The role of mini-PCNL as primary approach for the treatment of pediatric kidney stones in a high-income country. Ten-year single-center report.

PURPOSE: To describe our experience in the use of percutaneous nephrolithotomy (PCNL) as a primary treatment for paediatric kidney stones and to highlight its benefits. METHODS: The design was retrospective and observational. All the children treated for kidney stones from 2011 to 2021 were included. The population was divided into Group A (PCNL) and Group B (retrograde intrarenal surgery, RIRS). The outcomes were stone-free rate (SFR), the rate of procedures per patient, the rate of failure and the rate of complications. RESULTS: Twenty-eight patients with 33 kidney units were included. Eighteen of them (64%) were males. The median age was 10 (IQR 6.8-13) years. Forty-seven procedures were performed. Twenty-four of them (51%) were mini-PCNL. Group A included 17 patients (61%). Group A presented a higher SFR (p = 0.007) and a lower number of procedures (p < 0.001). RIRS failed in five cases (45%) because of non-compliant ureter. Two urinary tract infections (UTI) were reported after PCNL and four UTIs after RIRS (p = 0.121). No major complications were reported. CONCLUSION: Mini-PCNL should be suggested as a primary approach for pediatric kidney stones. This technique presented a better effectiveness with a reduced number of procedures when compared to RIRS.

Drug-Induced Urolithiasis in Pediatric Patients.

Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi.

Effect of infusion of spices into the oil vs. combined malaxation of olive paste and spices on quality of naturally flavoured virgin olive oils.

Olive oil flavouring with aromatic plants and spices is a traditional practice in Mediterranean gastronomy. The aim of this work was to compare the influence of two different flavouring techniques (infusion of spices into the oil vs. combined malaxation of olives paste and spices) on chemical and sensory quality of flavoured olive oil. In particular, oxidative and hydrolytic degradation (by routine and non-conventional analyses), phenolic profiles (by HPLC), volatile compounds (by SPME-GC/MS), antioxidant activity, and sensory properties (by a trained panel and by consumers) of the oils were evaluated. The obtained results evidenced that the malaxation method was more effective in extracting the phenolic compounds, with a significantly lower level of hydrolysis of secoiridoids. As a consequence, antioxidant activity was significantly lower in the oils obtained by infusion, which were characterized by a higher extent of the oxidative degradation. The volatile compounds were not significantly influenced by changing the flavouring method, apart for sulfur compounds that were more abundant in the oils obtained by the combined malaxation method. From a sensory point of view, more intense bitter and pungent tastes were perceived when the infusion method was adopted.

Comparison Between Different Flavored Olive Oil Production Techniques: Healthy Value and Process Efficiency.

Three different flavoring methods of olive oil were tested employing two different herbs, thyme and oregano. The traditional method consist in the infusion of herbs into the oil. A second scarcely diffused method is based on the addition of herbs to the crushed olives before the malaxation step during the extraction process. The third innovative method is the implementation of the ultrasound before the olive paste malaxation. The objective of the study is to verify the effect of the treatments on the quality of the product, assessed by means of the chemical characteristics, the phenol composition and the radical scavenging activity of the resulting oils. The less favorable method was the addition of herbs directly to the oil. A positive effect was achieved by the addition of herbs to the olive paste and other advantages were attained by the employment of ultrasound. These last two methods allow to produce oils "ready to sell", instead the infused oils need to be filtered. Moreover, the flavoring methods applied during the extraction process determine a significant increment of phenolic content and radical scavenging activity of olive oils. The increments were higher when oregano is used instead of thyme. Ultrasound inhibited the olive polyphenoloxidase, the endogenous enzyme responsible for olive oil phenol oxidation. This treatment of olive paste mixed with herbs before malaxation was revealed as the most favorable method due to the best efficiency, reduced time consumption and minor labor, enhancing the product quality of flavored olive oil.

Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology.

INTRODUCTION: Treatment of pediatric malignancies is becoming progressively more complex, implying the adoption of multimodal therapies. A reliable, long-lasting venous access represents one of the critical requirements for the success of those treatments. Recent technical innovations-such as minimally invasive procedures for placement, new devices and novel materials-have rapidly spread for clinical use in adult patients, but are still not consistently used in the pediatric population. METHODS: The Supportive Therapy Working Group of Italian Association of Hematology and Oncology (AIEOP) reviewed medical literature focusing on new aspects of central venous access devices (VADs) in pediatric patients affected by oncohematological diseases. RESULTS: Appropriate recommendations for clinical use in these patients have been discussed and formulated. CONCLUSIONS: The importance of the correct choice, management and use of VADs in pediatric oncohematological patients is a necessary prerequisite for an adequate standard of care, also considering the increased chances of cure and the longer life expectancy of those patients with modern therapies.

Comparação do desfecho de pacientes idosos muito idosos e jovens idosos internados com fratura de femur no HSPM / Comparison of outcome of very elderly and young elderly patients hospitalized with femoral fracture at HSPM

As fraturas de fêmur em idosos são um problema de saúde pública em todo o mundo. Além da alta taxa de mortalidade, estes pacientes necessitam de cuidados médicos intensivos e reabilitação funcional por longos períodos, gerando um alto custo para o sistema público. Os fatores mais relacionados com um aumento da mortalidade são: funcionalidade prévia a fratura, gênero masculino, idade, e o American Society of Anestesiology (ASA) escore. Objetivo: O objetivo deste trabalho foi comparar dois tipos de idosos maiores de 80 anos e jovens idosos, ou seja, menores de oitenta anos, internados por fratura de fêmur no Hospital do Servidor Público Municipal de São Paulo em relação ao desfecho cirúrgico e clínico, às condições pré e pós-operatórias, condições sociais e funcionais. Método: Foram analisados 17 pacientes idosos internados por fratura de fêmur no HSPM, no período de junho a agosto de 2014, através de entrevista com o paciente ou familiares e revisão de prontuários. Os participantes foram divididos em dois grupos de acordo com idade, um grupo de pacientes acima de 80 anos e outro de menos de 80 anos e foram analisadas as seguintes variáveis: local de queda, funcionalidade prévia, comorbidades, número de fármacos utilizados, complicações peroperatórias, tipo de fratura, tipo de tratamento cirúrgico e desfecho final. Resultados: A média de idade foi 75 anos. A maior parte dos pacientes era do sexo feminino (76%), 29% moravam sozinhos, 88,2% eram independentes para ABVDs e 70,6% independentes para AIVDs. Mais da metade dos pacientes apresentavam mais de duas comorbidades (64,7%). Não houve associação entre o número de comorbidades e a idade (p=0,031). Apenas 29% dos pacientes relataram ter osteoporose e 6% do total dos pacientes faziam uso de alguma droga antiosteoporótica. Quanto ao consumo de fármacos, 9 pacientes faziam uso de 3 ou mais drogas (47%), não teve relação de consumo de fármacos com a idade. O principal local da queda foi no próprio domicilio (59%). O tipo de fratura mais comum foi fratura de colo de fêmur (47,1%), seguida por fratura trans trocanteriana (41,2%) e fratura de diáfise de fêmur (11,8%). Apenas um paciente foi submetido ao tratamento conservador. O tempo decorrido da internação até a abordagem cirúrgica foi em 64,3% dos pacientes com mais de 96 horas. Estatisticamente, os pacientes com mais de 80 anos não apresentaram maior número de complicações pré (p=0.058) ou pós-operatórias (p=0.067) em relação aos pacientes com menos de 80 anos. Conclusão: Não houve diferença significante em relação ao tratamento da fratura de fêmur (cirúrgico x conservador) nos idosos muito idosos e jovens idosos

Comparação do desfecho de pacientes idosos muito idosos e jovens idosos internados com fratura de fêmur no Hospital do Servidor Público Municipal de São Paulo / Compared the outcome of very old elderly and older people hospitalized with hip fracture at the Hospital of the Municipal Public Servant of São Paulo

As fraturas de fêmur em idosos são um problema de saúde pública em todo o mundo. Além da alta taxa de mortalidade, estes pacientes necessitam de cuidados médicos e reabilitação por longos períodos, gerando um alto custo para o sistema público. O objetivo deste trabalho foi comparar dois tipos de idosos maiores de 80 anos e jovens idosos, ou seja, menores de oitenta anos, internados por fratura de fêmur no HSPM-SP. Foram analisadas as seguintes variáveis: local de queda, funcionalidade prévia, comorbidades, número de fármacos utilizados, complicações perioperatórias, tipo de fratura, tipo de tratamento cirúrgico e desfecho final. A média de idade foi 75 anos, grande parte do sexo feminino (76%), 29% moravam sozinhos, 88,2% eram independentes para ABVDs e 70,6% independentes para AIVDs. Mais da metade dos pacientes apresentavam mais de duas comorbidades (64,7%). Não houve associação entre o número de comorbidades e a idade (p=0,031). Apenas 29% dos pacientes relataram ter osteoporose e 6% do total dos pacientes faziam uso de alguma droga antiosteoporótica. Quanto ao consumo de fármacos, 9 pacientes faziam uso de 3 ou mais drogas (47%), não teve relação de consumo de fármacos com a idade. O principal local da queda foi no próprio domicilio (59%). O tipo de fratura mais comum foi fratura de colo de fêmur (47,1%), seguida por fratura transtrocanteriana (41,2%) e fratura de diáfise de fêmur (11,8%). Apenas um paciente foi submetido ao tratamento conservador. O tempo da internação até a abordagem cirúrgica foi em 64,3% dos pacientes com mais de 96 horas. Os pacientes com mais de 80 anos não apresentaram maior número de complicações pré (p=0.058) ou pós-operatórias (p=0.067) em relação aos pacientes com menos de 80 anos. Não houve diferença significante em relação ao tratamento da fratura de fêmur (cirúrgico x conservador) nos idosos muito idosos e jovens idosos

Working towards the development of innovative ultrasound equipment for the extraction of virgin olive oil.

Malaxation has been recognized as one of the most critical points in the mechanical extraction process for virgin olive oil (VOO). It is a low and continuous kneading of olive paste at a carefully monitored temperature. Through this essential technological operation the small droplets of the oil formed during the milling merge into large drops that can be easily separated with a decanter centrifuge. During this technological phase, a complex and necessary bioprocess takes place in order to determine the quality and composition of the final product. The malaxer is a heat exchanger characterized by a low overall heat transfer coefficient because the ratio of surface area to volume is disadvantageous, so it is important to find an innovative technology to improve heat-exchange. As matter of fact, the malaxing step is the only discontinuous phase in a continuous extraction process. In the next future, the essential challenge of VOO industrial plant manufacturing sector is to design and build advanced machines in order to transform the discontinuous malaxing step in a continuous phase and improve the working capacity of the industrial plants. In order to reduce the malaxing time enhancing the quality of the product, two ultrasound-assisted virgin olive oil extraction processes were tested against the traditional method. The sonication treatment was applied on olives submerged in a water bath (before the crushing) and on olive paste (after the crushing). The ultrasound technology provides a reduction of the malaxing duration improving VOO yields and its minor compounds content. Better extractibility and higher minor compounds contents were obtained by sonicating the olives submerged in a water bath than olive paste. After experimental trials the results were employed to suggest innovative scaling up solutions of the process and new applications of ultrasounds in the VOO industry.

A case of frozen pelvis: primary actinomycosis of urinary bladder in a young boy.

We report a case of urinary bladder actinomycosis in childhood. In children abdominal actinomycosis is rare and unlikely involves the urinary tract, so it is often misdiagnosed. An 7-year-old boy was referred to a secondary level hospital because of abdominal pain and dysuria. Physical examination revealed a left hypochondrial mass. Hypothesizing a pelvic rhabdomyosarcoma, a biopsy with mini-laparotomy access was performed. The first histopathological analysis did not show any malignant cells, and a 14-day antibiotic course was ineffective. Reoperation and biopsy was needed, and the histopathological examination made the diagnosis possible.

Bilateral xanthogranulomatous funiculitis and orchiepididymitis in a 13-year-old adolescent boy.

Xanthogranulomatous orchitis is an extremely rare inflammatory nonneoplastic lesion of the testis. We report a case of a 13-year-old adolescent boy who presented a painless left hemiscrotal swelling. The subsequent ultrasonography and magnetic resonance imaging revealed the presence of abnormal expanding tissue located in both testes and spermatic cord, reaching the internal inguinal ring. Testicular tumor markers were normal. The frozen section examination of the surgical specimen showed only inflammatory tissue and not neoplastic tissue. No orchiectomy was performed. Definitive histopathologic diagnosis was xanthogranulomatous inflammation. To our knowledge, this is the youngest case of xanthogranulomatous orchiepididymitis and funiculitis found in medical literature.

Once-daily intrapleural urokinase treatment of complicated parapneumonic effusion in pediatric patients.

In this paper, we describe our experience in the treatment of childhood empyema using urokinase. Patients' ages ranged from 2 to 12 years. Urokinase (dosage: 3,100 IU/kg/day) was diluted in normal saline to produce 1000 IU/ml (maximum dosage 100,000 IU in 100 ml of normal saline). After 2 hours, the clamped catheters were released and connected to water-seal suction at a negative pressure of 10 cm H2O. Pleural irrigations were continued once a day until thoracostomy tube output decreased to less than 10 ml/day (urokinase treatment mean duration: 11.5 days). The complete resolution of the chest effusion was assessed on chest ultrasound scan and radiographs. None of the patients experienced any side effects due to urokinase. It would now seem reasonable to advocate small chest tube thoracostomy and intrapleural urokinase as first-line treatment of pleural empyema in children, with surgery indicated as a secondary intervention.

Three small testes in left hemiscrotum: a rarer case of polyorchidism.

Polyorchidism is a rare congenital anomaly. A review of literature has yielded about 100 cases. We describe a rarer case of polyorchidism consisting of 3 testes on left hemiscrotum and one normal testis in right hemiscrotum. Diagnosis and management are discussed.