[Treatment of gastrointestinal bleeding in neonates: a case report]. / Scelta terapeutica nelle emorragie intestinali pediatriche: un controverso caso neonatale.

Gastrointestinal bleeding in infants and children is an uncommon and potentially serious problem, but fortunately is usually limited and most cases resolve with close medical attention. The therapeutic criteria is often difficult particularly in neonates. In this work we examine the case of a neonate with serious gastrointestinal bleeding and the delayed treatment for diagnostic difficulties.

Iatrogenic traumas by nasogastric tube in very premature infants: our cases and literature review.

OBJECTIVE: The nasogastric tube is the chosen nutritional technique in premature infants. However, it is not without complications. The aim of this study is to compare our experience in iatrogenic complications caused by nasogastric tube (especially in very low birth weight infants) to a review of the most recent literature. METHODS: From january to december of 2008, in the Department of Neonatal Pathology at the Hospital of Treviso, 118 premature patients were treated. 110 of them had a body weight less than 1,500gr: serious complications caused by nasogastric tube occurred in two of these very low birth weight infants. The first case relates an injury of the esophagus, while the second case is about a perforation of the posterior wall of the stomach, left lobe of the liver and the spleen hilus. RESULTS: The surgical treatment was limited to the second case ending in splenectomy and repair of the posterior gastric wall and liver lobe. DISCUSSION AND CONCLUSIONS: Among all the iatrogenic injuries described in the literature, this last case is the most serious. It is important to verify always the position of the gastric tube and to doubt for a dislocation in any case of deviation of the tube from the normal course. In those cases in which a patient suddenly goes from a full well-being to a critical state without a precise contingent cause it is imperative to check the nasogastric tube place. In addition those cases have guided us to change our habits for managing these critical patients: we are then oriented toward the usage of silastic gastric probes, which are softer, less dangerous for ulcer damages, and long term replaceable, thus reducing the possibility of a iatrogenic injury.

[Foreign body ingestion: a common problem in paediatric age]. / L'ingestione di corpi estranei in età pediatrica: una costante realtà.

Foreign body (F.B.) ingestion occurs very frequently in paediatric age. The kind of ingested foreign bodies depends on the patient's age. Children between 1 and 3 years of age mostly swallow coins, toy parts, stones and small batteries; instead, older children typically ingest boluses of meat. The aim of this study is to review our case histories according to the latest literature, focusing on some events that needed a therapeutic emergency treatment.

A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula.

BACKGROUND: Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS: A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS: A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS: This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.

Isolated blunt liver trauma: is nonoperative treatment justified?

During the past 8 years 13 children with isolated blunt liver trauma were managed nonoperatively. All patients selected for this management were hemodynamically stable after initial resuscitation and were without signs of other associated intraabdominal injuries on ultrasonogram and/or computed tomography. Patients were observed in an intensive care unit for at least 48 hours with repeated clinical assessments, laboratory studies, and bed rest. One patient with type 3 injury was operated on 8 days after injury because of sudden intraperitoneal bleeding on ambulation. Five patients required blood transfusions of not more than 300 mL per patient. Laboratory values returned to normal from 7 to 21 days after injury. Resolution of hepatic injury on ultrasonogram took from 1 to 3 months. Complete bed rest was prescribed for at least 10 days depending on the type of injury, with restricted activities up to 3 months postinjury. No complications were seen in this series.

Short bowel syndrome: experimental approach to increase intestinal surface in rats by gastric homologous acellular matrix.

BACKGROUND/PURPOSE: In this preliminary work the authors used homologous acellular matrix obtained by the gastric wall to increase the small bowel surface in Sprague-Downey rats; through this experimental model the authors verified that homologous acellular matrix can support cell migration and the reconstruction of the intestinal wall. METHODS: A tract of about 2 cm of tubular gastric acellular matrix was inserted with bilateral anastomosis in an isolated ileal loop, which was located in endoabdominal position through a short subcutaneous tunnel. Twelve animals were analyzed at each of the time-points ranging from 1 to 6 weeks after surgery. RESULTS: Histologic evaluation showed that the implanted matrix can be reintegrated in the normal small bowel in a period ranging between 3 and 6 weeks from surgery. The implanted matrix was organized with 4 different tonacae from the third week after the surgery, without interruption at the site of the anastomosis. CONCLUSIONS: To date, the authors do not have a demonstration of the function of the ileal loop reconstructed with this technique; based on these results the authors are engaged in an experimental trial of restoration of intestinal viability with the ileal prosthesis after 3 weeks to study its function.

[Surgical treatment of the complications of arteriovenous fistulas in childhood. On 2 unusual cases]. / Trattamento chirurgico delle complicanze nelle fistole A.V. in età pediatrica. Su due casi particolari.

The AA describe two particular complications of arteriovenous fistula for chronic hemodialysis in pediatric age: a king king and a stenosis. In these cases are necessary angiographic studies of the vessels and then, if it is possible, the AA prefer a surgical repair of the same arteriovenous fistula. The other alternatives in these cases are an extensive patch, a new angioaccess or a percutaneous transluminal angioplasty.

[Traumatic pseudodiverticulum of the esophagus. Description of a case in a preterm newborn infant]. / Pseudodiverticolo traumatico dell'esofago. Descrizione di un caso in un neonato pretermine.

A case of traumatic oesophageal pseudodiverticulum in a VLBW preterm infant is reported. Both clinical and radiological findings were suggestive for oesophageal atresia. A medical therapeutic approach, including the use of wide spectrum antibiotics and a regimen of total parenteral nutrition, was initially chosen for her highly premature status and bad clinical conditions (RDS). Nineteen days after birth the passage of orogastric tubes led to a second esophagography that showed a normally canalized oesophagus. The importance of considering the traumatic perforation among the causes of oesophageal obstruction in the neonatal period is stressed along with the safety and effectiveness of its simply medical management.

Functionless non-chromaffin retroperitoneal paraganglioma causing cauda equina compression.

The authors describe a case of functionless non-chromaffin paraganglioma of the retroperitoneal space, that invaded the spinal canal causing a cross section syndrome of the cauda equina. The case is described because of the unusual clinical evolution of the tumour in question, never previously described.

[Steroid therapy of hemangioma in children]. / Considerazioni sulla terapia steroidea degli emangiomi infantili.

Hemangiomata is the more frequent pediatric tumor, absent at birth and usually growing, sometimes very quickly, during the first week of life. It potentially represents a serious problem because of his unforeseeable evolution during the time: is it more useful to use a corticosteroid therapy or to wait for the involution of the tumor? Here we have the results of the treatment on 51 babies who presented with hemangiomas of various sites: 52.6% of the lesions were on the face and head, 13.4% on chest wall, 10% on upper limbs, 4% on abdominal wall, 10% on pelvis region and 10% multiple. Therapy was compression in 10% of patients, corticosteroid injection in 66%, oral administered corticosteroid in 12%, surgery post corticosteroid therapy in 11.5%, others in 2.5%. Best results were obtained on the lesion of the head and face (good in 96%), worst in those of the abdomen (any modification in 100%).

Thyroid tumours in children.

The authors present seven cases of primary tumours of the thyroid in young children (6 cancer, 1 Burkitt's lymphosarcoma) observed between 1968 and 1980. Using recent literature as a basis, diagnostic difficulties, surgical and radiotherapy treatment and the prognosis of these tumours are examined.

[Phimosis: when does it require surgical intervention?]. / Fimosi: quando è patologia di interesse chirurgico?

One of the most recurrent questions in pediatric age is the phimosis; this is a frequently underestimated problem and its resolution often cause a lot of discomforts in babies and parents. In many countries it has been treated on the roots of ancient sanitary measures (circumcision) whereas in others it's routinely treated with painful and useless maneuvers; instead, until three years of age this don't represents a problem but the normal situation of the baby. Herein the authors report the results of topic corticosteroid treatment of fimosis in 83 patients aged 1-14 years, with good outcome in 86.7% of cases. Therapy and results are discussed.

[Usefulness of long-term follow-up of patients operated on for cryptorchidism]. / Utilità del follow-up a lungo termine nei pazienti operati per criptorchidismo.

BACKGROUND: Cryptorchidism, testicular ectopia and rectractile testicle are different pathologies with conceivable different prognosis. As a matter of fact spermiogram used in these patients for the prognosis is really worse in bilateral cryptorchid than ectopic patients, because the tubular damage is present in the former than in the latter. It does not mean, anyway, that direct correlation exists between age of the patient at the operation and fertility. METHODS: 171 patients operated on for cryptorchidism or testicular ectopia at the Pediatric Surgery Department of the Regional Hospital of Treviso during the years 1974-1983 under-went follow-up at the age of 18 years with clinical evaluation, hormonal dosage (testosterone and gonadotropin after stimulus as GnRH) and spermiogram. RESULTS AND CONCLUSIONS: The present study does not differ from many other studies about hormonal levels and spermiograms of cryptorchid patients; it underlines long term follow-up utility of patients operated on for cryptorchidism and stresses the need of an eventual psychological evaluation of these patients.