Biomedical subjects

G La Scala

Publications and source records attributed to G La Scala.

13 recordsLinked to original sources

PubMed2000

Etiology and management of pediatric chylothorax.

OBJECTIVES: To determine the incidence and etiology of chylothorax and to assess our therapeutic management approach. STUDY DESIGN: We reviewed 51 patients diagnosed with chylothorax over a 12-year period. Cause, interval between operation and diagnosis, duration of chylothorax, and total volume loss per weight were recorded. RESULTS: Chylothorax was diagnosed in 46 children after cardiothoracic surgery, giving an incidence of 2.5% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifestation of lymph angiomatosis. Three etiologic groups were identified: group 1, direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and/or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment in 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuroperitoneal shunts. Patients in groups 2 and 3 were at higher risk for failure of conservative treatment (P <. 005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P <.01). CONCLUSION: Conservative treatment was successful in 80% of the patients with our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruction, may further improve success of conservative treatment. Congenital chylothorax seems different and may require a specific approach.

Angiomatosis↗

PubMed1999

[Value of the Pediatric Trauma Score in routine hospital practice--apropos of a prospective one-year trial].

AIM: To test the usefulness of the Pediatric Trauma Score (PTS) in a university hospital setting. METHODS: All injured children who were admitted to our emergency room during a one year period were prospectively studies. The study was performed at the Pediatric University Hospital of Geneva. Patients were divided into two groups: group one included severely injured children with a PTS equal or lower 8 and group two included patients with a PTS greater than 8. RESULTS: A total of 6804 injured children were admitted to our emergency room and 927 (14%) were hospitalized. In group one (104 children, 1.5%), six patients died whereas in group two (823 children, 12%), all patients survived. In addition, children in group one demonstrated a significant higher number of general anesthesia, a longer stay in the ICU and a longer stay, and an increased number of sequelae 3 months after trauma. DISCUSSION: Our result confirm the usefulness of the PTS and the cutoff value of 8 in pediatric trauma. In addition, the study underlines the important morbidity and the residual sequelae after severe trauma in children. CONCLUSION: The PTS should be used in all injured children in order to identify patients at risk. This would allow to begin an appropriate treatment or, if necessary, initiate a transfer to a surgical pediatric center without delay.

Adolescent↗

PubMed1998

A silicone-coated nylon dressing reduces healing time in burned paediatric patients in comparison with standard sulfadiazine treatment: a prospective randomized trial.

Mepitel is a new grid like silicone coated nylon dressing containing no additional biological compounds. We describe a prospective randomized pilot study comparing Mepitel to the standard silver sulfadiazine cream (Flamazine) dressing for the topical treatment of paediatric burns. Seventy-six children presenting within 24 h of injury with a non previously treated burn were randomly assigned to Mepitel treatment (group M) or Flamazine treatment (group F). Age, sex, surface area of burn and causal agent were noted at admission. The depth of the burn, cumulative number of dressings, presence or absence of a complete epithelial cover, infection, bleeding and allergy were noted at each dressing change. There were 41 children in group M and 35 children in group F. Five children were subsequently withdrawn from each group because they required skin grafting. Analysis of the above mentioned criteria showed no statistical difference between the two groups except for the healing time (group M: 7.58+/-3.12, group F: 11.26+/-6.02, p < 0.01) and the number of dressings (group M: 3.64+/-1.5, group F: 5.13+/-2.9, p < 0.05). Mepitel has proved to be an easy-to-remove dressing, adhering only to intact skin. The faster healing time found in the Mepitel group may be related to a direct effect of silicone on epithelial growth or to a decrease in surface-cell damage compared to the silver sulfadiazine group. This attractive product will be further assessed on a larger scale trial to confirm our observations.

Adolescent↗

PubMed1994

Surgical pitfalls in a patient with type IV Ehlers-Danlos syndrome and spontaneous colonic rupture. Report of a case.

PURPOSE: This paper intends to stress the importance of early diagnosis and discuss surgical treatment of Type IV Ehlers-Danlos syndrome (EDS-4), an autosomal dominant connective tissue disease characterized by typical features of the face and extremities, inappropriate and easy bruising, and extreme tissue fragility, which may lead to dramatic and often fatal complications, mostly spontaneous arterial or intestinal rupture. METHODS: We report the case of a 41-year-old female who presented with spontaneous perforation of the sigmoid colon. RESULTS: The patient was seen over a nine-year period, during which time she required six operations and presented with a great number of surgical complications including stenosis of an end-colostomy, repeated subocclusive episodes caused by intraperitoneal adhesions, and enterocutaneous fistulas, finally ending with an ileostomy and short bowel syndrome. It is only after a difficult laparotomy for ovarian cyst excision, marked by numerous adhesions and friable bowel, that the diagnosis of EDS-4 was considered and established. CONCLUSIONS: In case of "idiopathic" spontaneous perforation of the colon in a young adult, features of EDS-4 should be thoroughly looked into and, if found, skin fibroblast culture with collagen Type III analysis performed. The surgical treatment of choice consists of subtotal colectomy and permanent end-ileostomy. In case of patient refusal, a second-stage ileorectal anastomosis can be performed but carries the high risk of anastomotic leakage.

Adult↗

PubMed1993

Intrahepatic biliary lesions following blunt liver trauma in children--is nonoperative management or conservative operative treatment always safe?

Nonoperative management of blunt liver injuries has become standard care for children, in the absence of hemodynamic instability. However, attention has to be drawn to biliary complications which can manifest themselves after a latent period, even in the presence of rupture of main biliary ducts. Peripheral bile duct lesions are easily treated by wide drainage. However, the extremely rare intrahepatic main bile duct lesions require other treatments. We report 2 cases of severe liver trauma associated with intrahepatic bile duct lesions: the first, managed nonoperatively, developed biliary peritonitis on day 21. Lesions of the main right biliary ducts were discovered. Because the right liver vascularization was not compromised, an intrahepatic biliary reconstruction was performed through a large hepatotomy according to the functional anatomy. The second child, who had an emergency laparotomy on admission, suffered nevertheless from a bilioma, drained on day 38. Because of increasing daily bile flow through the drain a second laparotomy was performed that demonstrated a biliary leak from a main segmental duct. Resection of the segment cured the patient. These two cases illustrate the occurrence of intrahepatic main bile duct lesions, clinically apparent after a latent period, following blunt trauma of the liver treated by nonsurgical or conservative surgical management. Intrahepatic biliary reconstruction is an alternative to liver resection when viable vascularization of the involved sector justifies its preservation.

Bile Ducts, Intrahepatic↗

PubMed1990

[Sutures in dentistry. Traditional and PTFE materials].

Suture material in PTFE is successfully used in vascular and orthopaedic surgery since many years. More recently it has been applied also in periodontal surgeries, in the guided tissue regeneration technique, thanks to its chemical-physical, mechanical and biological characteristics. The Authors tried to evaluate the indications for the use of this material in different situations in the dental practice. Furthermore a microbiologic study has been carried out, both in vivo and in vitro, and this material has been compared with the twisted coated silk to evaluate the different bacteriological characteristics. In particular it has been demonstrated the reduced adhesion of PTFE in comparison to the twisted silk. This characteristic seemed to be even more relevant after a longer stay of the materials in the oral cavity.

Bacterial Adhesion↗

PubMed1988