Giuseppe Romeo

Disorders of the esophageal motor activity in atresia of the esophagus

Esophageal dysfunction has been reported after successful repair of esophageal atresia but its nature has not been clearly defined. We studied esophageal motility in 20 newborns with esophageal atresia by recording intraluminal pressure of both proximal and distal segments. The investigation was made by pressure monitoring of the upper pouch via the mouth and of the distal segment via the gastrostomy. In all cases we found motility disorders. Two patients (12.5%) showed incomplete relaxation of the upper esophageal sphincter. The resting pressure of the esophageal body in both segments was constantly positive in all cases. Lower esophageal sphincter (LES) function was normal in all but two patients (16.7%) in whom the LES pressure was reduced and one case (8.4%) with incomplete relaxation of the LES. These studies suggest that motility disorders are also present in esophageal atresia before surgery.

Impression cytology of the conjunctival epithelium in patients with vernal conjunctivitis.

The alterations in the conjunctival epithelium during the course of vernal conjunctivitis were examined by conjunctival impression cytology. The study was carried out on 53 patients with vernal conjunctivitis and 20 normal subjects as control. The results of impression cytology demonstrated that all cytological parameters were significantly modified in vernal conjunctivitis patients; the earliest alterations were found in the distribution of goblet cells, in the intercellular junctions, in the chromatin morphology and in the degree of keratinisation. The morphometric comparison showed that in vernal conjunctivitis patients the mean number of goblet cells per field was significantly higher than in controls. Moreover the mean diameter of goblet cells was smaller in patients than in controls. Impression cytology can, therefore, be a simple, non-invasive and cheap method for the study of the ocular surface in vernal conjunctivitis.

Prenatal testicular torsion: ultrasonographic features, management and histopathological findings.

Aim:  To highlight the ultrasonographic features of prenatal torsion of the testis in utero (IUTT) at presentation, the neonatal management and the histological findings postorchiectomy or biopsy.

Gastrointestinal sequelae in survivors of congenital diaphragmatic hernia

Background: Gastrointestinal sequelae have been sporadically reported in survivors of congenital diaphragmatic hernia (CDH). The aim of the present paper was to evaluate the gastrointestinal morbidity in infant, adolescent and adult patients who had undergone repair of CDH.

Age and Metabolic Control Influence Lens Opacity in Type I, Insulin-Dependent Diabetic Patients

Cataract is a frequent ocular complication in diabetic patients, but few data are available concerning early modifications occurring in the lens of these patients and their relationship with metabolic control and other clinical parameters. We measured lens opacity in 73 type I, insulin-dependent diabetic patients aging 50 years or less and without clinical evidence of cataract, and in 46 healthy volunteers of similar age. We used a quick, simple, and reliable instrument, the Lensmeter 701, which is based on a back-light scattering quantification system and is able to quantify lens transparency along the nuclear axis. Mean lens opacity was significantly (p = 0.0001) higher in diabetic patients than in the control group, and multiple regression analysis showed that it correlated with age (p = 0.0001) and HbA1c levels (p = 0.009). Moreover in the younger group of patients (age < or =20 years) the only observed correlation was that with Hba1c (p = 0.03), whereas in the older ones (age 21-30 and >30 years) lens opacity correlated with age (p = 0.02 and p = 0.01). These data indicate that early opacifications of the lens occur in type I, insulin-dependent diabetic patients and are influenced by the degree of the metabolic control in the younger ones, whereas the well-known role of aging on lens transparency became prevalent in the older patients. Only longitudinal studies, however, can demonstrate whether these alterations represent any early stage of cataractagenesis and the role of good metabolic control in preventing this ocular complication.

Is a complete urological evaluation necessary in all newborns with asymptomatic renal ectopia

Aim:  To evaluate if a complete urological screening is justified by potential urological anomalies in newborns or infants with asymptomatic renal ectopia (RE).

The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus

Objective To define the neonatal management and ultimate surgical correction via the anterior sagittal transanorectal approach (ASTRA) in cases of neonatal urinary hydrometrocolpos associated with a persistent urogenital sinus (UGS).

Surgical correction of penoscrotal transposition associated with hypospadias and bifid scrotum: our experience of two-stage repair

OBJECTIVE To assess the results of surgical correction of incomplete penoscrotal transposition and bifid scrotum using the Glenn-Anderson technique, and its impact on subsequent definitive urethroplasties and final outcome. PATIENTS AND METHODS We retrospectively reviewed 31 children that underwent two-stage repair for incomplete penoscrotal transposition with severe hypospadias and bifid scrotum. Patient age at stage 1 ranged from 12 to 24 months (average 16 months). The operative principle was based on achieving a normal anatomical position of the penis and scrotum using the Glenn-Anderson technique. In cases with associated scrotal or perineal hypospadias this was transformed into a penoscrotal hypospadias. Final stage urethroplasty was performed after a period of 6 months with a modified Thiersch-Duplay technique. RESULTS Cosmetic and functional results of the Glenn-Anderson operation were excellent. No major complications were observed. Of 31 patients, 12 (38%) had complications secondary to urethral repair. CONCLUSION The Glenn-Anderson technique for reconstruction of penoscrotal transposition and bifid scrotum is a simple technique, free of major complications. The purpose of this intervention is to improve the cosmetic appearance and function of the penis. A minimum period of 6 months between consecutive urethroplasties is important. The final stage guarantees good functional and cosmetic results preserving the prepuce.

Immunohistology of aquaporin-1 and stem cell factor-receptor in human undescended testes.

ObjectivesBoth aquaporin (AQP) 1 and the stem-cell factor/C-kit system seem to have a definite role in testis function, but very few studies have been reported in humans, especially in the paediatric age group. With the present study we wanted to investigate the expression of these proteins to better delineate their role in normal and pathologic testes.MethodsImmunohistology using AQP 1 and C-kit antibodies was performed on paraffin sections of open-testicular biopsies from 32 undescended testes. The testes of cryptorchid patients, with ages ranging from 2 to 15 years, were biopsied during an orchidopexy operation, after obtaining informed consent. Control biopsies, from 8 patients of matched age, were obtained during operations for inguinal hernia or hydrocele, always after obtaining informed consent. Positive results were recorded as diffuse or focal patterns and scored as weak, moderate or strong immunostaining.ResultsAQP 1 antibody strongly depicted microvessel endothelial cells, but was unlabeled in endotubular and interstitial cell lines, in both control and undescended testes. The C-kit immunostaining in normal testes revealed a diffuse, strong staining in the cytoplasm of spermatogonia and primary spermatocytes. However, in the undescended testes a focal C-kit immunolabelling was weakly recognized in both spermatogonial and immature Sertoli cells.ConclusionsThese results indicate a direct involvement of AQP 1 in the regulation of fluid transport across the endothelial cell membranes of testicular microvessels. A role of the C-kit receptor protein is also substantiated by its strong expression in the maturing spermatogonia of the normal testes, but was minimally or not recognizable in undescended prepubertal testes.

Can histologic changes of the upper pole justify a conservative approach in neonatal duplex ectopic ureterocele

Abstract.The aim of this study was to review the histology of the upper-pole segment in patients with duplex-system ectopic ureterocele (DEU) to determine if less aggressive surgery is justified in prenatally-diagnosed cases. The study included 15 consecutive patients with DEU treated between 1991 and 1999. The diagnosis was made according to the criteria of the Section on Urology of the American Academy of Pediatrics. The histology specimens were assessed for dysplastic, inflammatory, and obstructive changes. All 15 patients were surgically treated by heminephro-ureterectomy and the surgical specimens were histologically examined. Nine cases were diagnosed prenatally; the histology of the upper-pole segment in these patients showed segmental renal microcystic dysplasia, chondroid metaplasic islands, and an inflammatory tubulointerstitial nephropathy in 6 (66.6%) and nephroblastomatosis in 2 (22.2%). The histology of the 6 postnatally-diagnosed patients showed segmental multicystic renal dysplasia, inflammatory tubulo-interstitial nephropathy, and segmental parenchymal scars. The upper-pole histology of the prenatally-diagnosed patients did not show any evidence of reversible histologic changes. Considering this findings and the good outcome of patients treated with upper-pole nephroureterectomy, less aggressive surgery with preservation of the upper pole does not seem justified.