Pediatria Medica e Chirurgica最新文献

Congenital Hip Dysplasia (CHD) is characterized by a hip joint dislocation between the femoral head and the acetabulum, with a multifactorial etiology. This disorder can be an isolated condition or the manifestation of a syndromic condition, and it has been estimated with higher rates than registered, with a predominance in female sex and left side; risk factors are now defined. In Italy, the incidence rate is 3-4%, with significant regional differences: higher in Lombardy and lower in Sicily. Because clinical examination alone is insufficient to diagnose CHD, it is supplemented with ultrasonography and X-ray if necessary. Surveillance, static or dynamic splints, or osteotomies are the only treatment options. The goal of this study was to evaluate our experience in terms of management and conservative treatment of all newborns from January 2018 to May 2022: female sex and left hip were major involved, risk factors were not significant in our case, but results from early diagnosis and treatments, in terms of better outcome, were interesting. After a strict 6-month follow-up period, 89.13% of the patients were classified as grade Ia or Ib according to the Graf classification system. Finally, we emphasize the importance of early universal screening and subsequent diagnosis to allow for early treatment of the disorder, at an age when conservative treatments can yield good results.

The prevalence of traumatic knee disease in children and young athletes has steadily increased over the past few years. The subjects who have engaged in intense sporting activities since a young age were especially vulnerable to developing an anterior cruciate injury. With the development of new imaging and clinical examination methods, diagnosis has also improved. The need to ensure joint growth without complications and the rising demands for a return to competitive sport are driving the search for an appropriate surgical technique. Today, only a few cases should receive conservative treatment. The main flaw of the extra-articular technique is that it doesn't respect the anatomy and results in excessive rigidity. Even precocious subjects can use the allepyphiseal technique, which allows for the respect of the growth plates. It does not present a particularly high complication rate and permits a full return to sports activities prior to the trauma with an adequate learning curve on the part of the surgeon. However, in more mature subjects with still open physis, the traditional transepiphyseal arthroscopic technique is possible as long as the tunnel is not too large. In any case, it is crucial to provide a thorough and ongoing follow-up until the end of growth as well as individualized rehabilitation.

Tenotomy is the final step in the corrective phase for the resolution of residual equinus in the Ponseti method of treating clubfoot. There are several methods for obtaining a complete section of the tendon, ranging from mini-open techniques to percutaneous with a scalpel or percutaneous with a large-gauge needle. Since April 2022, Vittore Buzzi Children's Hospital has performed 36 percutaneous tenotomies of the Achilles tendon in 24 patients using the percutaneous large-gauge needle technique. When compared to the traditional percutaneous scalpel tenotomy procedure, the use of this procedure has allowed us to reduce operating room time, where we routinely perform this type of surgery to optimize pain control and patient safety during the procedure. The technique has proven to be simple, safe, and effective in obtaining a complete section of the tendon; there have been no reports of excessive bleeding, pseudoaneurysms, or nerve injury. There were no differences in clinical outcome or recurrences of equinus that required reoperation during the average three-month follow-up from the previously used technique.

Monteggia lesion is a traumatic condition that affects the forearm and is characterized by the association of an ulna fracture with a dislocation of the radius capitellar and proximal radius ulnar joints in the majority of cases. Although several authors have contributed to the understanding of this pathology over the years, it remains a challenge for orthopedists, and if not recognized and treated properly, it can have serious consequences. In these cases, a chronic injury develops, which is even more difficult to manage in terms of timing and treatment options. A narrative review of the literature on missed elbow injuries in children was conducted, and chronic Monteggia was the most frequently encountered injury. The analysis of the articles attempts to clarify some points and draw general conclusions on which to reflect.

One of the most prevalent hip pathologies that develops during adolescence is Slipped Capital Femoral Epiphysis (SCFE), and over the past few decades, its incidence has been rising. To ensure an early diagnosis and prompt intervention, orthopedic surgeons should be aware of this entity. Review of recent developments in clinical examination and imaging diagnostic procedures. The presentation includes commonly used imaging methods, slippage measurement techniques, and classification schemes that are pertinent to treatment. An overview of SCFE surgery based on pertinent study findings and knowledge gained from ongoing clinical practice. The gold standard treatment for stable SCFE cases- those in which the continuity of the metaphysis and epiphysis is preserved-is pinning in situ using a single cannulated screw without reduction. However, there are disagreements over the best course of action for stable moderate/severe SCFE. On the best surgical strategy for unstable epiphysiolysis, no universal agreement has been reached. Finding the surgical procedure that will improve the long-term outcomes of a slipped capital femoral epiphysis is the question at hand.

Paediatric Intestinal Transplantation (IT) presents the highest mortality on the waiting-list due to anatomical disproportion. Living-Donor IT (LDIT) offers the best advantages and when performed among identical monozygotic twins, it also benefits from unique immunology. According to MEDLINE/Pubmed, twin-to-twin LDIT has been performed in seven cases (6:7 males, median age of 32 years). None of the patients received immunosuppression postoperatively. Only one paediatric twinto- twin LDIT was carried out with a 160-cm mid-ileum tract: an interposed 4/5-cm arterial graft was required to ensure a tensionfree anastomosis to the anterior wall of the infra-renal abdominal aorta. In contrast, venous anastomosis was done directly to the inferior cava vein. We present a case for debate of a 13- month-old SBS patient where a twin-LDIT was discussed with parents, who decided to wait after careful analysis and ethical considerations.

Subclinical Acute Kidney Injury (AKI) describes patients who did not fulfill the classical criteria for AKI diagnosis but showed elevated levels of new biomarkers reflecting tubular injury. One of these biomarkers is Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study is to investigate the role of urinary NGAL and microalbuminuria as non-invasive biomarkers in the detection of subclinical AKI. Analysis of urinary NGAL and microalbuminuria in 91 subjects [30 pediatric intensive care unit (PICU) patients, 31 diabetic patients and 30 healthy controls] recruited from Cairo University Pediatric Hospital was done. Our study revealed that urinary NGAL was significantly higher in the PICU group followed by the diabetic group and lowest in the controls group (p=0.022). A positive correlation was found between urinary NGAL and microalbuminuria in the PICU group (Rvalue= 0.585, p-value=0.001). In diabetic group, a positive correlation was found between urinary NGAL and fasting blood glucose, 2 hours post prandial and HbA1C (R-value=0.421; pvalue= 0.021; R-value=0.426; p-value=0.019; R-value=0.438; pvalue= 0.018 respectively). Urinary NGAL may be a potential biomarker to detect subclinical AKI before actual functional renal damage leading to early intervention and reduction of mortality.

Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions. Scalp-IHs are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. We describe a case of a 30-months old female who presented a large scalp-IH at birth that rapidly grew in the first year of life. Topical and systemic treatments (with timolol ointment and oral propranolol, respectively) were not effective in reducing dimensions of the hemangioma. After vascular imaging study, the patient underwent surgical resection of the IH and primary closure with excellent cosmetic outcome. When medical therapy is ineffective or cosmetic and functional integrity is threatened, early surgery allows to completely removing large scalp-IHs, with good cosmetic results.