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.

[Lichen sclerosus in children with phimosis]. / Il lichen sclerosus in bambini con fimosi.

AIM: Lichen sclerosus, also known as lichen atrophicus, balanitis xerotica obliterans and kraurosis vulvae, is a chronic limphocytes-depending dermatitis predominantly found in the anogenital area of any age group, sex or race. It is most commonly found in Caucasian women: the female to male ratio ranges from 6:1 to 10:1. The real incidence of the disease observed in the literature depends remarkably on the age and sex group studied. The incidence in the pediatric population ranges from 10-15% to nearly 95% if we consider only boys with truly sclerosed and stenotic foreskins. METHODS: Our purpose is to evaluate the incidence of lichen sclerosus in a pediatric population with phimosis examinated from January 2001 to December 2004 in the Pediatric Surgery Department of Ferrara. RESULTS: Seventy-nine patients were circumcised: 71 because of a severe phimosis and associated problems such as disuria, urinary obstruction or balanitis and 8 to prevent urinary tract infections in children with vesico-ureteral reflux. Of the patients with severe phimosis 26 (36.6%) showed histologic evidence of lichen sclerosus of the foreskins. In the other group there was no evidence of lichen sclerosus of the prepuce. CONCLUSIONS: After the circumcision no recurrence of the disease has been observed.

Amputation neuroma following a circumcision: a case report.

We present a case of neuroma formation following the circumcision of an 11-year-old boy. Amputation neuroma is an extremely rare clinical finding. In the literature only a few cases of amputation neuroma have been reported, mainly located in the biliary tract, in the cystic duct, or in the main hepatic duct after cholecystectomy [1, 4, 8]. There are also few reported cases localised at the orbit, on the great auricular nerve [2], and in the neck after radical neck dissection for oral cancer [5, 7]. Neuroma formation has also been reported after digital amputation [6]. The only reported case of genital amputation neuroma is in a 27-year-old infibulated African woman [3].

Fishbone ingestion: two cases of late presentation as pediatric emergencies.

The authors report 2 cases of pediatric emergencies caused by fishbone ingestion. In the first case, 2 fishbones within the sac of an inguinal hernia were detected during an emergency operation for suspected testicular torsion; in the second case, a big fishbone was found in the omentum covering an inflammed appendix during an emergency appendicectomy. In some cases this three foreign bodies can be detected with a simple abdominal X-ray; the relationship between the fish species involved and the diagnosis is discussed.

[Thyroglossal duct cysts: a retrospective study]. / Le cisti del dotto tireoglosso. Studio retrospettivo.

BACKGROUND: Thyroglossal duct cysts are in second place after goitre as a cause of anterior neck mass in paediatric age. The essentially clinical diagnosis is made on the basis of the observation of an asymptomatic mass, in most cases between the ages of 3 and 5. In this study we re-examined the cases of thyroglossal duct cyst which underwent surgical correction at our Operative Unit in the last 25 years, with particular attention to the factors involved in the recurrences. METHODS: Patients studied numbered 76 with average age at the first operation of 5.3 years; diagnosis was based on clinical and echographic criteria. In 42% of patients one or more episodes of inflammation or suppuration characterised the clinical history. All operations were carried out according to Sistrunk's technique. Follow-up varied from 6 months to 25 years. RESULTS: The percentage of recurrences was 11.8%. The percentage of cysts with inflammation was similar in the group of recurrences and in that of non-recurrences. CONCLUSIONS: In conclusion, in the presence of a radical surgical intervention, the existence of inflammation does not significantly influence the incidence of recurrence. This radicality should be understood both in the sense of depth (exeresis of the hyoid bone) and in the sense of laterality (removal of the lateral ramifications starting from the main residual duct).

Carcinoid tumors of the appendix in children.

We report ten cases of carcinoid tumor of the appendix observed in children from 1988 to 1996. The patients included six females and four males with an average age of 13 years at presentation. They were admitted after complaining of pain in the lower abdominal quadrant. In eight children who presented with symptoms of acute appendicitis, the tumor was located at the tip of the appendix. Diagnosis was performed after appendicectomy (AE) and pathologic examination, which revealed a tumor slightly under 1 cm in size. Two other children were admitted with clinical signs of peritonitis due to larger tumors measuring more than 2 cm on the base of the appendix. One patient underwent a cecectomy, the other a right hemicolectomy. For all patients follow-up was 3 years, and all recovered fully. According to these findings and a review of the literature, we suggest conservative surgical procedures in children. More than 70% of these tumors are localized at the tip of the appendix and represent an incidental pathologic finding during AE; AE alone is curative. Patients with a bulky tumor of the appendicular base measuring 2 cm and invading the serosa and mesoappendix without metastases may be treated with a cecectomy; ileocecal resection may be indicated in cases where the tumor has infiltrated tissue beyond the cecum with localized metastases and in patients with incomplete gross resection. Right hemicolectomy is questionable in this age group and restricted to rare conditions.

Morgagni-Larrey hernia correction by laparoscopic surgery.

A new method of closure of Morgagni-Larrey hernia by video-assisted surgery is described in a child. Laparoscopy could in our opinion be an advantageous method for treatment of diaphragmatic defects.

[Pulmonary decortication through thoracoscopy in pediatric age]. / La decorticazione polmonare per via toracoscopica in età pediatrica.

The authors present the case of a 14 year old child who was successfully treated by pulmonary decortication with video-assisted thoracoscopy. Thoracoscopy caused less postoperative pain then open thoracoscopy, although it allows visualization of the entire pleural cavity. In our opinion an early use is indicated.

Intraoperative scrotal expansion before prosthesis insertion.

The use of an intraoperative sustained limited expansion (ISLE) tissue expander before placing a testicular prosthesis in a hypoplastic scrotum is described.

Malignant melanoma in a three-year-old child.

Malignant melanoma is an uncommon tumor in childhood. We report on a case occurring in a 3-year-old child with congenital multiple melanocytic nevi.

[Transplantation of the left lung in a 2-month-old piglet. The Study Group for Lung Transplantation]. / Il trapianto di polmone sinistro nel suinetto di due mesi. Gruppo di Studio per il Trapianto di polmone.

Experimental surgery in animals remains an irreplaceable model for the clinical application of a new technique. We performed a single lung allotransplantation in young pigs. The pigs were organized into groups: 1) 6 to assess the surgical anatomy; 2) 10 to receive left transplantation; 3) 3 to study the pathophysiology of the transplanted lung. The preliminary results demonstrated that the surgical model is useful.

[Sickle cell anemia in surgical patients. Significance and problems]. / La falcemia nel paziente chirurgico. Significato e problemi.

Drepanocytosis, a disease notoriously widespread among blacks, is surprisingly frequent in certain Italian islands. Surgical aspects of the disease are discussed: erythrocyte sequestration attacks, pigmentary cholelithiasis, priapism, malleolar ulcers and vaso-occlusive attacks. A knowledge of such aspects is considered fundamental for the purposes of a reasoned differential diagnosis in the field of paediatric pathologies requiring surgery.