La Pediatria Medica e Chirurgica 2020-05-22T06:36:28+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 2020-05-22T06:32:20+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 Copyright (c) 2019 Salvatore Fabio Chiarenza, Cosimo Bleve, Elisa Zolpi, Francesco Battaglino, Lorella Fasoli, Valeria Bucci Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of the esophageal atresia 2020-05-22T06:33:41+00:00 Salvatore Fabio Chiarenza Maria Luisa Conighi Ciro Esposito Maria Escolino Fabio Beretta Maurizio Cheli Vincenzo Di Benedetto Maria Grazia Scuderi Giovanni Casadio Maurizio Marzaro Leon Francesco Fascetti Andrea Conforti Pietro Bagolan Claudio Vella Cosimo Bleve Daniela Codric Paolo Caione <p>Esophageal Atresia (EA) is defined as an interruption in esophageal continuity that results in a proximal tract that ends in a blind pouch in 98% of cases, and a distal tract that in 87% of cases arises via a Fistula from the Trachea (TEF). (...).</p> 2019-12-19T00:00:00+00:00 Copyright (c) 2019 The Authors Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of pediatric nephrectomy and partial nephrectomy 2020-05-22T06:33:14+00:00 Salvatore Fabio Chiarenza Cosimo Bleve Ciro Esposito Maria Escolino Fabio Beretta Maurizio Cheli Vincenzo Di Benedetto Maria Grazia Scuderi Giovanni Casadio Maurizio Marzaro Leon Francesco Fascetti Pietro Bagolan Caludio Vella Maria Luisa Conighi Daniela Codric Simona Nappo Paolo Caione <p>Throughout history, the pediatric laparoscopic nephrectomy was first described at the beginning of the Nineties by Erlich and colleagues in a child and by Koyle and colleagues in an unweaned patient. (...)</p> 2019-12-19T00:00:00+00:00 Copyright (c) 2019 The Authors Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of the ureteropelvic-junction obstruction 2020-05-22T06:32:47+00:00 Salvatore Fabio Chiarenza Cosimo Bleve Ciro Esposito Maria Escolino Fabio Beretta Maurizio Cheli Vincenzo Di Benedetto Maria Grazia Scuderi Giovanni Casadio Maurizio Marzaro Leon Francesco Facetti Pietro Bagolan Claudio Vella Maria Luisa Conighi Daniela Codric Simona Nappo Paolo Caione <p>The hydronephrosis, characterized by the dilation of the renal pelvicalyceal system with possible functional damage to the renal parenchyma, is the most common congenital abnormality of the urinary system detected in utero through the prenatal ultrasound screening. (...)</p> 2019-12-19T00:00:00+00:00 Copyright (c) 2019 The Authors A rare cause of acute scrotum in a child: torsion of an epididymal cyst. Case report and review of the literature 2020-05-22T06:34:09+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 Copyright (c) 2019 Mario Messina, Giulia Fusi, Francesco Ferrara, Edoardo Bindi, Chiara Pellegrino, Francesco Molinaro, Rossella Angotti 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 2020-05-22T06:34:37+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 Copyright (c) 2019 Mauro Cinquetti, Anna Maria Colombari, Emanuela Battisti, Pierpaolo Marchetti, Giorgio Piacentini The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis 2020-05-22T06:35:06+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 Copyright (c) 2019 Mario Lima, Dora Persichetti-Proietti, Neil Di Salvo, Claudio Antonellini, Michele Libri, Beatrice Randi, Michela Maffi, Tommaso Gargano, Giovanni Ruggeri, Vincenzo Davide Catania Toward sutureless laparoscopic inguinal hernia repair in children? 2020-05-22T06:35:33+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 Copyright (c) 2019 Antonio Marte, Laura De Rosa, Lucia Pintozzi, Vincenzo Esposito Paediatric surgery in the robotic era: early experience and comparative analysis 2020-05-22T06:36:01+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 Copyright (c) 2019 Mario Lima, Eduje Thomas, Neil Di Salvo, Tommaso Gargano, Giovanni Ruggeri Hypoceruloplasminemia: an unusual biochemical finding in a girl with Hashimoto's thyroiditis and severe hypothyroidism 2020-05-22T06:36:28+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 Copyright (c) 2018 Mariella Valenzise, Federica Porcaro, Giuseppina Zirilli, Filippo De Luca, Maurizio Cinquegrani, Tommaso Aversa