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Biomedical subjects

E De Grazia

Publications and source records attributed to E De Grazia.

At least 19 recordsLinked to original sources
PubMed2006

Primary repair in esophageal atresia. The results of long term follow-up.

AIM: The aim of this study was to assess the impact of postoperative morbidity during a long-term follow-up (6-12 years) in children with esophageal atresia treated at birth by primary anastomosis. METHODS: Fifteen children with esophageal atresia and tracheoesophageal fistula were surgically treated at birth and their follow-up was extended to at least 6 up to 12 years. Data included clinical examination, evaluation of nutritional habit, continuous video recording of barium esophagogram, esophageal manometry, 24-h esophageal pH-monitoring and esophageal endoscopy. RESULTS: All the 15 patients completed the clinical evaluation and the set of tests. In the first 6 years, mild dysphagia and gastroesophageal reflux (GER) was observed in 3 cases whereas GER without dysphagia in 4 cases. These 7 patients were informed about simple nutritional behaviours to minimize symptoms and treated with H2-blockers. At long-term twelve-year analysis, all patients were between 50 degrees and 75 degrees percentile of expected growth. It was not referred peculiar food restrictions. Five patients showed mild dysphagia with solid foods; early satiety, epigastric burning and regurgitation were less frequent. Furthermore they showed multiple non-peristaltic body contractions at esophagogram and moderate impairment of esophageal motility at esophageal manometry. The 24-h esophageal pH-monitoring showed normal patterns in all patients. No major lesions of esophageal mucosa were detected at esophagoscopy. CONCLUSIONS: Although GER and esophageal dysmotility are reported as frequent findings in patients who underwent primary repair for esophageal atresia, these disorders don't cause any relevant impairment to the quality of their nutritional habit.

Child↗
PubMed2004

Needle perforation of the bowel in childhood.

Accidental ingestion of foreign bodies occurs frequently in childhood. The majority of them are passed spontaneously, and conservative management generally is recommended for foreign bodies in the stomach and duodenum. However, in some cases, operative intervention should be considered to prevent undesirable complications, such as intestinal perforation. Two cases of intestinal perforation owing to accidental ingestion of a needle are reported.

Abdomen, Acute↗
PubMed2004

Suture materials: do they affect fistula and stricture rates in flap urethroplasties?

INTRODUCTION: The effect of suture materials on urethroplasty complications is debated. Indeed, materials with a delayed absorption might either reduce the incidence of fistulas by ensuring a prolonged approximation of neo-urethral edges or increase the risk of urethral strictures due to a prolonged tissue reaction during suture absorption. We retrospectively evaluated the role of suture materials in the complication rate of urethroplasty procedures performed in our institution over a 10-year period. PATIENTS AND METHODS: Three hundred and thirty-six boys undergoing a flap procedure (parameatal based, preputial tube, or onlay preputial flap) for hypospadias repair were considered for this study. The patients were stratified into two groups according to the suture material used for urethroplasty. Polyglactin (Vicryl), a polyfilament with intermediate absorption, was used in 254 group A patients, whereas polydioxanone (PDS), a monofilament with prolonged absorption, was used in 82 group B patients. The success of a one-stage repair and stricture and fistula rates were evaluated. RESULTS: A successful one-stage repair was achieved in 82% of the group A and in 83% of the group B patients (p = 0.97). No statistically significant differences were noted in fistula and/or stricture rates in the two groups, even considering each procedure separately. CONCLUSIONS: This series suggests that suture materials do not affect the complication rate in flap urethroplasty procedures. Appropriate technique, meticulous surgery, and surgeon experience seem to be more crucial factors. A randomized trial is warranted.

Child↗
PubMed2003

Urethrocutaneous fistula repair after hypospadias surgery.

OBJECTIVE: To evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair. PATIENTS AND METHODS: The charts of 72 children who developed fistulae after hypospadias repair were reviewed; 39 had a simple closure of the fistula, whereas 32 had a 'pants over vest' repair, in all cases after excluding an impairment of urine outflow. RESULTS: The success rate at the first attempt was 74% for simple closure and 94% for the layered repair; at the second attempt it was 80% and 100%, the difference being statistically significant for both repairs. CONCLUSIONS: Although probably far from an optimal technique for repairing urethrocutaneous fistulae, the pants-over-vest repair allows a good success rate for penile shaft fistulae.

Child↗
PubMed2003

A giant fetal urinoma in a neonate without detectable obstructive uropathy.

UNLABELLED: Fetal urinoma is an uncommon finding in prenatal investigations. Most previous reports have, almost in every case, referred to the presence of an obstructive uropathy and thus to very high pressure in the upper urinary tract during fetal life. In this paper we present a prenatally detected fetal giant urinoma occurring in the absence of an apparent obstructive uropathy but associated with an ipsilateral vesico-ureteral reflux. CASE REPORT: A 5-day-old boy, born after a caesarean section in the 37th week of gestation, but without any perinatal distress, came under our observation because of the evidence of a right upper quadrant abdominal mass. This mass had already been detected prenatally, when during the 30th week of gestation ultrasound investigation showed a right anechogenic mass occupying more than half of the abdominal fetal profile. At postnatal US scan this liquid mass did not seem to have its own wall and moved the nearest organs laterally and upward. The right kidney was not visualised and no ascites was present. We decided to insert a percutaneous drainage tube to decompress the renal parenchyma; normal urine leaked out from it. Radionuclide 99 mTc-DTPA scan excluded an obstructive uropathy, while voiding cystourethrogram excluded posterior urethral valves but showed a vesico-ureteral reflux. We diagnosed a right-sided giant urinoma correlated with a vesico-ureteral reflux but without any urinary obstruction. DISCUSSION: It is very difficult to find a reasonable explanation for the occurrence of a urinary extravasation as a consequence of a vesico-ureteral reflux as seen in this neonate. We know that an intra-renal reflux can be the final result of high-grade vesico-ureteral reflux, but we find it very strange that this could induce a parenchymal rupture in the absence of a rapid increase of pressure and thus without a urinary stricture or stenosis. We can only assume that a prenatal transient urethral outflow obstruction was the cause of this renal rupture. A syringocoele might be the most probable transitory cause of prenatal obstruction.

Cysts↗
PubMed2003

[Cystic dysplasia of rete testis associated with ipsilateral renal agenesis. Case report].

Cystic dysplasia of the rete testis is a rare abnormality often associated with the ipsilateral agenesis of kidney. This malformation is due to a development defect of the mesonephric duct which is the cause of both the dilation of the testicular rete testis and renal agenesis. A case of this rare malformation, showing all the peculiarities described in the medical literature, is presented. A 3 years-4 months boy was examined for an asymptomatic left scrotal mass; thus, he underwent ultrasonography, which showed a multiple tubular and cystic dilatation of left rete testis, associated with the absence of left kidney, afterward confirmed by MAG3-radionuclide scan. Diagnosis was also validated by testicular biopsy. No surgery was required. The child is nowadays under observation and at 2-years follow-up he doesn't show any symptom. According to many authors, a conservative treatment of this benign congenital abnormality is suggested as well as serial ultrasonography to monitor the growth of the testicular mass, which in a longest follow-up, could require surgery. Malignant transformation nor infertility have never been described.

Abnormalities, Multiple↗
PubMed2003

Sub-inguinal interruption of dilated veins in adolescent varicocele: should it be considered a gold standard technique?

AIM: Surgeons of varicocele are at present still searching for a gold standard technique, which can correct varicocele without any recurrences, maintaining optimal testicular function, having got minimal current and future morbidity and being cost effective. We evaluated the presence of these criteria in the technique of sub-inguinal dilated vein interruption. METHODS: Between 1994 and 2001, 142 youngsters and adolescents underwent surgery for varicocele repair at our hospital. Average patient age was 12.4 years (range 8 to 15). One-hundred-six cases (74.7%) were grade III varicocele, while 36 (25.5 ) were grade II. Grade II varicoceles underwent surgery only if associated with scrotal discomfort, testicular softness or hypotrophy of the affected testis (differential volume between the 2 testicles more than 20% or more than 2 ml ). Varicoceles were repaired using a subinguinal ligation of intrafunicular and extrafunicolar dilated veins. The testicular vaginalis was not touched in 46 children (Group A) but it was reversed in 42 and resected in the other 54 cases to prevent postoperative hydrocele. RESULTS: In 126 cases (88.7%) varicocele disappeared after surgery, in 12 (8.4%) a mild residual vein dilatation persisted but without any sign of reflux at color-Doppler ultrasound, in 4 patients a postoperative venous reflux was found. Thus, our recurrence rate is nowadays 2.8%. Average postoperative follow-up was 2.3 years (range 1 to 5 years). No testicular atrophy was observed. Based on our last series, at 1 year follow-up control (26 cases throughout year 2000), mean testicular volume, assessed by ultrasound, increased not significantly after surgery from ml 4.69 (SD+/-1.46) preoperative volume to ml 5.19 (SD+/-1.36) postoperative (p=0.2). CONCLUSION: First of all, we found a recurrence rate of 2.9% similar to the lowest of the other procedures. Regarding morbidity, the main inconvenience consists in postoperative hydrocele. It occurred in 13% of our 1st series (group A), but only in 4.1% of patients after reversion or resection of the vaginalis tunica. Average postoperative testicular volume increases after varicocelectomy in our patients, even if not significantly. About sparing the testicular artery or not it has been demonstrated that ligation of this artery doesn't impair testicular growth up and our own observations confirm this evidence. Thus we believe it to be more useful and safe to interrupt this artery to avoid recurrences due to a periarterial venous network. Finally we can conclude that sub-inguinal ligature of dilated veins, when approached with rigorous understanding of the pathophysiology of varicocele is a very safe procedure and low cost effectiveness.

Adolescent↗
PubMed2001

Surgical or conservative treatment of congenital hydronephrosis. Ten years' experience.

BACKGROUND: Controversy exists concerning the ideal management of hydronephrosis diagnosed in the perinatal period. Different opinions depend on the absence of an accurate tool and of well-defined cut-off values for each test. For these reasons we retrospectively evaluated our management protocol. METHODS: Two-hundred and seventy-two patients with single system hydronephrosis were evaluated. Patients with bilateral hydronephrosis or with other renal or ureteral abnormalities were excluded. Diagnosis and grading of hydronephrosis were done by ultrasound. Before 1995, grade II or greater hydronephrosis was also evaluated with diuretic intravenous urography, but in cases studied afterwards, a functional evaluation of the obstruction was reached with well tempered diuretic renogram. Indications for surgery were considered: recurrent urinary tract infections, grade IV hydronephrosis, obstructive drainage pattern and differential renal function less than 40%. Patients managed non-operatively received serial re-evaluation with US-scan, urine test and functional tests if necessary. RESULTS: Hydronephrosis was on the right side in 98 cases (36%), and on the left side in the other 174 (64%). There were 129 grade I hydronephrosis (47%), 46 grade II (17%), 57 grade III (21%), 40 grade IV (15%). Fifty-seven (21%) cases of hydronephrosis underwent surgery: 49 (86%) showing obstructive pattern at functional tests, 40 (70%) presenting a differential renal function less than 40%, 5 (8%) because recurrent urinary tract infections, 40 (70%) affected by grade IV hydronephrosis. No children received nephrectomy. Average postoperative follow-up was 2.8 years: pelvic dilatation improved or remained unchanged but the obstructive pattern at functional tests always disappeared after surgery. The average follow up in the observational group of 163 patients (60%) was 4.1 years. In 149 (91%) pelvic dilatation improved, but in 14 (9%) it remained unchanged. CONCLUSIONS: The ideal management of congenital hydronephrosis is still debated since the natural history of these disease is not still completely understood and there is no accurate tool to assess these renal units. We believe that grade IV hydronephrosis always need surgery as well as those ones with recurrent urinary tract infections, longer drainage time or a differential renal function less than 40%. On the other hand grade I hydronephrosis never need surgery. Mild grade hydronephrosis can be safely managed non-operatively with a meticulous follow-up and undergoing surgery only when signs of deterioration occur.

Female↗
PubMed1999

[Oxybutinin-desmopressin association in the treatment of primary nocturnal enuresis with diurnal urination disorders].

BACKGROUND: Since most of the children observed in our Centre present enuresis with voiding disturbance, we carried out a study where these patients were treated with the DDAVP + Oxybutinin association. METHODS: We have treated 89 children with enuresis and voiding disturbances (urge incontinence, voiding urgency, urinated > 7 times a day), administering a drugs combination of desmopressin (20 micrograms/daily) and oxybutinin (0.3-0.6 mg/kg/bid or tid) for a variable period, depending on response to the treatment. RESULTS: The results demonstrate the efficacy of this association: we have observed a reduction in average bed wetting nights from 23.4 nights/month to 6.4 wet nights after 1 month, to 3.8 ad 2.9 respectively after 3 and 6 months from the beginning. Moreover we obtained a recovery of all daily voiding disturbances after 3 months. Fifty percent of children were cured after 4 months of therapy and finally 93.2% recovered at 6 months. On the other hand, 2 children were no-responders to the therapy even after 9 months of combined drugs administration. CONCLUSIONS: Based on these results we can affirm that children with nocturnal enuresis and voiding disturbance can be treated with this combined therapy. Actually, the reduction of urinary output and thus lower bladder filling, due to the desmopressin, decreases the onset of uninhibited bladder contractions and enhances oxybutinin activity.

Adolescent↗
PubMed1998

Modified-Mathieu's technique: a variation of the classic procedure for hypospadias surgical repair.

Distal penile curvature associated with anterior hypospadias can be corrected by urethral plate mobilization. The authors present 11 cases, in which this procedure was performed modifying the classic Mathieu's technique in the surgical treatment of coronal and distal shaft hypospadias associated with chordee. Performing this modified-Mathieu's technique, excellent results, both functional and cosmetic, are obtained without any complication.

Child↗
PubMed1997

Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin.

OBJECTIVE: Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. METHODS: 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. RESULTS: Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. CONCLUSIONS: The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.

Administration, Intranasal↗
PubMed1997

[Conservative treatment of dysplastic multicystic kidney].

BACKGROUND: Recent developments regarding the conservative management of multicystic dysplastic kidney disease (MDKD) have shown a reduction in the well-established practice of elective surgical treatment. It has been seen that in the majority of cases the evolution of MDKD is either partial or complete atrophy. The incidence of complications due to MDKD is very low. The aim was to study the ultrasound changes of MDKD in a group of patients from 1990, since this date the elective surgical procedure had been eliminated. MATERIALS AND METHODS: This group consisted of 16 patients. The diagnosis in each patient was confirmed by ultrasound and isotopic examinations. Other investigations were performed where there was a suspect of associated contralateral renal abnormalities or when a urinary tract infection occurred. RESULTS: Ultrasound follow-up revealed: no enlargement whatsoever in the kidney size in any patient; in 10 patients a reduction in the size of the MDK; in 3 patients a complete atrophy of MDK; in 3 patients there was no change at all. Five patients were found to have contralateral renal abnormalities. Compensatory hypertrophy of the contralateral kidney was present in all patients. No complications occurred. A nephrectomy was performed only in one patient aged 6 due to the express wishes of his parents. CONCLUSIONS: The results agree with recently published literature that routine surgical removal of the MDK is unnecessary.

Child, Preschool↗
PubMed1997

[Recent advances on retroperitoneal neuroblastoma].

Neuroblastoma, a malignant tumor of infancy and childhood, has some very interesting peculiars: good prognosis, even with disseminated disease, propensity to occasionally undergo spontaneous regression, its ability to undergo spontaneous or induced differentiation to a benign ganglioneuroma. Neuroblastoma may originate anywhere along the sympathetic nervous system chain. The most common site of primary tumor is, however, within the abdomen either in the adrenal gland or in a paraspinal ganglions. A great deal of progress has been made in advancing the knowledge of human neuroblastoma at the cellular and molecular viewpoint. The genetic predisposition to develop the tumor is clarified, a specific oncogene amplified (N-myc) in neuroblastoma cells shows precise prognostic significance and the deletion of chromosome 1's short arm has been defined. Work-up in neuroblastoma's diagnosis include the urine assay for catecholamine metabolites (VMA, HAVA, VLA) and serum assay for the specific markers as neuron-specific enolase (NSE), ferritin, GD2 ganglioside. Imaging include CT-scan, MIGB body-scan and the newest monoclonal antibodies scan. Abdominal tumors are shown in about 75% of children > 12 months old. In 2/3 of cases, tumor is widely disseminated at the time of diagnosis. In the period 1979-94 the Italian Group for Neuroblastoma (GCN-AIEOP) collected 1083 cases of tumors and 5-yrs survival was 45% +/- 2.4 for the patients studied in the period 1979-84, which is increased to 58% +/- 3 for the group of patients 1990-94 (p < 0.001). The overall survival was 53 +/- 1.7. About 5-yrs survival at different stages, AIEOP shows that it is increased from 88% +/- 3.3 (1979-84 group) to 91% +/- 2.8 (1985-92) in the stage I and II (280 cases). In the stage IV survival value improved from 79% +/- 7.1 to 84% +/- 7 (132 cases). No statistical improvement can be observed, anyway. Better improvements can be pointed out in stage III (221 cases, survival from 48% +/- 5.2 (79-84 group) to 69% +/- 4.8 (85-92) and stage IV (483 cases, survival from 16% +/- 2.6 to 28% +/- 3.4) (p < 0.001). Finally we can summarize about neuroblastoma: 1) better prognosis in the first year of life; 2) ability to spontaneous regression, first of all, in stage IVs; 3) partial and provisional response to therapy in advanced stages; 4) no recovery increasing despite advancing in surgery and chemotherapy.

Child↗
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↗