sometime be in an unusual location, and a laparoscopic surgeon with experience in this pathology is fundamental to finding the testis. In the case of adults with nonpalpable testis, when echography, computed tomography, and magnetic resonance imaging are not useful, the only effective diagnostic procedure is laparoscopy.
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