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Frediani S, Zarfati A, Pardi V, Aloi I, Bertocchini A, Accinni A, Beati F, Pasanisi M, Inserra A. A new custom-made bivalve brace for pectus carinatum in children and adolescents: preliminary promising experience of 140 patients from a tertiary center. Front Pediatr 2024; 12:1321633. [PMID: 38633328 PMCID: PMC11022594 DOI: 10.3389/fped.2024.1321633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction International research suggests that poor patient compliance is the main cause of tutor failures in the context of potential novel orthopedic bivalve braces for conservative treatment of pectus carinatum. Our entire experimental study is based on the hypothesis that a rigid bivalve brace that patients can accept could solve the main problem associated with the conservative approach-poor compliance. The hypothesis was to reduce the thickness and weight of the classic bivalve brace to ensure concealment and make it sustainable enough to be worn several hours a day without compromising its therapeutic efficacy. Materials and method The research was conducted from January 2020 to December 2022 to ensure follow-up of all participants for at least 6 months. In 36 months, 140 patients with pectus carinatum were assessed and conservatively treated with the studied guardian to analyze the therapeutic efficacy of the bivalve brace and patient compliance. From the initial visit, the parents and patient were informed that this is a 2-year therapeutic course during which the bivalve brace should be worn at least 23 h a day (with 1 h of abstinence per day for routine personal hygiene practices). Compliance is the key to therapy success, and the duration of treatment depends on patient adherence. Results The exceptional effectiveness of the experimental brace was confirmed by both the questionnaire from the patients (with an average satisfaction rate of 8.9/10) and an assessment of the therapy's results by a properly selected medical committee (with a VAS scale satisfaction of 7.2/10 for symmetric forms and 7.1/10 for asymmetric ones). Conclusion In conclusion, the analyzed data confirmed the research hypotheses. First, none of the 140 patients had cardiovascular diseases directly related to their condition, confirming that pectus carinatum is a pathology of a purely aesthetic nature. Second, a cheap, lightweight, and easily obscured brace significantly improved patient compliance. Along with this, the social relevance of the aesthetic aspect today may be an important factor in motivating the study cohort to adhere to therapy. In the past, esthetics and appearance were less relevant at the social level, which may have contributed to the high abandonment and reduced compliance rates of the many studies in the literature.
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Affiliation(s)
- Simone Frediani
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angelo Zarfati
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of Rome “Tor Vergata”, Rome, Italy
| | - Valerio Pardi
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Aloi
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federico Beati
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Massimiliano Pasanisi
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of Rome “Tor Vergata”, Rome, Italy
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Martucci C, Frediani S, Accinni A, Aloi IP, Bertocchini A, Crocoli A, Madafferi S, Pardi V, Persano G, Inserra A. Femoral hernia in pediatric population: a diagnostic and surgical challenge. Hernia 2024; 28:593-597. [PMID: 38270834 DOI: 10.1007/s10029-023-02953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management. METHODS A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed. RESULTS In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6%) were female. The mean age at time of surgery was 5.8 years (range 0.5-17.1 years). The rate of pre-operative misdiagnosis was 35.5% and open approach was adopted in all cases (16.1% with mesh application). Only two patients (6.4%) experienced surgical complications: one recurrence (repaired six months later) and one post-operative hematoma (treated successfully with conservative method). CONCLUSION Due to the high rate of misdiagnosis, the variety of surgical approaches proposed, and the potential for intraoperative complications, FH poses a challenge for pediatric surgeons and urologists, as confirmed by the literature. It is essential to underline the importance of a proper clinical examination in order to correctly diagnose FH, make the best surgical plan for the patient and prevent post-operative complications.
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Affiliation(s)
- Cristina Martucci
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy.
| | - Simone Frediani
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Antonella Accinni
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Ivan Pietro Aloi
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Arianna Bertocchini
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Madafferi
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Giorgio Persano
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
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Romano G, Frediani S, Aloi IP, Bertocchini A, Pardi V, Accinni A, Inserra A. Case Report: An unusual case of wide ileoileal intussusception associated with intestinal volvulus in a 8-months-old infant. Front Pediatr 2024; 12:1363731. [PMID: 38434726 PMCID: PMC10904457 DOI: 10.3389/fped.2024.1363731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Midgut volvulus and intussusception are prevalent paediatric abdominal emergencies. To the best of our knowledge, this is the first reported case of a connection between intestinal volvulus and a massive intussusception. Case report An 8-month-old male infant was brought to the emergency room with a history of abdominal pain and vomiting for <24 h. On physical examination, the child appeared restless and was found to have a circumferential hard mass of approximately 4 cm in diameter in the epigastric region. Upon admission, laboratory results showed a C-reactive protein level of 0.4 mg/dl, LDH level of 351 U/L, mild leukocytosis with a white blood cell count of 12 × 103 /µl, and 67% neutrophils. A physical exam was significant for abdominal distention, hyperresonance in percussion, and a palpable, painful epigastric mass. The findings of the operation included a dilated and ischemic intestinal loop, approximately 25 cm from the ileocecal valve, twisted upon itself for three turns. After de-rotation, an extensive occluding ileo-ileal invagination with an ischemic intestinal loop was identified, and a length of approximately 55-60 cm of the distal ileum, including the ischemic segment, was resected. Discussion This is the first reported case of a connection between intestinal volvulus and a massive intussusception. Currently, only two reported cases describe the connection between volvulus and intussusception, which are insufficient to establish a direct link between the two clinical conditions.
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Affiliation(s)
| | - Simone Frediani
- Department of General Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Corbi L, Frediani S, Aloi IP, Bertocchini A, Accinni A, Pardi V, Inserra A. Case Report: The acute appendicitis and incarcerated umbilical hernia: a rare association. Front Pediatr 2024; 12:1334562. [PMID: 38384658 PMCID: PMC10880186 DOI: 10.3389/fped.2024.1334562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction One of the most prevalent congenital wall abnormalities in children, umbilical hernias are often linked to premature or small-for-gestational-age babies. In cases of intestinal malrotation or if the cecum is very movable, generalized peritonitis may facilitate the imprisonment of these hernias. Case report We described a case of a 4-month-old baby who had a prior reducible umbilical hernia with a history of fever, vomiting, poor appetite, and constipation for around 48 h. The patient experienced significant intestinal bloating, vomiting, irreducibility of the umbilical hernia, skin pigmentation, and erythema at the umbilical site within 2 days after hospitalization. When there was no free abdominal air, a direct abdominal x-ray revealed evidence of hydro-gas stasis and various hydro-aerial levels that were pertinent to the ileum. In order to reduce the hernia, the patient had an emergency surgical treatment where the hernia sac was isolated and released from the ileal loop, which was securely attached to a fibrin plate. When the herniary sac was opened, a gangrenous and perforated appendix was found inside. On the seventh postoperative day, the patient was released from the hospital after an uncomplicated postoperative stay. Conclusion Our patient's clinical presentation is similar to that of only one other case report involving a 25-day-old male patient. Our case presented with a variant of the clinical symptoms of the previously described umbilical hernia, which became unfixable and strangulated as a result of appendix inflammation. The appendix was discovered inside the hernia sac during surgery.
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Affiliation(s)
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Frediani S, Beati F, Pardi V, Aloi IP, Bertocchini A, Accinni A, Reali S, Schingo PMS, Inserra A. Case Report: Modified Taulinoplasty: a new technique for minimally invasive repair of pectus excavatum. Front Surg 2024; 10:1343515. [PMID: 38283062 PMCID: PMC10811093 DOI: 10.3389/fsurg.2023.1343515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction About 95% of congenital chest wall deformities are pectus abnormalities, with pectus excavatum (PE) being the most common. The purpose of this work is to offer a modified Taulinoplasty Technique based on 35 consecutive PE patients' 1-year single-center experience in 2022. Technique One minimally invasive procedure for PE is taulinoplasty. In order to prevent invasion of the mediastinum or pleural cavity, it is considered that external traction can be used to raise the sternum. Our experience indicates that the most common surgical consequences of this procedure-which involves creating a submuscular and subcutaneous tunnel to install the metal device-are post-operative seroma and wound dehiscence. We modified the conventional method to achieve more aesthetically pleasing results. Discussion Taulinoplasty seems to be a safe technique, easier and more feasible than standard Taulinoplasty, with better outcomes in terms of surgical complications, although further experience is necessary to confirm our preliminary data.
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Affiliation(s)
- Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federico Beati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simone Reali
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Zarfati A, Pardi V, Frediani S, Aloi IP, Accinni A, Bertocchini A, Madafferi S, Inserra A. Conservative and operative management of spontaneous pneumothorax in children and adolescents: Are we abusing of CT? Pediatr Pulmonol 2024; 59:41-47. [PMID: 37753873 DOI: 10.1002/ppul.26703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/19/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND No age-specific pediatric guidelines exist for the management of spontaneous pneumothorax (SP) in children and adolescents. Treatment remains heterogeneous and center dependent. The role of computed tomography (CT) has yet to be defined. AIMS Review the management of SP in children and adolescents, with emphasis on conservative management and role of CT. METHODS Retrospective analysis of 61 consecutive patients with SP at single tertiary center. Clinical, radiological, surgical data, follow-up, and outcomes were revised. RESULTS First-line management was conservative for 32 (53%) patients and operative for 29 (47%). Asymptomatic/paucisymptomatic patients managed conservatively experienced less first-line treatment failure. Furthermore, the patients needing at least a chest drain or surgery during the follow-up were significantly lower in the conservative group. Conservative and operative patients showed no significant differences regarding ipsilateral recurrences or contralateral occurrences. Of the 61 overall CTs performed, 14 (23%) had an impact on management. Forty-three (70%) patients had at least a CT, in 22 (51%) the CT was positive for blebs. For 10 of these patients (45%) the presence of blebs had an impact on management. Patients with and without blebs showed no differences regarding ipsilateral recurrence, contralateral occurrences, or the need for at least a chest drain or surgery during the follow-up. CONCLUSIONS First-line conservative management had a significantly shorter hospitalization and better outcome, with a similar incidence of recurrences. The presence of blebs at CT does not predict the risk of recurrence. The CT scan should be reserved for a small number of selected patients who have post-VATS refractory or recurrent pneumothorax.
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Affiliation(s)
- Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Madafferi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Frediani S, Aloi IP, Krzysztofiak A, D'Angelo T, Bertocchini A, Madafferi S, Accinni A, Pardi V, Inserra A. The Intraperitoneal Use of Cephazolin: A Novelty in the Prevention of Intra-abdominal Abscess after Laparoscopic Appendectomy in Children. Ann Ital Chir 2024; 95:253-256. [PMID: 38684488 DOI: 10.62713/aic.3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Laparoscopic appendectomy followed by postoperative intravenous (IV) antibiotics is the standard of care for acute appendicitis and postoperative prevention of intra-abdominal abscesses. The aim of or study was to determine if intraperitoneal irrigation with antibiotics could help prevent intra-abdominal abscess formation after laparoscopic appendectomy for complicated appendicitis in pediatric patients. METHODS A retrospective study was conducted on consecutive pediatric patients with acute appendicitis who had appendectomy in our Pediatric Surgery Department between August 2020 and February 2022. We compared two groups with similar age and symptoms. The first group (A) was treated with the normal standard of care, i.e., laparoscopic appendectomy and postoperative IV antibiotic therapy. For the second group (B) intraperitoneal cefazoline irrigation was added at the end of the laparoscopic procedure. Postoperative intra-abdominal abscess was diagnosed with ultrasound examination, performed after clinical suspicion/abnormal blood test results. RESULTS One hundred sixty patients (males:females 109:51; median age 10.5 years [range 3-17 years]) who had laparosopic appendectomy for complicated appendicitis were included, 82 in group A and 78 in group B. In the first 7 days after surgery, 18 patients in group and 5 in group B developed an intra-abdominal abscess (p < 0.005). Drains were positioned in 38 patients in group A vs. 9 in group B. One patient in group A had a different complication which was infection of the surgical incision. CONCLUSIONS Intraperitoneal cefazoline irrigation at the end of the laparoscopic appendectomy in pediatric patients significantly reduces the formation of intra-abdominal abscesses.
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Affiliation(s)
- Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Andrzej Krzysztofiak
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Tommaso D'Angelo
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Silvia Madafferi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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Zarfati A, Frediani S, Pardi V, Aloi IP, Madafferi S, Accinni A, Bertocchini A, Inserra A. Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome? Front Pediatr 2023; 11:1301902. [PMID: 38173880 PMCID: PMC10764018 DOI: 10.3389/fped.2023.1301902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Background and objectives Marfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients. Methods Retrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10-June 22), with special emphasis on diagnosis, treatment, and follow-up (FU). Results Sixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up. Conclusions Treatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.
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Affiliation(s)
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Frediani S, Romano G, Pardi V, Aloi IP, Bertocchini A, Accinni A, Zarfati A, Inserra A. Benefits of using digital thoracic drainage systems for post-operative treatment in pediatric populations: personal experience and review of literature. Front Pediatr 2023; 11:1280834. [PMID: 37900681 PMCID: PMC10603228 DOI: 10.3389/fped.2023.1280834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The digital chest drainage monitoring system (Medela Thopaz+), unlike analogical systems, reliably regulates the pressure applied to the patient's chest and digitally and silently monitors critical therapeutic indicators (volume of fluid and/or drained air). Its use in adulthood has been widely described, but there is still little experience in the pediatric field. The aim of this study is to test this new device in the pediatric population. Materials and methods We conducted a retrospective study of 160 patients undergoing chest surgery at our Hospital. These patients were divided into 82 treated with the Thopaz system in the period from January 2021 to April 2023 and 78 in whom Pleurevac, had been used in the time period from January 2020 to April 2023. Results The average age of patients was 10.45 years (range: 3.1-17.2) for the Thopaz Group and 10.71 years for Pleurevac Group. The groups were homogeneus also by weight and type of intervention. The device was held in place for 10.64 days (mean) for Thopaz Group, compared to 16.87 days (mean) for Pleurevac Group (p < 0.05). The median number of postoperative x-rays before the closure of the chest tube was 4.29 in the digital drainage group compared to 8.41 in the traditional draining group (p < 0.05). Conclusions The digital chest monitoring device provides objective measurement, allows for rapid patient mobilization (with good pain control and increased compliance). In addition, the use of Thopaz in the paediatric population seems to be safe (there is no statistically significant difference in terms of complications such as prolonged air leaks and pneumothorax after the chest tube closure) and potentially beneficial.
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Affiliation(s)
- Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Inserra A, Zarfati A, Pardi V, Bertocchini A, Accinni A, Aloi IP, Martucci C, Frediani S. Case report: A simple and reliable approach for progressive internal distraction of the sternum for Jeune syndrome (asphyxiating thoracic dystrophy): preliminary experience and literature review of surgical techniques. Front Pediatr 2023; 11:1253383. [PMID: 37822322 PMCID: PMC10562558 DOI: 10.3389/fped.2023.1253383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Background Described for the first time in 1954, Jeune syndrome (JS), often called asphyxiating thoracic dystrophy, is a congenital musculoskeletal disease characterized by short ribs, a narrow thorax, and small limbs. In this study, we analyzed and presented our preliminary experience with a device for progressive internal distraction of the sternum (PIDS) in patients with symptomatic JS. In addition, we reviewed the contemporary English literature on existing surgical techniques for treating children with congenital JS. Material and methods A retrospective analysis of pediatric patients (<18 years old) treated for symptomatic JS at our tertiary center between 2017 and 2023 was performed. Results We presented two patients with JS who underwent surgery using an internal sternal distractor, a Zurich II Micro Zurich Modular Distractor, placed at the corpus of the sternum among the divided halves. Conclusions We obtained promising results regarding the safety and effectiveness of this less-invasive device for PIDS in patients with symptomatic JS. Further studies on long-term outcomes are needed to validate these findings.
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Affiliation(s)
- Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of “Tor Vergata”, Rome, Italy
| | - Valerio Pardi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Pietro Aloi
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina Martucci
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Beati F, Frediani S, Pardi V, Aloi I, Bertocchini A, Accinni A, Inserra A. Case report-Every thoracic surgeon's nightmare: cardiac and lung perforation during placement of Nuss bar for pectus excavatum. Front Pediatr 2023; 11:1241273. [PMID: 37744443 PMCID: PMC10513049 DOI: 10.3389/fped.2023.1241273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The prevalence of life-threatening complications (LTCs) related to the minimally invasive repair of pectus excavatum (MIRPE) is unknown and underreported. The aim of this study is to contribute to the real prevalence of these rare but dramatic complications and show what went wrong in order to prevent it in the future. Case presentation A 15-year-old boy affected by pectus excavatum with severe asymmetric deformity of the chest wall was evaluated for elective corrective surgery. Preoperative computed tomography showed a Haller index of 5.7 and a correction index of 0.40. MIRPE was performed under right video-assisted thoracoscopy. Cardiac arrhythmias occurred after placement of the bar introducer. The introducer was removed, and massive bleeding was noted. Emergency Clamshell thoracotomy was performed, and cardiac surgeon was alerted immediately. A first pulmonary wound was found and controlled. Two cardiac lacerations were found: on the interventricular wall and on the right atrium. Under cardiopulmonary bypass, cardiac lacerations were sutured and other three pulmonary wounds were repaired. An urgent fasciotomy was performed for compartmental syndrome of the right lower art after femoral cannulation. Pulmonary distress occurred; the patient was admitted on ECMO (ExtraCorporeal Membrane Oxygenation) in intensive care unit. Right lower lobectomy was carried out on the fifth postoperative day due to massive pulmonary bleeding requiring temporary tracheostomy. The patient was discharged to rehabilitation after 3 months with no brain injuries, minor hearing loss, and tracheostomy. Conclusion We want to maintain the high alertness required for this procedure. Reporting these scaring complications contributes to the real prevalence of LTCs. We suggest the use of bilateral thoracoscopy and crane elevator in severe sternal defects. We also suggest to have a cardiac surgeon available in the hospital owing to cardiac perforation.
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Affiliation(s)
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Crocoli A, Martucci C, Persano G, De Pasquale MD, Serra A, Accinni A, Aloi IP, Bertocchini A, Frediani S, Madafferi S, Pardi V, Inserra A. Vascular Access in Pediatric Oncology and Hematology: State of the Art. Children 2022; 9:children9010070. [PMID: 35053694 PMCID: PMC8774620 DOI: 10.3390/children9010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/15/2021] [Accepted: 12/30/2021] [Indexed: 12/27/2022]
Abstract
Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.
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Affiliation(s)
- Alessandro Crocoli
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Cristina Martucci
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
- Correspondence: ; Tel.: +39-0668592155
| | - Giorgio Persano
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Maria Debora De Pasquale
- Paediatric Haematology/Oncology Cell and Gene Therapy Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.D.D.P.); (A.S.)
| | - Annalisa Serra
- Paediatric Haematology/Oncology Cell and Gene Therapy Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.D.D.P.); (A.S.)
| | - Antonella Accinni
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Ivan Pietro Aloi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Arianna Bertocchini
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Simone Frediani
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Silvia Madafferi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Valerio Pardi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
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Martucci C, Crocoli A, Persano G, Bonito M, Stracuzzi A, Alaggio R, Bertocchini A, Accinni A, Inserra A. Uterine leiomyoma in pediatric population: A case report and review of the literature. Front Pediatr 2022; 10:1020072. [PMID: 36268039 PMCID: PMC9577596 DOI: 10.3389/fped.2022.1020072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Uterine leiomyomas are rare in the pediatric population with less than 20 cases in adolescences reported in the literature. Furthermore, these masses represent a common presentation of gynecologic tumors with increasing age. We report a case of a 14-year-old female who presented with abdominal pain and increasing abdominal girth. Workup with ultrasound, CT and MRI demonstrated a large pelvic mass. Complete resection by median laparotomy was performed. The mass weighed 5,596 g and was 29.5 cm × 27 cm × 19 cm; the pathological examination confirmed the hypothesis of leiomyoma. The patient remained asymptomatic at 3 months follow up.
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Affiliation(s)
- Cristina Martucci
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Giorgio Persano
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Marco Bonito
- Division of Obstetrics and Gynecology, San Pietro Hospital, Rome, Italy
| | | | - Rita Alaggio
- Department of Pathology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Antonella Accinni
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Alessandro Inserra
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
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Frediani S, Bertocchini A, Inserra A. Minimally invasive surgery in giant ovarian cyst in children: a safe approach. Ann R Coll Surg Engl 2021; 104:389-390. [PMID: 34939842 DOI: 10.1308/rcsann.2021.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Frediani
- Bambino Gesù Children's Hospital, Rome, Italy
| | | | - A Inserra
- Bambino Gesù Children's Hospital, Rome, Italy
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Aloi IP, Bertocchini A, Pardi V, Mazzei A, Capozza N, Inserra A. Unilateral vasectomy for intractable epididiymo-orchitis in patients with anorectal malformation. J Pediatr Urol 2021; 17:544.e1-544.e5. [PMID: 33812780 DOI: 10.1016/j.jpurol.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/04/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Male patients treated for anorectal malformations (ARM) and recto-urethral fistula (RUF) tend to develop recurrent epididymo-orchitis (EO) which occurs approximately in 20% of all them. The optimal management of this condition is unclear because of the extreme its rarity and the unavailability of detailed analysis in literature. To date the majority of this patients benefits from medical treatment and symptoms reduce over time but few data have been published in literature about management of patients with intractable EO. OBJECTIVE To describe the efficacy of unilateral vasectomy in patients operated on for anorectal malformations with RUF and affected by intractable EO. STUDY DESIGN We present five patients who met the criteria for intractable EO, and followed at our centre four of whom have undergone unilateral vasectomy. RESULTS The first episode of EO presented at 42,00 mos ±29.39. Initially, patients were all managed with analgesics and antibiotics. For the failure of therapy, five patients were all offered unilateral vasectomy but only four families accepted procedure. Surgical treatment was performed as a day case without complications. Postoperative follow up was 88,50 mos ±68.36. Prompt and durable resolution of symptoms was observed. DISCUSSION The long-term effects of recurrent EO in ARM are often underestimated. Prompt and appropriate intervention should prevent this undesirable sequela. Unfortunately, the optimal management of this complication is unclear, partly because of its extreme rarity. The established management needs to follow the route of correcting underlying anomalies and providing long-term analgesic and antibiotics but this may have undesired side effects. We therefore offered families vasectomy for complete symptom resolution and/or drug withdrawal. Vasectomy, as a form of treatment for, can be justified if it can prevent pain, infection and destruction of the testes. Early vasectomy may save enough functional testis tissue. CONCLUSION To date, the only available treatment to achieve definitive resolution of symptoms in intractable unilateral EO is vasectomy. Long-term effects of such procedure on fertility are unknown. The treatment of recurrent EO in cases without site predilection remains a matter of contention.
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Affiliation(s)
- I P Aloi
- General and Thoracic Surgery, Department of Surgery, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Roma, Italy
| | - A Bertocchini
- General and Thoracic Surgery, Department of Surgery, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Roma, Italy.
| | - V Pardi
- General and Thoracic Surgery, Department of Surgery, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Roma, Italy
| | - A Mazzei
- Pediatric Surgery, Department of Paediatric, Azienda Ospedaliera "Pugliese Ciaccio", Viale Pio X 83, 88100 Catanzaro, Italy
| | - N Capozza
- Urologic Surgery, Department of Surgery, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Roma, Italy
| | - A Inserra
- General and Thoracic Surgery, Department of Surgery, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Roma, Italy
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Mazzei A, Centonze A, Aloi IP, Bertocchini A, Baldassarre E. Rapunzel Syndrome: Endoscopy, Laparotomy, or Laparoscopy? J Indian Assoc Pediatr Surg 2021; 26:66-67. [PMID: 33953520 PMCID: PMC8074813 DOI: 10.4103/jiaps.jiaps_176_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/21/2020] [Accepted: 06/19/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Aurelio Mazzei
- Department of Paediatric Surgery, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Antonella Centonze
- Department of Paediatric Surgery, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Ivan Pietro Aloi
- Department of Paediatric Surgery, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Arianna Bertocchini
- Department of Paediatric Surgery, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Emanuele Baldassarre
- Department of Andrology and Paediatric Urology, Umberto Parini Hospital, Aosta, Italy
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Contini G, Bertocchini A, Carta R, Merli P, Inserra A, Bagolan P, Morini F. Case Report: Massive Intestinal Pneumatosis and Pneumoretroperitoneum Following Hematopoietic Stem Cell Transplantation in a 2-Year-Old Child. Front Pediatr 2021; 9:700736. [PMID: 34956969 PMCID: PMC8693778 DOI: 10.3389/fped.2021.700736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
A 2-year-old boy with severe combined immunodeficiency (SCID) developed intestinal graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT), associated with massive intestinal pneumatosis (IP), pneumoretroperitoneum (PRP), and pneumomediastinum. His fair clinical conditions allowed conservative management, with progressive normalization of imaging findings. The patient did not require surgery and is alive and in good clinical conditions at follow-up. In children with GVHD-related IP but good clinical conditions and no signs of peritonitis, IP is not a mandatory indication for surgery, despite its potentially striking imaging features. Conservative management, with intestinal rest, decompression, and antibiotics, often allows regression of the clinical picture.
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Affiliation(s)
- Giorgia Contini
- Medical and Surgical Department of the Fetus, Neonate and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberto Carta
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Merli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Medical and Surgical Department of the Fetus, Neonate and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Morini
- Medical and Surgical Department of the Fetus, Neonate and Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Frediani S, Pellegrino C, Bertocchini A, Aloi IP, Raponi M, Inserra A. Appendicitis in COVID19 Pandemic Era. Early experience of an International Referral Center of Pediatric Surgery. Ann Ital Chir 2021; 92:592-594. [PMID: 34795116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM We describe treatments of acute appendicitis at "Bambino Gesù" Children's Hospital during the peak of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) pandemic in Italy. MATERIAL AND METHODS From March 1st to May 31st, all suspected appendicitis admitted to hospital entered this study. Following Institutional COVID19-protocol, between March 1st-21st, only patients with respiratory symptoms and/or history of recent travel to risk areas received nasopharyngeal swab. From March 22nd to May 31st, protocol was adapted to worsening epidemic conditions and a pre-triage area has been arranged to accommodate all patients undergoing the swab. RESULTS 14 out of 53 patients were hospitalized between march 1st-21st, 39 from march 22nd to may 31st. swab was performed in 2 patient of first group and in all of second. DISCUSSION During the study period, no covid19-contagion occurred in hospital staff by covid19-patients. CONCLUSION Our covid19-protocol protected staff and patients allowing the maintenance of our standard of treatment. KEY WORDS Appendicitis, Children, Covid19, Sars-cov-2.
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Pardi V, Bertocchini A, Aloi IP, Frediani S, Martucci C, Inserra A. Electrocautery only for hyoid bone removal in pediatric thyroglossal duct cyst excision. Ann Ital Chir 2020; 91:688-691. [PMID: 33554940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM Surgical excision of hyoid bone is the mainstay of thyroglossal duct cyst removal, to prevent recurrences. Bone excision by cut - bone forceps may prove inaccurate and somewhat dangerous. Therefore, use of alternative methods has been advocated. MATERIAL AND METHODS The proposal of the study is to cut the body of the hyoid bone with the only electric scalpel. Surgical casenotes of 57 pediatric patients operated by our Institution with modified Sistrunk technique and complete dissection of the entire body of hyoid bone and its removal at the cartilage junction with lateral horn with monopolar cauterization were reviewed. RESULTS The population of our study had a mean age of 59.86 ± 29.57 months; 6/57 patients (10.5%) were under 2 years of age. Mean follow up was 55,04 ± 29,08 months ranging 2 to 115 months. In any patients post-operative bleeding was observed. Mean surgical time was 57,02 ± 11,77 minutes ranging from 35 to 125 minutes; 6 cases required postoperative drain. In 3 patients an immediate local edema was observed and in another one a partial wound dehiscence occurred, no late complications were observed. Cyst-recurrence requiring re-do surgery occurred in 5 patients (8.8%). CONCLUSIONS The complete hyoid bone section with electric scalpel only ensures the ideal access to the posterior hyoid space and allows a greater and more symmetrical access to the proximal portion of thyroglossal duct in children with still negligible complication and recurrence rate. KEY WORDS Modified Sistrunk technique, Sistrunk procedure, Thyroglossal duct cyst.
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Grimaldi C, Bertocchini A, Crocoli A, de Ville de Goyet J, Castellano A, Serra A, Spada M, Inserra A. Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature. J Pediatr Surg 2019; 54:557-561. [PMID: 29980348 DOI: 10.1016/j.jpedsurg.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Complete encasement of the inferior vena cava by retroperitoneal tumors is rare. Although replacement of the vena cava has been considered for various conditions in adults, it is rarely used in children except for challenging resections and as a last chance approach - often aiming more at debulking than cure. MATERIALS AND METHODS From January 2009 to February 2017, 4 patients (2 adrenal neuroblastomas, 1 renal cell carcinoma, 1 infantile fibrosarcoma) underwent elective en-bloc resection of tumor and of the infrahepatic portion of the inferior vena cava (IVC), with planned IVC prosthetic replacement. In three cases a portion of the left renal vein had to be resected as well, with the vein reanastomosed onto the prosthesis, and a concomitant auto-transplantation of the right kidney was associated in one neuroblastoma patient. RESULTS All patients had an uncomplicated postoperative course. In one patient, the prosthetic conduit is patent at long-term (43 months), while the middle portion of the prosthesis did eventually thrombose at mid-term after surgery in the three others - with no related symptoms. Interestingly, all renal venous reconstructions remain patent. Three patients (2 neuroblastomas and 1 infantile fibrosarcoma) are alive and disease-free at 43, 74 and 108 months after surgery, respectively. One patient with renal cell carcinoma died of recurrence of the disease 21 months after surgery. CONCLUSION Resection and reconstruction of the vena cava, including the renal vein portion, can be considered and planned electively in case of tumoral encasement. This strategy is associated with good tolerance of the operation, low morbidity and satisfactory long-term function, even in cases with progressive and/or secondary partial thrombosis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Chiara Grimaldi
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Arianna Bertocchini
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Alessandro Crocoli
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy.
| | - Jean de Ville de Goyet
- Department of Pediatrics, ISMETT IRCCS, Via Ernesto Tricomi 5, Palermo 90127, Italy; Pediatric Surgery, Tor Vergata University, Roma, Italy
| | - Aurora Castellano
- Pediatric Oncology and Hematology, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Analisa Serra
- Pediatric Oncology and Hematology, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Marco Spada
- Department of Pediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza San Onofrio 4, 00165, Rome, Italy
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Accinni A, Bertocchini A, Madafferi S, Natali G, Inserra A. Ultrasound-guided percutaneous sclerosis of congenital splenic cysts using ethyl alcohol 96% and minocycline hydrochloride 10%: A pediatric series. J Pediatr Surg 2016; 51:1480-4. [PMID: 27320839 DOI: 10.1016/j.jpedsurg.2016.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The management of congenital splenic cysts continues to evolve. In the past the standard treatment was splenectomy, but increased knowledge about the spleen's immunologic function has led most pediatric surgeons to preserve splenic tissue. A great number of studies using sclerosing substances have been published, but to date reports in children have been limited. Our study concerns a group of 15 children with congenital splenic cysts treated with percutaneous drainage and sclerosis with alcohol. We performed the procedure under general anesthesia and checked radiologically for possible leakage. METHODS In 2000 our group started managing pediatric patients with splenic cysts. During the first eight years surgery was the treatment of choice. From April 2008 to December 2014, a prospective study was conducted on 15 consecutive patients treated with percutaneous sclerotherapy. The outcomes regarding cystic dimensional variations before and after treatment were analyzed. RESULTS In 20% of patients complete disappearance of the cystic lesion was achieved. In 67% of the patients the maximum diameter of the cyst was reduced to below 50mm. CONCLUSION Our results should encourage the use of this treatment because it is a valid and safe option in childhood. The high success rate achieved with percutaneous drainage and sclerotherapy of cystic lesions supports our results.
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Affiliation(s)
- Antonella Accinni
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Arianna Bertocchini
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome.
| | - Silvia Madafferi
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Gianluigi Natali
- Interventional Radiology Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Alessandro Inserra
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
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Spinelli C, Rossi L, Strambi S, Piscioneri J, Natale G, Bertocchini A, Messineo A. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases. J Endocrinol Invest 2016; 39:529-35. [PMID: 26403983 DOI: 10.1007/s40618-015-0390-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients. METHODS We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies. RESULTS 27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %. CONCLUSIONS Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - J Piscioneri
- Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - A Bertocchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy
| | - A Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy
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di Francesco F, Monti L, Grimaldi C, Zupone CL, Bertocchini A, de Ville de Goyet J. Meso-Rex bypass to manage prehepatic portal hypertension after the failure of an intrahepatic portosystemic stent shunting. Pediatr Surg Int 2015; 31:101-5. [PMID: 25403486 DOI: 10.1007/s00383-014-3640-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/30/2022]
Abstract
A cavernomatous transformation of the extrahepatic portion of the portal vein is a common cause of chronic portal hypertension in children. A few attempts at radiological interventions have been reported, but have rarely been successful. In this report, a surgical Meso-Rex bypass was performed to treat complicated prehepatic portal hypertension, after the insertion of an intrahepatic stent for portosystemic shunting had failed. The review of this case nicely illustrates how differently effective are these two shunting procedures-in terms of restoring hepatopetal flow, managing portal hypertension, and establishing-or not-portosystemic connections.
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Affiliation(s)
- Fabrizio di Francesco
- Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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d'Ambrosio G, del Prete L, Grimaldi C, Bertocchini A, Lo Zupone C, Monti L, de Ville de Goyet J. Pancreaticoduodenectomy for malignancies in children. J Pediatr Surg 2014; 49:534-8. [PMID: 24726107 DOI: 10.1016/j.jpedsurg.2013.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/28/2013] [Accepted: 09/09/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE Malignant tumors of the common bile duct or of the pancreas head are uncommon in childhood [Perez EA, Gutierrez JC, Koniaris LG, Neville HL, Thompson WR, Sola JE. Malignant pancreatic tumors: incidence and outcome in 58 pediatric patients. J Pediatr Surg. 2009; Jan; 44 (1): 197-203]. With radical surgery being the standard cure for nonmetastatic diseases, pancreaticoduodenectomy (PD) is the best choice when the tumor is localized in the head of the pancreas, or in the lower portion of the common bile duct. The purpose of the present study is to describe five consecutive children managed by PD, and reviewing the particular aspects and results of this rare procedure in children. METHODS Between 2007 and 2010, five patients (median age: 7 years) underwent PD for nonmetastatic malignant tumors. In two cases, PD was performed en bloc with a right hepatectomy in order to achieve the radical resection of a recurrent biliary sarcoma. Four patients benefited from a "pylorus-preserving" PD procedure. In two patients, resection of the portal vein and vascular reconstruction was performed, and in one case, an extended resection of the biliary ductal system was necessary. RESULTS All resection margins were clear. The postoperative course was uneventful, with no pancreatic or biliary leakage in all of the patients. Oral refeeding was achieved by the eighth postoperative day. In two cases, a late revision of pancreatic-jejunal anastomosis was performed because of mild steatorrea and a suspected anastomotic stricture. Two of the patients, who were subsequently operated on second hand, for biliary sarcoma, died from the recurrence; while three of the others, with pancreatic malignancies, are alive and well, with a good functional outcome. CONCLUSIONS Surgical resection is the treatment of choice for tumors of the pancreatic head area. In the absence of regional or metastatic extension, the radicality of primary intervention is associated with favorable outcomes. Good functionality results were observed after the PD was limited to the head of the pancreas and subject to pylorus-preserving techniques.
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Affiliation(s)
- Giuseppe d'Ambrosio
- Department of Surgery and Transplantation Centre, Hepato-Biliary and Transplant Surgery Unit, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Laura del Prete
- Department of Surgery and Transplantation Centre, Hepato-Biliary and Transplant Surgery Unit, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Chiara Grimaldi
- Department of Surgery and Transplantation Centre, Hepato-Biliary and Transplant Surgery Unit, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Arianna Bertocchini
- Department of Surgery and Transplantation Centre, Hepato-Biliary and Transplant Surgery Unit, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Cristina Lo Zupone
- Department of Imaging, Hepato-Biliary Radiology Unit, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Lidia Monti
- Department of Imaging, Hepato-Biliary Radiology Unit, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Jean de Ville de Goyet
- Department of Surgery and Transplantation Centre, Hepato-Biliary and Transplant Surgery Unit, Bambino Gesù Childrens Hospital, Rome, Italy.
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25
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Bertocchini A, d'Ambrosio G, Grimaldi C, del Prete L, di Francesco F, Falappa P, Monti L, de Ville de Goyet J. Prehepatic portal hypertension with aneurysm of the portal vein: unusual but treatable malformative pattern. J Pediatr Surg 2014; 49:436-40. [PMID: 24650473 DOI: 10.1016/j.jpedsurg.2013.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/09/2013] [Accepted: 06/10/2013] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Portal vein aneurysms (PVAs) are usually located at the vein trunk or at its bifurcation, rarely intra-hepatic, or at the umbilical portion. Etiology remains unclear. METHODS Three children with PVA were identified over a 5-year period. PVA anatomy was assessed by Doppler Ultrasound, Angio CT/MRI, and trans-jugular retrograde portography. RESULTS Three children with intrahepatic PVA (including the umbilical portion) were identified during assessment for pre-hepatic portal hypertension: all had splenomegaly and hypersplenism. One presented with massive variceal bleeding. In two cases, a portal vein cavernoma was found, and in the third a severe stricture at the portal bifurcation was observed. Restoration of portal venous flow was achieved by a meso-Rex bypass in two cases and transposing the PV into the Rex in one. High hepatopetal portal flow was restored immediately, with follow-up confirming long-term patency and resolution of signs of portal hypertension with time. CONCLUSIONS These original observations suggest a common initial malformative pattern consisting of a portal venous stricture/web causing a post-stenotic aneurysmal dilatation of the intrahepatic portal branches complicated by thrombosis and cavernomatous transformation of the portal vein trunk. Importantly, the Meso-Rex bypass allows restoring a normal portal flow and cures the portal hypertension.
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Affiliation(s)
- Arianna Bertocchini
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy.
| | - Giuseppe d'Ambrosio
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Chiara Grimaldi
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Laura del Prete
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Fabrizio di Francesco
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Piergiorgio Falappa
- Interventional Radiology Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Lidia Monti
- Hepato-biliary Radiology Unit, Department of Imaging, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Jean de Ville de Goyet
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
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26
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Bertocchini A, Lo Zupone C, Callea F, Gennari F, Serra A, Monti L, de Ville de Goyet J. Unresectable multifocal omental and peritoneal inflammatory myofibroblastic tumor in a child: revisiting the role of adjuvant therapy. J Pediatr Surg 2011; 46:e17-e21. [PMID: 21496520 DOI: 10.1016/j.jpedsurg.2011.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/09/2010] [Accepted: 01/05/2011] [Indexed: 01/25/2023]
Abstract
Inflammatory myofibroblastic tumor is an uncommon lesion, also called pseudotumor, with a variable natural course from benign with spontaneous regression to mimicking malignant tumors. We report a case of diffuse peritoneal and omental pseudotumor in a 10-year-old boy characterized by aggressive behavior at the onset followed by stability after subtotal resection and chemotherapy. Total excision was not possible because of the tumor dissemination over the whole peritoneal surface. Adjuvant antiinflammatory drug (ketorolac tromethamine) and chemotherapy (methotrexate-vinblastine followed by ifosfamide-adriamycin and ifosfamide alone) were helpful to obtain rapidly complete resolution of clinical symptoms and anatomic stability of the residual lesions. Long-term evolution, in the absence of continued therapy, has been characterized by progressive involution and reduction of the residual masses.
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Affiliation(s)
| | - Cristina Lo Zupone
- Hepatobiliary Radiology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Francesco Callea
- Pathology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Fabrizio Gennari
- Liver Surgery Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Annalisa Serra
- Oncology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Lidia Monti
- Hepatobiliary Radiology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Jean de Ville de Goyet
- Liver Surgery Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy; Paediatric surgery, University of Roma Tor Vergata, Roma - 00133, Italy.
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27
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Falappa P, Natali GL, Bertocchini A, Inserra A, Devito R. Minimal invasive technique in mesenchymal hamartoma of the chest wall: use of radiofrequency thermoablation. J Pediatr Surg 2010; 45:1072-3; author reply 1074. [PMID: 20438961 DOI: 10.1016/j.jpedsurg.2010.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/08/2010] [Indexed: 01/19/2023]
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28
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Bertocchini A, Falappa P, Accinni A, Devito R, Inserra A. Radiofrequency thermoablation in chest wall mesenchymal hamartoma of an infant. Ann Thorac Surg 2007; 84:2091-3. [PMID: 18036945 DOI: 10.1016/j.athoracsur.2007.06.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 06/11/2007] [Accepted: 06/13/2007] [Indexed: 11/16/2022]
Abstract
We report on an infant presenting with a chondroid hamartoma managed with a combined conservative surgical treatment and radiofrequency thermoablation.
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Spinelli C, Bertocchini A, Massimetti M, Ughi C. Muscle thickness in infants hypertrophic pyloric stenosis. Pediatr Med Chir 2003; 25:148-50. [PMID: 12916445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Hypertrophic pyloric stenosis (IHPS) is the most common abdominal abnormality requiring surgery in infants. It occurs due to the hypertrophic and hyperplasia of the muscular layers of the pyloric. The usual age of clinical presentation is about three weeks of life. The most important symptom is non bilious emesis, intermittent or after each feeding. From march 1996 to June 2001, 21 infants, 20 males and 1 female, were subjected to ultrasonographic, radiographic exams and after diagnosis to the pyloromyotomy extramucosa. Ultrasonography was the study of choice used to identify hypertrophic pyloric stenosis; the markers to analyse were the length and the overall diameter of the pyloric canal and the muscle thickness of the wall. The results showed that a length of the pyloric canal 20 +/- 6 mm, a diameter 13.6 +/- 2.5 mm and a muscle thickness 4.1 +/- 1 mm are diagnostics for hypertrophic pyloric stenosis.
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Affiliation(s)
- C Spinelli
- Cattedra di Chirurgia Pediatrica, Università di Pisa, Via Roma, 67.
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30
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Spinelli C, Bertocchini A, Lima M, Miccoli P. Graves-Basedow's disease in children and adolescents: total vs subtotal thyroidectomy. Pediatr Med Chir 2002; 24:383-6. [PMID: 12494541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
"Graves' disease" is an autoimmune pathology and is the most important cause of hyperthyroidism in children and adolescents. The treatment for this disease is controversial; there are three different options: synthetic antithyroid drugs, ablation of the thyroid gland with I 131 or surgery. Our study reports the clinical and therapeutic aspects and long-term results of 27 patients (< = 18 years old) treated with total thyroidectomy or "near-total" thyroidectomy from 1975 to August 2001. Antithyroid drugs represent the preliminary treatment of choice. For a long time in the past therapy with radioactive iodine was not recommended; now it represents an efficiently therapy with low morbility. Surgical treatment is suitable when a young patient presents a considerable enlargement of the thyroid gland or when antithyroid medical treatment does not achieve a good control of the disease, or when rapid control of hyperthyroidism is necessary. The surgical treatment can be a total thyroidectomy or a "near-total" thyroidectomy. The first is the best choice for us, because it has a low risk of relapse and a major efficacy in the ophthalmopathy.
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Affiliation(s)
- C Spinelli
- Cattedra di Chirurgia Pediatrica, Università di Pisa, Via Roma 67.
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31
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Spinelli C, Puccini M, Bertocchini A, Lima M, Pacini F, Miccoli P. [Prophylactic total thyroidectomy in children and adolescents with genetic mutations in the RET-protooncogene]. Pediatr Med Chir 2002; 24:53-7. [PMID: 11938683 DOI: pmid/11938683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Medullary thyroid cancer (C.M.T.) can be a sporadic form generally in adults or a heredofamilial form where the first symptom appears in pediatric and adolescent age. The hereditary form can be isolated or associated with others endocrine neoplasias of type 2: MEN2a (with or without cutaneous lichen amyloidosis) and MEN2b. The responsible gene of the transmission has been identified in proto-oncogene RET localized on chromosome 10. Point form mutations of this proto-oncogene have been found on exons 10 and 11 in MEN2a and on 16 in MEN2b. In our study on 64 subjects, who belong 11 familiar groups, affected by MEN2a, MEN2b and familiar C.M.T., underwent a genetic research to look for point form mutations of proto-oncogene RET with PCR followed by the analysis of restriction. A genetic mutation has been revealed in 25 subjects: 18 were already known affected by MEN2 and so surgical treated and 7 seemed healthy (mean age 17.4 years, range 10-25). These 7 patients has been undergone clinical research and surgical treatment: a total thyroidectomy associated a lymphectomy of the central compartment. In all cases the histological exam showed C.M.T. moreover a patient had metastasis in lymph nodes of the central compartment. Another had hyperparathyroidism and pheochromocytoma treated with total thyroidectomy, parathyroidectomy and bilateral laparoscopic adrenalectomy. The identification in a very early age of carrier subjects of hill's gene inside an affected family, permits the execution of a prophylactic total thyroidectomy to prevent the C.M.T.. The penetrance of this neoplasia in hereditary form is 100%.
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Affiliation(s)
- C Spinelli
- Dipartimento di Chirurgica Generale, Università di Pisa, Via Roma, 67, Pisa
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