Mucoceles of the lesser salivary glands in neonates demonstrate a particular clinicopathological pattern and mandate urgent management.

Mucoceles of the lesser salivary glands are common benign lesions affecting all ages, most commonly appearing on the lower lip. However, mucoceles in neonates demonstrate a different clinicopathological pattern than in older children or adults and mandate urgent management. We present a case of a large mucocele on the tongue of a neonate, which impaired feeding and could block the airway. The lesion was resected on the 3rd day of life. We describe a surgical technique that facilitates this procedure. Our literature review revealed 13 neonatal lesser salivary gland mucocele cases, 7 of which were located on the tongue. All tongue cysts were large, impaired feeding and sometimes blocked the airway. Early treatment is usually imperative. Inclusion cysts outnumbered extravasation cysts. Prenatal diagnosis is important in order to arrange delivery in an organized center. Resection is the preferable procedure.

Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix.

Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence.

Embryonal/Fetal subtype hepatoblastoma: a case report.

Hepatoblastoma is the most common primary liver tumor of childhood and after neuroblastoma and nephroblastoma the third most common abdominal neoplasm in this age group. Hepatoblastoma is an embryonal tumor classified by histology as epithelial (including pure fetal subtype, mixed embryonal/fetal subtype, macrotrabecular subtype and small cell undifferentiated subtype), mixed epithelial and mesenchymal type (with teratoid and non-teratoid features) and hepatoblastoma not otherwise specified. We present a case of a five-months old girl with embryonal/fetal subtype hepatoblastoma. The clinical presentation was asymptomatic abdominal mass. Ultrasound and MRI scan demonstrated a solid hepatic tumor. She presented thrombocytosis and serum alpha-fetoprotein was increased. A left lobe hepatectomy was performed and the pathological examination revealed complete excision of a mixed embryonalfetal subtype hepatoblastoma.

Urethral plate grafting improves the results of tubularized incised plate urethroplasty in primary hypospadias.

OBJECTIVE: We conducted a competitive efficacy trial in order to examine whether grafting the raw area of the urethral plate (UP) with inner preputial skin in children with primary hypospadias (PH) during tubularized incised plate urethroplasty (TIP) improves the results of the operation. MATERIAL AND METHODS: Fifty consecutive patients with pathology ranging from glanular to proximal penile PH were randomized into two groups, comparable for age and pathology, to be operated on either with TIP or a grafted TIP (G-TIP) procedure. Three patients failed the re-examination protocol, so the TIP group comprised 23 children aged 9.0 months-9.6 years (mean age 3.4 years) and the G-TIP group comprised 24 children, aged 10.0 months-9.4 years (mean 3.5 years). The patients were followed up for a period of 2-5 years (mean 3.2 years). RESULTS: Within the TIP group, we observed the development of fistula with concomitant neourethral stenosis in two cases (8.7%), stenosis without fistula in four (17.4%), and glans dehiscence in one case (4.35%). Within the G-TIP group there was one case of fistula without stenosis (4.16%), no case of neourethral stenosis, and one case of glans dehiscence (4.16%). Two cases of non-slit-like meatus were observed in the TIP group. The results show that the complications of neourethral stenosis are significantly reduced (p < 0.05) in the G-TIP group, as is the total number of complications and unsatisfactory results. The duration of the TIP operation was 72-110 (mean 92) min, and for the G-TIP 100-136 (mean 115) min. No postoperative symptoms were observed that could be attributed to prolonged anesthesia time. CONCLUSION: UP grafting with inner preputial skin, when added to the TIP procedure in the treatment of PH, results in a significantly smaller number of unsatisfactory results, and particularly fewer cases of neourethral stenosis. G-TIP can be used as the procedure of choice in PH patients.

Diagnosis and management of congenital neonatal chylous ascites.

BACKGROUND: Congenital chylous ascites is a rare condition that constitutes a challenge for the physician. It is defined as the accumulation of chyle into the peritoneal cavity in infants younger than 3 months. This condition is often refractory to therapy and it is responsible for serious malnutrition and immunological deficiency because of the loss of proteins and lymphocytes. MATERIAL AND METHODS: Four cases of congenital neonatal chylous ascites, were treated by our staff during the last two years. One case was treated conservatively and three with laparotomy. Two of them had intraabdominal cysts that were excised and one was treated with ligation of the left lumbar lymphatic trunk and cisterna chyli and the use of fibrin glue. RESULTS: All four cases were treated successfully. On follow up tests no one showed recurrence of the ascites. All children, except the one that treated conservatively and also had other problems due to prematurity, are growing up normally. CONCLUSIONS: Congenital chylous ascites is a complex condition. Its diagnostic evaluation is difficult and its therapy of long duration. Conservative treatment is in most cases the initial choice, but when it fails, exploratory laparotomy could provide a successful alternative.

Smooth muscle cell differentiation in the processus vaginalis of children with hernia or hydrocele.

PURPOSE: Incomplete obliteration of the processus vaginalis (PV) in children with inguinal hernia or hydrocele has recently been proposed to relate to smooth muscle cell (SMC) persistence. The aim of this study was to evaluate the diversity and differentiation of smooth muscle phenotypes in sacs associated with inguinal hernia and hydrocele through the expression of alpha-smooth muscle actin (SMA), h-caldesmon, desmin, and vimentin. METHODS: Sacs associated with male hernia (n = 22), female hernia (n = 8), and hydrocele (n = 10) were immunohistochemically evaluated using monoclonal antibodies against SMA, h-caldesmon, desmin, and vimentin. Peritoneal samples (male, 4; female, 3) and obliterated PV (male, 3) obtained from age-matched patients served as controls. Expressions according to the groups were compared through chi-squared test, and P values less than 0.05 were considered to be statistically significant. RESULTS: Immunohistochemistry did not shown the presence of SMCs in control samples. The expression of SMA, desmin, and h-caldesmon did not differ among sacs obtained from patients with inguinal hernia and hydrocele. However, strong expression of vimentin in SMCs within sacs obtained from patients with hydrocele in comparison with sacs from male patients with inguinal hernia were observed. CONCLUSIONS: Our results indicate that sacs from patients with inguinal hernias and especially from male inguinal hernias have fully differentiated SMCs. On the other hand SMCs in sacs obtained from boys with hydrocele are in an intermediate state of differentiation-dedifferentiation. This phenotypic modulation may represent attempted apoptosis of SMCs, since sacs more sensitive to apoptosis appeared to have more dedifferentiated SMCs. It also probably depicts the differing influence of sympathetic and parasympathetic tonuses during the descent of the testis and the obliteration of PV.

Imperforate anus associated with atresia of the transverse colon: a case report.

We describe here a rare case of association of imperforate anus with transverse colon atresia in a male neonate. Preoperative X-ray studies demonstrated: a) a distended loop in the epigastrium with fluid levels on plain A/P upright radiography, b) absence of pelvic intestinal gas on the invertogram 16 hours later. A three-stage operative approach was undertaken comprising resection of the atretic loop and colostomy, posterior sagittal anorectoplasty a few months later, and finally closure of the colostomy. The postoperative outcome was good. The association of these anomalies should be kept in mind in neonates with anal atresia and abdominal distention.

Volvulus of the transverse colon in a child: a case report.

A case of transverse colon volvulus in a 10-year-old female child with trisomy 13 is reported, bringing the total number of cases of children reported in the English language medical literature to 14. Although this type of volvulus is rare, a definite pattern is noticeable, so we should suspect its diagnosis in a patient with chronic constipation, mental retardation and motor disturbances. Resection of the involved segment and primary anastomosis is the definite treatment.