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Biomedical subjects

A Zaccara

Publications and source records attributed to A Zaccara.

At least 37 records · Page 2Linked to original sources
PubMed1995

Spinal dysraphism detected by magnetic resonance imaging in patients with anorectal anomalies: incidence and clinical significance.

Though the concept of caudal regression, suggested in 1961 by Duhamel, could explain the association between anorectal anomalies (ARA) and spinal dysraphism (SD), its real incidence may be underestimated and its clinical significance is debatable. From 1988 to 1993, 111 patients with ARA were treated at the authors' institution. Associated anomalies were present in 36% of cases, with the exception of vesicoureteral reflux, which was considered functional rather than anatomical. In view of the late (1 to 2 years after surgical treatment) onset of vesical dysfunction and/or orthopaedic symptoms in some of these patients, a screening protocol was started in 1991, using magnetic resonance imaging (MRI) in all patients with ARA. Fifty patients, 29 boys and 21 girls, underwent a spinal cord MRI, with pathological findings in 25 cases (50%), 13 boys and 12 girls. The authors did not find any significant difference in incidence with respect to high, low, or cloacal malformations. A thickened filum, with or without fibrolipoma, was the most frequent finding, but even tethered cord, syringomyelia, and sac morphological alterations were present. MRI was also able to detect osteoarticular and/or muscular anomalies. Even when a urodynamic study and a neurological and orthopaedic workup were performed in 20 patients undergoing MRI, the clinical significance of these findings remained unclear. However, accurate follow-up of these patients is mandatory in order to detect early neurological symptoms, because currently it is not advisable to refer for neurosurgery all the patients with ARA presenting with anomalies of the spinal cord.

Abnormalities, Multiple↗
PubMed1995

Physical fitness testing in children operated on for tracheoesophageal fistula.

The maximal physical activity capacity of children operated on for tracheoesophageal fistula (TEF) has not been clearly defined. Eight patients (average age, 12 years) successfully operated on for TEF at birth underwent maximal exercise stress testing on a treadmill, according to the Bruce protocol, to test physical work capacity. Heart rate (HR), oxygen consumption (VO2), and pulmonary ventilation (VE) were measured by a portable lightweight telemetric device. Nine healthy children served as controls. Exercise duration was significantly lower for TEF subjects than for controls (11.6 +/- 1.7 minutes v 15.1 +/- 2.3 minutes; P < .01). Mean HR at rest and during exercise did not differ between the groups. All children reached the maximum HR according to their age; however, for the majority of TEF patients, this occurred at an earlier stage than in the controls. No differences were seen in mean VO2 at rest and on exertion between TEF and control children. However, maximal VO2, as measured at the end of exercise, was significantly different when normalized per kilogram of body weight (VO2/kg = 52.3 +/- 5.8 v 33.3 +/- 6.6; P < .005). The physical rehabilitation of TEF children usually takes into account only respiratory and nutritional factors. However, complete assessment of their cardiac and respiratory function, at rest and on exertion, also should be performed, because this may show that some patients have reduced motor performance; evidence is now accumulating that these children can safely participate in the same physical activities of their healthy peers.

Adolescent↗
PubMed1993

[Administration of 5% +EMLA cream for local anesthesia in ambulatory pediatric surgery].

The use of local anaesthesia has been advocated by most pediatric surgeons in order to cut down hospitalization costs as well as to avoid general anaesthesia. In 1992, 26 patients aged 4 to 14 years (avg. 8 years) underwent small surgical procedures with local anesthesia, obtained by the application of EMLA cream 60 to 120 minutes prior to the procedure. EMLA cream is aneutectic mixture of lidocaine and prilocaine with a meeting point at a lesser temperature than the two compounds separately. In this way, concentration of anaesthetics increases up to 80% in the emulsion droplets. This preparation enables small operations to be performed under local anesthesia even in small children who can be safely treated as outpatients. Disadvantages due to the long time necessary for optimal action can be overcome by application of the cream at home by the parents themselves.

Administration, Topical↗
PubMed1992

Prenatal diagnosis and clinical outcome of ovarian cysts.

Technical refinements of ultrasound (US) have greatly affected the antenatal diagnosis and treatment of ovarian cysts. From 1985 to 1990 25 consecutive fetuses with ovarian cysts were followed-up by US both during pregnancy and postnatally. All cases were diagnosed between the 28th and 39th weeks of gestation. Deliveries were all at term; cesarean section was required only for obstetric complications. Eight fetuses (32%) showed US patterns of cyst torsion, a finding confirmed at surgery in all. In five patients US patterns suggested complications postnatally that were also confirmed at operation. In six cases cysts increased or remained unchanged in size after 15 days of life: in 50% of these surgery showed ovarian torsion. In the remaining six cases spontaneous resolution occurred within 1 to 4 months. One patient required intrauterine needle aspiration. There were two cases of intestinal obstruction. To date, more than 60% of newborns with ovarian cysts require oophorectomy; however, different treatments (cystectomy, needle aspiration, uncapping) combined with a close US follow-up are likely to reduce this percentage.

Female↗
PubMed1991

Distal hypospadias repair by urethral sliding advancement and Y-V glanuloplasty.

Different techniques are available today for repairing distal (coronal and subcoronal) hypospadias but none is universally recommended. We developed the technique of a distal urethral advancement glanuloplasty operation that is specifically intended for distal hypospadias repair even with mild chordee. Mobilization of the distal urethra is performed for 1.0 to 1.5 cm. after subcoronal circumcision and a deep Y-shaped incision of the glans. The mobilized urethra is dorsally split and slid forward to the tip of the dart of the glans previously prepared. Glanuloplasty is performed using the 2 lateral flaps of glans tissue. From January 1987 to December 1989 we used this technique in 74 cases of distal hypospadias with mild or no chordee (patient age 18 months to 9 years, mean 3.5 years). A transurethral catheter was left indwelling for 3 to 4 days. Hospitalization time was 5 (plus or minus 1.5) days. Results after 4 to 40 months of followup are encouraging cosmetically and functionally. All patients were cured. In 3 cases (4%) meatal stenoses occurred requiring meatotomy and in 8 boys meatal dilations were performed on an outpatient basis. In 1 case (1.3%) a fistula developed, which was subsequently repaired without further complications. This operation may be successfully used in most cases of distal hypospadias, with a low complication rate and excellent cosmetic results. It also may be used if mild chordee is present, thus reducing the indications for flip-flap urethroplasty in those cases when meatal advancement procedures may not be effective.

Child↗
PubMed1991

Colonoscopic control of uretero-enteric anastomoses in internal urinary diversion.

Twenty-four patients with internal urinary diversion following total bladder ablation underwent colonoscopic control of the uretero-enteric anastomoses. The techniques performed were: rectal bladder with colostomy according to Mauclaire (11 patients); rectal bladder with abdomino-perineal pull-through according to Heitz-Boyer/Hovelacque (6); ureterosigmoidostomy (7). The uretero-enteric anastomoses were divided into 3 categories according to the colonoscopic appearance: "nipple-like", nearly flat and flat anastomosis. Urographic examinations were carried out in all patients and the results demonstrated that the "nipple-like" anastomosis was the most successful for the preservation of upper urinary tract integrity.

Anastomosis, Surgical↗
PubMed1991

Dermoid cyst in undescended testis in a 9-year-old boy.

Testicular dermoid cysts are rare in the pediatric age group: their discovery in an undescended testis is exceptional. The origin of this lesion is still unclear, but it should be considered as a monolayer expression of a mature teratoma. Though surgeons when confronted with these intratesticular cysts have traditionally opted for castration, in presence of small, compact masses, simple enucleation may be recommended, provided that the integrity of the neighboring parenchyma is not affected.

Child↗
PubMed1990

[Experience in the prophylactic use of ceftriaxone in pediatric surgery].

Authors report on their experience about ceftriaxone in surgical prophylaxis in childhood. 30 patients have been treated, suffering from surgical diseases, either thoracic or abdominal ones, including malignancies. Ceftriaxone was administered once a day; patients received ceftriaxone only once preoperatively: Results have been very satisfactory, the only two complications having been found in two severely immunocompromised patients.

Abdomen↗
PubMed1990

Successful intrauterine therapy of a large fetal ovarian cyst.

Fetal ovarian cysts can be managed in different ways, depending upon their size and clinical course: conservatively, by open surgery or by postnatal transabdominal puncture. However, in cases of large cysts detected antenatally and affecting the ongoing pregnancy, in utero transabdominal puncture can be undertaken, without increase of risk. A case of such a puncture at 30 weeks gestation is reported.

Adult↗
PubMed1990

Endoscopic manipulation of ureteral calculi in children by rigid operative ureterorenoscopy.

To date, rigid operative ureterorenoscopy with ultrasound lithotripsy for the treatment of ureteral calculi has been performed only in adults or older children. The size of the instrument with the working channel for the ultrasound probe has been considered unsuitable for delicate anatomical structures, such as those of children younger than 4 years. We performed 8 ureterorenoscopic examinations in 7 patients (3 boys) 3 to 8 years old and have demonstrated that the 11.5F ureteroscope can be inserted without difficulty into the ureteral meatus of a 3-year-old boy. Introduction of the instrument is facilitated by the use of the Perez-Castro irrigation pump. This procedure does not lead to any urethral or ureteral damage, nor is vesicoureteral reflux shown on a postoperative cystogram. This technique allows extracorporeal shock wave lithotripsy to be extended also to small children, offering the possibility of easy and successful management of any residual steinstrasse.

Child↗
PubMed1989

How prenatal ultrasound can affect the treatment of ureterocele in neonates and children.

Prenatal ultrasound has set the stage for new trends in the diagnosis and treatment of many urinary tract malformations, in particular duplication of the renal collecting system with ureterocele. The authors have reviewed their experience with 41 ureteroceles in 7 years. The 36 patients were divided into two groups: those with prenatal diagnosis and subsequent early treatment (group A, 14 cases), and those with diagnosis later after birth (group B, 27 cases) showing various degrees of renal impairment as assessed by a 99Tc-diethylenetriamine pentaacetic acid scan. The surgical approach carried out on the patients of each group with particular regard to the endoscopic incision of the ureterocele as the treatment of choice, especially in neonatal period, is discussed.

Child↗
PubMed1989

Mesosigmoidoplasty in the treatment of sigmoid volvulus in children.

Sigmoid volvulus is a rare disease of childhood, which requires surgery. The case of a 12-year-old boy is reported. The main aetiopathogenetic causes and the proper surgical approach are also described with particular reference to the so-called mesosigmoidoplasty, which consists of shortening the mesosigmoid by incision along its axis and transverse suture.

Child↗
PubMed1987

The importance of gastric emptying in reflux esophagitis: an experimental research on pigs.

A study was conducted on pigs to evaluate the importance of gastric emptying rate in reflux esophagitis development. Gastric emptying was previously measured in 25 pigs. Then, the following operative procedures were carried out: Heller's cardiomyotomy, common bile duct ligature, cholecysto-gastric anastomosis, and extramucosal duodenal myotomy on 10 animals (group A); the same procedures except extramucosal duodenal myotomy on another 10 animals (group B); common bile duct ligature and cholecysto-gastric anastomosis on the last 5 animals (group C). Six months later, gastric emptying was measured again; whereas in group A a significant shortening of gastric emptying was found, the other 2 groups remained unchanged. Then, all the animals were sacrificed and the lower third of the esophagus was removed for histologic examination. In all the pigs undergoing cardiomyotomy (groups A and B) appearance of esophagitis was found. No signs of esophagitis were found in group C. The conclusions reached are cardiomyotomy is in all cases responsible for reflux esophagitis development; extramucosal duodenal myotomy is capable of shortening gastric emptying, but this does not affect reflux esophagitis development.

Animals↗
PubMed1983

Synthesis, biological and biochemical properties of new anthracyclines modified in the aminosugar moiety.

New 4'-C-methyl analogues of daunorubicin, synthesized by the coupling reaction of daunomycinone with 1-chloroderivatives of protected 4-C-methyldaunosamine analogues, were chemically transformed to the corresponding doxorubicin analogues. Their cytotoxic effect against HeLa cells, ability to bind to DNA, and in vivo toxicity and antitumor activity were compared with those of daunorubicin, doxorubicin, and their 4'-O-methyl analogues. The cytotoxic effect of the new anthracyclines could be correlated with their ability to bind to DNA and with their toxicity in experimental animals; however, the antitumor effectiveness did not seem to be related to these parameters. In general all the compounds retained a remarkable antitumor activity at their optimal doses. The most active compound against P388 leukemia was 4'-O-methyldoxorubicin, which was also more active than doxorubicin against L1210 leukemia.

Animals↗