Pediatria Medica e Chirurgica最新文献

{"title":"Challenges in diagnosis and treatment of cushing disease in a 12-year-old boy. Case report.","authors":"Agim Gjikopulli, Sonila Tomori, Marjeta Tanka, Donjeta Bali","doi":"10.4081/pmc.2025.340","DOIUrl":"10.4081/pmc.2025.340","url":null,"abstract":"<p><p>Cushing's Disease (CD), defined as hypercortisolism caused by excess Adrenocorticotropic Hormone (ACTH) secretion by a pituitary corticotroph adenoma, rarely presents in the pediatric age range. The aim is to describe a 12-year-old Albanian boy with a challenging pathway to diagnosis and treatment process for Cushing's disease. He presented with headaches, rapid weight gain during the last three years, stunting, increased body hair growth, and a typical Cushingoid appearance. After a consultation in the Pediatric Endocrinology Unit at the University Hospital Center, \"Mother Teresa,\" in Tirana, the boy was pre-diagnosed with Cushing Syndrome, and hypophyseal adenoma was suspected due to suggestive laboratory tests, although non-consistent imaging results. An ectopic ACTH-dependent Cushing syndrome was suspected together with neuroendocrine neoplasia (carcinoid tumor) as a thoracic CT showed a nodular lesion with regular-lobulated sharp contours in the lower lobe of the right lobe resulted in pulmonary tuberculosis granuloma. Even imaging failed to identify the ACTHsecreting microadenoma; the decisive examination was an intervention to collect samples from the inferior petrosal sinus during the CRH test, which found a left-side ACTH-secreting focus. Left hemi-hypophysectomy was performed using gamma knife therapy, resulting in effective normalization of hypercortisolism, but with the side effect of growth hormone deficiency.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal lymphatic malformations in children: case series.","authors":"Carmine Noviello, Alfonso Papparella, Mirko Bertozzi, Giovanna Riccipetitoni, Ilaria Cascone, Carmine Botta, Giulia Fusi, Veronica Vitali, Mercedes Romano","doi":"10.4081/pmc.2025.348","DOIUrl":"10.4081/pmc.2025.348","url":null,"abstract":"<p><p>Lymphatic Malformations (LMs) are benign congenital malformations of the lymphatic system that commonly involve the abdomen in children (mesentery of the small intestine and omentum). The management of these malformations is not unique. 7 children with different ages (range: newborn to 14 years), diagnosis was incidental in some cases, while in others for abdominal pain. All patients underwent abdominal ultrasound and Magnetic Resonance Imaging (MRI). Laparoscopy for diagnosis was useful in 4 cases. Treatment was: conservative in 1 child, laparoscopic excision in 3 patients, laparotomic excision in 3 cases. At follow up we observed recurrence in a case that required integrated treatment and bowel occlusion after excision in 1 case. This benign malformations may not cause any symptoms to patient. The goal of treatment is to maintain organ function, preserve aesthetic integrity and complications control. Management of these patients could be varied: the best approach should be evaluated on the basis of the patient.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique challenges in managing pediatric colorectal diseases in under-resourced areas: context-aware adaptive responses from short-term surgical outreach visits.","authors":"Alessandro Calisti, Kibreab Belay, Giovanni Giuliani, Pierluigi Lelli Chiesa, Guglielmo Mazzoni, Philippe Molle, Paola Presutti, Diaaeldinn Yaseen Salman, Boniphace Tresphory","doi":"10.4081/pmc.2025.357","DOIUrl":"10.4081/pmc.2025.357","url":null,"abstract":"<p><p>Pediatric Colorectal Diseases (PCRD), mainly Anorectal Malformations (ARM) and Hirschsprung's Disease, are a major issue in Sub-Saharan Africa (SSA). Even with advances in healthcare facilities and global health initiatives, most of children living in low resources SSA lack of specialist pediatric surgical facilities. Improved healthcare access is needed to manage PCRD in these locations, to prevent and reduce missing or delayed diagnosis, early mismanagement by inexperienced health practitioners, and barriers to corrective therapy and long-term follow-up. A retrospective analysis of data from three SSA hospitals shows that international surgical outreach visits helped increase capacity. Along one hundred twentyfour weeks of staggered surgical outreach visits 174 ARM and 64 highly suspected HSCR cases were collected. The study evaluates 152 ARM and 59 HSCR patients who had not been treated before. Those who came after an unsuccessful treatment elsewhere were not included. Management, clinical course, complications and results are reported. Focus is on context-aware adaptive surgery and sustainable solutions to improve outcomes and quality of life for those children, discussing long-term follow-up options and results. The local context has a substantial impact on epidemiology, demographics, and presentation compared to high-resource countries. Intestinal stomas done at a primary health facility level presented at referral to our Hospital with 25% complication rate. Due to social, economical, and transit issues, only 108 ARM and 41 HSCR could finally receive a corrective treatment by the outreach visiting teams. Complications (9.1%) were controlled using adaptive solutions. Only one surgical fatality occurred. A limited proportion of patients (46% ARM, 31% HSCR) attended a regular follow up schedule for one year or more, and finding those lost in wide rural areas was difficult. Successful and comprehensive PCRD management in under-resourced SSA requires better training at the primary health level on early recognition and correct, first surgical approach, together with a referral network to specialist facilities for further treatment. Surgical short-term outreach trips can boost local capability in under-resourced areas. The research of adaptive and sustainable surgical solutions to reduce hospital stay and staged treatments time for PCRD must be emphasised. Nevertheless financial and logistical constraints still challenge post-discharge monitoring and follow-up, which remain crucial for long-term outcome.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phimosis in hooded foreskin is a curious presentation in adolescents: case series.","authors":"Carmine Noviello, Ilaria Cascone, Gaia De Francesco, Mercedes Romano, Mirko Bertozzi, Francesco Miele, Alfonso Papparella","doi":"10.4081/pmc.2025.358","DOIUrl":"10.4081/pmc.2025.358","url":null,"abstract":"<p><p>Phimosis is a pathological condition in children and is easy to diagnose. In particular cases it can be associated with curious malformations of the foreskin. Four adolescents (aged from 9 to 13 years) presented at our attention because of a phimosis with hooded foreskin. Symptoms complained were: balanitis, urinary infection, preputial urinary retention, or psychological problems. One of the cases was asymptomatic. No other malformations were present. The surgical treatment was to remove the hooded foreskin and treat the ventral part of the skin of the penis to avoid abnormal curvatures. This type of malformation should be recognized and treated even if asymptomatic because it can create psychological problems in adolescence. The surgical treatment must prevent penile curvatures.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report of rare presentation of schistosomiasis: delayed diagnosis of genitourinary schistosomiasis in an adolescent.","authors":"Valentina Caputo, Cosimo Bleve, Giulia Brooks, Elisa Zolpi, Salvatore Fabio Chiarenza","doi":"10.4081/pmc.2024.331","DOIUrl":"10.4081/pmc.2024.331","url":null,"abstract":"<p><p>Schistosomiasis is a tropical infection endemic to developing nations that can result in chronic liver damage, renal failure, infertility, and bladder cancer. Genitourinary localization is marked by dysuria, visible hematuria, and urinary obstruction. We present the case of a 17-year-old male adolescent from a rural area of Central Africa, who arrived in Italy two years prior, exhibiting hematuria and urinary symptoms. He came to our attention with a history of terminal hematuria, dysuria, and intermittent abdominal pain since the age of ten. We conducted initial blood tests, urine analyses, and ultrasonography, all yielding negative results. Cystoscopy was conducted with biopsy of an atypical bladder lesion due to the persistence of hematuria. Histopathology revealed morphological findings indicative of Schistosoma haematobium. The patient received praziquantel treatment and was monitored through parasitological urine analyses. Bladder schistosomiasis should be considered in children exhibiting terminal hematuria from endemic regions. Diagnosis can be established through a urinary microbiological examination. An endoscopic evaluation may assist in the diagnosis if the results are negative.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"46 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbidity related to major lung thoracoscopic resections in children.","authors":"Sara Ugolini, Lorenzo Tofani, Elisa Zolpi, Louise Montalva, Cosimo Lotti, Antonino Morabito, Fabio Chiarenza, Arnaud Bonnard","doi":"10.4081/pmc.2024.337","DOIUrl":"10.4081/pmc.2024.337","url":null,"abstract":"<p><p>In pediatric thoracic surgery, reported predictors for increased risk are symptoms and active/previous infections (RAP). We investigated the adverse events related to Video-Assisted Thoracic Surgery (VATS) in pediatric patients when considering RAP predictors. A retrospective analysis of pediatric VATS major lung resections in 2008-2021 was conducted at three institutions. We employed the pediatric surgical risk calculator to define patients' preoperative predicted risk (PredR). Postoperative complications were classified according to the Thoracic Morbidity & Mortality (TM&M) system. The observed TM&M rate (ObsR) and the PredR were compared. A subgroup analysis by RAP predictors was conducted. 37 patients (54% female) were included. Mean age and weight were 5.8 years and 22.8 kg. 56.7% had respiratory symptoms, 38.9% active infection and 59.5% history of infections (RAP subpopulations). VATS procedures were lobectomy (n=32), segmentectomy (n=3), bilobectomy (n=1) and pneumonectomy (n=1). The conversion rate was 5.4%. The mean PredR was of 4.43% (±1.8) and the overall ObsR was 45.94% with a median severity of II (I-III). This difference was significant and a higher PredR was not associated with complications development. PredR does not show association among the RAP vs non-RAP group. ObsR showed positive association with RAP, even if it reached statistical significance only for \"respiratory symptoms\" risk factor. ObsR reflected the number of bronchiectasis patients in our series (n=9), aligning with the hypothesis of \"earlier and safer surgery\". The risk calculator underestimates VATS morbidity. Multicentre studies will clarify the correlation between inflammation and surgical adverse events.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"46 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction and results of the subareolar incision as treatment for gynecomastia in adolescents: experience of two centers.","authors":"Andrea Zangari, Carmine Noviello, Camilla Todesco, Mercedes Romano, Letizia Trotta, Carmine Botta, Ilaria Cascone, Salvatore Scommegna, Gabriele Vasta, Vito Briganti, Alfonso Papparella","doi":"10.4081/pmc.2024.336","DOIUrl":"10.4081/pmc.2024.336","url":null,"abstract":"<p><p>Gynecomastia is a benign glandular proliferation that can affect adolescents causing significant psychological discomfort. Generally, it is idiopathic but underlying endocrinological conditions must be excluded. Different surgical techniques are available, the surgical correction with subareolar incision achieves the goal of satisfactory aesthetic result for patients. We studied all patients treated for gynecomastia in two centers of pediatric surgery. After collection of a detailed family history, we evaluated the presence of early onset of puberty, congenital abnormalities of the external genitalia, use of drugs, eating habits and the presence of genetic disorders. Laboratory tests and ultrasound were made to exclude endocrinological disorders. The surgical treatment was performed by a subareolar incision with gland and adipose tissue excision. A Body - Q chest module to evaluate patient satisfaction has been proposed to everyone before and after surgery. 47 adolescents with median age of 15 years were surgically treated. Three presented endocrinological disorders. Grade of gynecomastia for surgery was: III in 40 patients and IIb in 7 patients. Postoperative complications occurred in 5 patients. The Body - Q chest module was completed by 42 patients and showed good results for all points analyzed, except for social feelings. Gynecomastia in adolescents can be surgically treated with subareolar incision, reporting good aesthetic results and low incidence of complications. Specific tests are useful to assess patient satisfaction.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"46 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are the complications after laparo-assisted endo-rectal pull-through for Hirschsprung disease related to the change of the anal tone?","authors":"Carmine Noviello, Mercedes Romano, Letizia Trotta, Giuseppina Rosaria Umano, Alfonso Papparella","doi":"10.4081/pmc.2024.333","DOIUrl":"10.4081/pmc.2024.333","url":null,"abstract":"<p><p>The main advantage of the laparo-assisted transanal endorectal pull-through technique (LA - TERPT) for Hirschsprung Disease (HD) is the respect to the rectal-anal anatomy. Postoperative complications have been observed recently. The present study aims to determine how often these postoperative complications occur in these patients. From January 2009 to December 2018, a retrospective analysis was conducted on 36 children (25 males) with HD who underwent LA-TERPT. Data were collected on the age of diagnosis and surgery, sex, the presence of other pathologies, and cases of enterocolitis. In all cases, anorectal manometry (ARM) was performed to evaluate the anal tone. The median age at diagnosis was 2 months and the mean age at surgery was 5 months. Nine related pathologies were identified: five cases of Down syndrome, one case of hypertrophic stenosis of the pylorus, atresia of the esophagus, polydactyly, and anorectal malformation. A patient with total colonic aganglionosis was identified through laparoscopic serummuscular biopsies. Enterocolitis was diagnosed in 7 cases before and 6 after surgery. At follow-up, the complications recorded were: 5 cases of constipation (treated with fecal softeners), one case of anal stenosis (patient with anorectal malformation), 16 cases of soiling (treated with enemas) and 1 child with fecal incontinence (treated with a transanal irrigation system). The ARM was performed in all 36 cases and showed normal anal tone, except for one case with anal hypotonia. LA-TERPT is an important surgical technique for HD. According to the literature, soiling is the most main complication after HD surgery, probably due to \"pseudo-incontinence\" with normal anal sphincter tone.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"46 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of an educational program on illness uncertainty in mothers of children with type 1 diabetes: a quasi-experimental study.","authors":"Majid Reza Akbarizadeh, Fereshteh Ghaljaei, Alireza Hasanzadeh, Abdolghani Abdollahimohammad, Mahin Naderifar","doi":"10.4081/pmc.2024.335","DOIUrl":"10.4081/pmc.2024.335","url":null,"abstract":"<p><p>The mother is traditionally the primary caregiver for the child, and uncertainty is a major source of psychological distress for parents of sick children. As a result, the current study sought to investigate the impact of an educational program on illness uncertainty in mothers of children with insulin-dependent diabetes mellitus (IDDM). This is a quasi-experimental study with a pretest-posttest design, involving 40 mothers of children with IDDM. After visiting the research site and recruiting eligible mothers, the researcher used the purposive sampling method to randomly assign them to one of two intervention and control groups. Taking into account their needs and conditions, mothers were scheduled for at least three sessions, with a 30-minute interval every other day. The data analysis revealed no significant differences between the two groups in terms of child age and gender, mother age and education level, number of children, and duration of diabetes. There was a significant difference in the total score of uncertainty, total score of ambiguity, lack of clarity, lack of information, unpredictability, and their dimensions between mothers of diabetic children before and after the intervention (P=0.02). Based on the findings, it is recommended that the educational needs of children and their mothers be assessed upon admission and that educational content be prepared and taught accordingly, thereby helping to reduce illness uncertainty in mothers.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysphagia lusoria caused by aberrant right subclavian artery associated with truncus bicaroticus in an 8-month-old girl. Case report and review of literature.","authors":"Melpomeni Bizhga, Virtut Velmishi, Lorena Sila, Albert Koja, Stiljan Hoxha","doi":"10.4081/pmc.2024.332","DOIUrl":"https://doi.org/10.4081/pmc.2024.332","url":null,"abstract":"<p><p>Dysphagia lusoria is a rare pediatric condition caused by extrinsic compression of the esophagus by an abnormal subclavian artery. The most common congenital abnormality in aortic arch development is an aberrant right subclavian artery. The retroesophageal right subclavian artery is typically symptomatic in 10-33% of cases. The patient, an 8-month-old girl with a history of early dysphagia and stridor, was diagnosed with an abnormal right subclavian artery. She was admitted to the pneumology service multiple times due to stridor, vomiting, and failure to thrive. During hospitalization at the gastroenterology service, a barium swallow and an upper digestive endoscopy indicated an abnormal right subclavian artery, which was confirmed by an Angiography CT scan. She underwent surgery at the age of sixteen months. All symptoms are resolved following surgical intervention, and the patient is still asymptomatic and in good clinical condition 12 months later. Every physician should be aware of abnormal right subclavian arteries and their clinical symptoms in children and adults in order to recognize and diagnose them early. Only an early evaluation may reduce complications such as delayed physical growth, dysphagia, and recurrent respiratory infections.</p>","PeriodicalId":35535,"journal":{"name":"Pediatria Medica e Chirurgica","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}