Heterotopic pancreatic tissue at umbilicus.

Heterotopic pancreatic tissue at the umbilicus is a very rare anomaly with only 4 cases previously reported in the literature: we describe our experience with 2 additional cases.

[Advantages of the systematic combined use of endoscopy, monitored pH measurement and aimed biopsy in the study of gastroesophageal reflux]. / Vantaggi dell'impiego associato sistematico della endoscopia, della pHmetria monitorata e della biopsia mirata nello studio del reflusso gastroesofageo.

The Authors refer their experience using endoscopy, biopsy and 24 hours pHmetry associated in 62 patients with symptomatology of reflux. In 21 cases it was shown different grades of esophagitis, in 12 cases reflux potentially pathological. The Authors refer that this association in studying reflux is very comfortable for every Department.

Bilateral anterior pubic osteotomy in bladder exstrophy repair: report of increasing success.

Bilateral posterior iliac osteotomy is performed in most patients undergoing primary closure of an exstrophic bladder; the aims are to facilitate abdominal-wall closure, prevent postoperative wound dehiscene, and possibly, to achieve better urinary control in older age. A new technique, anterior pelvic osteotomy of the superior pubic ramus, seems to obtain tension-free symphysis approximation safely and quickly. We report our initial experience with this osteotomy. Five neonates, four males and one female from 1 to 4 days old, all underwent closure surgery for bladder exstrophy (BE) and subsequent bilateral osteotomy of the superior pubic ramus (SPRO). Postoperatively, Bryant's traction was applied. Tension-free, complete approximation of the symphysis and uncomplicated healing were achieved in all five cases without palsy of the obturator nerve or postoperative hemorrhage. Follow-up revealed partial rediastasis with a stable anterior pelvic ring. Tension-free closure and immobilization are important factors in both initial and subsequent closure of BE. Several osteotomy techniques are currently in use. SPRO presents numerous advantages, namely, ease and rapidity, minimal blood loss, and no requirement for an extra skin incision or need to turn the patient on the operating table. A certain degree of rediastasis with growth was subsequently observed: although undesirable, this complication is common to all osteotomy techniques. We believe that SPRO is a valid and uncomplicated method to facilitate BE closure.

Abdominoscrotal hydrocele in childhood: is it really a rare entity?

OBJECTIVES: Abdominoscrotal hydrocele (ASH) is an apparently highly uncommon clinical entity especially in childhood, with only about 80 pediatric cases reported in the modern literature. METHODS: The incidence, diagnosis, and treatment of ASH are discussed with reference to 9 cases observed at our institution and to cases in the literature. RESULTS: Surgical correction was successful in all our cases and no hydrocele or hernia recurrence was registered. CONCLUSIONS: ASH incidence appears to be higher than reported; undescended testis is a frequent association and surgical correction through an inguinal approach is always possible and curative. Ligation of the processus vaginalis may prevent recurrence.

Long-term results of ureterosigmoidostomy in children with bladder exstrophy.

PURPOSE: We evaluated long-term results of patients with bladder exstrophy who underwent ureterosigmoidostomy. MATERIALS AND METHODS: Of 4 women and 23 men monitored at our institution 16 (59%) underwent primary diversion by ureterosigmoidostomy, while 11 (41%) underwent primary bladder closure or an ileal conduit procedure before conversion to ureterosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years. RESULTS: Significant upper urinary tract changes developed in 18% of the patients. Metabolic acidosis was well compensated in most patients but 2 had problems with urinary retention leading to hyperammonemia and acidosis. Of the 19 patients monitored with biennial colonoscopy benign polyps were removed in 4. Daytime continence was achieved in 92% of cases and nighttime continence in 58%. CONCLUSIONS: Our experience with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabolic surveillance, biennial colonoscopy and nonsteroidal anti-inflammatory drugs we offer ureterosigmoidostomy as a viable alternative for patients with small bladders.

Perianal granuloma caused by Enterobius vermicularis: report of a new observation and review of the literature.

The literature reports 12 cases of enterobiasis presenting as perianal abscess or granuloma. We describe an additional case of a perianal granuloma containing Enterobius vermicularis eggs in a 5-year-old boy. We suggest routine parasite screening for all children presenting with this condition.

Fortuitous diagnosis of cystic fibrosis at laparotomy for acute appendicitis.

Two children aged 11 and 9 years were operated upon for acute appendicitis and were discovered to have cystic fibrosis: the histologic pattern of the removed appendix was typical for this disorder. Appendicitis may thus be the first presenting sign of occult cystic fibrosis.

Symptomatic unilateral renal angiomyolipoma in a child with tuberous sclerosis.

We report a case of unilateral renal angiomyolipoma in a 10-year-old boy with tuberous sclerosis. The case is worthy of attention because the symptoms occurred at an early age and because the lesion was unilateral, the latter confirmed at 11-year follow-up. The presentation and treatment are discussed, and the pertinent literature is reviewed. The case demonstrates that it is of clinical importance to monitor renal involvement in children with tuberous sclerosis.

Cortical kidney scan evaluation in the follow-up of children with vesico-ureteric reflux.

We present the results obtained in the follow-up of 66 children with vesico-ureteric reflux (VUR) of different grades (111 refluxing renal units, RU; the VUR being bilateral in 47 children), employing the renal cortical agent 99mTc-aprotinin (TcA). Together with the visual inspection of the scan, we adopted a quantitative approach, expressing the results as the split percent uptake of the injected dose. The detection of morphological anomalies was more frequent in the cases of more severe reflux. Scars were noted in 38 RU, with a higher prevalence in more severe grades, except for grade V where severe impairment was more frequent. With regard to the amount of functioning parenchyma, the probability of a significant loss of nephrons (expressed by a low uptake of TcA), rose with the grades, although the higher grades were not invariably associated with parenchymal failure. The abnormality detection rate is higher by about 2:1 with the TcA scan than with other diagnostic modalities such as i.v. pyelography or echography. No differences were found between RU with or without scars as regards evolution over time; only when the TcA uptake at presentation was lower than 10% was the normal development of the RU likely to be hindered. From these data it can be concluded that early diagnosis is the key factor in the management of these children with VUR; the morpho-functional assessment with TcA uptake is probably the most effective technique for the detection of parenchymal abnormalities. In addition, the test has a high prognostic value, an uptake lower than 10% indicating an unfavourable prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The long-term outcome in men with exstrophy/epispadias: sexual function and social integration.

PURPOSE: We evaluated the long-term outcome of social integration and sexual function in 29 men with bladder exstrophy and epispadias. MATERIALS AND METHODS: Four men with epispadias and 25 with bladder exstrophy were available for long-term followup. Patients were interviewed by telephone regarding sexual history and social integration. Semen analyses were obtained in 8 cases. RESULTS: Patient assessment of genital appearance was good or fair in 71%. Potency was present in all patients, and erections were straight in 66% and curved in 34% with no curvature so severe as to prevent sexual intercourse. Semen analysis showed a normal sperm count in 63% of the men and no azoospermia. Social integration was satisfactory: 100% of the men attended high school, 55% have a college education and all who are not attending school have full-time jobs. CONCLUSIONS: Our long-term review demonstrates that despite what appears to be a significant sexual handicap, patients with exstrophy/epispadias can have adequate sexual function and overall successful social integration.