Cascini V.,University of Chieti Pescara |
Lisi G.,University of Chieti Pescara |
Di Renzo D.,University of Chieti Pescara |
Pappalepore N.,Unit of Pediatric Surgery |
Lelli Chiesa P.,University of Chieti Pescara
Journal of Pediatric Surgery | Year: 2013
Abstract Indirect inguinal hernia is the most common congenital anomaly in the pediatric age group. About 15-20% of hernias in infant girls contain ovary, sometimes with a Fallopian tube. The presence of the uterus incarcerated with the adnexa is a very unusual occurrence in female infants with normal kariotype and phenotype, being commonly associated with several disorders of sex development. The surgical repair of this form of hernia is more difficult than a common herniorrhaphy because of the adhesions between the organs and the wall of the sac and the risk of damage during their freeing. We present a rare case of irreducible indirect inguinal hernia containing uterus and bilateral adnexa (fallopian tubes and ovaries) in a premature female infant, discussing the etiopathogenesis and the surgical features of this disorder. © 2013 Elsevier Inc.
Gentile G.,Clinical Research Center for Rare Diseases Aldo e Cele Dacco |
Somma C.,Unit of Nephrology and Dialysis |
Gennarini A.,Unit of Nephrology and Dialysis |
Mastroluca D.,University of Rome La Sapienza |
And 5 more authors.
American Journal of Nephrology | Year: 2015
Background/Aims: In renal transplantation, peri-operative low-dose rabbit-antithymocyte-globulin (RATG) plus basiliximab induction prevented acute allograft rejection more effectively than post-operative RATG plus basiliximab induction. We investigated the specific antirejection contribution of basiliximab in this context. Methods: This single-center, observational, matched-cohort study evaluated allograft rejections (primary outcome), steroid exposure and side effects, GFR (iohexol plasma clearance) and treatment costs in 16 deceased-donor renal transplant recipients induced with RATG (0.5 mg/kg/day) and 32 age-, gender- and treatment-matched reference-patients given RATG plus basiliximab (20 mg on days 0 and 4). Results: Induction was well tolerated. At 18 months, 8 patients (50%) vs. 3 reference-patients (9.4%) rejected the graft [HR (95% CI): 6.53 (1.73-24.70), p = 0.006]. Difference was significant (p < 0.01) even after adjusting for recipient/donor age and gender, cold ischemia time and HLA mismatches. There were 1 antibody-mediated rejection and 2 moderate cellular rejections in patients vs. none in reference-patients (p = 0.032). The median (interquartile range) prednisone cumulative dose was remarkably higher in patients than reference-patients [4.78 (1.12-6.10) vs. 0.19 (0.18-3.81) grams, p = 0.002]. Three patients vs. 24 reference-patients were off-steroid at study end (p < 0.001). Three patients vs. no reference-patient developed new-onset diabetes (p = 0.003). Both inductions similarly depleted B-cells. Outcomes of AZA- vs. MMF-treated participants were similar. GFR was similar in all groups. Compared to MMF, AZA therapy saved ≈ EUR 2,500/year and by month 14.3 post-transplant compensated basiliximab costs. Conclusion: In renal transplantation, basiliximab plus peri-operative low-dose RATG more efficiently prevented allograft rejection than RATG monotherapy, and minimized steroid exposure and toxicity. AZA- vs MMF-based maintenance immunosuppression largely compensated the extra costs of basiliximab. © 2015 S. Karger AG, Basel.
Arena S.,Policlinico di Messina |
Magno C.,Policlinico di Messina |
Montalto A.S.,Unit of Pediatric Surgery |
Russo T.,Unit of Pediatric Surgery |
And 4 more authors.
Scandinavian Journal of Urology and Nephrology | Year: 2012
Objective. Primary megaureter (PM) represents 610% of all antenatal displaced urinary malformations. Spontaneous resolution of PM is a well-known event. This long-term follow-up study evaluated the incidence and rate of resolution of PM. Some predictive factors were revised, based on morphological classification and scintigraphic pattern. Material and methods. Sixty neonates with PM were followed. The diagnosis was confirmed by ultrasound examination and 99mTc-DTPA diuretic renal scan. All the observed patients underwent antibiotic prophylaxis. All conservatively treated children were followed from 6 months to 15 years. Follow-up consisted of monthly urine cultures, renal ultrasound and DTPA diuretic renography. Hydroureteronephrosis was considered to have resolved when a retrovesical cross-sectional diameter of ureter less than 6 mm was found. Results. In total, 72 PM were identified in this series. At the end of the follow-up period, 38 PM (52.8%) had resolved, in 18 PM (25%) ureteral dilatation persisted and 16 PM (22.2%) required a surgical procedure. The median age at resolution was significantly affected by presenting hydronephrosis grade and cross-sectional diameter at diagnosis, but not by gender. The 99mTc-DTPA renogram results showed no functional impairment in resolved and persisting cases, even after long-term observation. Conclusions. The data show that 22% of neonatal PM require surgical treatment. Poor drainage on 99mTc-DTPA scan, grade IVV hydronephrosis and ureteric diameter more than 15.0 mm were statistically significant and independent predictive factors for surgery. The time to spontaneous resolution in neonatally diagnosed PM may exceed 3.6 years, after which recovery is rare. © 2012 Informa Healthcare.
Comploj E.,Central Hospital of Bolzano |
Cassar W.,Central Hospital of Bolzano |
Farina A.,Bambino Gesu Childrens Hospital |
Gasparella P.,Unit of Pediatric Surgery |
And 6 more authors.
Journal of Pediatric Urology | Year: 2013
Objective Renal abscesses in the paediatric patient population are a rare entity. Patients are usually treated with percutaneous surgical drainage of the renal abscess as conservative treatment with broad-spectrum antibiotics is not considered as effective. We describe the conservative management of renal abscesses without percutaneous drainage in 6 children. Materials and methods Six patients with a median age of 31 months, admitted over a 6 year period at two medical centers, were retrospectively studied. All patients were treated conservatively. Results In all patients, the abscesses were solitary, unilateral and located in the right kidney. The median abscess diameter was 38 mm. The diagnosis was made by ultrasonography. All 6 children were treated conservatively with a urinary catheter or suprapubic catheter and broad-spectrum antibiotics. None of the renal abscesses were surgically or percutaneously drained. Conclusions A series of 6 paediatric renal abscesses, all successfully treated without surgical intervention, is presented. We believe that, in carefully selected cases, renal abscesses can be managed without percutaneous drainage. Furthermore, all children had complete resolution of the abscess.