M. Di Pace

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color doppler ultrasound assessment.

BackgroundThis study aimed to assess whether laparoscopic treatment for any kind of varicocele is possible after preoperative identification of refluxing veins by color Doppler ultrasound (CDUS).MethodsAt the authors’ institution, 98 patients with a median age of 11.3 years (range, 7.1–16 years) were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and CDUS to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. In all the patients, laparoscopic division of the spermatic artery and veins was performed as close as possible to the internal inguinal ring. The other vessels were coagulated and divided if shown to be refluxing on CDUS.ResultsColor Doppler ultrasound showed reflux only in the ISV in 87 cases (88.7%), but in both the ISV and the deferential in the remaining 11 cases (11.2%). During a median follow-up period of 18 months (range, 6–49 months), none of the authors’ patients experienced varicocele recurrence either clinically or according to CDUS scanning. The median left testicular volume increased significantly postoperatively.ConclusionThe proposed technique based on laparoscopic interruption of the ISV and testicular artery very close to the internal inguinal ring, meticulous CDUS assessment to rule out reflux in the deferential vein, and coagulation of refluxing deferential veins allows successful laparoscopic treatment of most varicoceles.

TESTICULAR TUMORS IN CHILDHOOD : a National Report

The authors report preliminary data of an Italian multicentric, retrospective study of primary testicular tumors (PTT) in childhood involving 20 Italian departments of pediatric surgery. Forty cases of PTT were observed during a 10-year period (1977–1987), with yolk-sac tumors being the most frequent (45%). Most testicular tumors were first perceived as a unilateral testicular mass. Scrotal ultrasonography represents the main diagnostic investigation, together with serum marker levels.

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation

PURPOSE Functional bowel outcome in patients with anorectal malformation often is poor. For fecal incontinence resulting from sphincter dysfunction, biofeedback (BFB) training appears to be effective. The aim of study was to investigate the bowel function in incontinent children treated for ARM, using a clinical score, a manometric and pelvic magnetic resonance evaluation, in order to establish predictive parameters of response after BFB. METHODS 25 children (median age of 6.5 years) with true fecal incontinence were evaluated by clinical score, anorectal manometry and magnetic resonance imaging (MRI). According to these evaluations patients were divided in 4 groups: group 1 (favorables manometry and MRI); group 2 (favorable manometry and unfavorable MRI); group 3 (unfavorable manometry and favorable MRI); group 4 (unfavorables manometry and MRI). All groups started a cycle of BFB and six months after end of BFB, were reevaluated by clinical score and manometry. RESULTS The overall response to BFB was excellent in 44%, discrete in 40% and poor in 16%; a better response was found in groups 1 and 2 than groups 3 and 4. The differences between groups before BFB proportionally correlated with values after BFB; a correlation with genitourinary and spinal anomalies was found. CONCLUSIONS Our results showed that BFB is an effective for fecal incontinence when the assessment pretreatment (functional and morphologic) is favorable; the manometry can evaluate the potential sphincterial recovery after BFB with a further prognostic benefit if correlated to morphologic evaluation with MRI.

GERM CELL TUMOURS IN CHILDREN- A Report of 84 Cases

Publisher Summary This chapter discusses the results of a study examining germ cell tumors (GCTs) in children. In January 1991, a protocol for the diagnosis and treatment of GCTs in children was activated in 15 Italian pediatric centers. The diagnosis was made by the histological examination of a specimen obtained by surgical resection or biopsy and serum tumor marker positivity. Treatment was based on tumor site, histology, and stage. In the study, eighty-four patients were entered (40 males, 44 females), age range 0 to 14 years (median 5.1 years). The histological features were the following: (1) mature teratoma, 45 patients, (2) immature teratoma, 12 patients (eight grade II, four grade III), (3) MNSGCT 24 patients, including 2 cases of malignant relapse of one mature and one immature teratoma, and (4) seminomatous tumor, 5 patients. One patient with a SC tumor had a local malignant recurrence six months after surgical resection: the patient was disease-free 14 months after a second resection and 2 courses of chemotherapy (JE/IVA).