A. Pini Prato

A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula

BACKGROUND Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.

Histologic study of peritoneal adhesions in children and in a rat model

Abstract.Peritoneal adhesions (PA) represent a major cause of morbidity in pediatric surgical patients. The pathogenesis is still largely unknown. A possible role could be played by foreign bodies (FB) accidentally contaminating the operative field during surgery. We report a histologic study of PA in a rat model and in children, investigating the role of FB in their formation. Abdominal adhesions were studied in 18 rats. In 6 (group A) we performed a laparotomy and rubbed the visceral and parietal peritoneum with a cotton bud. In 6 (group B) we performed a minimal laparotomy and injected powdered autologous and heterologous material into the peritoneal cavity, avoiding any peritoneal abrasions. In 6 (group C) we performed a laparotomy and applied both treatment methods, i.e., rubbing and injection of FB. After 1 month, at autopsy rats were classified according to the presence and grade of surgical adhesions. Twenty-two PA were also collected from seven children undergoing abdominal surgery in whom one or more procedures had been previously performed. The adhesions were stained with hematoxylin-eosin and Giemsa stains for histologic examination. Adhesions were found in 4 rats of group A and all 6 rats of group C. None were identified in group B. Group C rats showed a higher grade of adhesions with respect to group A. In both humans and animals PA were always found to coexist with microscopic particles of solid substances, which were incorporated inside the connective tissue. However, after simple injection of FB into the abdominal cavity we did not observe any PA. These data suggest that two different stimuli are necessary for adhesion formation: a direct lesion of the mesothelial layers and a solid substrate (FB). We underline the importance of reducing contamination with FB during surgery. On the basis of these considerations, the laparoscopic approach seems to be particularly pertinent.

Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children: A 20-month preliminary experience with 109 procedures

Ultrasound‐guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20‐month experience with this approach in children.

Urinary Diversion in Infants with Primary High-Grade Vesicoureteric Reflux, Urinary Sepsis and Renal Function Impairment

Introduction: General consensus on the optimal treatment of septic infants with primary high-grade vesicoureteric reflux (VUR) and renal function impairment has not been reached. Our study aims at evaluating the role of temporary urinary diversion. Materials and Methods: Twenty male infants, affected by sepsis and primary high-grade VUR, underwent urinary diversion in 1996–2001 because of estimated risk of renal function deterioration, due to non-compliance with the antibiotic treatment. Plasmatic creatinine clearance, ultrasonography, micturition cystography and scintigraphy were evaluated. Results: Creatinine clearance was abnormal in 13 infants on admission, in 10 after urinary diversion and in 6 after second surgery. Renal damage (focal or diffuse) was evident in 16 patients, without modifications after surgery. No patient developed urinary tract infections (UTI). Vesicostomy was done in 12 cases, ureterostomy in 8. Nephrectomy was performed in 3 cases with poor renal function, and ureteroneocystostomy in 17. Conclusions: Urinary diversion in septic infants with high-grade VUR can represent an alternative approach to the conservative or surgical treatment in selected patients presenting risk of renal function impairment. This procedure allowed an easy management of UTI without worsening of renal function while waiting for a better anatomical status to perform reconstructive surgery.