Biomedical subjects
Publications and source records attributed to P Georgacopulo.
A new method of closure of Morgagni-Larrey hernia by video-assisted surgery is described in a child. Laparoscopy could in our opinion be an advantageous method for treatment of diaphragmatic defects.
Gastric volvulus in children might be observed both as an acute form, characterized by gastric necrosis with sudden perforation and patient's death and as an idiopathic or chronic form with a less severe insurgence that causes epigastric pain, vomit and gastric distension. The latter could resolve spontaneously but recurs frequently. The acute form rises in newborns and toddlers and is often associated with a diaphragmatic defect; the idiopathic forms are correlated on the opposite to a fixation deficit of the stomach which is held in place by the gastro-colic, gastro-hepatic, gastro phrenic and gastro-splenic ligaments. Since a diagnostic mistake could cause the patient's death gastric volvulus must be carefully considered as a possible cause of acute epigastric pain with vomit. In the two forms surgical therapy is mandatory for the simultaneous correction of both the anatomical defects of gastric fixation and malposition and the diaphragmatic ones. The case presented is an example of an acute gastric volvulus in a 2-year-old male child affected by a diaphragmatic defect The peculiar aspect of this case consists in the age of arousal being more usual in an earlier age An appropriate surgical treatment has permitted the patient's recovery.
The authors present the case of a 14 year old child who was successfully treated by pulmonary decortication with video-assisted thoracoscopy. Thoracoscopy caused less postoperative pain then open thoracoscopy, although it allows visualization of the entire pleural cavity. In our opinion an early use is indicated.
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We performed routine neonatal ultrasound screening on 3,454 neonates in the first week of life to establish the real incidence of congenital uropathy. Pronounced anomalies were found in 36 cases (1.04%) and mild renal pelvis dilatation in 159 (4.60%). In the population study prenatal ultrasonography showed evidence of severe anomalies in only 7 fetuses (0.2%). Surgical correction was required in 14 cases. Our results indicate that neonatal ultrasound screening has sufficient sensitivity and specificity for the early detection of the vast majority of urinary tract malformations. In 2 cases mild vesicoureteral reflux was not detected until a urinary tract infection was noted. Thus, neonatal sonography appears to be of limited value in detecting mild reflux.
Malignant melanoma is an uncommon tumor in childhood. We report on a case occurring in a 3-year-old child with congenital multiple melanocytic nevi.
Partial splenic embolization is an alternative procedure to total splenectomy in patients with hypersplenism, and was performed in 10 patients with beta-thalassaemia major who were then followed for 5 to 7 years. The results were compared with those of a 7-yr follow-up of 6 splenectomized thalassaemics. The blood consumption decreased and the leucocyte counts increased in both groups of patients. However, after partial splenic embolization, severe thrombocytosis--which is typical of splenectomized patients--did not develop and there were no severe complications from the operation, such as infections or reappearance of hypersplenism. In addition, the minor surgical injury and avoidance of abdominal scars were further advantages of partial splenic embolization over total splenectomy.
Experimental surgery in animals remains an irreplaceable model for the clinical application of a new technique. We performed a single lung allotransplantation in young pigs. The pigs were organized into groups: 1) 6 to assess the surgical anatomy; 2) 10 to receive left transplantation; 3) 3 to study the pathophysiology of the transplanted lung. The preliminary results demonstrated that the surgical model is useful.
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Drepanocytosis, a disease notoriously widespread among blacks, is surprisingly frequent in certain Italian islands. Surgical aspects of the disease are discussed: erythrocyte sequestration attacks, pigmentary cholelithiasis, priapism, malleolar ulcers and vaso-occlusive attacks. A knowledge of such aspects is considered fundamental for the purposes of a reasoned differential diagnosis in the field of paediatric pathologies requiring surgery.
Sickle cell anaemia is the most common hereditary haemoglobin pathology. It is found in either a homozygous or heterozygous form, associated in the latter case with other haemoglobinopathies. In view of the pathogenesis and the various related imbalances, amply confirmed by others, which can well prove disastrous, the pre, per and post-operative precautions to be adopted in such patients are assessed.
Experimental comparison of the lungs of 7 sheep foetuses with surgically induced CDH and 7 controls permitted an assessment to be made of the changes that take place in lung growth, generally described as hypoplasia, through a study of their morphology and histology, and the lung: lamb weight ratio. Changes increased in gravity in function of the duration of hernia. They included: reduced alveolar expansion, fewer generations of bronchi and alveoli, and septal thickening. An increase in the smooth muscle component of 5th-6th generation arteries (i.e. resistance) may offer an explanation of the hypertension characteristic of CDH, and the non-reactivity of these vessels in response to vasodilators. It is also suggested that damage to the mesenchyma can be regarded as the sole cause of the changes in lung growth observed in CDH. Early treatment before these changes become irreversible is thus advisable.
Correction of incontinence as the sequel of a pull-through operation for anorectal atresia, leaving aside cases due to a mistake of the surgical technique, is based on the construction of a new sphincter. This can be done in several ways, using striped, pedicled, denervated, free, or, more recently, smooth muscle. The techniques, objectives, and results are described with reference to the latest data in the literature.
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Up to 50% of the neonates operated during the first hours of life for a congenital diaphragmatic hernia die. The presence of a severe lung hypoplasia, which is at the origin of hypoxia, acidosis, increased pulmonary vascular resistance and right to left shunt, explains the poor clinical results, in spite of surgical success and intensive therapy. A modern approach to the problem includes treatment with pulmonary vasodilator drugs, whose effects are still discussed. Perhaps the prenatal recognition of the defect could improve prognosis. Lots of experience are needed to know more on the subject. This could be obtained with an experimental approach on newborn animals with a CDH. The article relates authors experience in the creation of a CDH in a foetus of sheep, by means of a surgical intervention during its intrauterine life.