Valentina Pastore

Urinary epidermal growth factor, monocyte chemotactic protein-1, and β2-microglobulin in children with ureteropelvic junction obstruction

BACKGROUND/PURPOSEnWe demonstrated down-regulation of epidermal growth factor (EGF) and up-regulation of monocyte chemotactic protein-1 (MCP-1) in the renal parenchyma in children who underwent pyeloplasty for ureteropelvic junction obstruction (UPJO). These findings were paralleled by urinary levels of EGF and MCP-1 before and after surgery. The aim of this study is to evaluate the urinary excretion of these cytokines and β2-microglobulin (β2M) in children with urine flow impairment at the ureteropelvic junction or who underwent pyeloplasty.nnnMETHODSnSeventy-six patients with UPJO and 30 normal children (CTRL) were enrolled in the study. The UPJO patients were divided into obstructive (12), functional (36), and operated (28). Epidermal growth factor, MCP-1, and β2M urinary levels were measured by enzyme-linked immunosorbent assay and normalized to urine creatinine.nnnRESULTSnUrinary β2M and MCP-1 increased significantly in the UPJO groups compared with the CTRL and significantly improved in the operated group. The obstructive group displayed reduced EGF excretion compared with the CTRL group. The urinary (u)EGF/uMCP-1, and uEGF/uβ2M ratios significantly decreased in both untreated groups. In the operated group, these ratios improved significantly.nnnCONCLUSIONSnThe present study substantiates the role of urinary EGF, MCP-1, and β2M as markers of tubulointerstitial damage in human obstructive nephropathy. Furthermore, it suggests that surgical intervention is effective in the management of children with UPJO.

“Extended” Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: A 10-year experience

OBJECTIVEnWe report a 10-year experience of children with recurrent thyroglossal duct cysts (TGDCs) who have been treated using the extended Sistrunk procedure.nnnMETHODSnWe performed a retrospective review of TGDC surgery from 2004 to 2013. Sistrunk operation was the procedure of choice in all patients. Seven children had TGDC recurrence. All of them underwent extended Sistrunk procedure. Follow up ranged from 6 months to 8 years.nnnRESULTSnThere were no gender differences, all recurrences presented within 12 months follow-up in the same location of the primary cyst. Five out of 7 (71%) patients have been treated for preoperative and 2/7 (29%) for postoperative infection at the time of primary surgery. Pathological examination of the surgical specimens showed a single tract in 2 children (29%) and multiple tracts in 5 (71%). We did not observe postoperative complications or further recurrences.nnnCONCLUSIONnOur experience suggest that recurrent TGDCs are equally common in both sexes, develop in the same location of the primary cyst and recur more commonly after perioperative infections. The extended Sistrunk procedure is highly effective and safe in treating recurrent TGDCs also if multiple duct tracts are detected.

Limits and advantages of abdominal ultrasonography in children with acute appendicitis syndrome

Background: Graded compression ultrasonography (US) has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013. Materials and Methods: Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients) and non-operated (260 patients) the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients. Results: Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis. Conclusion: Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis.

Laparascopic-assisted nephroureterectomy for shaped urolithiasis and xanthogranulomatous pyelonephritis: Case report and review of literature

We report a case of xanthogranulomatous pyelonephritis (XGP) complicated by shaped urolithiasis, severe hydroureteronephrosis and kidney exclusion treated by laparoscopic-assisted nephroureterectomy. A 9 year-old boy was referred to us for recurrent episodes of urinary tract infection, abdominal pain and severe hydronephrosis. Abdominal CT and a Tc-99m MAG3 scan showed a non-functioning obstructed kidney with shaped urolithiasis of the distal ureter. XGP was suspected, and nephroureterectomy was performed by laparoscopic distal ureterectomy and open extraperitoneal nephrectomy. This technique avoided the need for a more extended nephrectomy incision or even a second iliac incision. It also ensured complete excision of the distal ureter with minimal risk of developing the ureteral stump syndrome, which sometimes follows nephroureterectomy. We believe that laparoscopic-assisted nephroureterectomy may be a suitable technique in those cases of difficult nephrectomy where a ureteral stump syndrome is likely to develop.

A report of a giant epidermoid splenic cyst.

Splenic cysts are uncommon lesions and are classified as true or pseudocysts based on the presence of an epithelial lining. True congenital cysts can be epidermoid, dermoid or endodermoid and require surgery when large, sympthomatic or complicated. Ultrasonography and computerised tomography scan are useful for diagnosis and serum test for echinococcosis should be done. Several procedures, open or laparoscopic, have been described, with emphasis on the spleen-preserving surgery, when possible. We present a boy with a giant symptomatic epidermoid cyst in whom total splenectomy by open technique was carried out.

Sigmoid volvulus in a neonate: case report and review of literature.

Sigmoid volvulus (SV) is an extremely rare cause of bowel obstruction in the newborn period. We report a neonatal case of SV misdiagnosed as small bowel volvulus. At laparotomy, the classical findings of SV were observed without gangrene. The operative procedure consisted of simple detorsion without sigmoidopexy.

A Rare Case of Neonatal Complicated Appendicitis in a Child with Patau’s Syndrome

Neonatal appendicitis is a rare condition with high mortality rate. Signs and symptoms are often nonspecific, imaging modalities are not always diagnostic, and preoperative diagnosis is difficult with subsequent delay and complications. Its pathophysiology may be different from appendicitis in older children and comorbidities can be found. We report a case of a female neonate with Pataus syndrome, intestinal malrotation, and Fallot tetralogy in whom perforated appendix, probably occurring during fetal period due to vascular insufficiency, was found at laparotomy.

Prospective Study on Several Urinary Biomarkers as Indicators of Renal Damage in Children with CAKUT

Purpose The aim of the study was to investigate urinary levels of monocyte chemotactic protein‐1 (MCP‐1), epidermal growth factor (EGF), &bgr;‐2‐microglobulin (&bgr;2M), and FAS‐ligand (FAS‐L) in children with congenital anomalies of kidney and urinary tract (CAKUT) disease at risk of developing glomerular hyperfiltration syndrome. For this reason, we selected patients with multicystic kidney, renal agenesia and renal hypodysplasia, or underwent single nephrectomy. Materials and Methods This prospective, multicentric study was conducted in collaboration between the Pediatric Surgery Unit in Foggia and the Pediatric Nephrology Unit in Bari, Italy. We enrolled 80 children with CAKUT (40 hypodysplasia, 22 agenetic; 10 multicystic; 8 nephrectomy) who underwent extensive urological and nephrological workup. Exclusion criteria were recent urinary tract infections or pyelonephritis, age > 14 years, presence of systemic disease, or hypertension. A single urine sample was collected in a noninvasive way and processed for measuring by enzyme‐linked immunosorbent assay urine levels of MCP‐1, EGF, &bgr;2M, and FAS‐L. As control, urine samples were taken from 30 healthy children. Furthermore, we evaluated the urinary ratios uEGF/uMCP‐1 (indicator of regenerative vs inflammatory response) and uEGF/u&bgr;2M (indicator of regenerative response vs. tubular damage). Results These results suggest that urinary levels of MCP‐1 are overexpressed in CAKUT patients. Furthermore, our findings clearly demonstrated that both uEGF/uMCP‐1 and uEGF/u&bgr;2M ratios were significantly downregulated in all patient groups when compared with the control group. Conclusion These findings further support that CAKUT patients may, eventually, experience progressive renal damage and poor regenerative response. The increased urinary levels of MCP‐1 in all groups of CAKUT patients suggested that the main factor responsible for the above effects is chronic renal inflammation mediated by local monocytes.

Laparoscopic Ovarian Cystectomy in a Very Low-Birth Weight Preterm Newborn

Introduction: Minimally invasive surgery is normally used in children but is not so common in newborns, especially those with very low birth weight, as a consequence of an immature cardiopulmonary system and technical difficulties. Case Description: A preterm female with very low birth weight (1.4 kg), born in the 32nd week of gestation with a prenatal diagnosis of abdominal cyst, presented with distension of the abdomen and a palpable tension mass in the right iliac and hypochondriac region on the first day of postnatal life. Clinical investigation findings indicated a suspected simple right-side ovarian cyst measuring 5.4 8.55 8.72 cm occupying most of the abdomen. The patient’s clinical condition deteriorated quickly with respiratory distress due to the mass’s effect. The cyst was surgically aspirated, isolated, and removed by a completely laparoscopic approach. The operating time was 30 minutes, the respiratory distress resolved immediately, and the patient’s recovery was uneventful. Discussion: Ovarian cysts are the most common ovarian lesions in newborns; they are usually simple and benign but can be complicated and symptomatic. Minimally invasive surgery is nowadays the gold standard for newborns and children with ovarian cysts, even when complications occur. Furthermore, we have shown that laparoscopy also can be used safely in distressed preterm very low–birth weight newborns without cardiorespiratory consequences, anesthetic incidents, or hypothermia.

Clinical Characteristics and Management of Children with Ureteropelvic Junction Obstruction and Severe Vesicoureteral Reflux: Preliminary Results

ObjectiveThe aim of this study was to investigate the physiopathology of isolated or coexisting ureteropelvic junction obstruction (UPJ-O) and high-grade vesicoureteral reflux (VUR), including the clinical characteristics and management. Summary background dataThe association between UPJ-O and VUR was reported more frequently in boys with high-grade VUR; however, the physiopathology of concomitant UPJ-O and VUR is still unknown. Primary pyeloplasty, followed by ureteral reimplantation, if needed, has been widely accepted, although VUR should be treated first (most often by endoscopic treatment) in the presence of a functional obstruction. MethodsWe reviewed the charts of 78 children with isolated or coexisting high-grade VUR/UPJ-O. Among the children, 14 had isolated UPJ-O, 16 had high-grade VUR/UPJ-O, and 48 had high-grade VUR. Children with other urological or extrarenal conditions were excluded. ResultsPatients with isolated UPJ-O showed significantly different clinical characteristics compared with the other two groups of patients with high-grade VUR. Among the patients of group 2, 3/13 (23%) showed progression from functional to obstructive UPJ-O after endoscopic treatment. All of them underwent secondary pyeloplasty, which was complicated at follow-up by VUR recurrence needing further endoscopic injection. ConclusionWe suggest that UPJ-O in high-grade VUR patients is just a complication of severe VUR that produces structural changes in predisposed children. The treatment of children with associated high-grade VUR/UPJ-O may be complicated by the progression of urinary flow obstruction or VUR recurrence after pyeloplasty. Endoscopic treatment of high-grade VUR is associated with a high rate of VUR recurrence in children requiring subsequent pyeloplasty.