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Biomedical subjects

C Chiaramonte

Publications and source records attributed to C Chiaramonte.

11 recordsLinked to original sources
PubMed2002

[Treatment of complications in hypospadias surgery: modern advancement].

BACKGROUND: With today's improved surgical techniques, complications in hypospadias surgery are seen less often, especially in distal form (1-5%). However, in proximal or complex hypospadias complications rate varied between 15 and 57%. Corrective surgery is mandatory in maior complications (urethrocutaneous fistulas, persistent chorde, urethral strictures, superficial skin separation). The search for the innovative surgical procedures and the optimal urethral substitute continues because each tissue has its particular shortcomings and disadvantages. METHODS: At our hospital complications occurred in 25 ( 15%) of 177 patients who underwent primary hypospadias repair between 1994 and 1998. 9 patients required further surgery to repair the complications of previous hypospadias operations performed at other institutions. When local epithelial tissue was not available, different surgical procedures were performed, using bladder or buccal mucosa graft and free or vascularized tunica vaginalis flaps. RESULTS: Follow up ranged from 3 to 6 years: the cosmetic and functional results were excellent. Small fistulas occurred in 3 patients and were corrected successfully in a subsequent surgical procedure using a tunica vaginalis wrap. CONCLUSIONS: The concept of using tunica vaginalis in urethral reconstruction represent a recent innovation. This tissue is a valid alternative in cases of multiple failed repairs.

Cutaneous Fistula↗
PubMed2002

[Predicting factors of vesicoureteral evolution in children].

BACKGROUND: Despite the large number of children with reflux, management among urologists is still controversial. One of the most debated aspects is the choice between observation treatment or surgical treatment. METHODS: We assessed the natural course of children with vesico-ureteral reflux in the period 1990-1995, to correlate factors and identify patients with high risk of renal damage. We retrospectively reviewed the clinical course of 80 children with vesicoureteral reflux. Thirty-two were diagnosed during prenatal ultrasound scan. In the other cases urologic evaluation was requested because of urinary tract infections. The following data were analyzed: medical records, diagnostic and follow-up cystogram, renal imaging, medical therapy or surgical treatment carried out according to the reflux grade, diagnostic age, congenital reflux nephropathy or postnatal acquired scarring, voiding patterns, spontaneous resolution during medical management. Follow up ranged from 5 to 10 years. RESULTS: Vesicoureteral reflux resolved spontaneously in 29 patients: 25 were affected from moderate reflux, 4 from IV grade reflux. Surgical correction was carried out in 32 patients. Endoscopic treatment was performed in 25. Twenty-two children are still receiving prophylaxis and 12 were lost to follow-up. Congenital renal pathology correlate with poor outcome. CONCLUSIONS: The conclusion is drawn that there is a wide clinical variability in children with vescicoureteral reflux. The most important is host's susceptibility to urinary tract infection, but the severity of reflux, age of patients and congenital reflux nephropathy influence prognosis and long-term outcome.

Child↗
PubMed2002

[Microproteinuria as a marker of renal damage in children].

BACKGROUND: Elevated urinary levels of microproteinuria or renal enzyme have shown to be associated with renal injury. Data collected in children with vesico-ureteral reflux (VUR) or hydronephrosis have been evaluated to identify a means of predicting renal damage. METHODS: Levels of urinary microproteinuria (N-acetyl-beta-glucosaminidase, aminoalanina peptidase, lisozyme, beta(2)-microglobulin) were evaluated with immunoassay in catheterized or voided urine. The levels of urinary creatinine were also determined. Of the 85 children enrolled in this study 22 were affected from reflux, 16 had hydronephrosis. Urine was obtained from the bladder in all children and also from renal pelvis in 9 patients at surgery for ureteropelvic junction obstruction. In addition, urine was obtained from 27 patients with a variety of pathophysiological conditions (neoplasia, ematuria, parenteral nutrition, ecc.). Normal healthy controls were performed in 20 children who volunteered for the study. RESULTS: In the group of children affected from reflux urinary microprotein elevated levels were in 18. In children with hydronephrosis pathological findings were observed in 2 cases. Abnormal pattern was found in 27 patients as response to various agents. Data obtained in healthy children were normal. Sensitivity in reflecting renal damage makes urinary enzymes measurement attractive as an indicator of renal dysfunction. CONCLUSIONS: Urinary microproteinuria evaluation may be a useful marker of progression of renal injury in children with reflux. However, excretion level of these microproteins is not helpful in identifying upper tract obstruction in small children, but values arise in those left untreated.

Biomarkers↗
PubMed2001

Ovarian cysts in newborns.

Before the introduction of ultrasonography (US), ovarian cysts in newborns were thought to be rare. With the extended use of real-time US, prenatal detection has increased. There is still considerable controversy regarding the best treatment of these neonatal findings. A total of 27 instances in 24 consecutive newborns of antenatally-diagnosed ovarian cysts were reviewed for US data, management, and outcome to assess the ante- and postnatal evolution of the cyst and establish appropriate therapy. The cysts detected during pregnancy were studied by repeated postnatal US studies. In 10 children (2 with bilateral cysts) the cyst evolved spontaneously toward regression. Fourteen patients were operated upon; 10 had complex and 4 (in 1 bilateral) had simple cysts. Cystectomy was employed when possible to preserve the ovarian parenchyma (3 cases); in the remaining cases oophorectomy was performed. Histologically, the cysts were of follicular origin or necrosis made a diagnosis impossible. US was found to be a helpful diagnostic tool for simple ovarian cysts, but could not reliably distinguish between benign and malignant tumors if a sonographically complex lesion was present. Based on our experience, surgical management of ovarian cysts should be reserved to complex masses. Simple cysts can be monitored safely by close US follow-up; surgery is indicated if the cyst fails to regress after several months or becomes symptomatic.

Cesarean Section↗
PubMed1989

[Enuresis in children. Diagnostic assessment and treatment].

Many theories on the etiology of enuresis have been suggested, including psychogenic, structural abnormalities, dysfunctional aspects. The study consisted of 95 children with primary enuresis (35 girls, 60 boys). 58% of patients presented with enuresis plus evidence of voiding dysfunction. Patients with pure nocturnal enuresis were 17%. 42% of children have normal bladder on urodynamic testing. Anticholinergic medication was effective in children with voiding dysfunction. The base line treatment program, in children with normal urodynamic studies, included psychotherapy, medications, bladder training. Authors present their experience and results of treatment. The usefulness of urodynamic assessment in children with only nocturnal enuresis is discussed.

Adolescent↗
PubMedDate not supplied

Focal hematopoietic hyperplasia of the rib. Report of a case diagnosed by fine needle aspiration.

BACKGROUND: Focal hematopoietic hyperplasia (FHH) of the rib is a rare, benign, localized proliferation of bone marrow to such a degree that it produces a tumorlike expansion of the rib that can be the source of considerable clinical alarm. In the appropriate clinical setting, this lesion needs to be included in the differential diagnosis of solitary bone lesions, in particular when assessing the adequacy of a specimen at the time of aspiration. CASE: A large, lytic mass on the posterior aspect of the sixth rib was incidentally discovered on a chest roentgenogram from a 46-year-old male during a routine presurgical evaluation for diverticulitis. The radiologic characteristics of the tumor were thought to be consistent with a neoplasm; that prompted a recommendation for fine needle aspiration biopsy (FNAB). The mass was thoroughly sampled under radiologic guidance, performing multiple aspirations of different areas. All smears prepared at the time of the aspiration for the evaluation of specimen adequacy showed abundant marrow tissue without any evidence of malignancy. Although it was initially thought that the tissue was probably obtained from the periphery of the lesion, this notion was discarded after multiple passes from different areas showed only marrow tissue and since there was radiologic evidence that the sample was obtained from within the lesion. CONCLUSION: The diagnosis of FHH of the rib by FNAB or other small-biopsy techniques requires strict radiologic-pathologic correlation. Awareness of this entity will avoid unnecessary repeated biopsy procedures and potentially large, complicated surgical procedures. This case shares several features with the other two reported cases: a solitary lesion on the rib presenting in an asymptomatic patient with no evidence of associated hematologic disease.

Biopsy, Needle↗
PubMedDate not supplied

[Urodynamic evaluation in children with enuresis].

We performed an urodynamic study in enuretic children to evaluate the relationship between urodinamic findings and symptoms. We studied 175 patients, with age from 5 to 12 years, who presented with nocturnal enuresis: 45 monosymptomatic and 130 polysymptomatic (in association with urinary urgency, urge incontinence, etc.). Despite differences in symptoms, in 151 patients (86%) abnormal urodynamic findings were identified. Bladder instability was the most common disorder. However, mild abnormalities were found in the monosymptomatic patients. In treated patients urodinamic findings and clinical improvement were correlated. This study confirmed that most patients with nocturnal enuresis have cystometric abnormalities. Although possible etiologies of nocturnal enuresis are various, bladder dysfunction may be an underlying cause.

Child↗