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Pierucci UM, Paraboschi I, Mantica G, Costanzo S, Riccio A, Selvaggio GGO, Pelizzo G. Antenatal Determinants of Postnatal Renal Function in Fetal Megacystis: A Systematic Review. Diagnostics (Basel) 2024; 14:756. [PMID: 38611669 PMCID: PMC11012172 DOI: 10.3390/diagnostics14070756] [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: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: To evaluate the clinical usefulness of demographic data, fetal imaging findings and urinary analytes were used for predicting poor postnatal renal function in children with congenital megacystis. Materials and methods: A systematic review was conducted in MEDLINE's electronic database from inception to December 2023 using various combinations of keywords such as "luto" [All Fields] OR "lower urinary tract obstruction" [All Fields] OR "urethral valves" [All Fields] OR "megacystis" [All Fields] OR "urethral atresia" [All Fields] OR "megalourethra" [All Fields] AND "prenatal ultrasound" [All Fields] OR "maternal ultrasound" [All Fields] OR "ob-stetric ultrasound" [All Fields] OR "anhydramnios" [All Fields] OR "oligohydramnios" [All Fields] OR "renal echogenicity" [All Fields] OR "biomarkers" [All Fields] OR "fetal urine" [All Fields] OR "amniotic fluid" [All Fields] OR "beta2 microglobulin" [All Fields] OR "osmolarity" [All Fields] OR "proteome" [All Fields] AND "outcomes" [All Fields] OR "prognosis" [All Fields] OR "staging" [All Fields] OR "prognostic factors" [All Fields] OR "predictors" [All Fields] OR "renal function" [All Fields] OR "kidney function" [All Fields] OR "renal failure" [All Fields]. Two reviewers independently selected the articles in which the accuracy of prenatal imaging findings and fetal urinary analytes were evaluated to predict postnatal renal function. Results: Out of the 727 articles analyzed, 20 met the selection criteria, including 1049 fetuses. Regarding fetal imaging findings, the predictive value of the amniotic fluid was investigated by 15 articles, the renal appearance by 11, bladder findings by 4, and ureteral dilatation by 2. The postnatal renal function showed a statistically significant relationship with the occurrence of oligo- or anhydramnion in four studies, with an abnormal echogenic/cystic renal cortical appearance in three studies. Single articles proved the statistical prognostic value of the amniotic fluid index, the renal parenchymal area, the apparent diffusion coefficient (ADC) measured on fetal diffusion-weighted MRI, and the lower urinary tract obstruction (LUTO) stage (based on bladder volume at referral and gestational age at the appearance of oligo- or anhydramnios). Regarding the predictive value of fetal urinary analytes, sodium and β2-microglobulin were the two most common urinary analytes investigated (n = 10 articles), followed by calcium (n = 6), chloride (n = 5), urinary osmolarity (n = 4), and total protein (n = 3). Phosphorus, glucose, creatinine, and urea were analyzed by two articles, and ammonium, potassium, N-Acetyl-l3-D-glucosaminidase, and microalbumin were investigated by one article. The majority of the studies (n = 8) failed to prove the prognostic value of fetal urinary analytes. However, two studies showed that a favorable urinary biochemistry profile (made up of sodium < 100 mg/dL; calcium < 8 mg/dL; osmolality < 200 mOsm/L; β2-microglobulin < 4 mg/L; total protein < 20 mg/dL) could predict good postnatal renal outcomes with statistical significance and urinary levels of β2-microglobulin were significantly higher in fetuses that developed an impaired renal function in childhood (10.9 ± 5.0 mg/L vs. 1.3 ± 0.2 mg/L, p-value < 0.05). Conclusions: Several demographic data, fetal imaging parameters, and urinary analytes have been shown to play a role in reliably triaging fetuses with megacystis for the risk of adverse postnatal renal outcomes. We believe that this systematic review can help clinicians for counseling parents on the prognoses of their infants and identifying the selected cases eligible for antenatal intervention.
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Affiliation(s)
- Ugo Maria Pierucci
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
| | - Irene Paraboschi
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy;
| | - Guglielmo Mantica
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131 Genova, Italy;
| | - Sara Costanzo
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
| | - Angela Riccio
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
| | | | - Gloria Pelizzo
- Department of Pediatric Surgery, Buzzi Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.); (A.R.); (G.G.O.S.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy;
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Zingale VD, D’Angiolini S, Chiricosta L, Calcaterra V, Selvaggio GGO, Zuccotti G, Destro F, Pelizzo G, Mazzon E. Does Childhood Obesity Trigger Neuroinflammation? Biomedicines 2022; 10:biomedicines10081953. [PMID: 36009499 PMCID: PMC9405861 DOI: 10.3390/biomedicines10081953] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Childhood obesity is constantly increasing around the world, and it has become a major public health issue. Considerable evidence indicates that overweight and obesity are important risk factors for the development of comorbidities such as cognitive decline, neuroinflammation and neurodegenerative diseases. It is known that during obesity, adipose tissue undergoes immune, metabolic and functional changes which could induce a neuroinflammatory response of the central nervous system (CNS). In this context, to inspect if obesity can start to trigger the neuroinflammation from a pediatric age, we surgically collected and analyzed adipose tissue from the periumbilical area of three obese children (AT-OB) and two normal-weight children (AT-Ctrl). We considered the transcriptomic profile of our samples to detect alterations in different biological processes that might be also involved in the inflammatory and neuroinflammatory response. Our results show alterations of lipid and fatty acids metabolism in AT-OB compared to the AT-Ctrl. We also observed an onset of inflammatory response in AT-OB. Interestingly, among the genes involved in neuroinflammation, GRN and SMO were upregulated, while IFNGR1 and SNCA were downregulated. Our study highlights that obesity may trigger inflammation and neuroinflammation from a pediatric age.
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Affiliation(s)
- Valeria Domenica Zingale
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Simone D’Angiolini
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Luigi Chiricosta
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy
| | | | - Gianvincenzo Zuccotti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Francesca Destro
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Emanuela Mazzon
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
- Correspondence:
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Pelizzo G, Destro F, Selvaggio GGO, Maestri L, Roveri M, Bosetti A, Borsani B, Pendezza E, Meroni M, Pansini A, La Pergola E, Riccipetitoni G, De Silvestri A, Cena H, Calcaterra V. Esophageal Atresia: Nutritional Status and Energy Metabolism to Maximize Growth Outcome. Children (Basel) 2020; 7:children7110228. [PMID: 33202530 PMCID: PMC7696161 DOI: 10.3390/children7110228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term negative sequelae of esophageal atresia (EA) may induce poor growth and impaired nutritional status in childhood. We describe the nutritional profile and energy metabolism of children with repaired EA to identify malnutrition risk factors and optimize growth management. METHODS Twenty-one children (>4 years) were included, and anthropometric measurements, nutritional assessment, and energy metabolism were considered. The subjects were defined as undernourished if they met BMI < -2 standard deviation (SD). To grade undernutrition, we defined the prevalence of underweight, stunting, and wasting (cut-off level of <-2 SD). Medical records were reviewed for the type of EA and surgery and perinatal data. RESULTS Malnutrition was detected in 28.6% of children. Underweight was detected in 23.8% of patients (all with undernutrition p < 0.01). Wasting was noted in 28.6% of patients, of these 5 children were undernourished (p < 0.001) and stunting was noticed in only one patient with malnutrition (p = 0.5). Resting expenditure energy (REE) was lower in undernourished subjects compared to subjects with adequate nutritional status (p < 0.001). Malnutrition was associated to: type of EA (p = 0.003, particularly type A and C); intervention including deferred anastomosis due to long-gap repair (p = 0.04) with/or without jejunostomy (p = 0.02), gastric pull-up (p = 0.04), primary anastomosis (p = 0.04), pyloromyotomy in long-gap (p < 0.01); small for gestational age condition (p = 0.001). CONCLUSIONS undernutrition risk factors, beyond the type of malformation, surgery, and perinatal factors, must be early considered to personalize nutritional programming. Energy metabolism is important to monitor the nutritional requirements. The management of nutritional issues is surely a contributory factor able to counteract the poor growth of children with EA.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20157 Milano, Italy
- Correspondence:
| | - Francesca Destro
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Giorgio Giuseppe Orlando Selvaggio
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Luciano Maestri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Margherita Roveri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Alessandra Bosetti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
| | - Barbara Borsani
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
| | - Erica Pendezza
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
| | - Milena Meroni
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Andrea Pansini
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | - Enrico La Pergola
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (F.D.); (G.G.O.S.); (L.M.); (M.R.); (M.M.); (A.P.); (E.L.P.)
| | | | - Annalisa De Silvestri
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20157 Milano, Italy; (A.B.); (B.B.); (E.P.); (V.C.)
- Pediatric and Adolescent Unit. Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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Pelizzo G, Costanzo S, Maestri L, Selvaggio GGO, Pansini A, Zuccotti GV, Zoia E, De Filippis G, Visconti A, Calcaterra V. The Challenges of a Children's Hospital during the COVID-19 Pandemic: The Pediatric Surgeon's Point of View. Pediatr Rep 2020; 12:114-123. [PMID: 33198282 PMCID: PMC7717660 DOI: 10.3390/pediatric12030025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022] Open
Abstract
During the coronavirus disease of 2019 (COVID-19) emergency, in the pediatric surgical setting, it has been essential to avoid and contain infections as well as to protect both the patients and the surgical team. During this emergency, procedures and workflow were adapted to provide the safest possible environment for both the surgical team and the patients. Pediatric surgical activities were reorganized during the COVID-19 pandemic at the "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), Italy. Resources were optimized in order to maintain high levels of care and quality of assistance. During the COVID-19 emergency, the pediatric surgical department at the "Vittore Buzzi" Children's Hospital became an acute care surgical service. For the reorganization of surgical activities, institutional protocols were adapted in order to preserve the pediatric-specific characteristics of our service; five crucial points were specifically addressed. The pediatric surgical procedures carried out during the initial two months of the Italian lockdown are also reported. Continuity of care was maintained for children affected by severe diseases, such as tumors and neurosurgical conditions, whose treatment could not be deferred. Telemedicine and telecommunication were adopted as quick-support modalities for pre- and post-operative care. This reorganization allowed us to preserve the "pediatric specificity" and all care-related procedures offered at this high-quality/high-volume surgical care referral center.
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Affiliation(s)
- Gloria Pelizzo
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157 Milano, Italy;
- Correspondence: ; Tel.: +39-02-6363-5435
| | - Sara Costanzo
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Luciano Maestri
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Giorgio Giuseppe Orlando Selvaggio
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Andrea Pansini
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy; (S.C.); (L.M.); (G.G.O.S.); (A.P.)
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157 Milano, Italy;
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Elena Zoia
- Department of Pediatrics, Anesthesiology and Intensive Care Unit, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy;
| | - Giuseppe De Filippis
- “V. Buzzi” Children’s Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.D.F.); (A.V.)
| | - Alessandro Visconti
- “V. Buzzi” Children’s Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.D.F.); (A.V.)
| | - Valeria Calcaterra
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, 20157 Milan, Italy;
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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D'Auria E, Calcaterra V, Maestri L, Meroni M, Selvaggio GGO, Villanacci V, Nebuloni M, Pelizzo G. Case Report: Eosinophilic Myenteric Ganglionitis in a Child With Hirschsprung's Disease: A Challenge in Pseudo-Obstruction. Front Pediatr 2020; 8:617309. [PMID: 33614544 PMCID: PMC7890130 DOI: 10.3389/fped.2020.617309] [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: 10/15/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: The presentation of eosinophilic myenteric ganglionitis (EMG) can be similar to that of Hirschsprung's disease (HD). In a limited number of cases of pediatric patients, the diagnosis of both EMG and HD are reported. A case of pseudo-obstruction in EMG occurring in a child with HD diagnosis is discussed with literature review. Case Presentation: A boy aged 2 years and 6 months presented with intractable constipation and abdominal distension. Histological HD diagnosis was carried out and transanal Soave pullthrough was performed. At the age of 3 years and 2 months, an infectious enterocolitis occurred. One month later, he presented with constipation, marked abdominal distension and melena. Full thickness colonic biopsies revealed eosinophilic myenteric ganglionitis. Specific IgE tests were positive for several foods. Dietary exclusion was adopted with resolution of clinical symptoms and histologic remission. Conclusion: EMD may occur in patients with HD. At the onset, EMD may be associated with functional intestinal obstruction. The use of an elimination diet proved effective for the relief of symptoms. Long term follow-up is mandatory to define the timing of the reintroduction of foods.
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Affiliation(s)
- Enza D'Auria
- Allergology Unit, Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milan, Milan, Italy
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Luciano Maestri
- Pediatric Surgery Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Milena Meroni
- Pediatric Surgery Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | | | | | - Manuela Nebuloni
- Pathology Unit, Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, Milan, Italy.,Pediatric Surgery Unit, Vittore Buzzi Children's Hospital, Milan, Italy
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Destro F, Selvaggio GGO, Lima M, Riccipetitoni G, Klersy C, Di Salvo N, Marinoni F, Calcaterra V, Pelizzo G. Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery. Front Pediatr 2020; 8:377. [PMID: 32793523 PMCID: PMC7393988 DOI: 10.3389/fped.2020.00377] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment. Methods: Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered. Results: Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, p = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location (p < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent. Conclusions: MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.
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Affiliation(s)
- Francesca Destro
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Mario Lima
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Catherine Klersy
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Neil Di Salvo
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy
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Marinoni F, Destro F, Selvaggio GGO, Riccipetitoni G. Urothelial carcinoma in children: A case series. Bull Cancer 2018; 105:556-561. [PMID: 29724585 DOI: 10.1016/j.bulcan.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/04/2017] [Revised: 10/03/2017] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To report a series of 5 patients with urothelial bladder cancer (UBC) three of them with a history of exposure to amines and only two with gross hematuria. MATERIALS AND METHODS After obtaining ethical and legal authorization, we performed a restrospective monocentric study. We collected information of patients with UBC over a period of 10 years. We recorded: age, sex, reason for presentation, familial history and risk factors, preoperative assessment, surgical details, histological type and grade, follow-up. RESULTS 2 children came to our attention for hematuria and 3 for incidental bladder mass finding, at a median age of 11.8 years. We performed microscopically complete transurethral resection of the tumor (TURB). Median tumor size was 1.8cm. No further therapy was required. All cancers belonged to NMIBC (Non-muscle-invasive Bladder Cancer) considering the 2004 WHO classification: 2 urothelial papillomas, 2 papillary tumors with low grade malignancy (PUN-LPM) and 1 papillary urothelial carcinoma of low histological grade (LG-PUC Ta, N0, M0). There was not any complications and no relapse occurred during follow-up (median 30 months). CONCLUSIONS In this study, UBCs presenting at a young age were low-grade and have not recurred in follow-up. This confirms the results of other series reported in Literature. Therefore there might be the space to perform a follow-up dedicated to children.
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Affiliation(s)
- Federica Marinoni
- Ospedale dei Bambini V. Buzzi, Pediatric Surgery Department, Via Castelvetro 32, 20154 Milano, Italy
| | - Francesca Destro
- Ospedale dei Bambini V. Buzzi, Pediatric Surgery Department, Via Castelvetro 32, 20154 Milano, Italy.
| | | | - Giovanna Riccipetitoni
- Ospedale dei Bambini V. Buzzi, Pediatric Surgery Department, Via Castelvetro 32, 20154 Milano, Italy
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