Treatment of acute appendicitis with one-port transumbilical laparoscopic-assisted appendectomy: a six-year, single-centre experience.

BACKGROUND: Laparoscopic appendectomy is a feasible and safe alternative to open appendectomy for uncomplicated appendicitis. In the past decade several laparoscopic procedures have been described using one or more ports. We report our experience in treating acute appendicitis with one-port transumbilical laparoscopic-assisted appendectomy (TULAA). PATIENTS AND METHODS: We performed 231 TULAA on patients in the period from November 2001 to September 2007. We introduced an 11 mm Hasson's port using open technique; an operative channel with 10 mm telescope and an atraumatic grasper were used. After intra-abdominal laparoscopic dissection, the appendix was exteriorised through the umbilical access. The appendectomy was performed outside the abdomen as in the open procedure; the operation was completed using only one port in 227 patients (98%), two and three ports in two patients (1%) while conversion to open surgery was needed in two patients (1%). RESULTS: The average operating time was 38 minutes and the median time to discharge was three days. Four (1, 7%) early postoperative complications (two suppuration of the umbilical wound) with no major complications were observed. CONCLUSIONS: Our results demonstrate that TULAA, which combines the advantages of both open and laparoscopic procedures, is a valid alternative form of treating uncomplicated appendicitis. If appendectomy cannot be completed with only one port, insertion of one or more ports may be necessary to safely conclude the procedure.

The value of lung scintigraphy in the management of airways foreign bodies in children.

AIM: A retrospective analysis was made to evaluate our experience in the management of tracheobronchial foreign bodies (TFB) in children (age

[Conservative treatment of children constipation with Macrogol 4,000]. / Il trattamento conservativo della stipsi del bambino con macrogol 4000.

AIM: Macrogol 4,000 is one of the new generation's osmotic laxatives. It is constituted by a heavy molecular weight polymer without additional salts. In most of patients Macrogol 4,000 shows its efficacy in 48 hours from the beginning of treatment. Daily evacuations has been reported after first week therapy with an improvement in quality of life. The aim of this observational study was to demonstrate the efficacy of Macrogol 4,000 in the treatment of constipation in children. METHODS: The effect of Macrogol 4,000 was assessed in 120 children affected by constipation treated with therapeutic doses of Macrogol 4,000. The study period ranged from September 2006 to March 2007. The data analysis was collected with the evaluations concerning clinical examination and the consultation of daily diaries assembled by parents, tracking stooling pattern; in case of loosing contacts with the patient, a telephonic survey has been carried out. The child with symptoms improvement, i.e. reduction of the pain during defecation, daily spontaneous evacuations and better stool consistence, were considered ''normal''. RESULTS: Of the 120 patients, 89 returned to the clinical follow-up, while the remaining 31, who missed the follow-up, has been contacted by telephone. To the final analysis, 103 patients (85.8%) have had a normalization of the clinical symptoms, 9 patients (7.5%) have refused Macrogol 4,000 for the unpleasant flavour, 8 patients (6.7%) did not have any improvement from the treatment. CONCLUSION: The results of this observational study suggest that Macrogol 4,000 could be very useful to treat pediatric patients with constipation, also those affected by neuronal intestinal displasia (NID) type B.

[Congenital cysts of the pancreas. A case report]. / Cisti congenite del pancreas. Descrizione di un caso clinico.

The authors report a clinical case of congenital cyst of the pancreas occurred in a female aged 15 months. They stress how this pathology is particularly rare in pediatric age (only 22 cases in the literature) and how it is extremely difficult to formulate a preoperative diagnosis. The young patient was in good general condition with an enormous abdominal tumefaction and without alterations of hematochemical markers. Echographic and tomographic patterns led to four diagnostic hypotheses: a) mesenteric cyst; b) left ovarian cyst or compound ovarian tumor; c) intestinal duplication; d) pancreatic cyst. Only after surgery a correct diagnosis was formulated (on the basis of the topographic position and the intracystic content of amylase and lipase) and a complete resolution of this pathology was obtained. Surgery therefore has the double function of formulating a correct diagnosis and allowing the complete resolution of this pathology. The complete surgical removal of the mass, in view of the benignity of this lesion, is the therapeutic goal.

[A gastric trichobezoar: a report of a clinical case with anomalous presentation]. / Tricobezoar gastrico: descrizione di un caso clinico a presentazione anomala.

The Authors describe a case of a voluminous trichobezoar in a girl 9 years old. The patient was referred for evaluation of abdominal pain that presented after a banal blunt abdominal trauma occurred some days earlier. On physical examination an epigastric mass was detected. For a few days the girl suffered of inappetence and postprandial vomit. She was noted to have thin and sparse hair, thin eyebrows and onychodysplasia: these findings were considered as features of cutaneous adnexa dystrophy. The blood test and other laboratory findings were within normal limits. Abdominal US and UGI series failed to detect the nature of the mass. Therefore the patient underwent gastroscopy that showed a voluminous trichobezoar, so big and hard that gastrotomy was required for removal. The weight of the mass was 700 g; it occupied the whole stomach from fundus to pylorus. Postoperative recovery was uneventful. After discharge the patient was referred to the Neuropsychiatric Service for treatment trichophagia and prevention of recurrence. The most common site of trichobezoar is stomach. Clinical findings are often aspecific. US and UGI series may not allow the correct diagnosis. A rational diagnostic suspicion can arise when alopecia circumscripta is present. Endoscopy remains the elective technique: this procedure can be contemporarily diagnostic and therapeutic. Surgical approach is required only in case of trichobezoar with peculiar size, shape and hardness. We feel that a neuropsychiatric support is necessary to avoid recurrence.

[Hematoma and pulmonary contusion as a consequence of closed injury of the thorax in childhood]. / L'ematoma e la contusione polmonare quale conseguenza di trauma chiuso del torace in età pediatrica.

A personally observed case of internal chest injury is described with emphasis on the clinical and radiological features of the contusion and lung haematoma produced and the relative therapeutic problems.