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Adorisio O, Orazi C, Gregori LM, De Peppo F, Silveri M. Zinner syndrome in pediatric patients: rare disease leading to challenging management. Front Pediatr 2024; 12:1353960. [PMID: 38328345 PMCID: PMC10848245 DOI: 10.3389/fped.2024.1353960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Zinner syndrome (ZS) is the association of seminal vesicle cysts, ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. This condition is very rare in children and both diagnosis and treatment may be challenging. We reviewed the clinical presentation and treatment describing our experience with a series of three patients. Methods From January 2016 to January 2021, three patients (patients 1, 2, and 3) with symptomatic ZS, aged 2, 15, and 17 years, respectively, were diagnosed and treated. All three patients were symptomatic, manifesting pelvic pain and dysuria. The diagnosis was made by physical examination, ultrasonography, and abdominopelvic MRI. Patient 1 underwent open surgery, while for patients 2 and 3, laparoscopic excision was performed. Results The renal agenesis regarded the left side in patients 1 and 3, and the right side in patient 2. In all cases, the cystic complex was excised. The mean operating time was 4 h and the mean hospitalization time was 5 days (range 4-6 days). The mean follow-up period was 5 years (range 2-5 years). Patients 1 and 3 showed a complete resolution of the symptoms during postoperative follow-up. In patient 2, clinical symptoms relapsed because of the persistence of a 9 mm cyst requiring a redo laparoscopic excision. Conclusions Seminal vesicle cyst with ipsilateral renal agenesis, even if rare in pediatric age, should be suspected in young male patients presenting with pelvic cystic masses, pelvic pain, dysuria, and ipsilateral renal absence. Conservative management should be reversed to asymptomatic patients. Surgical treatment is mandatory in symptomatic cases and the preferred approach is minimally invasive surgery to magnify the operating field to spare anatomical structures, primarily the contralateral vas deferens. Radicality is crucial to avoid the persistence of symptoms and the need for reintervention.
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Affiliation(s)
- Ottavio Adorisio
- Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cinzia Orazi
- Diagnostic Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Francesco De Peppo
- Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Massimiliano Silveri
- Pediatric Andrological and Gynecological Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Adorisio O, Davoli E, De Peppo F. Evaluation of YouTube videos addressing thoracoscopic sympathectomy using the LAP-VEGaS guidelines. Front Surg 2023; 10:1133124. [PMID: 37021089 PMCID: PMC10067559 DOI: 10.3389/fsurg.2023.1133124] [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: 12/28/2022] [Accepted: 03/01/2023] [Indexed: 03/22/2023] Open
Abstract
IntroductionThe study aims to evaluate the quality of videos addressing thoracoscopic sympathectomy on YouTube® using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) criteria.MethodsYouTube was searched using the following keyword: “thoracoscopic sympathectomy” on August 22, 2021. The first 50 videos were analyzed and classified for baseline characteristics and conformity to the LAP-VEGaS checklist.ResultsDuration ranged from 19 s to 22 min. The mean number of likes was 14.8 (range 0–80). The mean number of dislikes was 2.5 (range 0–14). The mean number of comments was 8.5 (range 0–67). Nineteen videos did not meet our criteria and were excluded. Regarding the remaining 31 videos, none contained all 16 points of the LAP-VEGaS essential checklist (mean 5.4 points, range 2–14 points), with almost all neglecting preoperative information and outcomes. The mean percentage of conformity was 37% (range 12%–93%). The most viewed videos were not associated with higher conformity to LAP-VEGaS criteria showing only 4/16 points (25%).ConclusionsThe quality of videos addressing TS on YouTube®, based on the LAP-VEGaS checklist may be considered not acceptable. Experienced surgeons and surgeons in trainees should be aware of this when using it as a learning resource in their clinical practice.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Correspondence: Ottavio Adorisio
| | - Enrico Davoli
- Department of General Surgery, Campus Biomedico University Hospital, Rome, Italy
| | - Francesco De Peppo
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Adorisio O, Diomedi Camassei F, De Peppo F. Localised swelling of the tongue: a rare case of isolated angiokeratoma in a child. BMJ Case Rep 2022; 15:e247552. [PMID: 35351748 PMCID: PMC8966515 DOI: 10.1136/bcr-2021-247552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/03/2022] Open
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Adorisio O, Diomedi Camassei F, De Peppo F. Torsion of the hydatid of Morgagni in a teenage girl. BMJ Case Rep 2022; 15:e248804. [PMID: 35236710 PMCID: PMC8895994 DOI: 10.1136/bcr-2022-248804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/03/2022] Open
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Adorisio O, Davoli E, Ceriati E, Battaglia S, Camanni D, De Peppo F. Effectiveness of unilateral sequential video-assisted sympathetic chain blockage for primary palmar hyperidrosis in children and adolescents. Front Pediatr 2022; 10:1067141. [PMID: 36507132 PMCID: PMC9727172 DOI: 10.3389/fped.2022.1067141] [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: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Primary palmar hyperhidrosis (PPH) is a severely debilitating condition that can affect patients of any age. Thoracoscopic sympathectomy provides a definitive treatment for PPH. Aim of this study is to investigate the effectiveness of unilateral sequential video-assisted thoracic sympathetic chain clamping (VATSCC) by clips application in pediatric population. METHODS The surgical procedure was done in the semi-sitting position, under general anesthesia with orotracheal intubation. Mean operation time was 23 ± 6 min (range 12-45). Two 5 mm ports were inserted at the level of the middle axillary line in the second and fourth intercostal space respectively. The sympathetic chain was identified, and two clips were applied, the first one at the level of the third and the second one, at the level of the fourth rib. No chest tube was used. Resolution of symptoms, complications, recurrence rate, onset and duration of compensatory hyperhidrosis were analyzed. RESULTS From August 2017 to September 2021, 58 patients (male:female ratio 32:26), mean age 16.5 years (range 14-19), with PPH underwent unilateral sequential VATSCC by clips application, starting on the dominant hand. The contralateral side was operated 2 months after. All patients except one (transient pneumothorax) were discharged on the first post-op day. No immediate or late complications have been recorded. Mean follow-up was 32 months (range 6-41). All patients except one (1,7%), affected by Raynaud's disease, showed a complete resolution of the symptom. Seven patients (12%) developed transient moderate compensative hyperhidrosis (CH) that spontaneously disappeared in the postoperative period. CONCLUSIONS Unilateral sequential thoracoscopic sympathetic chain clamping for PPH in pediatric patients is a safe and very effective procedure with a low complication rate and low incidence of postoperative CH that, in our experience, resolved spontaneously in the postoperative period, after the second surgery leading to an improvement in the quality of life.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Enrico Davoli
- Department of General Surgery, Campus Biomedico University Hospital, Rome, Italy
| | - Emanuela Ceriati
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sonia Battaglia
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Camanni
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco De Peppo
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Adorisio O, Silveri M, Torino G. Evaluation of educational value of YouTube videos addressing robotic pyeloplasty in children. J Pediatr Urol 2021; 17:390.e1-390.e4. [PMID: 33558173 DOI: 10.1016/j.jpurol.2020.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/12/2020] [Revised: 12/19/2020] [Accepted: 12/27/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND/INTRODUCTION Ureteropelvic junction obstruction (UPJO) is the most frequent obstructive uropathy of the upper urinary tract in children. Video-sharing platforms have become a significant source of visual information for health care providers. Among these platforms, YouTube® (www.youtube.com), contains a high number of videos free of charge and represents one of the most important and known websites of video-sharing. YouTube® is a widely used open-access video sharing website that allows us to watch an unlimited number of video content, and to upload an infinitive number of videos. OBJECTIVE This study aims to evaluate the educational quality of videos related to robotic pyeloplasty in pediatric age because an increasing number of videos addressing these procedures is now available on YouTube®. STUDY DESIGN We performed a search on YouTube® by using the following keyword: "robotic pyeloplasty in children" on July 9, 2020. The first 50 videos were analyzed. The videos were classified according to the source in 1) academic (author/s was/were affiliated with a university), 2) physician (author/s who was/were not affiliated with a university), 3) patient, 4) commercial. All the videos were evaluated also according to the content in 1) surgical technique, 2) information about the surgery and disease 3) patient personal experience 4) advertisement. Duplicated videos and videos not in English were excluded. The search for videos was done based on the website's default settings in order of the proposed relevance. The reliability was evaluated using DISCREN and JAMA scores. The Global Quality Score (GWS) was used to assess the educational value. Time since upload, run time, like, dislike and number of views were recorded. RESULTS The first 50 videos were analyzed. Seven videos (14%) did not meet our criteria and were excluded (three videos were duplicated while 4 out of seven were not in English). The mean DISCERN was 32.47 ± 12.24 (range 15-78). The mean JAMA Score was 2.1 ± 0.9 (range 0-4). Mean GQS was 2,12 ± 0.9. DISCERN and JAMAS and GQS scores of academic/physician sourced videos were significantly higher than the patient sourced videos (p = 0.037, p = 0.023, p = 0.017 respectively). Regarding content, the surgical technique had significantly higher DISCERN, JAMAS and GQS scores than videos based on patient experience (p = 0.012, p: 0.021, p = 0.023 respectively). CONCLUSIONS Videos uploaded by Physicians and Academic Institutions show higher DISCERN and JAMAS and GQS compared to other sourced videos and should be considered more suitable for teaching respect to those originating from patients or non-physicians.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy.
| | - Massimiliano Silveri
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy
| | - Giovanni Torino
- Pediatric Urology Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
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Torino G, Adorisio O, Cobellis G, Mariscoli F, Zaccara A. Robotic Excision of the Vagina in a 46 XX DSD Male Patient. First Pediatric Report. Urol J 2021; 18:466-468. [PMID: 33840088 DOI: 10.22037/uj.v18i.6470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Disorders of Sex Differentiation (DSD) represent a wide range of congenital anomalies of the genitalia. Surgical treatment of these cases may become a challenge. We present a case of a 16-year-old boy with 46 XX DSD, SRY negative, presented with persistent dribbling incontinence, recurrent UTI and perineal pain. Past medical history included right orchiectomy, laparoscopic excision of uterus, fallopian tubes and left streak gonad at another institution at the age of 2 years. The native vagina was left in place. VCUG confirmed the presence of the residual vagina (8 cm in maximum length), connected with the bulbar urethra. Robotic-assisted laparoscopy of the vagina was performed with satisfying short and long-term results.
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Affiliation(s)
- Giovanni Torino
- Pediatric Urology Unit, "Santobono-Pausilipon" Children's Hospital, Naples (Italy).
| | - Ottavio Adorisio
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy.
| | - Giovanni Cobellis
- Pediatric Surgery and Urology Unit, "G. Salesi" Children's Hospital, Marche Polytechnic University, Ancona, Italy.
| | - Francesca Mariscoli
- Pediatric Surgery and Urology Unit, "G. Salesi" Children's Hospital, Marche Polytechnic University, Ancona, Italy.
| | - Antonio Zaccara
- Department of Pediatric Surgery, Pediatric Urology and Urodynamics Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy.
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Adorisio O, Silveri M, Stracuzzi A, De Peppo F. Mammary duct ectasia without bloody nipple discharge in a five-year-old girl. Pediatr Int 2021; 63:346-347. [PMID: 33580890 DOI: 10.1111/ped.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/11/2019] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ottavio Adorisio
- Pediatric Surgery Unit, Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy
| | - Massimiliano Silveri
- Pediatric Surgery Unit, Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy
| | - Alessandra Stracuzzi
- Pathology Unit, Department of Laboratories, Research Institute, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy
| | - Francesco De Peppo
- Pediatric Surgery Unit, Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy
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Adorisio O, Silveri M, Ceriati E, Marchetti P, Orazi C, Colajacomo M, Gregori L, De Peppo F. Giant appendicolith causing severe lameness in a child. Pediatr Int 2017; 59:381-382. [PMID: 28317298 DOI: 10.1111/ped.13220] [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: 05/18/2016] [Revised: 10/05/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ottavio Adorisio
- Pediatric Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Massimiliano Silveri
- Pediatric Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Emanuela Ceriati
- Pediatric Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Paola Marchetti
- Pediatric Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Cinzia Orazi
- Department of Imaging, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Mauro Colajacomo
- Department of Imaging, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Lorenzo Gregori
- Department of Imaging, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
| | - Francesco De Peppo
- Pediatric Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Palidoro, Italy
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De Peppo F, Caccamo R, Adorisio O, Ceriati E, Marchetti P, Contursi A, Alterio A, Della Corte C, Manco M, Nobili V. The Obalon swallowable intragastric balloon in pediatric and adolescent morbid obesity. Endosc Int Open 2017; 5:E59-E63. [PMID: 28180149 PMCID: PMC5283171 DOI: 10.1055/s-0042-120413] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and study aims Incidence of morbid obesity has grown dramatically in the last half century and this phenomenon affects with particular severity the pediatric population. Dietary restrictions and careful programs to improve lifestyle are often ineffective to manage this particular group of patients, due to poor compliance typical of the adolescence. The aim of this study was to evaluate the effectiveness of a new intragastric balloon for treatment of morbidly obese children. Patients and methods A new swallowable intragastric balloon (Obalon) has been used for the first time in 17 obese children in order to assess its safety and effectiveness in terms of reduction in excess weight. In 9 of 17 children a second balloon was placed 30 to 40 days after the first insertion. All devices were endoscopically removed after a mean time of 18 weeks. Results In the group of 16 patients who completed the study (1 patient still under treatment) mean weight decreased from 95.8 ± 18.4 Kg to 83.6 ± 27.1 (P < 0.05). Mean body mass index (BMI) decreased from 35.27± 5.89 (range 30.4 - 48) to 32.25 ± 7.1 (range 23.5 - 45.7) (P > 0.05); mean excess weight, calculated according to Cole's curves for pediatric populations, decreased from 36.2 ± 15.9 to 29.4 ± 18.3 Kg (P = 0.14), with an %EWL of 20.1 ± 9.8 (range 2.3 - 35.1). Waist circumference decreased from 109 ± 12.3 cm to 99 ± 10.5 cm (P < 0.05). Conclusions Obalon can be administered easily without complications, inducing an appreciable weight loss with a statistically significant reduction in BMI and an improvement in associated comorbidities.
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Affiliation(s)
- Francesco De Peppo
- Department of Pediatric Surgery and
Transplantation Center, Pediatric Surgery Unit, Bambino Gesù Children’s
Hospital, Research Institute, Passoscuro, Rome, Italy
| | - Romina Caccamo
- Department of Pediatric Surgery and
Transplantation Center, Hepato-Biliary Surgery Unit, Bambino Gesù Children’s
Hospital, Research Institute, Passoscuro, Rome, Italy
| | - Ottavio Adorisio
- Department of Pediatric Surgery and
Transplantation Center, Pediatric Surgery Unit, Bambino Gesù Children’s
Hospital, Research Institute, Passoscuro, Rome, Italy,Corresponding author Dr. Ottavio
Adorisio Department of Pediatric
SurgeryChildren’s Hospital “Bambino Gesu”
Children’s Hospitalvia della torre di Palidoro
50Palidoro,
RomeItaly0039-06-68593373
| | - Emanuela Ceriati
- Department of Pediatric Surgery and
Transplantation Center, Hepato-Biliary Surgery Unit, Bambino Gesù Children’s
Hospital, Research Institute, Passoscuro, Rome, Italy
| | - Paola Marchetti
- Department of Pediatric Surgery and
Transplantation Center, Hepato-Biliary Surgery Unit, Bambino Gesù Children’s
Hospital, Research Institute, Passoscuro, Rome, Italy
| | - Antonio Contursi
- Department of Pediatric Anesthesiology,
Bambino Gesù Children’s Hospital, Research Institute, Passoscuro, Rome,
Italy
| | - Arianna Alterio
- Hepato-Metabolic Disease Unit and Liver
Research Unit, “Bambino Gesu”, Childrenʼs Hospital, IRCCS, Rome, Italy
| | - Claudia Della Corte
- Hepato-Metabolic Disease Unit and Liver
Research Unit, “Bambino Gesu”, Childrenʼs Hospital, IRCCS, Rome, Italy
| | - Malnia Manco
- Hepato-Metabolic Disease Unit and Liver
Research Unit, “Bambino Gesu”, Childrenʼs Hospital, IRCCS, Rome, Italy
| | - Valerio Nobili
- Hepato-Metabolic Disease Unit and Liver
Research Unit, “Bambino Gesu”, Childrenʼs Hospital, IRCCS, Rome, Italy
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Abstract
Internet became one of the most important sources of public health informations especially for relatives and/or caregivers of sick children. Use of YouTube as a source of information in pediatric surgery has not been evaluated. In this study, we want to evaluate the use of YouTube as a source of information about one of the most frequent surgical urgency in pediatric patients, the acute appendicitis, to evaluate the risks for patients and parents.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Passoscuro, Rome, Italy
| | - Massimiliano Silveri
- Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Passoscuro, Rome, Italy
| | - Francesco De Peppo
- Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Passoscuro, Rome, Italy
| | - Emanuela Ceriati
- Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Passoscuro, Rome, Italy
| | - Paola Marchetti
- Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Passoscuro, Rome, Italy
| | - Jean De Ville De Goyet
- Department of Pediatric Surgery, Research Institute, Bambino Gesù Children's Hospital, Passoscuro, Rome, Italy
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Silveri M, Bassani F, Adorisio O. Changing concepts in microsurgical pediatric varicocelectomy: is retroperitoneal approach better than subinguinal one? Urol J 2015; 12:2032-2035. [PMID: 25703914] [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] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/15/2014] [Accepted: 12/20/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE To compare and to assess two different microsurgical "lymphatic-sparing" techniques (subinguinal/inguinal vs. retroperitoneal) used for the treatment of a pediatric and adolescent varicocele in terms of success rate, complications and mean operative time. MATERIALS AND METHODS A retrospective study included 54 consecutive patients affected by a varicocele and treated with a microsurgical (loupes--operating microscope) magnification. Thirty-four out of 54 (group 1) underwent subinguinal ligation with the help of loupes magnification (× 3); 20 out of 54 (group 2) underwent retroperitoneal (Palomo like) ligation with preservation of lymphatics and with the help of an operating microscope (× 6 to 10). The two groups were homogeneous in terms of mean age, clinical and color Doppler ultrasound grade of disease. Pre- and post-operative testicular volume was measured in all cases. All the procedures were performed under general anesthesia and in an outpatient basis. RESULTS Mean post-operative follow-up time was 23.6 months. In group 1 we observed 3 (8.8%) early complications (wound's infection, transient hydrocele), 2 (5.8%) recurrences and 1 (2.9%) major complication (atrophy of the testis). Mean operative time was 45 +/- 6 min. In group 2 we did not observe complications and/or varicocele recurrence and mean operative time was 38 +/- 7 min. Comparison of mean operative time between the two groups resulted statistically significant differences (P < .05) such as the difference in testicular "catch-up" growth volume between pre- and post-operative evaluations. CONCLUSION Retroperitoneal microsurgical "lymphatic-sparing" varicocelectomy is safe and effective method. In our experience, it is preferable, in the pediatric and adolescent patient, to the subinguinal/inguinal approach in terms of success rate, complications and operative time duration.
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Affiliation(s)
- Massimiliano Silveri
- Department of Surgery and Transplantation, Center Bambino Gesù Children's Research Hospital, Via Torre di Palidoro 00050, Palidoro, Rome,
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Landi L, Elia A, Adorisio O. Prolapsed vaginal ureterocele as a cause of urinary incontinence in a child. Urol J 2015; 12:1999-2000. [PMID: 25703907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 02/22/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Luca Landi
- Department of Pediatric Surgery, Pediatric Urology Unit, Anna Meyer Children's Hospital, Florence, Italy
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Marchetti P, De Peppo F, Ceriati E, Adorisio O. Comet-tail artefacts and abdominal pain: radiological mistake or an underestimated event? BMJ Case Rep 2013; 2013:bcr-2013-009896. [PMID: 23761610 DOI: 10.1136/bcr-2013-009896] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Paola Marchetti
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Palidoro, Italy
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Marchetti P, Adorisio O, De Peppo F, Fassari F, Natali G, Lombardi R, Buonuomo PS, De Ville De Goyet J. Giant varicocele inducing chronic pelvic pain in a girl. J Pediatr 2013; 162:1295, 1295.e1. [PMID: 23333132 DOI: 10.1016/j.jpeds.2012.12.028] [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: 11/10/2012] [Accepted: 12/07/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Paola Marchetti
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Passoscuro, Rome, Italy
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Palidoro, Italy.
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Abstract
Cobb's collar is a membranous stricture of the bulbar urethra, often misdiagnosed, potentially leading to acute urinary retention, upper urinary tract dilations, enuresis, infectious diseases, poor streaming and haematuria. A 14-year-old boy with a history of previous hospitalisations came to our attention. A Cobb's collar was diagnosed and successfully managed with a videoendoscopic one-step approach. Although extremely uncommon, paediatric urologists must be aware of this congenital anomaly. A correct and timely diagnosis and endoscopic management may affect positively the clinical onset of these patients avoiding major urethral surgery and preserving renal and bladder function.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Palidoro, Italy.
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Adorisio O, Ceriati E, Camassei FD, De Peppo F. Segmental haemorrhagic infarction of the testis in a paediatric patient: a rare aftermath of epididymitis. BMJ Case Rep 2013; 2013:bcr-2012-007970. [PMID: 23299693 DOI: 10.1136/bcr-2012-007970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Testicular infarction is an uncommon finding in paediatric age and is usually due to testicular torsion or trauma causing venous rupture with thrombosis and/or arteriolar obstruction. Other causes of segmental infarction of the testes are represented by polyarteritis nodosa, thromboangioiitis obliterans and hypersensitivity angiitis. A few cases of testicular infarction due to epididymitis have been described in the literature related mainly to adult patients. Epididymitis is usually treated in the outpatient setting with close follow-up, but according to our present experience, and reviewing the literature, there may be some cases in which, surgical exploration is mandatory in order to avoid testicular damage.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy.
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Buonuomo PS, Adorisio O. Perspectives on quality and content of information for juvenile idiopathic arthritis on Italian Web pages: a different way to meet the needs of families? Rheumatol Int 2012; 32:4073. [DOI: 10.1007/s00296-011-2204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
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Bassani F, Silveri M, Grossi A, Orazi C, Adorisio O. Updating on the management of germ-cell tumors in disorders of sex development: intratubular germ-cell neoplasia, unclassified type in a 46,XY DSD patient with persistent Müllerian duct syndrome. Eur J Pediatr Surg 2012; 22:257-9. [PMID: 22576304 DOI: 10.1055/s-0032-1308701] [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)
- Francesca Bassani
- Pediatric Surgery and Transplantation Center, Department of Pediatrics, Endocrinology Unit, Bambino Gesù Children's Research Hospital, Rome, Italy
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Adorisio O, Silveri M, Rivosecchi M, Tozzi AE, Scottoni F, Buonuomo PS. Analysis of readability and quality of web pages addressing both common and uncommon topics in pediatric surgery. Eur J Pediatr Surg 2012; 22:228-33. [PMID: 22576301 DOI: 10.1055/s-0032-1308704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The quality medical information on Internet is highly variable. The aim of this study is to determine if Web pages addressing four common pediatric surgical topics (CT) and four uncommon pediatric surgical topics (UT) differ significantly in terms of quality and/or characteristics. MATERIALS AND METHODS We performed an Internet search regarding four CT, addressing more frequent clinical conditions with an incidence≤1:1.500 children (inguinal hernia, varicocele, umbilical hernia, and phimosis) and four UT addressing less frequent clinical conditions with an incidence≥1:1.500 children (anorectal malformation, intestinal atresia, gastroschisis, and omphalocele), using a popular search engine (Google). We evaluated readability with the Flesch reading ease (FRE) and the Flesch-Kincaid grade (FKG) and quality of content using the site checker of the HON Code of Conduct (HON code) for each website. RESULTS In this study, 30/40 websites addressing CT versus 33/50 addressing UT responded to our criteria. No differences statistically significant in advertisements between the two groups were found (15 vs. 16%) (p>0.05). No differences were found in terms of time from last update, owner/author type, financial disclosure, accreditation, or advertising. CT had higher quality level according to the HON code (6.54±1.38 vs. 5.05±1.82) (p<0.05). Mean FRE was 47.38±14.27 versus 46.24±14.56, respectively, for CT and UT (p>0.05). The mean FKG was 8.1±1.9 for CT versus 8±1.9 for UT (p>0.05). CONCLUSIONS Websites devoted to pediatric surgical topics have higher readability and quality information for disease diagnosis and natural history. Otherwise, the quality of pediatric surgical information on the Internet is high for CT and UT. A high reading level is required to use these resources.
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Affiliation(s)
- Ottavio Adorisio
- Pediatric Surgery and Transplantation Center, Bambino Gesù Children's Hospital, Rome, Italy.
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Adorisio O, Silveri M, Colajacomo M, Fassari F, Rivosecchi M. Appendiceal abscess and right ovarian teratoma: a rare association. Minerva Pediatr 2012; 64:239-242. [PMID: 22495197] [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: 05/31/2023]
Abstract
Many pediatric patients presenting to the Emergency Department with acute abdomen are subject to one or even more than one imaging modalities in order to determine the reason for the patient's symptoms. Most of the times, imaging can render an accurate diagnosis and help clinicians and surgeons for the decision making plan and further management. In some circumstances, image findings are equivocal, non specific or simply misinterpreted and a correct diagnosis cannot been made preoperatively. Authors present a unique case of an unexpected acute appendicitis found during surgical exploration performed in order to remove an ovarian tumor in an eight-year-old girl.
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Affiliation(s)
- O Adorisio
- Bambino Gesù Children Hospital, Research Institute Passoscuro, Rome, Italy.
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Adorisio O, Silveri M, Colajacomo M, Bassani F, Rivosecchi M. The impact of perinatal urinoma formation on renal function: our experience and review of the literature. J Paediatr Child Health 2011; 47:217-22. [PMID: 21199055 DOI: 10.1111/j.1440-1754.2010.01927.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A urinoma is a fluid mass consisting of extravasated urine in the perirenal space. Its impact on renal function was analysed. METHODS All cases of prenatal and neonatal urinoma reported in the literature were analysed as well as two cases recently observed in our department. RESULTS A review of all prenatally diagnosed urinomas revealed 25 cases, for a total of 30 renal units. The cause of obstruction was: lower urinary tract (LUT) obstruction in 16 cases (62.5%), upper urinary tract (UUT) obstruction in seven cases (29.5%) and unknown in two cases (8%). A preserved renal function was found in only 30% of all cases. Furthermore, prognosis for renal function was better in posterior urethral valve (PUV) patients than in uretero-pelvic junction obstruction (UPJO) patients. In addition, we analysed 35 published cases of urinoma with a neonatal onset, without prenatal diagnosis, and secondary to LUT obstruction in 27 cases (77%), UUT obstruction in seven cases (20%), while the underlying cause was unknown in one cases (3%). A preserved renal function was observed in 84% of cases with UUT obstruction and in 80% of cases presenting a LUT obstruction. CONCLUSIONS Prognosis concerning renal function seems to be mainly related to two factors: age at presentation and underlying diagnosis. Decompression of the urinary tract by urine extravasation produces the best results in terms of preservation of the renal function in LUT obstruction (75% in prenatal and 84% in postnatal cases); UUT obstruction however is associated with a good prognosis in the neonatal period (80% of preserved renal function) but with a severe impairment (only 20% of preserved renal function) in prenatally detected cases.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
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Adorisio O, Elia A, Landi L, Taverna M, Malvasio V, Danti AD. Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System. Urology 2011; 77:191-4. [DOI: 10.1016/j.urology.2010.02.061] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 02/23/2010] [Accepted: 02/23/2010] [Indexed: 11/24/2022]
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Silveri M, Bassani F, Colajacomo M, Orazi C, Adorisio O. Management and follow-up of pediatric asymptomatic testicular microlithiasis: are we doing it well? Urol J 2011; 8:287-290. [PMID: 22090047] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To define timing and methods for a balanced follow-up of testicular microlithiasis (TM) in pediatric age. MATERIALS AND METHODS We retrospectively reviewed medical records of 21 pediatric asymptomatic patients (42 testicular units) diagnosed with TM and without associated risk factors. Microliths were found bilaterally on ultrasonography in all the patients. Distribution of microliths (focal or diffuse) inside the parenchyma was evaluated as well as its eventual variation over time. Every six months, each patient underwent clinical and ultrasonography evaluation, as well as serum chemistry markers (α-fetoprotein and β-human chorionic gonadotropin) measurement to detect potential malignancy. In the interval between the follow-ups, parents and/or patients themselves were asked to control eventual enlargement of the gonads or scrotal swelling. Testicular biopsy was not performed in any of our subjects. RESULTS Of 21 patients, 6 had unilateral undescended testis, 4 varicocele, and 1 patent processus vaginalis with scrotal swelling while 10 patients did not show associated anomalies. The distribution pattern of microliths on ultrasonography remained unchanged in all follow-ups in every patient, showing a predominance of diffuse pattern in the undescended testis series. Tumor markers remained within normal limits. In no subject, we observed a shift toward a malignant condition. CONCLUSION In the pediatric population with an incidentally diagnosed TM and without any associated risk factor, a slight follow-up is suggested, consisting of clinical evaluation every 6 months, without any justifiable recommendation to perform a testis biopsy and a measurement of serum tumor markers.
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Affiliation(s)
- Massimiliano Silveri
- Department of Pediatric Surgery, Bambino Gesù Children Hospital, Palidoro (Rome), Italy.
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Silveri M, Bassani F, Adorisio O. Endoscopic management of a type IV syringocele causing massive perirenal urinoma in an infant. J Pediatr Surg 2010; 45:2254-5. [PMID: 21034956 DOI: 10.1016/j.jpedsurg.2010.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 02/04/2010] [Revised: 05/30/2010] [Accepted: 06/22/2010] [Indexed: 11/17/2022]
Abstract
The finding of a urinoma in the fetal and neonatal period is almost always related to an obstruction distal to the collection itself. Syringocele is a congenital or acquired dilation of a bulbourethral Cowper's gland. An exceedingly rare case of neonatal anterior urethral obstruction caused by a syringocele and manifesting itself with a dramatic clinical onset is presented. Clinical and radiologic findings are discussed and minimally invasive therapeutic strategies emphasized.
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Affiliation(s)
- Massimiliano Silveri
- Department of Surgery and Transplantation Centre, Pediatric Surgery, Palidoro, Via Torre di Palidoro, 00050 Palidoro, Rome, Italy.
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De Gennaro M, Capitanucci ML, Di Ciommo V, Adorisio O, Mosiello G, Orazi C, Tubaro A. Reliability of bladder volume measurement with BladderScan® in paediatric patients. ACTA ACUST UNITED AC 2009; 40:370-5. [PMID: 17060082 DOI: 10.1080/00365590600679137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the reliability of estimates of bladder volume (BV) in children made with the BladderScan BVI 2500 (BS) and their agreement with standard ultrasound (US) measurements. MATERIAL AND METHODS BV was measured using both US and BS in 92 children (41 females, 51 males; age range 3 months to 16 years) who underwent standard US measurements for various reasons. Patients were stratified into three groups according to age (3-35, 36-83 and > 83 months) and BV (< 20%, 20-50% and > 50% of expected bladder capacity for age). US and BS measurements were compared by means of the percentage difference and Pearson's correlation coefficient (r); limits of clinical agreement were evaluated by means of Bland-Altman analysis. RESULTS Overall, a difference of -12.9% and a correlation coefficient of r = 0.98 were found between US and BS. The percentage difference was higher in younger patients (-27.8%) and for low volumes (-24.8%). Correlation analysis confirmed this trend in different age (3-35 months, r = 0.74; 36-83 months, r = 0.93; > 83 months, r = 0.97) and BV (< 20%, r = 0.70; 20-50%, r = 0.94; >50%, r = 0.97) groups. Bland-Altman analysis showed large limits of clinical agreement between the two methods in terms of overall measurements (-45 to 29.3 ml) and in both age (-25.3 to 56.9 ml) and BV (-27.5 to 52.5 ml) groups. CONCLUSIONS A good correlation between US and BS measurements of BV was found in children aged > 7 years and in those with a BV > 20% of expected bladder capacity. Thus, BS avoids the need for standard US equipment to assess BV for schoolchildren with voiding dysfunction. Nevertheless, a dedicated BS instrument should be used in younger children.
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Affiliation(s)
- Mario De Gennaro
- Department of Nephrology and Urology, Urodynamic Unit, Ospedale Pediatrico Bambino Gesu, Piazza Sant'Onofrio, Rome, Italy
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Abstract
Twenty-two cases of scrotal hematoma caused by neonatal adrenal hemorrhage are reported in the literature and unnecessary surgical exploration was performed in nine (41%), suspecting testicular torsion. In this paper, we present a newborn male with right adrenal gland hemorrhage causing right scrotal swelling and discoloration of groin managed conservatively.
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Affiliation(s)
- O Adorisio
- Department of Pediatric Surgery, Pediatric Urology Unit, Children's Hospital Anna Meyer, Florence, Italy.
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Grande M, Torquati A, Tucci G, Rulli F, Adorisio O, Farinon AM. Preoperative risk factors for common bile duct stones: defining the patient at high risk in the laparoscopic cholecystectomy era. J Laparoendosc Adv Surg Tech A 2005; 14:281-6. [PMID: 15630944 DOI: 10.1089/lap.2004.14.281] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Common bile duct stones (CBDS) are present in 3-20% of patients with cholelithiasis. Intraoperative cholangiography has high sensitivity in detecting CBDS but its routine use is associated with increased costs and operating room time. The aim of our study was to define an accurate and simple model for the prediction of CBDS using preoperative variables. METHODS The study consisted of a retrospective analysis followed by a prospective study. Multivariate analysis of the retrospective data was used to create a predictive model for the presence of concurrent CBDS in patients undergoing cholecystectomy. The predictive model was then validated in a prospective series of 160 patients undergoing laparoscopic cholecystectomy. RESULTS Among the 19 potentially predictive variables for CBDS, only four were found to be statistically significant and independent: X1-alkaline phosphatase levels (UI/L); X2-number of gallbladder stones; X3-total serum bilirubin (mg/dL); and X4-CBD diameter (mm). Using these four variables, the multivariate analysis created the equation: score = 0.002 x X1 + 0.485 x X2 + 0.232 x X3 + 0.220 x X4 - 4.167 to define the risk of CBDS in each patient. The predictive model, tested prospectively in 160 patients undergoing laparoscopic cholecystectomy (LC), showed an elevated index of correlation (r = 0.75) among the predicted and the observed frequencies (chi2 = 126.6; P < 0.0001). The predictive model sensitivity and specificity were 92.9% and 99.3%, respectively. CONCLUSIONS In patients undergoing cholecystectomy, accurate prediction of the risk for concurrent CBDS can be achieved using four preoperative variables. The use of this predictive model can contribute to reducing the number of unnecessary common bile duct explorations.
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Affiliation(s)
- Michele Grande
- Department of Surgery, University of Rome Tor Vergata, Italy.
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Abstract
BACKGROUND Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, little is known about the effects of extensive surgery in the pelvic and perineal region, which involves disruption of muscles providing maximal support in normal walking. METHODS Thirteen patients operated on at birth for SCT with extensive muscle dissection underwent gait studies with a Vicon 3-D motion analysis system with 6 cameras. Results were compared with 15 age-matched controls. Statistical analysis was performed with Mann-Whitney test; correlations were sought with Spearman's correlation coefficient. RESULTS All subjects were independent ambulators, and no statistically significant differences were seen in walking velocity and stride length. However, in all patients, toe-off occurred earlier (at 58% +/- 1.82% of stride length) than controls (at 65.5% +/- 0.52%; P <.05). On kinetics, all patients exhibited, on both limbs, a significant reduction of hip extensory moment (-0.11 +/- 0.11 left; -0.16 +/- 0.15 right v 1.19 +/- 0.08 Newtonmeter/kg; P <.05) and of ankle dorsi/plantar moment (-0.07 +/- 0.09 right; -0.08 +/- 0.16 v -0.15 +/- 0.05 Nm/kg, p < 0.05). Knee power was also significantly reduced (0.44 +/- 0.55 right, 0.63 +/- 0.45 left v 0.04 +/- 0.05 W/kg), whereas ankle power was increased (3 +/- 1.5 right; 2.8 +/- 0.9 left v 1.97 +/- 0.2 W/kg; P <.05). No statistically significant correlation was found between tumor size and either muscle power generation or flexory/extensory moments. CONCLUSIONS Patients operated on for SCT exhibit nearly normal gait patterns. However, this normal pattern is accompanied by abnormal kinetics of some ambulatory muscles, and the extent of these abnormalities appears to be independent of tumor size. A careful follow-up is warranted to verify if such modifications are stable or progress over the years, thereby impairing ambulatory potential or leading to early arthrosis.
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Affiliation(s)
- Antonio Zaccara
- Newborn Surgery and Pediatric, Bambino Gesù Children's Hospital, Rome, Italy
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Mosiello G, Adorisio O, Gatti C, Boeris Clemen F, Dall'Oglio L, Federici di Abriola G. [Ascariasis as a cause of acute abdomen: a case report]. Pediatr Med Chir 2003; 25:452-4. [PMID: 15279372] [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: 04/30/2023] Open
Abstract
Ascaris Lumbricoides Infestation (ALI) is one of the most common helmintic disease of the gastrointestinal tract, and may cause severe surgical complications, especially in children. ALI is frequent in tropical and subtropical countries. We present our experience with a case of a 5-years old pakistan girl treated in Italy for acute abdomen in which ALI was detected during surgical exploration.
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Affiliation(s)
- G Mosiello
- Divisione di Chirurgia Pediatrica, Ospedale Pediatrico Bambino Gesù, Roma.
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Mosiello G, Capitanucci ML, Gatti C, Adorisio O, Lucchetti MC, Silveri M, Schingo PSM, De Gennaro M. How to Investigate Neurovesical Dysfunction in Children With Anorectal Malformations. J Urol 2003; 170:1610-3. [PMID: 14501674 DOI: 10.1097/01.ju.0000083883.16836.91] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Neurovesical dysfunction (NVD) is common in children with anorectal malformation (ARM). NVD is mainly related to tethered cord or iatrogenic injury but how to investigate it is still debated. We evaluate the usefulness of routine magnetic resonance imaging (MRI) and urodynamics (UDS) for ARM. MATERIALS AND METHODS A total of 89 children were screened for sacral, spinal or urological anomalies using sacrum x-ray, MRI, renal and spinal ultrasound, uroflowmetry and/or 4-hour voiding observation. UDS was performed in 60 patients with suspected NVD. Mean +/- SD followup was 9.8 +/- 5.2 years. RESULTS Of the 89 patients 29 presented with urinary tract anomalies. The prevalence of sacral (53 cases) and spinal cord (54) anomalies was no different between patients with low, intermediate and high ARM. Spinal cord tethering was present in 13 patients with a normal sacrum x-ray. NVD was found in 31 of the 89 patients (hyperreflexia 21 and hypo-areflexia 10), and was associated with sacral and spinal anomalies in 23, occult spinal dysraphism without bone lesion in 3 and sacral anomalies in 5. The incidence of NVD was 40% of cases with low and 51% with high ARM. CONCLUSIONS Because tethered cord occurs in children without sacral anomalies as well as in those with low ARM, we recommend evaluation of all patients using MRI. When MRI is positive UDS should be performed. We agree with a previous suggestion to evaluate all males with rectourethral fistula and females with cloaca malformations. Finally we recommend a noninvasive evaluation for all other children and UDS when neurogenic dysfunction is suspected.
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Affiliation(s)
- Giovanni Mosiello
- Department of Pediatric Surgery and Radiology, Urodynamic Unit, Bambino Gesù Children's Hospital, Rome, Italy.
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Silveri M, Adorisio O, Pane A, Colajacomo M, De Gennaro M. Subinguinal microsurgical ligation--its effectiveness in pediatric and adolescent varicocele. Scand J Urol Nephrol 2003; 37:53-4. [PMID: 12745745 DOI: 10.1080/00365590310008703] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Treatment of varicocele using a microsurgical vein ligation approach is a successful procedure when applied to adult patients. We performed this procedure in prepubertal and pubertal patients in order to verify its feasibility and effectiveness in a younger population. MATERIAL AND METHODS Between January 1998 and December 1999, 46 patients (average age 13 years) were operated on for a left varicocele using a microsurgical selective vein ligation procedure. All patients were evaluated clinically and using color Doppler ultrasound (CDUS): 34/46 patients were classified clinically as grade III and the remaining 12 as grade II. We used a magnification loupe (x3) in 34/46 patients and an operating microscope (x 10-16) in the remaining 12. RESULTS The procedure was successful in all but one patient (2.1%) who showed recurrence of the disease at the time of the first postoperative follow-up CDUS scan and required a repeat procedure. The average operative times were 45 and 60 min for loupe and microscopic procedures, respectively. In three cases (6.5%), early postoperative complications (wound infection and transient hydrocele) occurred and quickly resolved. All the patients were discharged within 24 h, returned to normal daily life within 2 days and resumed physical and sporting activities within 1 week. CONCLUSION Subinguinal "artery- and lymphatic-sparing" microsurgical varicocelectomy, considered the gold standard treatment in adults, also proved to be successful in this preliminary experience with pediatric patients. The minimally invasive approach ensures the prevention of recurrences and/or postoperative complications, and is associated with a very low morbidity rate.
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Affiliation(s)
- M Silveri
- Department of Pediatric Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
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Silveri M, Adorisio O, Pane A, Zaccara A, Bilancioni E, Giorlandino C, De Gennaro M. Fetal monolateral urinoma and neonatal renal function outcome in posterior urethral valves obstruction: the pop-off mechanism. Pediatr Med Chir 2002; 24:394-6. [PMID: 12494545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
The "fetal urinoma" is a clinical and diagnostic entity due to urinary extravasation, early diagnosed in fetal and/or neonatal period. Both urinoma and urinary ascites, whose pathogenesis is not clear, are recognized associations of uterero-pelvic junction obstruction (UPJO) and neonatal posterior urethral valves (PUV) related with a protected fetal and neonatal renal function. Clinical and experimental studies have demonstrated that fetal urinary tract obstruction results in severe renal parenchymal injury. The so called "pop-off" valve mechanism has been advocated to justify the upper tract function preservation. Protective "pop-off" mechanisms, such as a unilateral reflux and dysplasia, urinary extravasation and congenital bladder diverticula are present in about 30% of patients with PUV. Their presence correlates with better overall long-term renal function. This mechanism has been justified as a sort of self derivation, to explain the renal function preservation in fetal and neonatal period. In the last two years we observed three cases of fetal monolateral urinoma, prenatally detected in fetuses with diagnosis of PUV. All three cases did well for that concerning renal function despite some current opinions suggesting the necessity of a bilateral urinary extravasation in order to preserve upper urinary tract function.
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Affiliation(s)
- M Silveri
- Department of Pediatric Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
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Grande M, Tucci GF, Adorisio O, Barini A, Rulli F, Neri A, Franchi F, Farinon AM. Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 2002; 16:313-6. [PMID: 11967686 DOI: 10.1007/s00464-001-9042-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2001] [Accepted: 06/27/2001] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cytokines are the main mediators of inflammation and the response to trauma. The purpose of this study was to compare variations in cytokine levels following laparoscopic cholecystectomy (LC) and mini-laparotomy cholecystectomy (OC), since these two types of operations were considered to be a unique model for examining the role of local tissue injury in postoperative inflammatory reactions. METHODS A total of 40 patients were studied. Eighteen of them underwent LC; the remaining 22 were operated on using the open technique. Systemic concentrations of interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured before and after the operation. In addition, we compared pre- and postoperative white blood cell (WBC) counts, postoperative body temperature, and length of postoperative hospitalization. RESULTS There was no difference between the two groups in IL-1 and TNF response. The rise in plasma IL-6 levels (18.86 +/- 9.61 vs 5.00 +/- 0.0 pg/ml, p < 0.0001) and CRP (8.40 +/- 5.81 vs 1.43 +/- 1.30 mg/dl, p < 0.001) were more marked after open cholecystectomy than after the laparoscopic procedure. There was no correlation between serum CRP concentrations and the other postoperative parameters. CONCLUSION The magnitude of the acute-phase response was less pronounced following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.
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Affiliation(s)
- M Grande
- Department of Surgery, University of Rome Tor Vergata, via di Tor Vergata 135, 00131 Rome, Italy.
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