1,721,201 research outputs found
Urology in Pediatrics
No full textPediatric urology has been developed by many pediatric urologists and pediatric surgeons from all over the world [...]
Giant Hydatid lung cyst in non-endemic area
No full textEchinococcosis is a parasitic zoonosis in which humans are involved as an intermediate host. It is a very common pathology in the areas of Eastern Europe and Asia, where the main activity is represented by pastoralism and animal breeding. In humans, the most frequently affected sites are the liver (60–70%) and lungs (20–30%), manifesting themselves with symptoms such as abdominal pain, coughing, dyspnea, hemoptysis, up to cases of anaphylactic shock. In Italy it is not a common disease with an incidence of 2:100.000 inhabitants, and it's extremely rare in pediatric population. In this work we presented a case of a 11-years male patient came for a persistent cough, to whom was found a giant cystic mass in the thorax. Serological tests confirmed the diagnosis of echinococcosis. Patient underwent to thoracotomy to remove the cyst and he begun the antiparasitic therapy. Post-operative outcome was good and the patient is, until now, free of problems. Echinococcosis is a challenging problem for a pediatric surgeon, especially in non-endemic area, not only because it is not a common disease in pediatric population, but also for the surgical management that can presents some difficulties and complications in the post-operative course. © 2020 The Author
Preoperative percutaneous catheter drainage for symptomatic macrocystic congenital pulmonary airway malformation: A case report
Full text linkIntroduction: Infants with congenital pulmonary airway malformation (CPAM) are generally asymptomatic and the surgical treatment can be planned using a thoracoscopic technique. We report the case of a newborn with a large type 1 CPAM who presented with severe respiratory distress and was treated with percutaneous transthoracic drainage before open surgery. Case report: A full-term male patient was born via vaginal delivery. Antenatal imaging had raised suspicion of type 1 CPAM in the right lung. At birth, he was admitted to the neonatal intensive care unit (NICU) due to ventilatory insufficiency and oxygen dependence. A chest X-ray confirmed the antenatal diagnosis of a large type 1 CPAM. On the first days of life (DOL), we inserted a percutaneous transthoracic chest tube to drain the large cyst and initiated high-frequency oscillatory ventilation (HFOV). Although the patient initially showed clinical improvement, his condition subsequently deteriorated. Suspecting tube dislocation, on the seventh DOL a second drainage was placed in the cyst. On the tenth DOL, given the persistent clinical severity, a right upper lobectomy was performed. Postoperatively, the patient was supported by conventional ventilation with a reduced oxygen requirement. On the thirteenth DOL, the infant was successfully extubated. Histological analysis confirmed the diagnosis of type 1 CPAM. After nearly a month, the infant was transferred to the pediatric surgery ward and later discharged. During multidisciplinary follow-up, the patient maintained good general health with no signs of recurrence. Conclusion: In newborns with large, symptomatic type-1 CPAMs a percutaneous catheter drainage can be used as a temporizing measure before the definitive surgical resection
Pyeloplasty in Children with Ureteropelvic Junction Obstruction and Associated Kidney Anomalies: Can a Robotic Approach Make Surgery Easier?
No full textBackground: Robot-assisted pyeloplasty is widely used in pediatric surgery because of its well-known advantages over open or laparoscopic surgery. The aim is to explore our experience and evaluate the achievements we have made. Methods: We evaluated patients undergoing robotic pyeloplasty from January 2016 to November 2021, including those who presented with a ureteropelvic junction obstruction associated with other anomalies of the kidney. The parameters examined were: age, weight, associated renal malformations, conversion rate, operative time, and intra- and postoperative complications. Results: Of 39 patients, 7 (20%) were included, of whom 5 (71%) were male and 2 (29%) were female. The mean age at surgery was 84 months (range 36–180 months), and the mean weight at surgery was 24.4 kg (range 11–40 kg). In five (71%) patients the ureteropelvic junction obstruction (UPJO) was left-sided and in two (29%) it was right-sided. In four (57%) cases, UPJO was associated with a horseshoe kidney, right-sided in one (25%) patient, and left-sided in the other three (75%). A 180° rotation of the kidney was present in one (14%) patient. Nephrolithiasis was present in two (29%) patients. The mean operative time was 160 min (range 140–240 min). The average bladder catheter dwell time was 1 day (range 2–3 days), while the average abdominal drainage dwell time was 2 days (range 2–4 days). The mean hospitalization time was 4 days (range 3–9 days). On average, after 45 days (range 30–65) the JJ ureteral stent was removed cystoscopically. No intraoperative complications were reported, while one case of persistent macrohematuria with anemia requiring blood transfusion occurred postoperatively. Conclusions: Ureteropelvic junction obstruction might be associated with other congenital urinary tract anomalies such as a duplicated collecting system, horseshoe kidney, or pelvic kidney. These kinds of malformations can complicate surgery and require more attention and accuracy from the surgeon. Our experience shows that, with regards to the robotic learning curve required for pyeloplasty, the treatment of the ureteropelvic junction in these situations does not present insurmountable difficulties nor is burdened by complications. The application of robot-assisted surgery in pediatric urology makes difficult pyeloplasties easier
How replace the gastrostomy tube in children with extremely compromised general conditions
No full textThe percutaneous endoscopic gastrostomy is the best technique to use in case of children requiring long-time enteral nutrition. The first replacement of the tube is easy in most of the patient, but this step can be extremely problematic in patients with compromised general conditions. The authors report their experience in some cases. Two boys with endoscopic gastrostomy had a deterioration in the general conditions, when replacing the probe, these conditions contraindicated anaesthesia for which the 'cut-and-push' technique was adopted in a patient with heart malformation and a local anaesthetic in a neuropathic patient. Both the boys died a few days after this procedure. In our opinion, in children who are not using anaesthesia to reposition the gastrostomy probe, it is best to continue feeding through the nasogastric probe. © 2019 Wolters Kluwer Medknow Publications. All rights reserved
Clinical and radiological findings for early diagnosis of Herlyn-Werner-Wunderlich syndrome in pediatric age: experience of a single center.
No full textOBJECTIVE:
The authors present their experience in the management of pediatric patients with Herlyn-Werner-Wunderlich syndrome (HWWS) considering clinical classification and anatomical characteristics of the malformation.
METHODS:
All the data of the patient presented at our Pediatric Surgery Unit from February 2010 to August 2015 were collected. According to the type of malformations, patients were divided in 3 groups: A (completely obstructed hemivagina), B (incompletely obstructed hemivagina), and C (communication between the duplicated cervices).
RESULTS:
Six patients were treated in the study period. The mean age was 9 years (2 months-15 years). According to the characteristics of the HWWS, we had 5 patients in group A, 1 in group B, and none in group C. One-stage surgical treatment was performed in all cases of complete obstruction, but in one case a second look was necessary for a better resection of the septum. At a mean follow-up of 18 months all patients were symptoms free.
CONCLUSIONS:
Prognosis of this malformation is good in case of early diagnosis and treatment. We suggest that when a renal agenesia is diagnosed, the patient needs an ultrasonographic follow-up of the contralateral kidney but also of the genital tract to find each minimal abnormalities, furthermore, a MRI scanning before the onset of menstruation can be necessar
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