Edson Samesima Tatsuo

Use of a plastic hemoderivative bag in the treatment of gastroschisis

Abstract The authors report their experience with the use of a polyvinyl chloride (PVC) bag for blood-derivative transfer as a prosthesis for the creation of a silo for surgical treatment of gastroschisis (GS) in seven newborn infants. The bag is sterile, impermeable to micro-organisms, transparent, flexible, resistant, internally smooth, does not adhere to the bowel loops, readily available, and inexpensive, properties that make it an excellent alternative as a prosthesis for staged surgical treatment of congenital anomalies of the abdominal wall such as GS and omphalocele. The importance of a multidisciplinary team for the care of newborns with GS is also emphasized for a good postoperative outcome.

Omphalocele: how big does it have to be a giant one?

We read with great interest the recent article by Kumar et al [1] showing the significant differences in the frequency of associated anomalies between small and large omphaloceles. Children were divided in 2 groups, depending on the size of the abdominal wall opening: small (≤4 cm) or large omphaloceles (N4 cm). As the authors emphasized, determination of the omphaloceles size was based on a nonstandardized method of measurement made by initial physical examination and/or at operation. Defining minor and major omphaloceles based on a single measurement is controversial for several reasons. Varying defect size has been randomly employed to characterize minor and major omphaloceles. Minor omphaloceles have been defined as those smaller than 3 cm [2], 4 cm [3], or 5 cm [4-6]. Major omphaloceles have been characterized as those larger than 5 cm [4-11], 6 cm [2,12-17], or 8 cm [18]. Although most authors measured the diameter of the abdominal wall opening [1,2,5-8,11,12,16], others referred to the diameter of the omphalocele sac [4], and some did not specify what was being measured [9,10]. Measuring only the diameter of the abdominal wall defect is inadequate because we know that a large volume of viscera may leave the peritoneal cavity through a narrow opening [19] (Fig. 1). Measuring only the diameter of the omphalocele sac is also inaccurate because this size can changes in different states (if the infant is awake or sleeping, crying, or under general anesthesia). To determine if an omphalocele is amenable or not to primary closure, the degree of peritoneal cavity hypoplasia (ie, size of the peritoneal cavity) is as important as the diameters of the abdominal wall opening and of the omphalocele sac. Computed tomography was used in 1 infant [17] and 1 older child [16] to show relative volumes of the omphalocele sac and the peritoneal cavity in an attempt to estimate the degree of visceroabdominal disproportion. However, the benefit of exposing every newborn with an omphalocele to an abdominal computed tomographic scan is uncertain. Some authors also have used the presence of liver inside the omphalocele sac as a parameter to characterize the anomaly as a large one [6,7,9-11,14,16]. This concept lacks specificity because the volume of eviscerated organs (not only the liver) is actually a consequence of peritoneal cavity hypoplasia. In a study by Stringel and Filler [2], the presence of liver inside the omphalocele sac did not impact mortality. For all the reasons listed above, we suggest that the presence of a single organ or the use of a single measurement to differentiate small from large omphaloceles should be avoided. Clinical judgment of the pediatric surgeon is sufficient to estimate the degree of visceroabdominal disproportion and to classify an omphalocele as a minor defect (amenable to primary closure) or major defect (not amenable to primary closure), thus simplifying concepts and management. www.elsevier.com/locate/jpedsurg

Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome

OBJECTIVE The aim of this study was to describe the clinical course and ultrasound outcome of prenatally detected multicystic dysplastic kidney. METHODS Fifty-three children with unilateral multicystic dysplastic kidney detected by prenatal ultrasound between 1989 and 2004 were included in the analysis. All children were submitted to conservative management with follow-up visits every six months. Follow-up ultrasound examinations were performed at six-month intervals during the first two years of life and yearly thereafter. The following clinical parameters were evaluated: blood pressure, urinary tract infection, renal function, and growth. The following ultrasound parameters were evaluated: involution of multicystic dysplastic kidney and contralateral renal growth. RESULTS The mean follow-up time was 68 months. Two children presented hypertension during follow-up and five had urinary tract infection (only one with recurrent episodes). There was no malignant degeneration of multicystic dysplastic kidney. A total of 334 ultrasound scans were analyzed. US scan demonstrated involution of the multicystic dysplastic kidney in 48 (90%) cases, including complete involution in nine (17%). The involution rate was faster in the first 30 months of life. There was progressive compensatory renal hypertrophy of the contralateral renal unit; the rate of growth was greater in the first 24 months of life. CONCLUSION The results of prolonged follow-up of children with conservatively managed multicystic dysplastic kidney suggest that clinical approach is safe, the incidence of complications is small, and that there is a clear tendency for multicystic dysplastic kidney to decrease in size. Our data also suggest that the involution rate of multicystic dysplastic kidney as well as the growth of the contralateral kidney is greater in the first 24 months of life.

Mobilização total do seio urogenital para tratamento da genitália ambígua em crianças com hiperplasia adrenal congênita

The surgical approach to patients with congenital adrenal hyperplasia (CAH) has been a challenge and it is still controversial. The aim of this study was to review 10 children with 46,XX CAH who underwent one-stage total urogenital sinus mobilization (TUM). Age at operation ranged from 11 to 78 months (mean= 32) and the follow-up from 15 to 36 months (mean= 26). Cosmetic results were good in 7 patients and satisfactory in 3. After a mean follow-up of 26 months, our results showed that TUM was a good option to repair ambiguous genitalia in children with CAH.

Decompressive fasciotomy in testicular torsion of the spermatic cord in rats

PURPOSE To evaluate the effect of decompression fasciotomy on testes undergoing torsion of the spermatic cord. METHODS Spermatic cord torsion was induced in 40 Wistar testes for six and 12 hours. At the time of distortion, decompression fasciotomy was performed on half of the animals. After 42 days, the testicles were examined both macroscopically and microscopically. A non-parametric Mann- Whitney U- test was used for statistical analysis. The results were considered significant at p≤0.05. RESULTS Testicular weight; volume and degree of histological alterations were evaluated. When the groups without and with fasciotomy were compared, a 12-hour torsion subgroup in the fasciotomy group was noted to present larger volume, heavier weight and superior histological classification when compared with the 12-hour subgroup in the without fasciotomy group. No differences between the two groups after six hours of torsion were found. No significant changes were noticed in the contralateral testis. CONCLUSIONS Testicular fasciotomy (decompression) benefited the macroscopic and histological aspects of the testicles undergoing cord torsion for a 12-hour period. These results demonstrate the role played by compartment syndrome in the pathophysiology of spermatic cord torsion and the need for decompression.

Tratamento conservador do rim displásico multicístico: curso clínico e ultra-sonográfico

OBJECTIVE:The aim of this study was to describe the clinical course and ultrasound outcome of prenatally detected multicystic dysplastic kidney. METHODS: Fifty-three children with unilateral multicystic dysplastic kidney detected by prenatal ultrasound between 1989 and 2004 were included in the analysis. All children were submitted to conservative management with follow-up visits every six months. Follow-up ultrasound examinations were performed at six-month intervals during the first two years of life and yearly thereafter. The following clinical parameters were evaluated: blood pressure, urinary tract infection, renal function, and growth. The following ultrasound parameters were evaluated: involution of multicystic dysplastic kidney and contralateral renal growth. RESULTS: The mean follow-up time was 68 months. Two children presented hypertension during follow-up and five had urinary tract infection (only one with recurrent episodes). There was no malignant degeneration of multicystic dysplastic kidney. A total of 334 ultrasound scans were analyzed. US scan demonstrated involution of the multicystic dysplastic kidney in 48 (90%) cases, including complete involution in nine (17%). The involution rate was faster in the first 30 months of life. There was progressive compensatory renal hypertrophy of the contralateral renal unit; the rate of growth was greater in the first 24 months of life. CONCLUSION: The results of prolonged follow-up of children with conservatively managed multicystic dysplastic kidney suggest that clinical approach is safe, the incidence of complications is small, and that there is a clear tendency for multicystic dysplastic kidney to decrease in size. Our data also suggest that the involution rate of multicystic dysplastic kidney as well as the growth of the contralateral kidney is greater in the first 24 months of life.

Effects of human chorionic gonadotropin on the normal testicular tissue of rats

PURPOSE To investigate the effects of human chorionic gonadotropin (hCG) on the testicular tissue of young male rats. METHODS Male Wistar rats were assigned to groups (10 rats/group).Control Group received subcutaneous saline solution; Group 1 received hCG 50 UI/Kg/dose; and Group 2 received hCG 100 UI/Kg/dose, daily for 15 days. Half was submitted to bilateral orchiectomy on the 16th day and the other half 45 days after the beginning of the hormone application. Testicles were weighed, measured and has their volumes determined. The diameter of the tubules and the thickness of the seminiferous epithelium were measured. RESULTS Control Group presented the highest values of testicles volume and weight. Rats in the Control presented normal histology. In G1 and G2 atrophy of the seminiferous tubules, apoptosis of germ cells and multinucleated giant cells were observed. Comparing groups, in the first operation Control rats had higher diameter values. In the second operation, the Control was only different from G1. As for thickness, Control had higher values in both operations. Comparing the time of operation, the diameter values were higher in G1 and G2 in the second operation. For all groups, the thickness of the epithelium was higher in the second operation. CONCLUSIONS Human chorionic gonadotropin is gonadotoxic in rats. This effect was temporary and can affect reproductive potential. The total recovery of testicular damage in the studied range could not be proved, and the effects were not dose-dependent.

Metástases pulmonares em crianças: estamos operando desnecessariamente?

OBJECTIVE to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. METHODS we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. RESULTS we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. CONCLUSION among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.

Bladder perforation by ventriculoperitoneal shunt

BackgroundBladder perforation by ventriculoperitoneal shunt is a rare complication that has been describe in 19 cases in prior literature.Case descriptionThis work describes the case of a 4-month-old baby who presented with extrusion of the distal catheter through the urethra. The patient underwent a laparotomy; the catheter was cut close to the bladder wall and repositioned into the peritoneal cavity. The bladder wall was sutured, and the remaining distal portion of the catheter was removed through the urethra.Discussion and conclusionBased on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.

Measurement of testicular volume in Wistar rats using a caliper and ultrasonography in experimental surgery

PURPOSE To compare the measurement of the testicular volume of Wistar rats using a caliper and ultrasonography. METHODS Forty Wistar rats were randomly assigned into four groups. A tensile force of 1.6 Newton (N) and 1.0 N was applied to the right spermatic cord in group I and group II, respectively. Group III was the sham group, and group IV served as a control. The initial and final testicular volumes were measured using a caliper and ultrasonography and compared. A significance level of 5% was used. RESULTS The Kappa coefficient was equal to 0.292 (p = 0.006). The Pearson correlation coefficient obtained for the percent reduction in the right testicular volume using ultrasonography and a caliper was equal to 0.696 (p < 0.001). CONCLUSION There was reasonable agreement and a significant positive correlation between the percent reduction in the right testicular volume using ultrasonography and a caliper.