La Pediatria Medica e Chirurgica 2020-04-06T03:07:55+00:00 Francesca Savio Open Journal Systems <p><strong>La Pediatria Medica e Chirurgica&nbsp;</strong>(Medical and Surgical Pediatrics) publishes original papers in the field of basic science, clinical and laboratory research pertinent to medical and surgical pediatrics.</p> <p>In addition to Original Articles, <strong>La Pediatria Medica e Chirurgica&nbsp;</strong>(Medical and Surgical Pediatrics) welcomes Editorials (on invitation), Brief Reports, Letters to the Editor and Book Reviews as well. All manuscripts are critically assessed by external and/or in-house experts in accordance with the principles of peer review. Manuscripts must be written in English or Italian.</p> Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors 2020-04-06T03:07:49+00:00 Salvatore Fabio Chiarenza Cosimo Bleve Elisa Zolpi Francesco Battaglino Lorella Fasoli Valeria Bucci <p>The management of congenital primary obstructive megaureter (POM) is usually conservative, especially during the first year of life. Endoscopic high-pressure balloon dilatation (EHPBD) is indicated when symptoms, increasing dilatation and progressive renal damage are recorded, particularly in children younger than one year of age. We identified and described endoscopic prognostic factors predicting the success or failure of endoscopic dilatation. Thirty-eight patients (33 M;5 F) with POM from 2005-2018 were included. Diagnosis was based on US distal ureter dilatation (&gt;7 mm), obstructive MAG-3 diuretic renogram and absence of vesicoureteral reflux (cystography). 24 patients were under 1 year of age. All patients underwent cystoscopy and high-pressure balloon dilatation with 3,5 Fr dilating balloon, after ascending pyelography. Median follow-up was of 6.5 years. We identified characteristics with poor prognosis: stenotic punctiform ureteral ostium and/or ostium located in a bladder diverticulum (9 pts) and stenotic tract longer than 1 cm (5 pts). The patients with a stenotic tract shorter than 1 cm (18 pts) were divided into two groups: &lt;5 mm (5 pts) and between 5 and 10 mm (13 pts) showed a good response to dilatation. Endoscopic evaluation of ureteral ostium with pneumatic dilatation when possible is a useful diagnostic and therapeutic solution for POM treatment, especially under one year of age. EHPBD is effective in short stenotic tracts (&lt;5 mm). It may also be repeated with good results in intermediate stenotic sections (5 mm-1 cm). According to our preliminary results, the procedure is more effective if performed earlier (3-7 months of life). Greater cohort and longer follow-up are needed to verify the stability of these results.</p> 2019-12-23T00:00:00+00:00 ##submission.copyrightStatement## A rare cause of acute scrotum in a child: torsion of an epididymal cyst. Case report and review of the literature 2020-04-06T03:07:50+00:00 Mario Messina Giulia Fusi Francesco Ferrara Edoardo Bindi Chiara Pellegrino Francesco Molinaro Rossella Angotti <p>Torsion of an epididymal cyst is an extremely rare cause of acute scrotum in children and in young boys. Its reported incidence is 5-20%. The treatment is usually conservative. Many cases (up to 60%) regress spontaneously, especially if below 3 cm. Few cases have been reported in Literature (7 cases/2018). We add our patient as eighth case. He was a 13-year-old boy who was admitted for acute scrotum. Ultrasound excluded torsion of the testis and he was managed for 5 day conservatively. Based on clinical history and physical exam, we decided to perform a prompt surgery that revealed a torsion of epididymal cyst that was confirmed by histological exam.</p> 2019-06-21T12:29:11+00:00 ##submission.copyrightStatement## The influence of type of delivery, skin-to-skin contact and maternal nationality on breastfeeding rates at hospital discharge in a baby-friendly hospital in Italy 2020-04-06T03:07:51+00:00 Mauro Cinquetti Anna Maria Colombari Emanuela Battisti Pierpaolo Marchetti Giorgio Piacentini <p>The aim of this epidemiological study is to evaluate how type of delivery, skin-to-skin contact and maternal nationality influence breastfeeding practices of newborns at discharge in a large population of babies born in the Baby-Friendly Hospital of San Bonifacio, Verona, Italy. Data were collected for all healthy newborns consecutively born over a period of three years, regarding type of delivery, feeding at hospital discharge, skin-to-skin procedure, and for a smaller group maternal nationality was recorded as well. The rate of exclusive breastfeeding in a group of 6017 newborns was 82.1%, higher among babies born by vaginal delivery than in those born by cesarean section (84.9% <em>vs</em> 65%; P&lt;0.001). It was higher in those who had skin-to-skin contact than in those who did not, in both vaginal delivery (85.3% <em>vs</em> 69.2%; P&lt;0.001) and cesarean section (67.7% <em>vs</em> 55.1%; P=0.009). Also, it was found to be higher in babies born to immigrant mothers than in those born to Italian mothers (89.9% <em>vs</em> 79.5%). Vaginal delivery, skin-to-skin contact and maternal foreign nationality have a positive association with breastfeeding at hospital discharge.</p> 2019-05-22T10:16:04+00:00 ##submission.copyrightStatement## The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis 2020-04-06T03:07:51+00:00 Mario Lima Dora Persichetti-Proietti Neil Di Salvo Claudio Antonellini Michele Libri Beatrice Randi Michela Maffi Tommaso Gargano Giovanni Ruggeri Vincenzo Davide Catania <p>Our aim was to develop an APpendictis-PEdiatric score (APPE score) in quantifying risk of acute appendicitis based on combination of clinical and laboratory markers. 1025 patients were classified in: acute appendicitis (AA) and non-appendicitis. Demographic/clinical features, and laboratory were collected. They were compared for quantitative-variables and categorical-variables. Significant predictors (P=&lt;0,05) were included in logistic regression model. Based on regression-coefficients, a diagnostic score was tested by calculating the area under the ROC curve. Two cut-offs were established to define classes of risk of AA. 9 variables were identified as potentially predictors for AA. Those underwent logistic regression and a score was assigned, for maximum 21-points. The score showed an area under the curve: 0.831 and a linear proportion with the state of appendicular inflammation (R20.85). Patients with a score ≤8 were at low risk of AA (sensitivity 94%); those with a score ≥15 were at high risk for AA (specificity 93%). Those between 8 and 15 were defined at intermediate risk class. APPE-score guides clinicians in classifying patients with suspected-AA according to clinical and laboratory findings in order to improve their management.</p> 2019-04-02T09:35:01+00:00 ##submission.copyrightStatement## Toward sutureless laparoscopic inguinal hernia repair in children? 2020-04-06T03:07:52+00:00 Antonio Marte Laura De Rosa Lucia Pintozzi Vincenzo Esposito <p>We report our experience with a sutureless technique for laparoscopic inguinal hernia repair in children. Twenty-eight children, 12 girls and 16 boys, aged 3 months to 7 years, underwent sutureless laparoscopic inguinal hernia repair. In girls, we utilized simple cauterization of the internal inguinal ring with a single trocar technique. In boys denudation of the peritoneum was obtained utilizing a three-trocar technique. The peritoneum around the internal inguinal ring was peeled off and detached from the vas and the vessels, and then wrapped around the grasper, resulting in a large area of denudation. No perioperative complications were observed. No recurrences nor testicular damage were noted after a mean follow-up of 18 months (range 6-35 months). The mean operative time was 12 min (range 7-20 min) for girls and 19 min (range 15-30 min) for boys. A 6-year-old girl exhibited a lymphocele. The sutureless technique appears to be easy, safe, and effective, provided that the patients are carefully selected. In boys, special attention needs to be paid to preservation of the vas and the testicular vessels.</p> 2019-03-19T11:44:49+00:00 ##submission.copyrightStatement## Paediatric surgery in the robotic era: early experience and comparative analysis 2020-04-06T03:07:53+00:00 Mario Lima Eduje Thomas Neil Di Salvo Tommaso Gargano Giovanni Ruggeri <p>The aim of this study is to present our preliminary experience in robotics and a comparative analysis with conventional Minimally- Invasive Surgery (MIS). Cases operated by da Vinci Xi® System from February 2016 to October 2017 are reviewed retrospectively through demographics, diagnosis-procedure and short-term outcome parameters. A comparison with a matching conventional MIS population was also conducted. 40 robotic procedures were carried out and 112 (out of 3705) non-robotic procedures met inclusion criteria for comparison. Among robotic patients we observed: an average age of 143.5 months, weight of 42.9 Kg, operative and anaesthesia induction time respectively of 116.8 and 34.8 minutes. Furthermore, we observed a 6.1-day length of stay, 2.5% conversion rate and no complications. From the comparison between the groups, no statistical difference emerged in the length of stay, in conversion rates or in complications. A statistical significance was observed in terms of operative time in favour of non-Robotic- System. Our experience has meant to introduce the System in our surgical environment, comparing to the conventional MIS (an already established approach routinely performed at our center). Results have shown comparable safety and feasibility.</p> 2019-01-18T16:16:14+00:00 ##submission.copyrightStatement## Hypoceruloplasminemia: an unusual biochemical finding in a girl with Hashimoto's thyroiditis and severe hypothyroidism 2020-04-06T03:07:53+00:00 Mariella Valenzise Federica Porcaro Giuseppina Zirilli Filippo De Luca Maurizio Cinquegrani Tommaso Aversa <p>Clinical picture of Hashimoto’s thyroiditis (HT) may significantly vary in pediatric age, ranging from euthyroidism to subclinical hypothyroidism or hyperthyroidism; only rarely HT presentation may be characterized by a severe hypothyroidism also in pediatric age. Here we describe a 3-year-old Caucasian girl who was admitted to our Clinic due to pericardial effusion, muscle weakness and weight gain. At clinical examination, she presented with bradycardia, pale and round face, pseudohypertrophy of calf muscles and no pitting edema of the limbs. Routine blood investigations showed high serum aspartate and alanine aminotransferase levels, low serum ceruloplasmin without clinical signs of Wilson’s disease, dyslipidemia. Thyroid function tests revealed a picture of severe hypothyroidism associated with HT. After the replacement treatment with L-T4, thyroid-stimulating hormone serum levels gradually decreased, with concomitant resolution of pericardial effusion and normalization of ceruloplasmin levels.</p> 2018-12-05T09:50:08+00:00 ##submission.copyrightStatement## Robot-assisted resection of gastric duplication cysts in a child: a detailed case report 2020-04-06T03:07:54+00:00 Riccardo Rizzo Gabriele Lisi Nino Marino Giuseppe Lauriti Dacia Di Renzo Pierluigi Lelli Chiesa <p>Gastric duplication cysts (GDCs) represent 4-9% of alimentary tract duplications. Early diagnosis and surgical excision are essential to avoid morbidity or neoplastic degeneration. Roboticassisted excision of GDCs has never been described in childhood. We report an asymptomatic male patient with 2 gastric cystic masses at ultrasonography (US)-study (diameter 25mm and 8mm), increasing in size at follow-up. At 20 months of age, magnetic- resonance-imaging-scan confirmed 2 round gastric masses (44×35mm and 16×12mm, respectively). Two months later, an elective robotic-assisted excision of GDCs was completed without complications. The patient was discharged at day 6 after procedure. Histology confirmed the diagnosis of GDCs. At a 2-year follow- up, US-study did not evidence any issue. In this first reported case of robotic-assisted cystectomy for CGD in childhood, the procedure seems safe, effective, and feasible. This approach improves the movements of the surgical instruments with better 3- D visualization in comparison with the laparoscopic approach.</p> 2018-12-04T11:16:12+00:00 ##submission.copyrightStatement## The isolated tubal torsion: an insidious pediatric and adolescent pelvic urgency 2020-04-06T03:07:54+00:00 Carmine Noviello Mercedes Romano Alfonso Papparella Andrea Ciavattini Ascanio Martino Giovanni Cobellis <p>Isolated tubal torsion (ITT) is a rare cause of acute abdominal pain. Preoperative diagnosis is difficult because of a lack of specific signs. Surgery is recommended to preserve the integrity of the tube. Seven patients of median age of 13 years (range 9 to 15) came to our observation for worsening abdominal pain, nausea and vomiting. On admission, all girls had blood tests and ultrasound. Laparoscopy was performed for diagnosis in all cases. The girls had one-month and one-year ultrasound and clinic follow up. In all cases diagnosis was delayed, median 66 hours after the onset of symptoms and laparoscopy showed necrosis of the Fallopian tube. In five girls a laparoscopic salpingectomy was performed. In the other two, an open salpingectomy was necessary because of pelvic adhesions. Histology showed a hemorrhagic infarction of the Fallopian tubes. At follow up all patients were asymptomatic with normal ovaries, but one ovarian cyst. In the differential diagnosis of acute abdominal pain in children or female adolescents the possibility of ITT should be considered for a conservative treatment. Laparoscopy allows for definitive diagnosis and treatment.</p> 2018-12-04T11:05:58+00:00 ##submission.copyrightStatement## Pseudoarthrosis of second metatarsal fracture 2020-04-06T03:07:55+00:00 Jessica Zanovello Barbara Bertani Redento Mora Gabriella Tuvo Mario Mosconi Luisella Pedrotti <p>Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.</p> 2018-10-19T15:24:56+00:00 ##submission.copyrightStatement##