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Biomedical subjects

L Musi

Publications and source records attributed to L Musi.

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

[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

[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

[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↗
PubMedDate not supplied

[Ureterocele: study of 66 cases observed in 60 children].

Ureterocele is an unfrequent urinary malformation in pediatric age, but frequently it is clinically severe. Ureterocele in a double pyelo-ureteral system often presents very difficult treatment problems not uniformely dealt with. Authors report their experience with 66 ureteroceles observed in 60 children; more than a half of which were less than one year old. In the authors experience simple ureterocele does'nt 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 heminephoureterectomy in one stage. This treatment can be used successfully in the majority of ectopic ureteroceles in pediatric age.

Adolescent↗
PubMedDate not supplied

[Portal hypertension and bleeding esophageal varices in children. Esophageal transection with paraesophagogastric devascularization versus shunting procedures (author's transl)].

It is known that portasystemic shunts in the treatment of portal hypertension causes in the long term a high rate of complications in children. The most severe are encephalopathy, postoperative hepatic failure in intrahepatic hypertension and occlusion or poor functioning of the shunts. The incidence of the last mentioned complication is high in children, especially in those operated in their early years of life. The most severe danger of portal hypertension is the haemorrhage from bleeding esophageal varices. During the last few years the technique of esophagogastric devascularization with esophageal transection and ligation of varices (Sugiura's procedure) has given a very high percentage of success in the long term. The Authors report their experience with Sugiura's procedure in 9 children with portal hypertension (average age at operation of four and half years). In six cases there was a prehepatic and in the other three an intrahepatic hypertension. The follow-up varied from six months to seven and half years with an average of almost four years. In all the children the surgical treatment was successful with the complete disappearance of haemorrhage and esophageal varices. For their own experience and for Sugiura's long-term results, the Authors think that Sugiura's procedure offers the most effective alternative to portasystemic shunts in the surgical treatment of portal hypertension, especially in early childhood.

Child↗
PubMedDate not supplied

[Hydronephrosis in infancy and childhood].

Hydronephrosis in infancy and childhood is almost always congenital. In 80% of the cases is due to ureteropelvic junction obstruction, in 20% is due to anomalous renal vessels sometimes associated to ureteropelvic junction obstruction. The authors analyze their experience in the surgical treatment of this urinary malformation during a ten years period (1971-1981). 119 hydronephrosis out of 105 patients were operated on. The surgical procedures were successful in 93% of the 119 operated hydronephrosis and in 80% of the giant hydronephrosis. Primary nephrectomy was carried out in only 5% of the operated hydronephrosis (6/119). The Authors stress the importance of early diagnosis to improve surgical results.

Child↗
PubMedDate not supplied

[Nonpalpable testis: current diagnostic and therapeutic trends].

Management of the nonpalpable testis often represent a significant diagnostic and therapeutic challenge for the pediatric surgeon. A variety of imaging studies may locate nonpalpable testis and include ultrasound, CT, MRI, gonadal vasography, and herniography, but none is completely reliable in locating a gonad or proving its absence. Laparoscopy has the advantage of great reliability in locating testes or proving their absence and can be coupled with surgical management; the laparoscopic findings determine the subsequent operative steps. Accurate knowledge of testis location facilitates development of an appropriate surgical strategy either laparoscopic or laparoscopic-assisted or open procedure. The Authors report their preliminary experience with laparoscopy in 30 patients (age range 2-5 years) with 34 nonpalpable testes: 18 testes were intraabdominal, 7 canalicular, 9 atrophic or absent. Out of the 18 intraabdominal testes 2 patients underwent orchiectomy (very small testes), 1 patient testis detorsion and 15 internal spermatic vessels clipping and cutting (first step of staging Fowler-Stephens orchidopexy). At the moment 8 patients, after a 8-10 months interval, underwent second staged vas-based orchidopexy with good results as judged by size and throphism of the relocated testes. An inguinal exploration has been made in 7 patients: 4 orchiectomy (hypo-atrophic testis), 3 standard orchidopexy. In 9 patients the testis were absent. In order to have a good-sized adolescent scrotal pouch, insertion of an infant-size testicular prosthesis is recommended for children with a vanishing or absent testis, if the parents agree.

Algorithms↗
PubMedDate not supplied

[Varicocele: an epidemiological study and indications for treatment].

The varicocele is still the most common correctable cause of male infertility. The epidemiologic studies revealed a gradually increasing incidence of varicocele in patients 10 to 18 years old, as height at the end of puberty as that of the adult male population. The pediatric varicocele is often associated with smaller and hypotrophic testis which presents also histological and progressive changes. Surgical correction of a varicocele in the adult usually produces poor results. In order to improve the fertility rate in adulthood an early varicocelectomy has been suggested. On the basis of our own studies and after a review of the literature, we conclude that all grade III varicoceles and grade II associated with testicular hypotrophy must be early operated on. This hearing provides a higher fertility rate and can prevent the reduced fertility associated with delayed varicocelectomy.

Adolescent↗
PubMedDate not supplied

[Current trends in the treatment of varicocele].

A varicocele first develops in early adolescence and it can negatively affect testicular growth, histology and function. The use of early varicocelectomy to prevent severe testicular damage and sub-infertility in adulthood seems to be incontrovertible. However there is a difference of opinion as to the proper surgical procedure of varicocele ablation. To date, the inguinal and high retroperitoneal approaches are the most commonly accepted methods. However significant postoperative morbidity is common, with a recurrence rate ranging from 1 to 25% and return to normal activity often is prolonged. This considerations have prompted many to search for alternative techniques. The Authors performed laparoscopic clipping and division of the internal spermatic vein or the internal spermatic vessels in 55 adolescents to treat varicocele. Indications for the operation were third degree varicocele and second degree with testicular hypotrophy. At a mean 6 months follow-up, they did not observe either relapses or complications; no hydrocele was noted and testicular size did not decrease in any patient. In the Authors' experience and opinion, laparoscopic varicocelectomy is a simple, safe, effective and minimally invasive surgical procedure and it can be proposed as a viable alternative to open traditional surgical methods.

Adolescent↗
PubMedDate not supplied

[Recurrent facial paralysis in a child with renovascular hypertension].

Hypertension is rarely observed in childhood. The renal diseases are the most common causes of this condition. Headache, seizures, cranial nerve palsy and hemiplegia are the most frequent neurological manifestations. The Authors report on a patient with a severe involvement of central nervous system due to renal hypertension. The main clinical features were recurrent episodes of facial nerve palsy.

Child, Preschool↗
PubMedDate not supplied

[A flowmetric study after a Mathieu-Righini intervention in medial-distal hypospadias].

Uroflowmetric long-term data (mean follow-up 4.5 years) of 64 nonselected patients successfully treated for mid-distal hypospadias with Mathieu-Righini procedure were analyzed. None of our patients needed meatal dilation after primary procedure. Four patients (6.3%) presenting a plateau pattern and a maximum flow rate less than -2 standard deviations were considered to have meatal obstruction. These patients were successfully treated with meatoplasty. We conclude that functional characteristics of the neourethra are quite equivalent to a normal urethra in most of boys and adolescents after meatal based flap urethroplasty. On the other hand, in order to prevent the possibility of unknown strictures postoperative uroflowmetric controls are strongly recommended.

Child↗
PubMedDate not supplied

[Primary varicocele: a substimated pathology in pediatrico-adolescent age].

Idiopathic varicocele is a neglected entity in classic pediatric textbooks. Yet vast epidemiologic studies revealed that the incidence of varicocele gradually increases in patients between 10 and 15 years old and is comparable to that of the adult male population. Clinically, the pediatric varicocele is often associated with smaller and hypotrophic testis; histologically it also is associated with pathological and progressive changes of the testis. We report on the preliminary results of a personal epidemiologic study and a comparative follow-up to value the efficacy of surgical correction in two groups of adolescent and adult patients. Early recognition and treatment of a severe varicocele with testicular hypotrophy may help to prevent in adults the infertility associated with this condition.

Adolescent↗
PubMedDate not supplied

[Varicocele: epidemiologic study and indications for its treatment].

The varicocele is still the most common correctable cause of male infertility. The epidemiologic studies revealed a gradually increasing incidence of varicocele in patients 10 to 18 years old, as height at the end of puberty as that of the adult male population. The pediatric varicocele is often associated with smaller and hypotrophic testis which presents also histological and progressive changes. Surgical correction of a varicocele in the adult usually produces poor results. In order to improve the fertility rate in adulthood an early varicocelectomy has been suggested. On the basis of our own studies and after a review of the literature, we conclude that all grade III varicoceles and grade II associated with testicular hypotrophy must be early operated on. This hearing provides a higher fertility rate and can prevent the reduced fertility associated with delayed varicocelectomy.

Adolescent↗
PubMedDate not supplied

[Modern trends in the treatment of varicocele].

A varicocele first develops in early adolescence and it can negatively affect testicular growth, histology and function. The use of early varicocelectomy to prevent severe testicular damage and sub-infertility in adulthood seems to be incontrovertible. However there is a difference of opinion as to the proper surgical procedure of varicocele ablation. To date, the inguinal and high retroperitoneal approaches are the most commonly accepted methods. However significant postoperative morbidity is common, with a recurrence rate ranging from 1 to 25% and return to normal activity often is prolonged. This considerations have prompted many to search for alternative techniques. The Authors performed laparoscopic clipping and division of the internal spermatic vein or the internal spermatic vessels in 55 adolescents to treat varicocele. Indications for the operation were third degree varicocele and second degree with testicular hypotrophy. At a mean 6 months follow-up, they did not observe either relapses or complications; no hydrocele was noted and testicular size did not decrease in any patient. In the Authors' experience and opinion, laparoscopic varicocelectomy is a simple, safe, effective and minimally invasive surgical procedure and it can be proposed as a viable alternative to open traditional surgical methods.

Adult↗