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Gentile L, Boscarelli A, Giangreco M, Guida E, Scarpa MG, Olenik D, Schleef J, Codrich D. Management of pleural effusion and empyema in a third-level pediatric surgical center. Minerva Pediatr (Torino) 2023:S2724-5276.23.07420-7. [PMID: 37906133 DOI: 10.23736/s2724-5276.23.07420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Pleural effusion and empyema are frequent complications of acute bacterial pneumonia in children. To date, evidence regarding the optimal treatment of this condition is limited in the literature. METHODS Patients with pleural effusion and empyema admitted at our Department of Pediatric Surgery over the last ten years were enrolled in this retrospective study, and successively compared with the clinical charts of patients treated before the introduction of a new diagnostic and therapeutic algorithm. In particular, primary outcomes investigated between pre- and postalgorithm period were the use of diagnostic tools and antibiotics, the need for additional therapeutic approaches, complications, and the length of stay. RESULTS After the introduction of the new algorithm there were a decrease in the use of chest radiography for re-evaluation (100% vs. 79%, P=0.003), a more focused use of computed tomography (68% vs. 15%, P=0.001), and a decrease in the use of a second computed tomography (18% vs. 3%, P=0.07); in favor of an increase in the use of the ultrasound scan (40% vs. 100%, P=0.001). There was also a shift from the use of chest tube drainage alone to the use of drainage for urokinase administration (50% vs. 92.3%, P=0.001), and a statistically significant decrease in the need for video-assisted thoracoscopic surgery (25% vs. 7.7%, P=0.001). CONCLUSIONS The introduction of a diagnostic and therapeutic algorithm for the management of pediatric pleural effusion and empyema has notably resulted in a decrease in the utilization of radiography and computed tomography and an increase in the use of ultrasonography, reducing unnecessary radiation exposure in children and overall costs.
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Affiliation(s)
- Lucrezia Gentile
- Faculty of Medicine and Surgery, University of Trieste, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy -
| | - Manuela Giangreco
- Unit of Clinical Epidemiology and Public Health Research, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Maria Grazia Scarpa
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
- Department of Surgery, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, IRCCS Materno Infantile "Burlo Garofolo", Trieste, Italy
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Stefani B, Codrich D, Caputo MR, Guida E, Scarpa MG, Boscarelli A, Schleef J. Informed consent in minor and intermediate pediatric elective surgery: results of an in-house questionnaire. Front Surg 2023; 10:1194657. [PMID: 37215351 PMCID: PMC10196251 DOI: 10.3389/fsurg.2023.1194657] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Background The aim of this study was to evaluate the quality of our surgical informed consent and parents'/guardians' late recall of surgical procedures and risks of elective day surgery after pre-operative interview with surgeons. Methods All parents/guardians of patients <18 years of age undergoing minor and intermediate elective procedures from January 15th to September 1st, 2022, were prospectively enrolled in the study. Before discharge, parents/guardians were asked to complete an in-house questionnaire regarding the duration of the consent procedure, duration of the interview, quality of the informative handouts, and their ability to recall the type of disease, type of surgical procedure, and surgical risks. Results One hundred and two questionnaires were returned. In all cases, informed consent was obtained between 24 and 72 h prior to surgery. The following responses were collected: 98/102 (96%) parents/guardians reported that the duration of the consent process was adequate; 95/102 (93%) reported that the handouts were fully informative, and 7/102 (7%) reported that they were partially informative regarding explanation of the disease and surgical procedure; regarding complications, 93/102 (91%) perceived the handouts to be fully/partially informative, while 4/102 (4%) perceived the handouts to be poorly/non-informative, and 5/102 (5%) did not provide a response; 94/102 (92%) stated that they remembered the pathology, but only 87/94 (93%) recalled it correctly; 90/102 (88%) stated that they remembered the type of procedure, but only 76/90 (84%) recalled it correctly; and 53/102 (52%) stated that they remembered the surgical risks, but only 20/53 (38%) could recall more than one complication. Conclusions Late recall of surgical complications by parents was poor despite the high perceived quality of the surgical risk handouts and medical interview. Implementation of expedient methods may improve overall comprehension and satisfaction of parents/guardians regarding the IC process. Further, more efforts should be made to develop standardized guidelines for an optimal IC process.
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Affiliation(s)
- Bianca Stefani
- Pediatric Surgery Division, Women's And Children's Health Department, University of Padua, Padua, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Maria Rita Caputo
- Pediatric Surgery Division, Women's And Children's Health Department, University of Padua, Padua, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
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Boscarelli A, Giglione E, Caputo MR, Guida E, Iaquinto M, Scarpa MG, Olenik D, Codrich D, Schleef J. Robotic-assisted surgery in pediatrics: what is evidence-based?-a literature review. Transl Pediatr 2023; 12:271-279. [PMID: 36891357 PMCID: PMC9986791 DOI: 10.21037/tp-22-338] [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: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The use of robotic-assisted surgery (RAS) has increased more slowly in pediatrics than in the adult population. Despite the many advantages of robotic instruments, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) still presents some limitations for use in pediatric surgery. This study aims to examine evidence-based indications for RAS in the different fields of pediatric surgery according to the published literature. METHODS A database search (MEDLINE, Scopus, Web of Science) was performed to identify articles covering any aspect of RAS in the pediatric population. Using Boolean operators AND/OR, all possible combinations of the following search terms were used: robotic surgery, pediatrics, neonatal surgery, thoracic surgery, abdominal surgery, urologic surgery, hepatobiliary surgery, and surgical oncology. The selection criteria were limited to the English language, pediatric patients (under 18 years of age), and articles published after 2010. KEY CONTENT AND FINDINGS A total of 239 abstracts were reviewed. Of these, 10 published articles met the purposes of our study with the highest level of evidence and therefore were analyzed. Notably, most of the articles included in this review reported evidence-based indications in urological surgery. CONCLUSIONS According to this study, the exclusive indications for RAS in the pediatric population are pyeloplasty for ureteropelvic junction obstruction in older children and ureteral reimplantation according to the Lich-Gregoire technique in selected cases for the need to access the pelvis with a narrow anatomical and working space. All other indications for RAS in pediatric surgery are still under discussion to date, and cannot be supported by papers with a high level of evidence. However, RAS is certainly a promising technology. Further evidence is strongly encouraged in the future.
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Affiliation(s)
- Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Emanuela Giglione
- Pediatric Surgery Division, Women's and Children's Health Department, University of Padua, Padua, Italy
| | - Maria Rita Caputo
- Pediatric Surgery Division, Women's and Children's Health Department, University of Padua, Padua, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marianna Iaquinto
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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Fattori S, Boscarelli A, Codrich D, Ammar L, Barbi E, Granata C, Schleef J. Nocturnal cough and difficulty breathing during exertion in a young boy: Do not miss the forest for the trees. J Paediatr Child Health 2023; 59:407. [PMID: 35229926 PMCID: PMC10078642 DOI: 10.1111/jpc.15918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Silvia Fattori
- Faculty of Medicine and Surgery, University of Trieste, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Lydie Ammar
- Radiology Department, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Department of Paediatrics, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Claudio Granata
- Radiology Department, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jurgen Schleef
- Department of Paediatric Surgery and Urology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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Cleva M, Vaivoda A, Boscarelli A, Codrich D, Spezzacatene A, Murru FM. Giant non-parasitic mixed splenic cyst in a child. J Paediatr Child Health 2023; 59:175-177. [PMID: 36124936 DOI: 10.1111/jpc.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/30/2022] [Accepted: 08/27/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Mirco Cleva
- Department of Radiology, University of Trieste, ASUGI, Ospedale di Cattinara, Trieste, Italy
| | - Anna Vaivoda
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Anita Spezzacatene
- Radiology Department, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Flora M Murru
- Radiology Department, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
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Scarpa MG, Codrich D, Duci M, Olenik D, Schleef J. Laparoscopic fundoplication after oesophageal atresia repair. Afr J Paediatr Surg 2022; 19:149-152. [PMID: 35775515 PMCID: PMC9290357 DOI: 10.4103/ajps.ajps_25_21] [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] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Esophageal atresia (EA) is a rare congenital malformation. A high incidence of GER unresponsive to medical management is noted with EA. Literature suggests that complications from GER can persist in adulthood. In paediatric age, laparoscopic treatment is a valid option even if recurrence rate is not negligible. AIMS AND OBJECTIVES To evaluate our experience with gastro-esophageal reflux (GER) treatment after esophageal atresia (EA) repair. MATERIALS AND METHODS We retrospectively analysed 29 consecutive patients treated for EA at birth and studied for GER at our Institute in a period of 11 years. RESULTS 24/29 (82,7%) cases had symptoms of reflux, 17/29 (58,6%) cases were treated with laparoscopic fundoplication (LF). Three infants were younger than 6 months and had apparent life threatening events (ALTE) condition as principal indication for surgery. No intra-operative complications occurred. 3/17 LF had open surgical conversion due to technical problems. 2/17 cases required a second operation. At the last follow-up: (1) 6/17 (35,3%) of patients healed after the last operation, (2) 8/17 (47,1%) have GER improvement (four still in medical treatment), (3) 2/17 (11,8%) have persistent GER, (4) 1/17 (5,9%) died for causes not related to antireflux surgery. CONCLUSIONS According to literature and to our retrospective analysis, LF for GER after EA repair is feasible, even if recurrence risk is not negligible. Infants less than 6 months old with associated conditions (malformations, gastrostomy/jejunostomy) seem to have a higher failure rate with a greater risk of conversion. Longer follow-up and multicenter experiences would guarantee an adequate surveillance for patients with EA.
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Affiliation(s)
- Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Miriam Duci
- Pediatric Surgery Division, Women's and Children's Health Department, University of Padua, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
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Bisol M, Tykhomyrova S, Pagliara C, Scarpa MG, Guida E, Olenik D, Codrich D, Schleef J, Boscarelli A. Oxygen-enriched oleic matrix (NovoX) for wound healing in pediatric patients undergoing open surgical treatment for pilonidal disease: Preliminary experience. Front Pediatr 2022; 10:1068280. [PMID: 36507121 PMCID: PMC9732366 DOI: 10.3389/fped.2022.1068280] [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: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Pilonidal disease (PD) is a common infectious and inflammatory condition affecting the gluteal cleft and sacrococcygeal region. The optimal treatment for PD remains controversial. While the open technique reduces the number of relapses compared to minimally invasive approaches, it is associated with a longer healing time. Reactive oxygen species are a key part of the normal wound-healing process. Herein, we reported our preliminary experience using a new oxygen-enriched oil-based product called NovoX for wound healing after open surgery for PD. MATERIALS AND METHODS We used a new oxygen-enriched product for wound healing in three pediatric patients undergoing open surgical repair for PD between December 2021 and April 2022. During postoperative follow-up, healing time and the aesthetic result were evaluated. RESULTS Our preliminary study included three patients with chronic PD. The average follow-up time was 5 weeks, corresponding to the end of the healing process and the resumption of normal daily activities. Only one mild complication occurred during the study period. No short-term side effects were reported. The cosmetic result was reported as satisfactory. CONCLUSION NovoX is easy to apply, safe, and effective for treating pediatric patients undergoing open surgical treatment for PD, leading to slightly faster wound healing with good aesthetic outcomes.
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Affiliation(s)
- Marta Bisol
- Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sophia Tykhomyrova
- Municipal Non-Profit Enterprise "Lviv Territorial Medical Union", Multidisciplinary Clinical Hospital of Emergency and Intensive Care - Separated Division "Hospital of Saint Nicolaus", Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Camilla Pagliara
- Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Chief of Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Spezzotto G, Boscarelli A, Giangreco M, Ceschiutti G, Codrich D, Scarpa MG, Iaquinto M, Olenik D, Guida E, Schleef J. Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study. Front Pediatr 2022; 10:945641. [PMID: 35832585 PMCID: PMC9271819 DOI: 10.3389/fped.2022.945641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. The aim of this study was to investigate the risk of recurrence after non-surgical treatment vs. surgery, the difference in the length of stay (LOS) between various treatment options, and the role of computed tomography (CT) in the management of PSP. MATERIALS AND METHODS We retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected. RESULTS Twenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9-18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Chest drain was used for large PSP (≥2 cm) if the patient was clinically unstable. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients. Chest drain insertion was associated with a longer LOS than observation alone (6.36 vs. 2.4 days), and surgery resulted in a longer LOS than other types of treatment (P = 0.001). CONCLUSION According to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion.
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Affiliation(s)
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Ceschiutti
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marianna Iaquinto
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Codrich D, Staffa P, Boscarelli A, Grasso DL, Muzzi E, Orzan E, Schleef J. Giant pedunculated mass arising from the left tonsillar fossa. J Paediatr Child Health 2021; 57:2034. [PMID: 34902889 DOI: 10.1111/jpc.1_15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniela Codrich
- Department of Paediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Paola Staffa
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Paediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Domenico L Grasso
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Enrico Muzzi
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Eva Orzan
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Jurgen Schleef
- Department of Paediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Scarpa MG, Codrich D, Iaquinto M, Guida E, Cerrina A, Schleef J. Medium-term outcome after stented and un-stented distal urethroplasty: A retrospective analysis on redo-urethroplasty need and cosmetic results. Actas Urol Esp 2021; 45:642-647. [PMID: 34764052 DOI: 10.1016/j.acuroe.2020.10.015] [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] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need for a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-years pilot study on stented/un-stented distal urethroplasties. MATERIALS AND METHODS A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by the same pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5-8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P < 0.05) for statistical analysis. RESULTS Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P = 1.000). CONCLUSION Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.
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Affiliation(s)
- M G Scarpa
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy.
| | - D Codrich
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - M Iaquinto
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - E Guida
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - A Cerrina
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - J Schleef
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
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11
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Pederiva F, Bussani R, Shafiei V, Codrich D, Guida E, Schleef J. The Histopathology of the Appendix in Children at Interval Appendectomy. Children (Basel) 2021; 8:children8090811. [PMID: 34572243 PMCID: PMC8466409 DOI: 10.3390/children8090811] [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] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.
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Affiliation(s)
- Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (D.C.); (E.G.); (J.S.)
- Correspondence: ; Fax: +39-0403785314
| | - Rossana Bussani
- Department of Pathology, Azienda Sanitaria Universitaria Integrata di Trieste, 34137 Trieste, Italy; (R.B.); (V.S.)
| | - Vennus Shafiei
- Department of Pathology, Azienda Sanitaria Universitaria Integrata di Trieste, 34137 Trieste, Italy; (R.B.); (V.S.)
| | - Daniela Codrich
- Pediatric Surgery, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (D.C.); (E.G.); (J.S.)
| | - Edoardo Guida
- Pediatric Surgery, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (D.C.); (E.G.); (J.S.)
| | - Jurgen Schleef
- Pediatric Surgery, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (D.C.); (E.G.); (J.S.)
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12
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Rancan A, Boscarelli A, Codrich D, Berti I, Guida E, Schleef J. Pyogenic granuloma arising within capillary malformations in children: A case report and literature review. Dermatol Reports 2021; 13:9115. [PMID: 34497700 PMCID: PMC8404425 DOI: 10.4081/dr.2021.9115] [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] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
Pyogenic granuloma (PG) is an acquired benign vascular hyperplasia. Even though PG is not so rare, its etiology is still unclear. Assuredly, an association between vascular anomalies and PG is an extremely rare finding, and a proper management of these cases is not well standardized to date. Herein, we report our experience with a giant PG arising spontaneously within a port-wine stain of the thorax. Previous cases reported in the pediatric literature and strategies of treatment are also discussed.
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Affiliation(s)
- Alessandra Rancan
- Pediatric Surgery Unit, Department of Women's and Children's Health, University of Padua.,Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste
| | - Irene Berti
- Department of Pediatrics, Unit of Pediatric Dermatology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste
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13
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Scarpa MG, Codrich D, Iaquinto M, Guida E, Cerrina A, Schleef J. Medium-term outcome after stented and un-stented distal urethroplasty: A retrospective analysis on redo-urethroplasty need and cosmetic results. Actas Urol Esp 2021; 45:S0210-4806(21)00105-4. [PMID: 34332810 DOI: 10.1016/j.acuro.2020.10.016] [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] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/26/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need of a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-year pilot study on stented/un-stented distal urethroplasties. MATERIALS AND METHODS A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by one pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5-8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P<0.05) for statistical analysis. RESULTS Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P=1.000). CONCLUSION Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.
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Affiliation(s)
- M G Scarpa
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia.
| | - D Codrich
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - M Iaquinto
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - E Guida
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - A Cerrina
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - J Schleef
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
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14
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Codrich D, Boscarelli A, Cerrina A, Scarpa MG, Iaquinto M, Olenik D, Guida E, Schleef J. Glans ischemia after circumcision in children: Two case reports. World J Clin Pediatr 2021; 10:79-83. [PMID: 34316441 PMCID: PMC8290995 DOI: 10.5409/wjcp.v10.i4.79] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/11/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Circumcision refers to the removal of the skin covering the tip of the penis and is one of the most common surgical procedures performed in childhood. Even though circumcision is a well-standardized operation, several minor and major complications may be experienced by paediatric surgeons. Glans ischemia (GI) has been widely reported in the paediatric literature as a complication following circumcision. Nonetheless, etiopathogenesis of GI is not well defined and management guidelines are lacking.
CASE SUMMARY We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical vasodilator.
CONCLUSION Hypothetical causes and different management strategies are discussed.
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Affiliation(s)
- Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Alessia Cerrina
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Marianna Iaquinto
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
| | - Jurgen Schleef
- Department of Pediatric Surgery and Urology, Institute for maternal and child health-IRCCS Burlo Garofolo, Trieste 34137, Italy
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15
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Scarpa MG, Iaquinto M, Codrich D, Schleef J. Bilateral sactosalphinx and congenital adrenal hyperplasia: case report on two rare conditions in two virgin girls. Ital J Pediatr 2021; 47:141. [PMID: 34187553 PMCID: PMC8244243 DOI: 10.1186/s13052-021-01089-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. CASE PRESENTATION We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. CONCLUSIONS CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility.
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Affiliation(s)
- Maria-Grazia Scarpa
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy.
| | - Marianna Iaquinto
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
| | - Daniela Codrich
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
| | - Jürgen Schleef
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
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16
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Boscarelli A, Codrich D, Schleef J. Technical innovations for autologous intestinal reconstruction surgery in children with short bowel syndrome. Pediatr Surg Int 2021; 37:523-524. [PMID: 33403476 DOI: 10.1007/s00383-020-04844-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy.
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy.,Chief of Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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17
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Codrich D, Staffa P, Boscarelli A, Grasso DL, Muzzi E, Orzan E, Schleef J. Giant pedunculated mass arising from the left tonsillar fossa. J Paediatr Child Health 2021:jpc.15416. [PMID: 33665907 DOI: 10.1111/jpc.15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Daniela Codrich
- Department of Paediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Paola Staffa
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Paediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Domenico L Grasso
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Enrico Muzzi
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Eva Orzan
- Unit of Paediatric Audiology and Otorhinolaryngology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Jurgen Schleef
- Department of Paediatric Surgery and Urology, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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18
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Pavan M, Pillon R, Bua J, Codrich D, Murru FM, Travan L, Risso FM. Milk curd problems in preterm infants are not just about obstructive symptoms. Acta Paediatr 2021; 110:487-488. [PMID: 32810297 DOI: 10.1111/apa.15545] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Matteo Pavan
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste Italy
| | - Roberto Pillon
- Pediatric Department Santa Maria degli Angeli Hospital Pordenone Italy
| | - Jenny Bua
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste Italy
| | - Daniela Codrich
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste Italy
| | - Flora Maria Murru
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste Italy
| | - Laura Travan
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste Italy
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19
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Iaquinto M, De Castro R, Scarpa MG, Cerrina A, Codrich D, Guida E, Pederiva F, Lembo MA, Murru FM, Schleef J. Incomplete duplex renal system with severe obstruction at the uretero-ureteral junction and minor obstruction at the common stem-vesical junction: Challenging diagnosis and conclusive laparoscopic treatment. j-pucr 2020. [DOI: 10.14534/j-pucr.2020461252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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20
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La Pergola E, Sgrò A, Rebosio F, Vavassori D, Fava G, Codrich D, Montanaro B, Leva E, Schleef J, Cheli M, Pelizzo G, Gamba P, Alberti D, Betalli P. Appendicitis in Children in a Large Italian COVID-19 Pandemic Area. Front Pediatr 2020; 8:600320. [PMID: 33363065 PMCID: PMC7755995 DOI: 10.3389/fped.2020.600320] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the routine activities of pediatric surgical centers, and it determined the reduction of admissions in the pediatric emergency departments (PED). We reviewed the records of patients affected by acute appendicitis (AA) during the COVID-19 pandemic period in a large Italian COVID-19 pandemic area. Methods: Data regarding demographics, age, macroscopic and microscopic findings, and time between symptom onset and PED admission of patients affected by confirmed AA in the period between March and April 2020 were considered. The data were compared with those obtained during the same period of 2019, 2018, and 2017 in the included centers. Data were quoted as median (range) or absolute number. Non-parametric statistical tests were used to compare groups. A p ≤ 0.05 was regarded as significant. Since only anonymous data have been used and the data storage meets current data protection regulations, ethical committee approval was not required for this study. Results: Eighty-six patients underwent surgical appendectomy for AA between February 20th, 2020 and April 20th, 2020; 32.5% were complicated appendicitis and 67.5% were uncomplicated. Fifty-three patients were males and 33 were females. Patients' age ranged from 3 to 17 years and the median age was 10 years. The median time between the onset of symptoms and the admission in PED was 1.85 days. The average time between the symptom onset and PED admission was 1.8 days. Conclusions: Although fear from the COVID-19 pandemic determined a delayed diagnosis of serious pediatric diseases, the increasing prevalence and severity of AA were not demonstrated in the most COVID-19-affected areas of Italy.
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Affiliation(s)
- Enrico La Pergola
- Paediatric Surgery Unit, Ospedale dei Bambini V. Buzzi, Milan, Italy
| | - Alberto Sgrò
- Paediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Federico Rebosio
- Paediatric Surgery Unit, Ospedale dei Bambini V. Buzzi, Milan, Italy.,Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Daniele Vavassori
- Department of Paediatric Surgery, Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Codrich
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Beatrice Montanaro
- Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jurgen Schleef
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - M Cheli
- Department of Paediatric Surgery, Papa Giovanni XXIII, Bergamo, Italy
| | - Gloria Pelizzo
- Paediatric Surgery Unit, Ospedale dei Bambini V. Buzzi, Milan, Italy
| | - Piergiorgio Gamba
- Paediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Daniele Alberti
- Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Pietro Betalli
- Department of Paediatric Surgery, Papa Giovanni XXIII, Bergamo, Italy
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21
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Agrusti A, Gregori M, Salviato T, Codrich D, Barbi E. Adenomyomatosis of the Gallbladder as a Cause of Recurrent Abdominal Pain. J Pediatr 2018; 202:328-328.e1. [PMID: 29903530 DOI: 10.1016/j.jpeds.2018.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/11/2018] [Indexed: 01/24/2023]
Affiliation(s)
| | | | | | - Daniela Codrich
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste
| | - Egidio Barbi
- University of Trieste; Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste; Trieste, Italy
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22
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Guida E, Verzotti E, Codrich D, Pederiva F, Di Grazia M, Schleef J. Voiceless disability: A worth case of bilateral infrainguinal testicular torsion in a patient with cerebropalsy. Ann Med Surg (Lond) 2018; 33:47-49. [PMID: 30167304 PMCID: PMC6111052 DOI: 10.1016/j.amsu.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction A fast surgical treatment is the gold standard when a testicular torsion is diagnosed. However, an early diagnosis of torsion may not be feasible in case of torsion associated with undescended testis in the patients affected by cerebropalsy. Case presentation A Bolivian 16 year old male with acquired cerebropalsy and spastic neuromuscular disease was admitted to our Institute for a right inguinal swelling observed by the father in the morning. Indeed, the father had reported that the swelling had may be started two days before without pain or any other symptoms apparently. Two episodes of vomiting were only reported. At the general examination the patient, apparently, seemed to laugh repeatedly and a spastic movements increase were observed. The child had an infrainguinal bilateral cryptorchidism. An urgent left infrainguinal orchyectomy had been performed in the past and controlateral cryptorchidism was not corrected. At the right inguinal exploration, a complete twist of the spermatic chord was observed and a right orchyectomy was then performed. Discussion Testicular torsion in the inguinal canal is a rare reported condition that usually can involve patients with spastic neuromuscular disease. Processing, communication and verbalization of a chronic or acute pain seems to be different in a child with or without intellectual disability. It could be a lot more difficult to correct pain interpretation, with an important repercussion on pain accurate assessment and management. Conclusion In the patients with intellectual disability, a control of the testicles, it should always be done, mostly in case of atypical behaviour. An early diagnosis of a testicular torsion may not be feasible in case of torsion associated with undescended testis in the patients affected by intellectual disability. Processing, communication and verbalization of a chronic or acute pain seems to be different in a child with or without intellectual disability. Atypical behaviour could be present in the children without capacity to verbalize the pain. In the patients with intellectual disability, a control of the testicles should always be carried out, mostly in case of atypical behaviour.
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Affiliation(s)
- Edoardo Guida
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Daniela Codrich
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Federica Pederiva
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Massimo Di Grazia
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Jurgen Schleef
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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23
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Cozzi G, Galdo F, Germani C, Codrich D, Gregori M, Barbi E. Still toddler: A clinical clue for acute appendicitis. J Paediatr Child Health 2018; 54:913-914. [PMID: 29561068 DOI: 10.1111/jpc.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/31/2018] [Accepted: 02/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health, Burlo Garofolo Pediatric Institute, Trieste, Italy
| | - Francesca Galdo
- Department of General and Specialized Surgery for Women and Children, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Germani
- Institute for Maternal and Child Health, Burlo Garofolo Pediatric Institute, Trieste, Italy
| | - Daniela Codrich
- Institute for Maternal and Child Health, Burlo Garofolo Pediatric Institute, Trieste, Italy
| | - Massimo Gregori
- Institute for Maternal and Child Health, Burlo Garofolo Pediatric Institute, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, Burlo Garofolo Pediatric Institute, Trieste, Italy
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24
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Scarpa MG, Perin G, Di Grazia M, Codrich D, Pederiva F, Guida E, Lembo MA, Giannotta A, Schleef J. Surgery for distal hypospadias: what about the catheter? Pediatr Med Chir 2017; 39:145. [PMID: 29034655 DOI: 10.4081/pmc.2017.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 11/23/2022] Open
Abstract
No agreed recommendations exist for timing of urethral stent removal, after distal hypospadias surgery. We compared our preliminary case series with outcomes from literature: 18/44 patients were treated with catheter and 26/44 without it. The surgical outcome was comparable in the two groups. After hypospadias surgery, the main advantage of the immediate postoperative catheter removal was the shorter hospital stay without negatively affecting the care and home management.
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Affiliation(s)
- Maria-Grazia Scarpa
- Pediatric Surgery, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste.
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Bertozzi M, Esposito C, Vella C, Briganti V, Zampieri N, Codrich D, Ubertazzi M, Trucchi A, Magrini E, Battaglia S, Bini V, Conighi ML, Gulia C, Farina A, Camoglio FS, Rigamonti W, Gamba P, Riccipetitoni G, Chiarenza SF, Inserra A, Appignani A. Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study. J Pediatr Adolesc Gynecol 2017; 30:413-417. [PMID: 27894860 DOI: 10.1016/j.jpag.2016.11.008] [Citation(s) in RCA: 22] [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: 08/23/2016] [Revised: 10/23/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence. DESIGN Multicenter retrospective cohort study. SETTING Italian Units of Pediatric Surgery. PARTICIPANTS Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014. INTERVENTIONS Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively. MAIN OUTCOME MEASURES A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries. RESULTS Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00). CONCLUSION Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.
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Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Claudio Vella
- S.C. di Chirurgia Pediatrica, Ospedale dei Bambini "V. Buzzi," Milano, Italy
| | - Vito Briganti
- U.O.C. di Chirurgia e Urologia Pediatrica Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy
| | - Nicola Zampieri
- Pediatric Surgical Unit, Department of Surgical Sciences, G.B. Rossi Hospital, Verona, Italy
| | - Daniela Codrich
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo" Via dell'Istria, Trieste, Italy
| | - Michele Ubertazzi
- U.O. di Chirurgia Pediatrica, Azienda Ospedaliero, Universitaria di Sassari Viale S. Pietro, Sassari, Italy
| | - Alessandro Trucchi
- U.O.C. Chirurgia Generale e Toracica Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elisa Magrini
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Sonia Battaglia
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Padua, Italy
| | - Vittorio Bini
- Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy
| | | | - Caterina Gulia
- U.O.C. di Chirurgia e Urologia Pediatrica Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy
| | - Alessandra Farina
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Waifro Rigamonti
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo," University of Trieste, Trieste, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Padua, Italy
| | | | | | - Alessandro Inserra
- U.O.C. Chirurgia Generale e Toracica Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Pederiva F, Guida E, Codrich D, Scarpa MG, Olenik D, Schleef J. Laparoscopic orchiopexy: short-term outcomes. Experience of a single centre. Minerva Pediatr 2016; 68:278-281. [PMID: 26505958] [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: 06/05/2023]
Abstract
BACKGROUND Increased infertility and smaller volume accompany undescended testis. Timing of orchiopexy is still a matter of debate. We evaluated the growth of non-palpable testes after laparoscopic orchiopexy according to age at surgery, intraoperative findings and type of procedure. METHODS Forty-one boys undergoing laparoscopy for nonpalpable testes were retrospectively reviewed and divided into two groups, ≤18 months and >18 months, according to their age at surgery. RESULTS At follow-up, 14 testes in the younger group had normal size, while 3 atrophied either after single (2) or two stage procedure (1). Similarly, in older boys 11 testes grew normally, while 5 atrophied after both procedures. CONCLUSIONS Most of the non-palpable testes grew normally after laparoscopic orchiopexy and the postoperative volume seemed independent from the surgical strategy. Both techniques led to a few cases of testicular hypotrophy. In our experience, the age at surgery did not affect the outcome in terms of testicular growth.
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Affiliation(s)
- Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy -
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Ferrara G, Stampalija T, Codrich D, Simionato C, Taddio A, Travan L. More than (Double) Bubble. J Pediatr 2015; 167:942-942.e1. [PMID: 26227438 DOI: 10.1016/j.jpeds.2015.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Tamara Stampalija
- Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Daniela Codrich
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Cristina Simionato
- Department of Gynecology and Obstetrics, San Donà di Piave Hospital, Venice, Italy
| | - Andrea Taddio
- University of Trieste, Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Travan
- Neonatology Division, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Pederiva F, Guida E, Maschio M, Rigamonti W, Gregori M, Codrich D. Handlebar injury in children: The hidden danger. Surgery 2015; 159:1477. [PMID: 26387787 DOI: 10.1016/j.surg.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Edoardo Guida
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Massimo Maschio
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Waifro Rigamonti
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Massimo Gregori
- Department of Radiology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Daniela Codrich
- Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy.
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Pini Prato A, Carlucci M, Bagolan P, Gamba PG, Bernardi M, Leva E, Paradies G, Manzoni C, Noccioli B, Tramontano A, Jasonni V, Vaccarella F, De Pascale S, Alberti D, Riccipetitoni G, Falchetti D, Caccia F, Pelizzo G, Schleef J, Lima M, Andriolo P, Franchella A, Cacciari A, Caravaggi F, Federici S, Andermarcher M, Perrino G, Codrich D, Camoglio FS, Chiarenza FS, Martino A, Appignani A, Briganti V, Caterino S, Cozzi D, Messina M, Rizzo A, Liotta L, Salerno D, Aceti MGR, Bartoli F, Romeo C, Esposito C, Lelli Chiesa PL, Clemente E, Mascia L, Cacciaguerra S, Di Benedetto V, Licciardi S, De Grazia E, Ubertazzi M, Piazza G, Mattioli G, Rossi F, Nobili M. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50:1441-56. [PMID: 25783403 DOI: 10.1016/j.jpedsurg.2015.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 10/28/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.
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Affiliation(s)
| | - M Carlucci
- Istituto Giannina Gaslini, Genova, Italy
| | - P Bagolan
- Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - P G Gamba
- Azienda Ospedaliero-Universitaria, Padova, Italy
| | - M Bernardi
- Azienda Ospedaliera della Provincia di Lecco, Merate, Italy
| | - E Leva
- Ospedale Maggiore Policlinico Magiagalli, Milano, Italy
| | | | | | - B Noccioli
- Ospedale Pediatrico Meyer, Firenze, Italy
| | - A Tramontano
- Azienda Ospedaliera Pediatrica Santobono Pausilipon, Napoli, Italy
| | - V Jasonni
- Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - F Vaccarella
- ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | | | | | - F Caccia
- Ospedale San Carlo Borromeo, Milano
| | | | - J Schleef
- Ospedale Infantile Regina Margherita, Torino
| | - M Lima
- Ospedale Sant'Orsola Malpighi, Bologna
| | | | | | | | | | | | | | | | - D Codrich
- Ospedale Infantile Burlo Garofalo, Trieste
| | | | | | | | - A Appignani
- Ospedale Santa Maria della Misericordia, Perugia
| | | | | | | | - M Messina
- Ospedale Policlinico Santa Maria alle Scotte, Siena
| | | | - L Liotta
- Ospedale Francesco Ferrari, Casarano
| | - D Salerno
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | | | - F Bartoli
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
| | - C Romeo
- Azienda Ospedaliero-Universitaria G. Martino, Messina
| | - C Esposito
- Policlinico Universitario Federico II, Napoli
| | | | - E Clemente
- Azienda Ospedaliera Universitaria S. Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | | | | | - E De Grazia
- Azienda Ospedaliero-Universitaria Policlinico P. Giaccone
| | | | - G Piazza
- Ospedale Sant'Antonio Abate, Trapani
| | | | - F Rossi
- Ospedale Maggiore della carità, Novara
| | - M Nobili
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
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Guida E, Pederiva F, Grazia MD, Codrich D, Lembo MA, Scarpa MG, Rigamonti W. Perforated appendix with abscess: Immediate or interval appendectomy? Some examples to explain our choice. Int J Surg Case Rep 2015; 12:15-8. [PMID: 25985296 PMCID: PMC4485681 DOI: 10.1016/j.ijscr.2015.05.003] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 11/28/2022] Open
Abstract
There are no clear guidelines in the treatment of a perforated appendicitis associated with localized abscess. Our team’s therapeutic choice, also with presence of coprolith, is the initial conservative case management followed by a routine interval appendectomy. Interval appendectomy should be performed not later than 4 months after discharge.
Introduction There are no clear guidelines in the treatment of a perforated appendicitis associated with periappendiceal abscess without generalized peritonitis. Presentation of cases We retrospectively studied six examples of treated children in order to discuss the reasons of our team’s therapeutic approach. Some children were treated with a conservative antibiotic therapy to solve acute abdomen pain, planning a routine interval appendectomy after some months. Others, instead, underwent an immediate appendectomy. Discussion By examining these examples we wanted to highlight how the first approach may be associated with shorter surgery time, fewer overall hospital days, faster refeeding and minor complications. Conclusion Our team’s therapeutic choice, in the case of a perforated appendicitis with an abscess and coprolith is an initial conservative case management followed by a routine interval appendectomy performed not later than 4 months after discharge.
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Affiliation(s)
- Edoardo Guida
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Federica Pederiva
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Daniela Codrich
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Maria Grazia Scarpa
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Waifro Rigamonti
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy; University of Trieste, Italy
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Guida E, Pederiva F, Codrich D, Schleef J. Vermiform appendix inside the sac: uncommon case of inguinal hernia. Indian J Pediatr 2014; 81:523. [PMID: 24347338 DOI: 10.1007/s12098-013-1302-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Edoardo Guida
- Department of Pediatric Surgery, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Via dell'Istria, 65/1, 34137, Trieste, Italy,
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Pederiva F, De Cunto A, Paviotti G, Codrich D, Demarini S. Neonatal Cullen's Sign: A Distinguishing Feature of Intrauterine Volvulus with Hemorrhagic Ascites. APSP J Case Rep 2013; 4:53. [PMID: 24381849 PMCID: PMC3863842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/25/2013] [Indexed: 11/24/2022] Open
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Copertino M, Pederiva F, Barbieri F, Codrich D, Gregori M, Ventura A. A boy with unexplained recurrent abdominal pain. J Pediatr 2013; 163:1794-1794.e1. [PMID: 24075255 DOI: 10.1016/j.jpeds.2013.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
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Beleites C, Bonifacio A, Codrich D, Krafft C, Sergo V. Raman Spectroscopy and Imaging: Promising Optical Diagnostic Tools in Pediatrics. Curr Med Chem 2013; 20:2176-87. [DOI: 10.2174/0929867311320170003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 01/25/2013] [Accepted: 02/10/2013] [Indexed: 11/22/2022]
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Codrich D, Lembo MA, Schleef J. Thoracoscopic removal of a bulky cystic mediastinal mature teratoma in a 4-year-old child: report of one case and few surgical tricks. Eur J Pediatr Surg 2012; 22:318-20. [PMID: 22576302 DOI: 10.1055/s-0032-1308697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Daniela Codrich
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
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Codrich D, Taddio A, Schleef J, Ventura A, Marchetti F. Meckel’s diverticulum masked by a long period of intermittent recurrent subocclusive episodes. World J Gastroenterol 2009; 15:2809-11. [PMID: 19522035 PMCID: PMC2695900 DOI: 10.3748/wjg.15.2809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Meckel’s diverticulum (MD) is the most frequent congenital abnormality of the small bowel and it is often difficult to diagnose. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting, symptoms erroneously related to a cyclic vomiting syndrome but not to MD. The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.
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Pelizzo G, Barbi E, Codrich D, Lembo MA, Zennaro F, Bussani R, Schleef J. Chronic inflammation in congenital cystic adenomatoid malformations. An underestimated risk factor? J Pediatr Surg 2009; 44:616-9. [PMID: 19302868 DOI: 10.1016/j.jpedsurg.2008.10.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [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: 01/10/2008] [Revised: 10/16/2008] [Accepted: 10/17/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE Congenital cystic malformations of the lung are more frequently diagnosed before birth, but guidelines for surgical management of asymptomatic cases are lacking. The aim of this article is to review our 10-year results with antenatally diagnosed congenital cystic adenomatoid malformations (CCAMs) to debate indications for early postnatal surgical management in asymptomatic patients. METHOD Twenty-four cases were reviewed; of these, 18 were operated on before 15 days of life for respiratory distress or mediastinal shift, whereas 6 were submitted to elective surgery at 3 months of age. RESULTS Twenty lobectomies and 4 atypical resections were performed. Two of the latter required a second surgery for incomplete primary perinatal resection. No postsurgical complications were reported. Nineteen (19/24) of the resected specimens showed signs of chronic inflammation. In the perinatal period, 100% (8 cases) of CCAM type II and 50% (8 cases) of CCAM type I resulted to be inflamed. Of the asymptomatic cases, 50% (3/6) were also found to be affected. No infections were detected at bacteriologic culture and bacterial debris was stained in 3 specimens. CONCLUSION In this series, a 79% incidence of pulmonary inflammation was detected. The CCAM type II resulted to be always involved in this process of inflammation. This was an unexpected finding, particularly in cases without mediastinal shift or respiratory distress. In light of these results, early postnatal treatment, at around 3 to 6 months of age, could be considered even in asymptomatic patients.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, IRCCS Burlo Garofolo, 34137 Trieste, Italy
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Pelizzo G, Codrich D, Zennaro F, Dell'oste C, Maso G, D'Ottavio G, Schleef J. Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int 2008; 24:1061-5. [PMID: 18668257 DOI: 10.1007/s00383-008-2194-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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] [Accepted: 07/08/2008] [Indexed: 01/13/2023]
Abstract
Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, Children's Hospital of Trieste, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
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Pelizzo G, Codrich D, Zennaro F, Dell'oste C, Maso G, D'Ottavio G, Schleef J. Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery. Pediatr Surg Int 2008. [PMID: 18668257 DOI: 10.1007/s00383-0 08-2194-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, Children's Hospital of Trieste, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
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Abstract
Colon tissue constitutes a valid model for the comparative analysis of soft tissue by Raman and Fourier transform infrared (FTIR) imaging because it contains four major tissue types such as muscle tissue, connective tissue, epithelium and nerve cells. Raman microscopic images were recorded in the mapping mode using 785 nm laser excitation and a step size of 10 microm from three regions within a thin section that encompassed mucus, mucosa, submucosa, and longitudinal and circular muscle layers. FTIR microscopic images that were composed of 4, 8 and 9 individual images of 4096 spectra each were recorded from the same regions using a FTIR spectrometer coupled to a microscope with a focal plane array detector. Furthermore, Raman microscopic images were recorded at a step size of 2.5 microm from three ganglia that belong to the myenteric plexus. The results are discussed with respect to lateral resolution, spectral resolution, acquisition time and sensitivity of both modalities.
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Krafft C, Codrich D, Pelizzo G, Sergo V. Raman mapping and FTIR imaging of lung tissue: congenital cystic adenomatoid malformation. Analyst 2008; 133:361-71. [DOI: 10.1039/b712958k] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Codrich D, Monai M, Pelizzo G, Bussani R, Rabusin M, Guastalla P, Barbi E, Schleef J. Primary pulmonary Hodgkin's disease and tuberculosis in an 11-year-old boy: case report and review of the literature. Pediatr Pulmonol 2006; 41:694-8. [PMID: 16703583 DOI: 10.1002/ppul.20422] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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] [Indexed: 11/11/2022]
Abstract
Tuberculosis (TB) has been described in association with different malignancies including Hodgkin's disease. However, the association with primary pulmonary Hodgkin's disease (PPHD) is hardly reported in literature and in teenage is quite exceptional. We report a case of an 11 years old boy in whom the diagnosis of tuberculosis preceded and delayed the diagnosis of PPHL.
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Affiliation(s)
- Daniela Codrich
- Department of Surgery, Instituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Children's Hospital, Trieste, Italy.
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Affiliation(s)
- Loredana Lepore
- Clinica Pediatrica, IRCCS Burlo Garofolo, Università di Trieste, Italy.
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Abstract
Internal anal sphincter (IAS) achalasia is a disorder of defecation in which the IAS fails to relax. Botulinum toxin (BT), which has been successfully used to relax the anal and lower esophageal sphincters, was injected twice into the IAS of one adolescent and three infants with manometric, radiologic, and in 2 cases histochemical diagnosis of anal achalasia: in the adolescent a third injection was necessary. Spontaneous defecation was achieved in all patients following the second injection. In one case a diagnosis of short-segment Hirschsprung's disease was obtained after the second injection. Local infiltration of BT into the IAS proved effective in the treatment of IAS achalasia. Double-blind studies and longer follow-up periods are needed to better evaluate these preliminary results and define the limits of this promising therapy.
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Affiliation(s)
- A Messineo
- Department of Pediatric Surgery, IRCCS, Burlo Garofolo, Trieste, Italy
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