Pediatria Medica e Chirurgica最新文献

Over the past decades, digital innovation has profoundly transformed pediatric care, promoting more integrated, personalized, and continuous models of assistance across hospital, community, and home settings. This contribution explores the impact of three key technological domains: telemedicine, virtual and augmented reality, and artificial intelligence. Telemedicine has expanded access to healthcare services, improved monitoring of chronic conditions, and strengthened communication between healthcare professionals and families. Its rapid development during the COVID-19 pandemic demonstrated its value in ensuring continuity of care and supporting vulnerable pediatric populations. Virtual and augmented reality offer new possibilities in surgical planning, medical training, rehabilitation, and psychological support, helping reduce anxiety and pain during procedures while enhancing understanding of clinical pathways. Artificial intelligence enables the analysis of large volumes of clinical and behavioral data, supporting early diagnosis, predictive modeling, and personalized clinical decision-making. Despite these opportunities, the integration of emerging technologies into pediatric practice requires careful attention to ethical, organizational, and educational issues, including data security, equitable access, and professional training. Overall, digital technologies are reshaping pediatrics toward more accessible, efficient, family-centered care.

Proximal and complex hypospadias repairs remain among the most technically demanding procedures in pediatric urology, particularly in patients with inadequate local tissue or previous failed reconstructions. This study reports a five-year institutional experience with a single-stage hybrid technique combining the Snodgrass Tubularized Incised Plate (TIP) repair and the Duckett transverse preputial island flap urethroplasty. Between 2019 and 2024, forty-two patients with severe hypospadias underwent hybrid Snodgrass- Duckett urethroplasty at our institution. Patients were categorized as: Group A (n = 12) with 46,XY Disorders of Sexual Development (DSD); Group B (n = 16) with primary proximal perineoscrotal hypospadias; and Group C (n = 14) with multiple failed prior repairs. The proximal urethra was reconstructed using a Tubularized Native Plate (TNP) and the distal segment with a tubularized preputial island flap (Duckett), joined via an oblique anastomosis. Penile curvature correction and ventral coverage were achieved using lateral flaps. Functional and cosmetic outcomes, as well as complications, were recorded prospectively. A glans-tip meatus was achieved in all patients. Cosmetic appearance was deemed satisfactory in all cases. Uroflowmetry was normal in 95.2% (40/42; 95% CI 86.6- 100). Complications occurred in seven patients (16.7%; 95% CI 5.6-27.7), including urethrocutaneous fistula (n = 4), diverticulum (n = 1), and early breakdown (n = 2), all successfully corrected. Median follow-up was 26 months (IQR 18-36). No urethral strictures or meatal stenosis developed during follow-up. The hybrid Snodgrass-Duckett urethroplasty represents a feasible single-stage alter- native for selected severe hypospadias cases, including reoperative and DSD patients, when local tissue is insufficient. The approach combines the vascular reliability of the preputial flap with the stability of the native urethral plate. While results are encouraging, the retrospective design, absence of a control group, and heterogeneity of the cohort limit generalizability. Prospective multicenter studies with standardized functional and cosmetic scoring are warranted.

Intestinal lymphangiectasia is a protein losing intestinal disease caused by congenital malformation or obstruction of intestinal lymphatics. Based on etiology, it is classified as primary or secondary. Primary Intestinal Lymphangiectasia (PIL) is a rare disorder of intestinal lymphatic dysfunction and may present with a wide spectrum of clinical manifestations but it very infrequently presents as intussusception in children. To the best of our knowledge this is the second only reported case in children, both cases being described from the Indian subcontinent. A 12-year-old male presented complaining of abdominal pain for one week. Examination revealed a palpable mass in the right upper quadrant and abdominal tenderness. A provisional diagnosis of acute intestinal obstruction was made and the child underwent an emergency laparotomy which revealed a segment of distal ileum displaying intussusception. On cut opening, no growth was seen. Histopathology of the telescoped segment showed many ectatic and dilated lymphatic channels filled with lymph. PIL should be considered in the differential diagnosis in children presenting with intestinal obstruction.

Although rare, pool suction-drain injuries may result in potentially fatal consequences: risk of drowning due to hair or extremities entrapment, bowel evisceration, hypovolemic shock, and death. We present two case reports: the first patient was entrapped by a suction grate (placed at the bottom of a water park pool), resulting in an extensive circular lesion on his back; the second child was evaluated for foot entrapment by suction. Both patients were discharged after observation with a good prognosis and without complications. Accidents associated with suction systems are little known, for this reason it is important to emphasize primary prevention. While awaiting new technological tools, public awareness and careful supervision are fundamental. European standards and pool circulation systems must be respected, particularly the use of anti-vortex covers, automatic power cut-offs for filtration systems, dual- drain systems, poolside panic buttons, and supervision of swimmers.

Colostrum is a source of growth factors and nutrients aiding newborns in adaptation to extrauterine life. Its clinical use has been investigated as an immunological component to protect, especially preterm newborns, from early infectious complications. This article aims to investigate the current knowledge about the value of colostrum in enhancing mechanisms of intestinal adaptation in patients affected by Short Bowel Syndrome (SBS). A MEDLINE systematic search was conducted. Inclusion criteria were English language and post-operative colostrum administration in animals and humans undergoing bowel resection. From a total of 734, 10 full-text articles were included: 5 studies on animal models, 4 on humans affected by SBS, and 1 study on animal and paediatric populations. Intestinal adaptation was investigated through diverse clinical, morphological, and functional parameters. No clear benefits of colostrum were reported in both populations. Paucity of trials, limited study duration, and heterogeneous conditions led to poorly standardized results. Colostrum tolerability is an encouraging result, but the outcome of colostrum clinical use in short bowel has still to be determined. Further investigations are required to safely promote use of colostrum in nutritional programs. Standard parameters of intestinal adaptation would be required to evaluate the possible role of colostrum in the process.

The purpose of this paper was to define the specturm of management for Parapneumonial Pleural Effusion/Pleural Empyema (PE/PPE) in children in Italy. We conducted an online survey, distributed by the SIVI committee to 54 Italian pediatric surgery centers. A total of 23/54 (43%) Italian pediatric surgery centers responded. All responders (100%) required an anteroposterior chest radiograph (CXR) as the first imaging approach to suspect PPE, and chest Ultrasound (US) was routinely used in 96% of centers. A preoperative CT scan was routinely performed in 70% of centers. An etiological diagnosis was obtained in more than 80% of patients in 13% of centers, between 40% and 80% of cases in 61% of centers and in less than 40% of patients in 26% of centers. Empirical antimicrobial therapy with 2 antibiotics is the most commonly used therapeutic scheme (78% of centers) and targeted antibiotic therapy was used in 82% of enrolled centers. The majority of centers (57%) approached advanced stage pleural empyema with pleural drain placement and fibrinolysis (PDF); 26% of centers preferred to execute upfront Video-Assisted Thoracoscopic Debridement (VATD), and in 13% of centers, both fibrinolysis and VATD were used. In all cases (100%), urokinase was the fibrinolytic agent of choice. Broncho-Pleural Fistula (BPF) was treated conservatively with prolonged Pleural Drainage (PD) and antibiotics in 82% of centers, while the remaining 18% proposed early surgical treatment. 82% of centers proposed prolonged antimicrobial therapy for the treatment of Lung Abscess (LA), while 18% of centers preferred to execute upfront ultrasound-guided or thoracoscopic positioning of a pig-tail drain. As expected, we observed a lack of homogeneity in the treatment between the different centers: most of these have a preference for fibrinolysis over the use of primary VATD, with urokinase being the only fibrinolytic agent used in all centers. It would be desirable to involve as many centers as possible for the drafting of shared national guidelines in the treatment of PPE in children in Italy.

Nutcracker Syndrome (NCS) is characterized by impeded blood flow from the Left Renal Vein (LRV) into the inferior vena cava due to an abnormally narrow angle between the abdominal aorta and superior mesenteric artery. This syndrome is usually associated with hematuria, abdominal pain and orthostatic proteinuria. We described three patients diagnosed with NCS (mean age 16.3 years). The aortomesenteric angle, LRV diameter ratio and peak velocity ratio were assessed through doppler ultrasonography and CT angiography. A kidney model was printed out for surgical planning. An extravascular stent was designed based on the LRV's structure using computer software and printed in three dimensions with a precision setting of 20μm. Patients underwent laparoscopic placement of the extravascular stent. The mean duration of surgery was 180 minutes. There were no intraoperative complications. CT examinations revealed that pre- and postoperative AMA ranged from 18.7°±4.3° to 55.0°±4.4, respectively. No side effects were observed in the follow-up period (range 12-24 months). At present, treatment guidelines for NCS are unclear, and the different therapeutic principles need to be applied in a patient-specific manner. Our results confirm previous reports in literature concerning the efficacy and safety of ES in pediatric patients.

Pilomatricoma and trichilemmal cyst are two benign tumors of hair follicles that can affect children. We performed a retrospective study to histologically differentiate the two tumors to determine if this has clinical utility. For 5 years, we conducted a retrospective study on the patients who underwent surgery and evaluated some parameters (site, recurrence and scar outcome) categorizing them based on their histological type. We treated 71 patients, with an average age of 7.6 years. Most of the lesions were localized on the scalp, head and neck. Histological examination diagnosed 55 pilomatricomas and 16 trichilemmal cysts. Five patients with pilomatricoma developed an unaesthetic scar (4 in subscapular region), while the recurrence was present in 10 cases, of which 6 were trichilemmal cysts (37,5% of 16 cases). Both types of lesions healed successfully, however trichilemmal cysts are more susceptible to recurrence.

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.

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.