A prospective study in children: Pre- and post-surgery use of vitamin E in surgical incisions.

BACKGROUND: One of the main problems of elective surgery is the cosmetic result. OBJECTIVE: This prospective controlled study aims to determine the effects of topical vitamin E on cosmetic results in children. METHODS: A single-blind study was carried out. Topical vitamin E was used on the intended incision site for at least 15 days, thrice daily, before surgery and for at least 30 days, twice daily, after surgery (group A). The control group received topical petrolatum-based ointment (group B). RESULTS: No patients in group A developed keloids. A total of 96% of patients (or parents) considered the cosmetic results very good. No patients had wound infection. In the control group, only 78% of patients (or parents) considered the cosmetic results very good and 13 (6.5%) patients developed keloids after 6 months. There were no cases of wound infection. CONCLUSION: Topical vitamin E before and after surgery improved surgical wound healing and improved cosmetic results.

Recurrent abdominal pain due to buckshots in the appendix.

UNLABELLED: Ingestion of foreign bodies is a common paediatric problem, with more than 100,000 cases occurring each year. The majority of these objects are radiopaque. This paper reports a case of elective appendectomy in a patient with unknown ingestion of buckshots affected by recurrent abdominal pain. Plain abdominal films and ultrasound scans showed that the foreign bodies were located in the right lower abdominal quadrant, more specifically in the appendix. CONCLUSION: Foreign bodies in the appendiceal lumen may cause inflammation, perforation and peritonitis. Surgery seems to be the only effective therapeutic approach to foreign bodies in the appendix.

Relationship between varicocele grade, vein reflux and testicular growth arrest.

The development of testicular hypotrophy (or testicular growth arrest) in pediatric patients with varicocele is the first indication for surgery. The aim of this study is to identify the correlation between grade of varicocele, grade of vein reflux and testicular growth arrest. Between 2000 and 2001, we recruited 226 patients affected by varicocele without testicular hypotrophy and with grades 2-3 spermatic vein reflux observed during Doppler velocimetry. Medical examinations carried out every 6 months allowed the assessment of varicocele grade, testicular volume, and grade of vein reflux. Other parameters considered in the study were: mean time of grade deterioration, mean time to onset of testicular growth arrest and the relationship between varicocele grade and testicular growth arrest. Deterioration of the condition was experienced in 92 patients (40%) in which 60 patients showed higher varicocele grades without testicular growth arrest, while 32 patients developed testicular growth arrest. There was a statistically significant relationship between testicular growth arrest and varicocele grades (grade 2 and 3) and between grade of reflux and testicular growth arrest. Although it is not possible to determine which patients will develop testicular growth arrest, the assessment of vein reflux allows the identification of those subjects who may potentially develop such a condition.

Longitudinal study of semen quality in adolescents with varicocele: to treat or not?

OBJECTIVES: To assess the role of varicocelectomy in pediatric patients through a careful semen analysis. METHODS: A total of 214 patients with grade 2 and 3 left idiopathic varicocele were enrolled. Of these 214 patients, 106 (group 1) were treated surgically for testicular hypotrophy, 54 (group 2) were treated surgically with a normal testis, and 54 with a normal testis (group 3) were observed with follow-up visits every 6 months. The spermiogram results for each group were divided into two subgroups: normal, if they met the evaluation criteria and abnormal in the remaining cases. RESULTS: The spermiogram analysis for groups 1 and 2 showed no statistically significant difference in terms of normal and abnormal spermiogram findings (P >0.01). Even though the patients included in group 3 had reported no testicular hypotrophy or pain, the qualitative semen analysis showed the same trend observed in patients affected by varicocele, but the difference was not statistically significant in the variables considered for the other groups (P >0.01). Preservation of the testicular artery in patients with hypotrophy was associated with better results in terms of semen quality. CONCLUSIONS: Testicular hypotrophy remains the most objective indication for surgical treatment of varicocele, and preservation of the testicular artery gives better results in terms of semen quality only in patients affected by testicular hypotrophy.

Varicocele and adolescents: semen quality after 2 different laparoscopic procedures.

The aim of this prospective study was to assess long-term functional results (spermiograms) in subjects who underwent laparoscopic varicocelectomy via either of 2 procedures (ligation or preservation of testicular artery). A total of 122 patients underwent laparoscopic varicocelectomy performed via either of the 2 different procedures: complete ligation of the spermatic vessels or preservation of the spermatic artery. After surgery when patients achieved 18 years, they were asked to undergo semen analysis. Spermiogram results were divided into 2 subgroups: "normal" and "abnormal." We analyzed volume, sperm count per mL, percentage of motile spermatozoa, percentage of normal spermatozoa, and percentage of vitality for each group. Both groups showed the same results in terms of "normal" and "abnormal" spermiograms (World Health Organization criteria), but analysis showed higher sperm concentration per mL, sperm motility, volume, vitality, and rate of morphologically normal sperm for the group with arteries preserved and "normal" spermiograms (P < .01). Analysis of data from the spermiograms showed that preservation of the testicular artery was the best possible option in terms of semen quality. Therefore, we believe that surgical treatment of varicocele should be carried out using procedures involving artery preservation.

Phimosis and topical steroids: new clinical findings.

Phimosis has been defined as unretractable foreskin without adherences and/or a circular band of tight prepuce preventing full retraction. The aim of this study is to evaluate the efficacy (response rate) of topical steroids for the treatment of tight phimosis at different age stages. After using the same medication with different dosage schemes, a retrospective analysis was carried out to assess the efficacy of topical steroids in the treatment of tight phimosis. Patients were divided into three groups: group A (betamethasone scheme A), group B (betamethasone scheme B) and group C (control group). Remission of phimosis, with a complete exposure and without a narrowing behind the glans, was considered a complete response to treatment. The outcomes were then related to dosage scheme and patient's age. The dosage for group A was more effective than the dosage for groups B and C (control group). Phimosis resolved in 90% (group A), 72% (group B) and 56% (group C) of cases. A successful treatment was closely related to the age of patients at the beginning of steroid application. The results showed that treatment with topical steroids, which in general gives good results, proved to be much more successful in patients aged between 4 and 8 years, suggesting the efficacy of an early beginning of the treatment.