Sindrome del midollo fissato o «Tethered cord»

Il «Tethered Cord» è una malformazione congenita polimorfa the insorge a partire dalla 6° settimana di vita embrionale. II quadro anatomo-radiologico è caratterizzato da un cono midollare ancorato in posizione anomala, per lo più estremamente bassa, da alcune forme di anomalie intradurali, e si inquadra frequentemente nell'ambito della sequenza malformativa di uno stato disrafico.

Il miglioramento prodotto dalla TC e dalla mielo-TC nella neurodiagnostica dei disrafismi spinali è stato ulteriormente incrementato dall'avvento della risonanza magnetica. Anche se quest'ultima consente frequentemente un inquadramento completo, in alcuni casi l'integrazione con mielo-TC permette una valutazione più precisa dell'estensione e dei rapporti delle varie componenti la malformazione.

Tuttavia alcuni aspetti della malformazione possono restare poco chiari, ancora insoluto appare il problema del riconoscimento del cono midollare dal filum terminale ispessito in alcune forme di «Tethered Cord». In questi casi tale difficoltà si riscontra anche in sede operatoria, pur utilizzando tecniche microchirurgiche. Proponiamo pertanto di definire l'unità anatomica Cono Midollare - Filum Terminale ispessito morfologicamente indistinti: «Struttura neurofibrosa».

Is perioperative cholangiography necessary in children undergoing elective laparoscopic cholecystectomy?

BACKGROUND

The necessity of carrying out pre- or intra-operative imaging of the biliary tree to rule out a possible anatomical abnormality or the presence of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is debated. We prospectively assessed the risk of developing symptoms related to bile duct injury or CBD stones after LC in children not receiving peri-operative cholangiography.

MATERIALS AND METHODS

All patients <or= 14 years undergoing elective LC at our institution from January 2003 to June 2005 were included in this study. Peri-operative cholangiography of the CBD was not performed unless there was a suspicion of CBD stones based on clinical examination, liver biochemistry, serum amylase levels or liver ultrasound scan. Patients were prospectively followed up, looking for possible symptoms or clinical, biochemical and radiological signs related to bile duct injury or CBD stones.

RESULTS

Twenty-six patients fulfilled the inclusion criteria. The median age at elective LC was 9.8 (4.1 - 14.3) years. Surgery was uneventful in all patients. All patients were discharged on postoperative day 1. None developed early symptoms of stone migration. USS performed 1 month after surgery did not show dilatation of the biliary system or stones in the CBD in any patient and no patient developed symptoms related to CBD stones after a median postoperative follow-up of 25 (6 - 37) months.

CONCLUSIONS

Patients scheduled for elective LC presenting with unremarkable clinical examination, normal liver biochemistry and serum amylase levels, and without dilatation of the biliary tree on ultrasound scan do not need pre- or intra-operative cholangiography.

Pulmonary lymphangiectasia

Congenital pulmonary lymphangiectasia (PL) is a rare developmental disorder involving the lung and is characterized by pulmonary subpleural, interlobar, perivascular, and peribronchial lymphatic dilatation. Both frequency and etiology are unknown. PL presents at birth with severe respiratory distress, tachypnea, and cyanosis, with a very high mortality rate at or within a few hours of birth. At birth, mechanical ventilation and pleural drainage are nearly always necessary to obtain a favorable outcome of respiratory distress. Home supplemental oxygen therapy and symptomatic treatment of recurrent cough and wheeze are often necessary during childhood, sometimes associated to prolonged pleural drainage. Recent advances in intensive neonatal care have changed the previously nearly fatal outcome of PL at birth. Patients affected by PL who survive infancy present medical problems which are characteristic of chronic lung disease.

Diagnosis of neonatal hemochromatosis with MR imaging and duplex Doppler sonography

Neonatal hemochromatosis is a rare congenital disorder which affects both fetuses and newborns. It is characterized by hepatocellular failure, often appearing on the first day of life in the form of coagulopathy, hypoalbuminemia, hypoglycemia, and jaundice. Most of the affected infants die early in life, and definitive diagnosis has often been made only by post-mortem evaluation. With the help of MRI, plus increasing awareness of the disorder, diagnosis is now often made early, even in utero. Duplex Doppler sonography does not provide information on siderosis but shows abnormalities in the liver or blood-flow patterns associated with liver disease.

Cervical lymphadenitis caused by nontuberculous mycobacteria in immunocompetent children: clinical and therapeutic experience

BACKGROUND

Cervical lymphadenitis is a frequent manifestation of nontuberculous mycobacteria (NTM) infection in immunocompetent children. Surgical excision, the treatment of choice, is often incomplete and may be difficult. A medical approach could reduce treatment morbidity.

METHODS

Systemic antibiotic therapy was administered to seven children for at least 6 months as treatment for cervical lymphadenitis due to NTM: rifabutin and clarithromycin in 4 cases; rifabutin, clarithromicyn, and ethambutol in 2 cases; rifabutin, amikacin, and cycloserine in 1 case.

RESULTS

All patients, six followed for a mean of 3 years and one for 6 months, were initially seen with regression of local signs of infection without relapse. Toxicity, likely due to rifabutin, was represented by neutropenia in three patients and yellow skin pigmentation in one patient.

CONCLUSIONS

Systemic antibiotic therapy was safe and effective in children with lymphadenitis due to NTM. This approach could represent a sound alternative or adjunct to surgery.

Bronchioloalveolar carcinoma arising in congenital cystic adenomatoid malformation in a child: a case report and review on malignancies originating in congenital cystic adenomatoid malformation

A type I congenital cystic adenomatoid malformation (CCAM) in the left lower lobe was removed from a 11-year-old boy with a 3-month history of recurrent pneumonia. As incidental finding, a bronchioloalveolar carcinoma (BAC) was found in the lung parenchyma adjacent to the cyst. A left lower lobectomy was performed. At 18 months after surgery the patient is well and free of neoplastic disease. To the best of our knowledge, this association has not been reported previously in a pediatric patient. Malignancies complicating CCAM are rarely seen, but have been reported in adults. Including our case, eight cases of BAC and five cases of rhabdomyosarcoma (RMS) in association with CCAM have been reported so far. As CCAM can host metaplastic mucous cells, primitive mesenchymal cells and differentiated but poorly organized striated muscle fibers, it has been proposed that CCAM may act as a predisposing condition for oncogenesis. Our experience adds further support that CCAM can act as a premalignant lesion. Previous reports of both BAC and RMS in asymptomatic CCAM suggest prompt resection shortly after diagnosis.

Results of a clinical multicentric randomized phase-ii study of nonsmall cell lung-cancer treated with vinorelbine Cisplatin versus vinorelbine alone

From July 1992 to December 1993, 62 patients with non-small cell lung cancer (NSCLC) were admitted to a multicentric randomized study. The patients were treated with vinorelbine (V) alone at a dose of 25 mg/m(2)/i.v. weekly or with V at a dose of 25 mg/m(2)/i.v. on day 1 and 8 plus cisplatin at a dose of 80 mg/m(2)/i.v. on day 1 every 3-4 weeks (VP). An objective response was observed in 42% of patients treated with VP versus 12.5% of those treated with vinorelbine alone (p=0.038). There was no significant difference in the median survival duration between the two groups (38 versus 30 weeks for VP and V, respectively). Toxicity was tolerable but more severe in the VP regimen. These data suggest that V is an active agent in NSCLC and that the VP regimen may yield results comparable to other cisplatin combinations for treatment of these tumors.

Solid-state phase transitions initiated by water vapor sorption of crystalline L-660,711, a leukotriene D4 receptor antagonist

Significant water vapor sorption at room temperature by the crystalline and lyophilized forms of L-660,711, a potent, selective leukotriene D4 receptor antagonist, has been measured and shown to produce increasingly more nonflowing, semisolid masses with increasing relative humidity. Thermal analysis, SEM, powder X-ray diffraction, solid-state NMR, and thermomicroscopic measurements reveal that water vapor sorbed at room temperature converts the crystalline form to a noncrystalline form resembling the lyophilized sample. Evidence is presented to indicate that L-660,711 has surface active properties with a critical micellization concentration of approximately 1 x 10(-4) M and an ability to form thermotropic and lyotropic mesomorphic phases when the crystal is heated above 80 degrees C in the anhydrous state; it is lyophilized from aqueous solution, and it is exposed to relative humidities at and above 12%, at room temperature.

Leiomyomatosis of oesophagus, congenital cataracts and hematuria. Report of a case with rectal involvement

Isolated oesophageal leiomyomatosis in children is very rare. The association between leiomyomatosis of oesophagus and female genital tract and an Alport like hematuric nephritis has been recognized as a distinct entity by Garcia-Torres and Guarner. Since then few other cases of this syndrome have been observed. Congenital cataracts and neurosensory deafness have been added to the clinical spectrum. Autosomal dominant inheritance is suggested by the familial cases. We report a patient who presents, as a new finding, leiomyomatosis of the rectum.

[The relationship between ligation of the ductus arteriosus and intracranial hemorrhage in preterm infants]

Surgical closure of patent ductus arteriosus (PDA) and perioperative time have been proposed as conditions of increased risk of peri-intraventricular hemorrhage (PVH-IVH) in preterm infants. We examined by pre- and postoperative ultrasound (US) scan 15 low birth-weight neonates who underwent PDA ligation within the first two weeks of life. They were assessed with regard to clinical state, perioperative management and development of PVH-IVH. Fourteen did not show onset or extension of intracranial hemorrhage in the immediate postoperative period. One patient developed a wide III grade IVH in the 24 perioperative hours. His conditions were particularly severe, suggesting that many factors such as acidosis, hypoxia, hypercapnia and hypotension might have combined to lead to hemorrhage. We conclude that PDA ligation is not likely to increase the risk of PVH-IVH per se.

[Ultrasonics in the study of periencephalic post-traumatic effusions in the newborn and suckling infants]

The authors report their experience in 8 cases of cranial post-traumatic superficial collections, studied by US. Traumatic cranial injuries with superficial collections are not rare in newborns; their early and complete diagnosis is necessary for a correct therapeutic approach. Sonography could be used as a first choice procedure but presents some limitations in the study of the posterior fossa. Therefore CT remains the technique of choice.

Schizencephaly: prenatal diagnosis by computed sonography and magnetic resonance imaging

Magnetic resonance (MR) imaging was performed at 29 weeks of pregnancy after ultrasonographic detection of an abnormal cleft in the fetal brain. Fetal neuromuscular blockade was induced by pancuronium bromide injected into the umbilical vein under continuous ultrasound (US) guidance. MR images supported the echotomographic diagnosis of schizencephaly improving the visualization of symmetrical broad clefts connecting the lateral ventricles with the subarachnoid space. Schizencephaly was finally confirmed by neonatal US, computed tomography, and MR.

Arteriovenous fistula with false aneurysm of the inferior medial geniculate artery. A complication of total knee arthroplasty

Two cases of traumatic arteriovenous fistula with false aneurysm of the inferior medial geniculate artery are reported as a complication of total knee arthroplasty. Both cases were diagnosed within the first two months following the knee surgery. Diagnosis in both cases was confirmed by arteriography. Surgical excision of this lesion with ligation of the inferior medial geniculate artery resolved both of these complications. Strict hemostasis in the region of the inferior medial geniculate artery following subperiosteal release of the medial ligaments in total knee arthroplasty should prevent this complication.

[A rare cause of urologic emergency in childhood: obstruction of the urinary tract caused by Candida]

AA. report a case history about a 3 month old female baby affected by bilateral pyelo-ureteric obstruction by fungus ball, presented as urine ascites because of fissure in renal pelvis and successfully treated by surgery. In spite of disobstruction and subsequent medical treatment, the obstruction relapsed and a second operation was necessary. This time a bilateral nephrostomy was done allowing irrigation with anti-candida drugs. This case has to be considered unusual because of the age of the patient, the clinical presentation as ascites, the bilateral affection, the tendency to relapse after disobstruction, and the successful treatment after the second operation.