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Biomedical subjects

L Musi

Publications and source records attributed to L Musi.

At least 19 recordsLinked to original sources
PubMed1992

Sugiura procedure in the surgical treatment of bleeding esophageal varices in children: long-term results.

Recurrent bleeding, the high occurrence of encephalopathy, and the impairment of hepatic function in the successful cases of portasystemic shunts have led to increasing dissatisfaction with these procedures in recent years. Between March 1974 and November 1990 we have operated on 15 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization). In two cases the entire procedure was performed via the thoracic approach. The spleen was left in place in five cases. We have had no mortality. Operative complications included bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Follow-up was from 4 years 3 months to 16 years 8 months with an average of 10 years 4 months. Long-term results have been gratifying in 12 patients (80%) with disappearance of the varices and no evidence of recurrent bleeding. Three children (20% of the patients) had recurrent bleeding 4 1/2 years, 4 years 2 months, and 2 1/2 years after the surgical procedure. In all cases there was no evidence of esophageal stenosis, gastroesophageal reflux, or hiatal hernia, nor signs of encephalopathy nor impairment of hepatic function. In our opinion the Sugiura procedure is a valid procedure in the surgical treatment of esophageal varices bleeding in the pediatric age with a high rate of success (80%) and without late complications.

Child↗
PubMed1979

Ureteral reimplantation in children with neurogenic bladder.

The treatment of urologic complications from myelomeningocele and especially of vesico-renal reflux is a controversial problem. A series of 26 reimplanted ureters in 17 children, with good results in more than 85%, is reported. Ureteroneocystostomy, carried out with a few technical innovation, may represent a useful method for the treatment of vesico-renal reflux and obstruction of the uretero-vesical junction in neurogenic bladder associated with myelomeningocele. This surgical approach leads to the disappearance of the reflux, decrease of dilatation of the upper urinary tract and preservation of renal function in most cases; moreover, infection can be more easily controlled. Ureteral reimplantation should be preceded by periodic urethral dilatation, external transurethral sphincterotomy, and pharmacologic regulation in order to attempt to decrease urethral resistance. After successful surgery, it is possible to try to reeducate the bladder. Reimplantation should be preferred to permanent urinary diversion even if there is gross reflux.

Adolescent↗
PubMedDate not supplied

[The urological complications of renal ectopia in childhood].

Fifty-four cases of anomalies of position in 52 children were reviewed. Of the 52 children 24 (46%) had anomalies involving organs outside the urinary tract and contralateral renal units. Twenty-five ectopic kidneys showed major urological complications (46%). Four were treated conservatively and 21 with surgery. The postoperative results have been excellent in all the cases. Renal anomalies of position often are associated with congenital renal and extrarenal malformations. Nearly 50% of ectopic kidneys are involved by pathological process that often require surgery. Surgical treatment of urological complications of renal ectopia is discussed.

Child↗
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

[Correction of anterior or distal hypospadia using the Mathieu-Righini technic].

In a overall series of 1621 hypospadias operated on, the Authors describe the technical aspects and report the precise indications and results in 141 cases of anterior and middle penile hypospadias using the one-stage Mathieu-Righini repair. This technique has resulted in remarkably few complications and very nice aesthetic results. There was a remarkably low (3.5%) rate of fistula and no urethral stenosis without necessity of postoperative urethral dilatations. The penis looks "normal" in appearance as well as in function.

Adolescent↗
PubMedDate not supplied

[Supernumerary liver localized in the navel. Description of a case].

The authors report a case of a supernumerary hepatic lobe at the umbilicus of a newborn. They review the different symptoms, varietes and frequencies of supernumerary hepatic lobes. The importance of this embryological anomaly is underlined in order to be differentiated from urachal and omphalo-mesenteric duct malformations.

Humans↗
PubMedDate not supplied

[Neonatal perirenal urine extravasation and urinary ascites associated with obstructive uropathy].

We report two cases of perirenal urinary extravasation one of which associated with urinary ascites. An underlying congenital obstructive uropathic condition was discovered in both patients. A localised parenchymal perforation was found in both cases. Prompt treatment with correction of metabolic acidosis and decompression of the tense abdomen and the urinary tract is recommended. The patients survive in good health.

Ascites↗
PubMedDate not supplied

[Prune belly syndrome].

The prune belly syndrome consists of congenital absence or deficiency of the anterior abdominal muscle, bilateral cryptorchidism and anomalies of urogenital tract. Neurological problems are common in these patients as respiratory, orthopedic, gastrointestinal and chromosomal anomalies. We have treated 17 cases of prune belly syndrome. Mortality is 23.5%: two patients died in the neonatal period of respiratory failure; one patient, aged two months, died of septicemia in postoperative period, another, 14 years old, died of respiratory failure with normal renal function. Two patients are female without urological anomalies, one male has an incomplete form with normal urinary tract. Two patients with complete syndrome are treated conservatively. Ten patients with vesicourethral reflux or ureteral dilatation for distal obstruction are treated surgically. We performed 20 ureteral reimplantations with 16 tailoring of the ureters. In three patients ureteral reimplantation failed and in these patients we performed successfully a transureteroureterostomy. All patients have adequate complete bladder emptying without surgical procedure. Renal function is normal in seven, slightly reduced in one and reduced but stable in the others. Orchidopexy was performed successfully in eleven patients (10 Fowler-Stephens procedures). Orchiectomy with testicular prosthesis was performed in a patient 12 years old. Five patients have moderate respiratory insufficiency treated with chest physiotherapy. Urinary tract abnormalities are the most common cause of morbidity and mortality in patients with prune belly syndrome. Treatment regimen must be individualized. Respiratory problems are also frequent and is mandatory a precocious chest physiotherapy.

Adolescent↗
PubMedDate not supplied

[Bladder exstrophy: a neonatal emergency. I: Functional reconstruction].

The goal of the treatment involving the children with exstrophy of the bladder must include urinary continence, protection of renal function, good reconstruction of the penis and a good quality of life. The staged approach (Jeff's protocol) includes bladder closure with penile lengthening, when necessary, in the first week of age, epispadias repair and finally bladder neck reconstruction with bilateral ureteral reimplantation. The authors present their experience on staged functional reconstruction of classical bladder exstrophy (40 patients). They had no dehiscences of the abdominal wall and bladder at the primary bladder closure, at any age, with or without bilateral iliac osteotomy. The final successful rate in the staged functional bladder reconstruction was about 70% and it is continuously improving. In the authors' opinion the successful initial bladder closure is perhaps the most important factor for obtaining a larger bladder more quickly and for achieving a high urinary continence; it must be performed in tre first days of life.

Adolescent↗
PubMedDate not supplied

[Bladder exstrophy: a neonatal emergency. II: Urinary diversion].

The goal of the therapy involving the children with exstrophy of bladder must include urinary continence, protection of renal function and a good quality of life. Primary closure of the bladder would seem to be the ideal solution, but when it is impossible or fails, ureterosigmoidostomy can provide satisfactory solution. We have treated 15 selected exstrophied patients with ureterosigmoidostomy. The average length of follow up was 8 years and 9 months (range is from 19 years to 18 months). All patients have normal renal function; in 13 patients upper urinary tract is normal and two have a moderate ureteral dilatation. In 13 patients the fecal and urinary continence is complete, in two it's acceptable. We report radiological and manometric studies of the rectum and sigma after ureterosigmoidostomy. The long term results are excellent; it is mandatory to have correct indications, meticulous care in the operative technique producing a long submucosal tunnel with direct anastomosis of the ureter to the bowel, post operative management and follow up care.

Adolescent↗
PubMedDate not supplied

[Ectopic ureter].

Ectopic ureter is quite a rare malformation, and it can be more or less serious depending on its anatomy (monolateral or bilateral ectopy, duplicated ureter, single ureter) and the associated malformations. It's more common in female patients. Ectopic ureteral orifice can be either intravesical (bladder neck) or, more often, extravesical. Ectopia in women is more frequently found in the urethra and the vaginal vestibule; much less frequently in vagina and in uterus. In men it is mostly found in the posterior urethra; in the male genital tract is very rare. In most cases ectopic ureter is associated with pyelo-ureteral complete duplication: the upper kidney usually works badly or doesn't work at all, due to renal dysplasia or pyelonephritis. More rarely ureteral ectopia affects a single urinary system and can be monolateral or, in the most serious forms, bilateral. The main clinical signs are urinary incontinence accompanied by regular micturition (more exactly pseudoincontinence) in the female patients, and urinary infection. In the male there is no urinary incontinence. Authors report their experience about 54 ectopic ureters in 51 children. Treatment is always by surgery: the choice has to be made between conservative or radical attitude. 38 total exeresis of the ectopic excretory pathway (upper heminephroureterectomy or nephroureterectomy), 9 ureteral reimplantations, 1 uretero-pyeloanastomosis have been done. Outcome is always satisfactory in monolateral forms, more uncertain in bilateral forms with single ectopic ureter, due to incontinence and reduced bladder capacity problems and the possible associated renal failure.

Female↗