This report is aimed at describing our preliminary experience with the preperitoneoscopic approach to the bladder neck for rectus fascial sling suspension in neurogenic bladder.A 13-year-old boy with spina bifida was admitted to our institution to treat bladder incontinence. A bladder neck suspension and bladder augmentation was planned. The preperitoneal space was progressively gained by blunt dissection under direct vision (laparoscopy with a single left subcostal trocar), and a total of three preperitoneal ports were inserted. Dissection of the bladder proved to be relatively easy, and the retropubic space as well as the deep pelvis were safely exposed. Owing to the excellent endoscopic visualization, the bladder was dissected downward from the rectum. Once complete mobilization of the bladder neck was achieved, an umbilical tape was passed around the proximal urethra to create an adequate passage for the fascial sling.The preperitoneoscopic procedure lasted 2 hours. No complications occurred. A good daytime dry period was achieved at the 4-month follow-up.Direct visualization of the bladder neck and minimal dissection to the deep pelvis are the key points of this approach. Provided certain technical details are considered, the minimally invasive preperitoneal access is a valuable alternative to the open approach for the rectus fascial sling procedure, particularly when dealing with male patients. Technical advances will, presumably, lead to a complete minimally invasive treatment of urinary incontinence in male patients with spina bifida.
Cholangiography during conventional cholecystectomy has always been useful for anatomo-topographic study and for research of the stones of biliary tree. After a natural period of training the authors included the easy technique of cholangiography in laparoscopic cholecystectomy. The study was performed in 13 patients using Olsen's cannula with an internal a normal catheter for cholangiography. The catheterization of the cystic duct was performed in 85% of cases (11 patients), in the other 15% (2 patients) it was not possible to cannulate the cystic duct. Non complication. The mean duration of the study was 14 minutes. The authors describe the technique and conclude, after a brief discussion of the reports in the literature and personal experience, that peroperative cholangiography is an easy and safe procedure without risk and prevents the injuries to the biliary tract whose incidence is about 1.3%.
We report a case of primary intestinal infection due to filamentous fungi in an adolescent with Ewing sarcoma. The clinical picture was that of peritonitis secondary to intestinal perforation and the diagnosis was established only on histopathological bases. This condition is very rare, and only one case of primary intestinal mold infection in children with solid tumors has been reported in the literature, although more records can be found describing similar conditions in other cancer patient populations (i.e. adults with solid tumors or children with hematological malignancies or patients receiving hemopoietic stem cell transplant). Clinicians must be aware of this possibility since only an aggressive medical and surgical approach can improve patients' prognosis.
Light and electron microscopy were used to study projections emerging from areas of the sponge Oscarella lobularis. These projections seem to arise from foldings of the exopinacoderm, a process also involving mesohyl cells. Besides folding, exopinacocytes invaginate giving rise to small pockets. These may open directly to the outside and represent the precursors of flagellated chambers. Exopinacocytes lining pockets and spaces between projections transform into endopinacocytelike cells. As pockets become isolated from the exterior, cells further differentiate into choanocytes. Remodeling processes, involving fusion of adjacent protrusions and transformation of the intervening spaces into canals, eventually realize a functional aquiferous system. Allowing the sponge to increase its size, these events represent the steps of a growth mechanism.
Abstract Purpose To evaluate the impact of image‐defined risk factor (IDRF) modification after chemotherapy on surgical outcomes, event‐free survival (EFS), and overall survival (OS) among patients enrolled in the European Unresectable Neuroblastoma (EUNB) study. Methods IDRFs were assigned according to the corresponding surgical risk factors list reported in the database. Surgical outcomes, EFS, and OS were related to IDRF modification with chemotherapy. The predictive value of preoperative IDRF for surgical outcomes was analyzed. Cox proportional hazards models for EFS and OS, including preoperative IDRF, surgical outcomes, and other known clinical risk factors, were created. Results Of the 160 patients enrolled in the EUNB study, 143 patients met the inclusion criteria. A total of 228 IDRF were thus collected. Following chemotherapy, 76 (33%) IDRF disappeared in 32.2% of patients, 33 (14%) new IDRF appeared in 18.8% of patients, and 49% of patients did not show any IDRF change. Complete resection/minimal residual disease (71.2%) was more frequent among children who had disappearance/numerical reduction of IDRF ( P = 0.005). Infiltration of the branches of the mesenteric artery was predictive of an unfavorable surgical outcome. Prolonged preoperative chemotherapy over five courses and encasement of the celiac axis and/or mesenteric artery origin impacted EFS and OS. Conclusions The unchanged IDRF pattern in 50% of patients and the appearance of new IDRF during chemotherapy in approximately 20% of patients strengthens the idea that prolonged chemotherapy is useless for improving surgical resection in this population of patients. In addition, midline perivascular abdominal preoperative IDRF appeared to be predictive not only of surgical outcomes but also of EFS and OS.
Laparoscopic surgery in acute appendectomy is a very much debated subject also for skilled teams of mini-invasive surgery. The authors review 25 urgent laparoscopic interventions for acute appendicitis, treating some technical aspects of trocar introduction and Endoloops and EndoGia employment in this field. They conclude by emphasizing that the laparoscopic approach for acute appendicitis is the treatment of choice, considering the good results and the future prospects of laparoscopic versus open surgery.
