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Biomedical subjects

G Belloli

Publications and source records attributed to G Belloli.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

[Sugiura's operation in the treatment of hemorrhaging esophageal varices].

Rebleeding, the long time high occurrence of encephalopathy and the impairment of hepatic function in the successful cases have led to increasing dissatisfaction in the last years with portasystemic shunt procedures. In the past 12 years we have operated on 14 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization); in two cases the entire procedure was performed through the thoracic approach. We had no mortality. Complications include bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Patient follow-up has been between 16 months and 11 1/2 years with an average of 6 1/2 years. The long term controls have been gratifying in 12 patients with disappearance of the varices and no evidence of rebleeding, esophageal strictures, gastroesophageal reflux, encephalopathy or impairment of the hepatic function; in two other patients the operations was unsuccessful. In our opinion the Sugiura procedure should be the elected operation in the surgical treatment of esophageal varices bleeding in pediatric age, after an attempt with sclerotherapy.

Child↗
PubMedDate not supplied

[Indications and results of surgical treatment in gastroesophageal reflux and hiatal hernia].

It is well known that closure of the cardia is incomplete in about 25-30% of all infants; the GER is a direct consequence. Roughly two-thirds of these infants do not show symptoms and only one-third become symptomatic. The symptoms are mild in about 75% of the symptomatic children; no treatment or medical treatment by pediatrician is required. In the remaining 25% the symptoms are moderate or severe and the clinical treatment is necessary. About the 85% of these children are cured with conservative treatment and only 15% of this small remaining group require surgery. In the paper the diagnostic problems and indications for surgery are considered. The Authors report the results of 66 children operated on for GER without (44 children) and with (22 children) hiatus hernia. The operative technique was gastropexy according to Boerema plus retroesophageal hiatopexy in the cases of important hiatus hernia. At the follow-up 61 children (92.5%) were completely asymptomatic and three showed mild symptoms without pathological radiological findings. Clinical and radiological recurrences occurred in two patients (4.5%) with severe brain damage. Two children were reoperated on postoperatively for an ileus due to adhesion. The mortality rate has been zero. In the author's opinion, the Boerema procedure is a simple, physiologic and fast technique, associated with very few complications and no mortality rate and should be considered the elective method in the surgical treatment of GER and hiatal hernia in pediatric patients.

Child, Preschool↗
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[Value of rectal sensitivity test in chronic childhood constipation].

The rectal sensitivity test evaluates the distension volume for which the initial transient sensation occurs on defecation (conscious rectal sensitivity threshold). The conscious rectal sensitivity threshold (S.S.R.C.) was performed on 10 normal controlled subjects and 103 children with chronic constipation, functional megarectum and normal rectoanal inhibitory reflex. Children were between 5 and 14 years old. S.S.R.C. was increased in children with chronic constipation. Encopresis was proportionally increased with relation to S.S.R.C. increase. A therapeutical protocol was applied in all patients. Fifteen patients are still being treated: 87 obtained a normal function within 8 to 23 months of treatment; in one case the treatment was unsuccessful. The period of treatment was proportional to S.S.R.C. increase. Physiopathological background of a correct management is discussed.

Adolescent↗
PubMedDate not supplied

[Hirschsprung disease. Results of surgical treatment].

The Authors report their experience in the treatment of 86 patients, in pediatric age, with Hirschsprung's disease: 40 with congenital rectosigmoid or subtotal megacolon, 8 with total colic or ileocolic aganglionosis and 38 with ultrashort aganglionic segment. Out of the patients 29% had necrotizing enterocolitis with 40% mortality rate in rectosigmoid or subtotal forms and with 75% mortality rate in total colic or ileocolic forms. In the last group the mortality was higher related also to difficulties and complications of surgical treatment. Necrotizing enterocolitis is the major cause of death in infants with Hirschsprung's disease. Early diagnosis and treatment can reduce the mortality rate.

Child, Preschool↗
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[Deep hypothermia and cardiocirculatory arrest with the technic of central cooling in patients with simple transposition of the great arteries].

The deep hypothermia and cardiocirculatory arrest are employed mainly for two reasons; to reduce as much as possible the extra corporeal circulation time in patients more suitable to present the deleterious effects of the by-pass circulation, and to have surgical field completely free from the blood, making easier some surgical procedures. In the classic description of Hykasa the deep hypothermia necessary to have a safe cardiocirculatory arrest is obtained by means of surface cooling and an extracorporeal heat exchanger. In our experience deep hypothermia and cardiocirculatory arrest were achieved only by means of core cooling technique; 64 patients with TGA weighing less than 10 kg were operated upon by this method with a mortality rate of 3.1%. The most important mortality risk factors were associated to the low weight of the patients and to the age. The major criticism against core cooling is represented by the thought that this type of cooling can impair cerebral function. In 2 patients we had neurological complications but were unrelated to the technique. We conclude that, when is necessary to perform a cardiocirculatory arrest, the core cooling deep hypothermia is a good, simple and useful technique, with a low danger of neurological complications.

Extracorporeal Circulation↗
PubMedDate not supplied

[Results of the surgical treatment of primary obstructive megaureter in the child].

Primary obstructive megaureter (P.O.M.) is a dilatation, different in size, of upper urinary tract without reflux and secondary to a functional obstructive malformation of terminal segment of ureter. Infection and renal function impairment complicate P.O.M. in a rather high percentage of cases. In Authors' experience, in about 22% another urinary malformation and in more than 8% an extraurinary malformation are associated. Authors' experience in the treatment of 119 P.O.M. (102 patients) is reported. 14 P.O.M. (9 patients) were not operated on. In 104 megaureters (92 patients) an ureteric reimplantation with shortening and tailoring without preoperative temporary urinary diversion was carried out. In 4 megaureters a V.U.R. and in another 4 an ureteric stenosis taken place as postoperative complications. In 96 ureters (92.3%) positive results were obtained with normalisation or impressive improvement of upper urinary tract and improvement of renal function.

Child↗
PubMedDate not supplied

[The ureterocele in childhood. Type of treatment and results].

Ureterocele is an infrequent urinary malformation in pediatric age, but it is frequently clinically severe. Ureterocele in a duplex pyelo-ureteral system often presents very difficult treatment problems not uniformly dealt with. Authors report their experience with 79 ureteroceles observed in 72 children. 27 children were less than one year old. In the authors experience simple ureterocele with a single collecting system doesn't give any surgical problem. On the contrary ectopic ureterocele, almost always associated with a pyeloureteral duplication, frequently gives some problems of surgical treatment. Treatment is always individualized but in our experience the best results have been achieved with unroofing of the ureterocele and upper heminephroureterectomy in one stage, eventually associated with lower ureteral reimplantation. This treatment can be used successfully in the majority of ectopic ureteroceles in pediatric age.

Adolescent↗
PubMedDate not supplied

[Primary vesico-uretero-renal reflux. Results of surgical treatment in over 1,100 refluxing ureters].

Primary vesicorenal reflux (P.V.R.R.) is the most important cause in the pathogenesis of chronic pyelonephritis, better known in medical literature as "reflux nephropathy". The Authors stress out the criteria adopted in their Center for surgical treatment of P.V.R.R. and report the results in 1158 refluxing ureters (858 children) operated on. In 5 ureters an ureteronephrectomy and in 1153 remaining ureters and ureteral reimplantation was carried out. About 57% of ureters operated on was affected by severe reflux (IV - V grade). The Authors obtained 98.6% of surgical successes. In 16 ureters operated on, stricture (9 ureters) and reflux (7 ureters) were postoperatively present. The percentage of successes in infants less than 2 years old at operation was 98%.

Adolescent↗
PubMedDate not supplied

[Hydronephrosis surgically treated in the 1st year of life. Short- and long-term radiologic and functional evaluation].

Hydronephrosis in infancy and childhood is a frequent urinary malformation and is almost always congenital. In over 80% of the cases it is due to ureteropelvic junction obstruction; much less frequently it is due to anomalous renal vessels, sometimes associated to ureteropelvic junction obstruction. In this paper the Authors analyze their experience in the surgical treatment of this urinary malformation. 234 hydronephrosis out of 222 patients were operated on from January 1972 to June 1985. 61 hydronephrosis were operated on in 55 infants under 1 year. Primary nephrectomy was carried out only in 9 of the 234 hydronephrosis operated on (3.9%) and in 3 of the 61 hydronephrosis operated on in infants less than 1 year old (4.9%). All the 55 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants for a total of 30 hydronephrosis had a glomerular filtration rate determination during sequential scan for individual kidney function assessment. 90% of the kidneys operated on showed a normal or slightly reduced glomerular filtration rate. Recent advances in prenatal echographic diagnosis and relationship between obstructive uropathy, renal development and pulmonary hypoplasia are discussed. The Authors stress out the importance of early diagnosis to improve surgical results.

Adolescent↗
PubMedDate not supplied

[Long=term evaluation of renal damage in primary vesico-renal reflux after corrective surgery].

Traditionally 3 mechanisms are responsible for the development of renal damage when primary vesico-renal reflux is present: reflux is a manifestation of abnormal embryological development of the ureteral bud, with subsequent dysplasia; sterile reflux damages the kidney, perhaps trough a mechanical or/and an immunological mechanism; renal damage occurs as a result of the reflux of infected urine into susceptible renal papilla (intrarenal reflux). Whatever the mechanism, it is apparent that reflux and renal damage are intimately related. It does appear that for the most part damage is done at an early age. Operative repair of vesico-renal reflux has been advocated as a reliable method to stop reflux, with attendant cessation of renal damage and improvement in renal function. However some recent prospective study found that the rate of continued renal scarring is independent of medical or surgical therapy. The aim of the present paper is to study the functional and radiological long-term results after successful antireflux surgery (mean follow-up 6 years 4/12). 90 patients for a total of 140 refluxing ureters were studied for assessment of urinary infection, blood pressure and renal function. 40 patients for a total of 62 refluxing ureters were evaluated for determination of renal parameters evolution. At follow-up from 3 to 14 years (mean 6 4/12 years), less than 10% of the patients showed pathological bacteriuria generally without episodes of acute pyelonephritis. Hypertension was present in 4 (4.4%) out of 90 patients, aged from 14 to 18 years. There was a significant improvement in renal function after operation, especially in infants operated on in the first two years of life. The postoperative radiological study showed a growing of affected kidneys in about 89%. In almost 47%, the affected kidneys showed an increased growth. Only about the 5% of the kidneys showed a decreased development with a final evolution toward a small pyelonephritic kidney. The best results were obtained in patients operated on very early in the life. Our greatest challenge is to prevent the early destruction of nephrons. This means an early diagnosis of urinary tract infection and detection of vesico-renal reflux with an early treatment. The administration of prophylactic antibiotics and, when indicated, an early surgical treatment can minimize, in our opinion, the magnitude of renal damage for the most part of patients.

Child, Preschool↗
PubMedDate not supplied

[Posterior urethral valves. Type of treatment and short- and long-term evaluation of renal function].

In this paper the authors have analyzed the management and the outcome of 81 cases of posterior urethral valves which occurred during the period January 1972 - April 1985. 53 children presented very severe urethral valves (grade 4 according to Hendren), 28 mild valve type. All the children of the first group but two had a dilatation of the U.U.T. Vesico-renal reflux, usually severe, was present in 51 ureters; in another 50 ureters a dilatation without reflux was present. 47% of the children of the first group had a renal function within the limits of normality at the moment of presentation and the remaining 53% a reduced renal function. In 9 patients (8 under 50 days of age) a cutaneous vesicostomy according to Blocksom followed, at the age of 10-18 months, by transurethral valve destruction was done. In 6 infants, in the early part of the series, the valve was removed with a hook via the perineal approach. In 38 patients we performed a transurethral valve destruction with the n. 3 Bugbee electrode. 36 out of 53 children (68%) had exclusively a removal of the valvular obstruction. After the removal of the obstruction, 32 out of 37 non refluxing dilated ureters (86.5%) showed a clear improvement. In 7 out of 29 refluxing ureters a nephrectomy was carried out. In the remaining 22 ureters the reflux vanished in 17 and improved in the other 5. 17 children had other types of operations after valvular removal. 23 ureters in 13 patients were reimplanted, with 3 failures (13%). In the 53 children with very severe valve (grade 4) supravesical diversions were not carried out. In the follow-up of 51 children (from 6 month to about 14 years) the renal function was within the limits of normality in 74% (before the operation it was 47%). The best results were obtained in children diagnosed and treated in the first months of life. Cutaneous vesicostomy showed itself to be a very useful method of treatment in very young babies with severe complications. We observed a slight terminal urethral stricture, easily dilatable, in only 1 child. All the children over the age of 12-13 years were continent. In 28 children with mild valves, as well as transurethral valve destruction, an ureteric reimplantation was carried out with success in 5 children (8 ureters) and a vesical diverticulectomy in another 2.

Child↗
PubMedDate not supplied

[Urodynamic study of the lower urinary tract in children today].

The urodynamic study of the lower urinary tract is the only investigation that permits an evaluation of the vesico-sphincter function. On the ground of the personal experience of 3262 urodynamic study on 1221 children, the authors are reviewed the methods, indications, limits and pitfalls of urodynamics and synchronous video-flow-cystourethrography. Indications in the personal experience are: neuropathic bladder; non neuropathic vesico-urethral dysfunction; urinary incontinence; intravesical obstruction; recurrent cystitis; vesico-uretero-renal reflux and obstructive megaureter; nocturnal enuresis. Informations given by urodynamics in these pathologic conditions are very important for the diagnosis, prognosis and therapy. The urodynamic study is a very reliable and useful method, also in pediatric age, if correctly performed by expert investigators.

Adolescent↗
PubMedDate not supplied

[Proposed functional classification of urination disorders of a neurologic nature in children].

It is absolutely necessary for all individuals engaged in the care of pediatric patients with neurogenic voiding dysfunction to have a useful means of categorizing the patient's problems. Actually the most accepted classifications are the "urodynamic" proposed by Krane and Siroky and the "functional" proposed by Wein. These Authors present two different approaches to accomplishing the same purpose: namely, directing the appropriate therapy for the patient's problems. In the authors opinion, from a diagnostic and therapeutic standpoints, a working understanding of both of these classifications seems advisable. In this paper the authors present a functional-urodynamic classification of neurologic voiding dysfunctions in pediatric age, clinically and therapeutically useful.

Child↗
PubMedDate not supplied

[Neuropathic bladder in childhood. Treatment of the complications and prevention].

We treated 91 children with neuropathic bladder and 141 refluxing ureters in an attempt to eliminate or ameliorate reflux and preserve renal function. The reflux was 1 and 2 degree in 48 ureters and 3 and 4 degree in 93 according to the classification of Dwoskin and Perlmutter. In the lower degree refluxes we preferred a conservative treatment with intermittent vesical catheterization, appropriate drug use and, much less frequently, transurethral external sphincterotomy. The reflux disappeared in 11 ureters in intermittent vesical catheterization and improved in an additional 17 ureters; in these cases the presence of bacteriuria without clinical significance and renal deterioration was rather common. In the severe refluxes, often associated with recurrent serious episodes of infection and renal damage, we preferred surgical treatment. All together, we performed 49 ureteral reimplantation, 15 transuretero-ureterostomy, 9 cutaneous vesicostomy (18 ureters), 1 bladder augmentation plus sphincterotomy (2 ureters) and 4 urinary diversions (7 ureters). Our primary differentiated approach resulted in cure in 83 ureters (58.9%) and in improvement of the reflux without renal deterioration in an additional 43 ureters (30.5%); failures were present in 15 ureters (10.5%). In our opinion the approach to management of upper urinary tract dilatation without reflux should be more conservative (78 dilated ureters in 46 patients). In these cases it is very important to lower, with conservative measures, the vesical pressure. When this treatment is unsuccessful, a cutaneous vesicostomy or bladder augmentation or a transureteroureterostomy in unilateral cases should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMedDate not supplied

[Urinary incontinence in the neuropathic bladder in children. Treatment using an artificial urinary sphincter].

The neurogenic urinary incontinence can be successfully managed by implantation of an artificial urinary sphincter. The most important requirement for implantation is the recognition that the patient has failed to respond to well-accepted conservative measures or is an unsuitable candidate for such conservative measures. It is necessary to rule out the presence of detrusor hyperreflexia or to show that, if it exists, hyperreflexia can be easily pharmacologically controlled. At the same time the bladder's capability for storage of urine must be "adequate" and the vesical compliance normal or only slightly reduced. The bladder emptying should be unobstructed, without residual urine. The patient must be psychologically motivated and able to utilize the artificial sphincter intelligently. The upper urinary tract should be either normal or stable, preferable with no evidence of vesicorenal reflux. Finally, according to the authors, the patient should be more than 11 years old. In the author's opinion these are the ideal candidates for sphincter implantation. The authors operated on 25 patients with neurogenic urinary incontinence, aged from 13 to 19; 23 were males and 2 females. All the male patient had preoperative transurethral external sphincterotomy. In the first 2 cases we applied model AS 792; both these sphincters were substituted with the last model AS 800. In the other 23 cases model AS 800 was used. The cuff was always placed at the bladder neck and only in 1 case, with a previous operation on the neck, at the urethral bulb. Obviously in this late case, the lower pressure balloon was chosen. In all cases primary deactivation was performed; the sphincter was activated after about 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗