Antibiotics and pleural drainage with continuous suction is effective in treatment of childhood pleural empyema. However a recognizable number of childhood pleural empyema fail to improve or to cure after this treatment. This study reviews our experience with 27 children over past 8 years. All patients were treated with antibiotics, seven with only pleural drainage, twenty with pulmonary decortication. Indications for decortication were: clinical and radiological failure after 4-5 days of treatment with pleural drainage and continuous suction; persistent fever; persistent respiratory distress; persistent signs of general illness; persistent loculated pleural effusions; worsening parenchymal disease. The clinical and radiological improvements following decortication were dramatic with immediate lung reexpansion and improvement of clinical course. The chest tubes were removed by the fifth postoperative day and the children were discharged by the seventh-nine postoperative day. There were no complications and no deaths. In our experience pulmonary decortication is a simple and effective treatment of childhood empyema in the advanced fibro-purulent and/or early organizing phase with immediate and long-term excellent results.

Adolescent↗

PubMedDate not supplied

[Renovascular hypertension in childhood].

One to two per cent of children and up to 11% of adolescent have arterial hypertension. In most cases children and adolescent are not recognized to be hypertensive because physicians do not routinely measure blood pressure. Often the diagnosis is recognized only when the pediatric patients develop a complication: seizure, stroke, heart failure or paraplegia. Renovascular hypertension in children and adolescents is more common than all of the other causes combined, except for coarctation of the aorta. The diagnosis is not so easy and includes the usual history, physical examination (signs and symptoms of coarctation of the isthmic or abdominal aorta or of an abdominal mass or of one of the adrenal causes of hypertension), laboratory studies, abdominal ultrasound study and chest x-ray. Sometime a CAT can be usefull. The next steps are the early and rapid-sequence IVP, renal angiography and peripheral and renal renin activity. The management of renovascular hypertension in children and adolescent includes a conservative approach (percutaneous transluminal renal angioplasty or renal embolization), rarely used in pediatric age, and the surgical treatment. This latter includes all the surgical procedures of renal revascularization and, in unilateral renal parenchymal diseases, the nephrectomy or a partial nephrectomy. The postoperative results are very good in a high percentage of cases. In bilateral cases, the revascularization surgical procedures improve or normalize also the impaired renal function.

Angioplasty, Balloon↗

PubMedDate not supplied

[Esophageal atresia, today].

In recent years there have been remarkable improvements in the treatment of babies with congenital esophageal atresia. This improvement in survival and in preservation of esophagus is due: to progress in neonatal anesthesia and in preoperative and postoperative intensive care; to progress in surgical management of associated anomalies (mainly congenital malformations of the heart); to progress in surgical management of the malformation. Esophageal anastomosis may be performed in the majority of babies with "long gap" esophageal atresia by operative techniques for lengthening of the upper esophageal segment or by elongation of the upper and lower pouches by means of bougienage or mercury-filled bag. Today the indications for replacement of the esophagus by colon interposition or reversed gastric tube are limited.

Esophageal Atresia↗

PubMedDate not supplied

[Interstitial-cell tumor of the testicle. A case report].

The authors introduce the case of a seven-years-old patient suffering from a tumor of the Leydig cells testicle, which is a pathological entity rare to be found during pediatric age. The clinical history is characterised by the absence of any endocrine phenomena, such as precocious pseudopuberty, which are usually linked to the presence of a "Leydigoma". Surgical therapy, in connection with the described constant evolution that favours such lesions during pediatric age, with the absence of any cellular anomaly which is typical of a malignant case and lastly, with the clear delimitation of the tumor from the healthy testicular parenchyma, has so far restricted itself to the enucleation alone, without orchiectomy.

Biopsy↗

PubMedDate not supplied

[A case of idiopathic mediastinal fibrosis with fatal outcome].

Particular difficulties arise when trying to classify mediastinal fibrosis and determining its etiology and clinical evolution. In this paper, the Authors describe a case of mediastinal fibrosis which was characterized by a specific clinical origins (mild fever-anemia). It was not possible to establish the real etiology of the mediastinal lesion which in the end led to an unfavourable outcome that was linked to the local development of the illness, in spite of its benign histological characteristics.

Child↗