Alberto Ottolenghi

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.

Varicocele and Retrograde Adrenal Metabolites Flow

Background: Idiopathic varicocele is one of the causes of potentially correctable male subfertility. The mechanisms causing spermatogenesis impairment have yet to be clarified. The aim of this study is to analyze the effects of renal and adrenal metabolite reflux on testicular exocrine function in a rat experimental model. Materials and Methods: In the study, 45 male Lewis Stock adult rats, each weighing 300 g, were used. The rats were subdivided into three groups of 15 rats. In group A (control group) testicular volume and basal follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were measured at the beginning of the study and after 9 months. In group B, varicocele was induced by means of rings introduced in the left renal vein in order to cause a renospermatic reflux. In group C, similarly to group B, varicocele was induced after removal of left adrenal gland. The effects of varicocele on testicular function were then analyzed 3, 6 and 9 months after surgery. After 9 months, all rats underwent testicular biopsy. Results: Both groups B and C showed a reduction in testicular volume, an increase in FSH and a decrease in testosterone levels. These levels were higher in group B. Testicular histological assessment showed important structural abnormalities in group B rats. Conclusions: These data support the hypothesis that renal and adrenal metabolites enhance varicocele-induced testicular damage. This theory is supported both by hormonal impairment and testicular histological analysis.

Testicular Catch-up Growth After Varicocelectomy: Does Surgical Technique Make a Difference?

OBJECTIVES Catch-up growth of the affected testis in adolescents after varicocele repair has been well documented. Many investigators have found evidence that testicular hypotrophy related to varicocele can be reversed by early intervention. The aim of this study was to analyze the testicular catch-up growth rate in pediatric patients, correlating it with patient age at surgery, varicocele size, procedures used, and semen quality. METHODS Between March 1990 and September 2006, a total of 465 varicocelectomies were performed at our department. We evaluated the mean testicular volume before and after varicocelectomy in patients aged 9-14 years. Two procedures were used: laparoscopic artery-preserving varicocelectomy (group 1) and open inguinal microscopic artery-preserving varicocelectomy with a venous-venous bypass (group 2). The testicular volume was measured before and after surgery using ultrasonography, and the mean testicular catch-up growth was recorded. RESULTS Although the overall catch-up growth rate for both groups was 80%, after 18 months, only 45% of patients in group 1 and 34% of patients in group 2 had equal bilateral testicular volume. None of these procedures showed a statistically significant correlation with age at surgery, varicocele size, or catch-up rate. The semen analysis results did not show statistically significant differences between the 2 groups. CONCLUSIONS Although 80% of patients demonstrated testicular catch-up, with a different distribution depending on the procedure type used but without statistically significant differences, only 32% of patients had complete and real testicular volume catch-up.

Secondary omental torsion in children: report of two cases and review of the literature.

Abstract Torsion of the greater omentum (TGO) may be due to a congenital abnormal attachment of its free edge. There are no specific symptoms that allow a preoperative differential diagnosis of this condition from common pathologies such as acute appendicitis. Attachment of the omentum to the large bowel and the absence of concomitant diseases make it possible to distinguish TGO secondary to a congenital attachment anomaly from omental infarction, primary TGO, and TGO secondary to an acquired attachment anomaly (attachment to cysts, tumours, hernias, surgical scars, or perforated bowel segments). Resection of the ischaemic portion of the omentum permits complete resolution of the clinical symptoms. The authors report two cases of TGO in children due to abnormal attachment of the greater omentum to the ascending and transverse colon, respectively.

Painful varicocele in pediatric age: is there a correlation between pain, testicular damage and hormonal values to justify surgery?

PurposePain is one of the indications to treat varicocele at any age. The purpose of this study is to find a possible correlation between pain and objective testicular damage through the analysis of hormonal values.MethodsBetween 1990 and 2001, varicocelectomy was performed on 44 adolescents with painful varicocele using two different techniques. Thirty-eight patients were eligible for the study. Pre- and post-operative hormonal values were analyzed retrospectively to find a possible correlation between pain and testicular damage or discomfort. The patients had to fill out a simple questionnaire about their type of pain following a two-grade rating scale. After treatment, relief of pain or persistence of symptoms were recorded.ResultsSix months after surgery 26 patients showed complete relief of pain. There was not a statistically significant correlation between grade of varicocele, type of surgery and relief of symptoms. Clinically there was not a statistically significant correlation between pain and hormonal values.ConclusionsManagement of painful varicocele in pediatric patients should be studied through randomized trials comparing conservative and surgical treatments. While waiting for objective data supporting surgery, clinical evidence justifies varicocelectomy which, on the other hand, is not supported by objective clinical data (i.e., hormonal values).

Percutaneous Aspiration for Hydroceles After Varicocelectomy

OBJECTIVES To assess the role and efficacy of aspiration alone in the treatment of hydroceles occurring after varicocelectomy. Hydroceles represent one of the most common complications related to varicocelectomy at any age. METHODS From September 1990 to 2008 at our department, a total of 453 varicocelectomies were performed. Inclusion and exclusion criteria were created. The patients with postoperative hydrocele formation were followed up every 3 months. Aspiration was suggested and then performed after 2 consecutive follow-up visits showing an enlarged hydrocele. In compliance with the protocol implemented at our institution, the clinicians performed >or=3 aspirations before suggesting surgical treatment. RESULTS A total of 256 patients were considered for the present study. All patients underwent laparoscopic varicocelectomy, and 31 (11%) developed postoperative hydrocele. Of the 31 patients, 9 (29%) underwent surgical hydrocelectomy after 3 aspirations, 7 (22.5%) had spontaneous resolution of the hydrocele, and 15 (48.5%) were treated with aspiration only. The success rate of aspiration seemed to be related only to the aspirated fluid volume, with <50 mL/aspiration guaranteeing spontaneous resolution in 60% of patients (P <.05). CONCLUSIONS The results of our study have shown that the management of postoperative hydrocele formation should be conservative for almost 18-24 months, with a minimum of 3 aspirations, if necessary. If confirmed by additional studies, the volume of fluid aspirated from hydroceles could be used as an early indicator of the need for surgery.

Unusual diagnosis of multiple magnet ingestion R1.

Foreign bodies in the alimentary tract of children are commonly managed by pediatricians and surgeons. The pediatric population aged 1–5 years represents about 80% of patients who come to hospital after foreign body ingestion, with a peak frequency during the first two years of life. Coins, marbles, pins, keys, toys, button batteries, stones, nails, rings and magnets are some of the most common foreign bodies ingested by children. Ten to 20% of ingested foreign bodies will fail to pass through the entire gastrointestinal tract and an endoscopic or surgical removal is needed. A decision should be based on the nature of the foreign body in those cases, as to whether a corrosive or toxic metal is ingested. Similarly, ingestion of atypical or multiple foreign bodies often may require more aggressive management depending on the type of object ingested and the location. Surgical removal is indicated if the foreign body has sharp points or if it remains in one location for more than 4–5 days, especially in the presence of symptoms. In the literature, many authors have reported cases of unintentional magnet ingestion; the high rate of complications reported in many different cases requires early removal of such objects. Intestinal perforation, peritonitis, volvulus and intestinal fistula are the most commonly reported secondary complications related to the ingestion of magnets and are mainly caused by their late removal. The authors of the present report studied an interesting case of magnet ingestion incidentally diagnosed during chest X-rays for a suspected relapse of pneumonia.

Recurrent abdominal pain due to buckshots in the appendix.

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.

Surgical Treatment of Chordee without Hypospadias

Objective: The aim of this study was to retrospectively assess the efficacy of the surgical techniques commonly used in three types of chordee without hypospadias (Devine and Horton classification).Methods: Twenty–six patients, ranging in age from 3 to 14 years, had chordee without hypospadias and underwent Nesbit dorsal plication (9 cases out of 12, type III), associated extensive mobilization of the urethra (10 cases out of 10, type II), and vascularized neourethra (3 cases out of 4, type I).Results: Eleven subjects undergoing follow–up investigation for the milder forms of chordee were satisfied with the outcome achieved; there was no impediment of any kind in the sex lives of 5 adult subjects. Of the 11 patients undergoing follow–up after more complex surgery for Devine and Horton type I–II chordee without hypospadias, a residual abnormal curvature was present in 4 subjects. These patients were submitted to one or more reoperations with outcomes defined as satisfactory.Conclusion: To avoid the risks of persistent chordee, the authors suggest more radical and accurate operations for the treatment of type I and II pseudohypospadias.

An unusual case of extra-abdominal desmoid tumour

Desmoid tumour is relatively rare and generally non-metastatisizing lesion of mesenchymal origin composed of fibrous tissue and fitting in the group of aggressive fibromatosis; it is a locally aggressive proliferative soft-tissue lesion with controversial nature. This tumour accounts for 0.03% of all tumours and 3% of soft-tissue tumours with annual incidence of two to four cases per million. Although desmoid tumours are more common in persons aged 10-40 years than in others, they do occur in young children and older adults; in children the sex incidence is equal. This is a rare case of extra-abdominal desmoid tumour in a 14-year-old girl affected by spastic tetraparesis. To our knowledge no similar cases are present in literature to date.