Endoscopic Injection Treatment of Vesicoureteral Reflux in Children: Meeting with the Factors Involved in the Success Rate.

The challenges and controversies in vesicoureteral reflux intervention guidelines resulted in a more individualized treatment planning. Endoscopic injection therapy is now widely used and is considered preferable, but still remains less successful than ureteral reimplantation. Τhe endoscopic vesicoureteral reflux approach should be risk-adapted to current knowledge, so more experience and longer-term follow-up are needed. The precise of preoperative, intraoperative, and postoperative factors that affecting endoscopic injection therapy success rates and outcome have not yet been clearly determined. The aim of this study was to investigate these associated factors. Although the reflux grade is the most well-known factor that can affect the success of the procedure, there is no agreement on which factors are the most influential for the efficacy of endoscopic reflux treatment. So, we carried out a broad review of published papers on this topic, and we presented all the potential predictive variables of endoscopic reflux resolution in children.

Chest wall lipoblastoma in a 3 year-old boy.

BACKGROUND: Lipoblastoma is a rare, benign, fatty tissue tumor that occurs in infancy and early childhood. The most common tumor locations are the extremities and the torso. The location of this tumor in the chest wall and an intrathoracic extension is uncommon. CASE REPORT: We present a case of a 3-year-old boy with anterior chest wall lipoblastoma with an intrathoracic extension. Computed tomography was suggestive of lipoblastoma. The mass was completely excised through a right posterolateral thoracotomy. The histologic examination of the lesion confirmed the diagnosis of lipoblastoma. CONCLUSION: Although extremely rare, chest wall lipoblastoma should be included in the differential diagnosis of thoracic mass in childhood.

Successful treatment of familial congenital chylothorax by ligation of the thoracic duct: A case report.

A full term boy was admitted with respiratory distress in the fourth week of his life due to spontaneous chylothorax in his right hemithorax. Spontaneous chylothorax occurred previously in a first cousin of the neonate establishing that way the final diagnosis of familial idiopathic congenital pneumothorax. Failure of the conservative treatment consisting of chest tube drainage, discontinuation of oral diet and administration of total parenteral nutrition in combination with octreotide for one month was followed by the successful ligation of the thoracic duct through a right thoracotomy. The boy still remains free of symptoms and without recurrence of the chylothorax two years later.

Dimercaptosuccinic acid scan challenges in childhood urinary tract infection, vesicoureteral reflux and renal scarring investigation and management.

Vesicoureteral reflux (VUR) is a precipitating factor in acute pyelonephritis (APN), and a risk factor for renal scar formation, even if VUR and APN occur independently. There is no scientific evidence on a specific diagnostic evaluation of children after a febrile urinary tract infection (UTI). Based on recent literature and our clinical experience, we reviewed the role of 99mTc dimercaptosuccinic acid (DMSA) renal scan in UTI/VUR imaging. We also reviewed the DMSA challenges and controversies in UTI/VUR management. A DMSA renal scan is the most reliable tool for the establishment of the diagnosis of APN during febrile UTIs acute phase. The "top-down" approach focuses on kidney involvement during UTI rather than on VUR existence, with a goal of diagnosing APN and/or renal dysplasia. Therefore, DMSA is performed before void cysteourethrography (VCUG). Late DMSA scanning should be performed to evaluate the presence of permanent renal scars. DMSA may be considered valuable in the follow-up of children with VUR, in order to detect new renal scarring after breakthrough or recurrent UTIs. An abnormal DMSA scan comprises a risk factor for VUR identification after UTI, for recurrent UTIs, renal damage/scarring, renal function deterioration, and a negative predictive risk factor for VUR improvement and/or spontaneous resolution. An individualized DMSA risk-based dynamic approach may assist physicians on VUR management decisions. DMSA could play an important role in selecting children with UTI/VUR who would benefit from close monitoring and/or early intervention. However, more data are needed for evidence-based guidelines.

Adrenal injuries following blunt abdominal trauma in children: report of two cases.

Adrenal injuries following blunt abdominal trauma are uncommon. Adrenal hemorrhage in children associated with multiple organ injury, which has received little attention in the past, is an increasingly recognized phenomenon in modern trauma centers with the widespread use of abdominal computed tomography. Adrenal trauma occurs in the setting of multisystem organ injury. Isolated adrenal injury is exceedingly rare. We report two children with blunt adrenal trauma (one isolated and one with associated injuries), who were admitted during the last two years to our Pediatric Surgery Department after abdominal trauma. We determined the prevalence, management and general prognosis of blunt adrenal injury in the pediatric population. Traumatic adrenal hemorrhage appears to be an incidental and unsuspected finding that resolves on follow-up imaging.