The use of the Limberg skin flap for closure of large lumbosacral myelomeningoceles.

Closure of the skin defect in myelomeningocele repair is an essential step that determines the quality of the surgical result. In large myelomeningoceles, however, adequate skin coverage may not be accomplished by direct closure or skin undermining. In such cases, the skin defect is best repaired using flaps.

[Ovarian tumors in children].

Ovarian tumors in children are uncommon. We reviewed all cases of ovarian tumors treated at the Department of Pediatric Surgery of Vicenza Regional Hospital from 1979 to 1994. They include 6 cases of cystic teratoma and 1 gonadoblastoma; the malignant lesions included 1 immature teratoma, 1 dysgerminoma, 1 yolk-sac tumors and 1 patient with ovarian infiltration from malignant leukemia.

[Testicular and paratesticular tumors in children].

Testis tumors in children occur infrequently and exibit differences in their histopathology, clinical behaviour and therapy from their adult counterparts. From 1979 to 1994, 17 children and adolescent with testicular tumors were treated at the Pediatric Surgical Department of Vicenza Regional Hospital. Paratesticular rabdomiosarcoma were present in 3 cases, 4 patients had embrional carcinoma, 1 Sertoli cell tumor, 2 Leydig cell gonadal stromal tumor, and leukemic infiltrates of the testis were clinically evident in 7 patients.

[Retroperitoneal nodular fasciitis: analysis of a case].

A case of nodular fasciitis occurring in a 14-year-old girl is described and the clinical-pathological profile and the diagnostic problems are analyzed. The Authors believe this report useful to be reported for the relative rarity of the disease, especially in children, the very great dimension and the unusual retroperitoneal localization.

[Nonpalpable testis: current diagnostic and therapeutic trends].

Management of the nonpalpable testis often represent a significant diagnostic and therapeutic challenge for the pediatric surgeon. A variety of imaging studies may locate nonpalpable testis and include ultrasound, CT, MRI, gonadal vasography, and herniography, but none is completely reliable in locating a gonad or proving its absence. Laparoscopy has the advantage of great reliability in locating testes or proving their absence and can be coupled with surgical management; the laparoscopic findings determine the subsequent operative steps.

[True hermaphroditism in crossed testicular ectopy: report of a case].

Crossed testicular ectopia is a congenital anomaly characterized by the presence of both testes in the same hemiscrotum and may be associated in 20% of the cases with genitourinary developmental abnormalities. This review underscores the complexities of assessment and surgical management of an uncommon case in which crossed testicular ectopia and true hermaphroditism are simultaneously described.

[Mesenteric lymphangioma: report of a case].

Lymphangiomas are benign tumours that appears to arise from congenital malformation of the lymphatics. They are most commonly reported in the head and neck regions. The clinical presentation, diagnosis and treatment of a rare case of mesenteric lymphangiomas are reviewed.

[Spontaneous and traumatic rupture of the renal parenchyma in primary obstructive megaureter: a report of 2 cases].

Urinary extravasation in infants may occur secondary to a variety of congenital obstructive uropathic conditions. This condition has been reported most often in infants with posterior urethral valves and pelviureteral junction obstruction. We present two cases of perirenal urinary extravasation from the kidney due to primary obstructive megaureter.

[Chondroid hamartoma of the thoracic wall: apropos of a case treated by extensive surgical exeresis].

The Authors describe a case of chest wall hamartoma, very rare in infants and usually present at birth. This lesion, histologically, is benign. Surgical ablation is mandatory and curative, but the ablation of the tumor and the reconstruction of the large residual parietal defect are sometimes very difficult.

[A case of idiopathic mediastinal fibrosis with fatal outcome].

Particular difficulties arise when trying to classify mediastinal fibrosis and determining its etiology and clinical evolution. In this paper, the Authors describe a case of mediastinal fibrosis which was characterized by a specific clinical origins (mild fever-anemia). It was not possible to establish the real etiology of the mediastinal lesion which in the end led to an unfavourable outcome that was linked to the local development of the illness, in spite of its benign histological characteristics.

[Interstitial-cell tumor of the testicle. A case report].

The authors introduce the case of a seven-years-old patient suffering from a tumor of the Leydig cells testicle, which is a pathological entity rare to be found during pediatric age. The clinical history is characterised by the absence of any endocrine phenomena, such as precocious pseudopuberty, which are usually linked to the presence of a "Leydigoma". Surgical therapy, in connection with the described constant evolution that favours such lesions during pediatric age, with the absence of any cellular anomaly which is typical of a malignant case and lastly, with the clear delimitation of the tumor from the healthy testicular parenchyma, has so far restricted itself to the enucleation alone, without orchiectomy.

[Neonatal perirenal urine extravasation and urinary ascites associated with obstructive uropathy].

We report two cases of perirenal urinary extravasation one of which associated with urinary ascites. An underlying congenital obstructive uropathic condition was discovered in both patients. A localised parenchymal perforation was found in both cases.

[Bilateral multicystic renal dysplasia. Description of a case].

This is a case report of a newborn with bilateral multicystic kidney; The Authors report the etiology and the histologic features of the renal multicystic dysplasia considering the role of the sonographic examination in its precocious diagnosis. Peritoneal dialysis and renal transplantation in the first year of age are dealt about as the possible current therapeutic measures in the bilateral cases.

[Hydronephrosis in childhood. Long and mid-term morphologic and functional results].

Hydronephrosis in infancy and childhood is a frequent urinary malformation and is almost always congenital. In over 80% of the cases it is due to ureteropelvic junction obstruction; in about 17%, anomalous renal vessels at the ureteropelvic junction are present. The authors analyze their experience in the surgical treatment of hydronephrosis.

[Retrotendinous ureter. An exceptional cause of obstruction in the upper urinary tract].

Retrotendineus ureter is an exceptional anomaly presenting, in our experience, without clinical signs of urinary infection and obstruction. The radiological diagnosis was retrocaval ureter. The Authors report a case of a 9 years old boy who was successfully treated by ureteral section, excision of the obstructed ureteral segment and uretero-ureteral anastomosis.

[A rare cause of occult neuropathic bladder in children: the tethered cord syndrome].

The tethered cord syndrome is a form of spinal dysraphism in which a short, thickened filum terminale prevents the ascent of the conus medullaris and intraspinal lipoma causes compression upon the caudal part of the spinal cord. In pediatric age the first symptoms are urological: urinary incontinence and infection. Diagnosis is performed with urodynamic studies followed by nuclear magnetic resonance.

[Inflammatory pseudotumor as a cause of obstructive jaundice. Report of a case in a child].

Inflammatory pseudotumor involving the common bile duct, is a very rare event. The Authors were able to observe such a case in a 10 year old boy and report here the peculiar clinical findings.

[Kawasaki disease. Description of a case with atypical onset and course].

The authors, pointing out this case, intend to lay emphasis upon the possibility that, within a clinical-nosological entity complex itself, there were atypic forms (persisting pulmonary infiltration, marked hepatosplenomegaly, noticeably delayed thrombocitosis), for which only a careful estimate of all the elements permits the diagnosis.

[Hirschsprung disease. Results of surgical treatment].

The Authors report their experience in the treatment of 86 patients, in pediatric age, with Hirschsprung's disease: 40 with congenital rectosigmoid or subtotal megacolon, 8 with total colic or ileocolic aganglionosis and 38 with ultrashort aganglionic segment. Out of the patients 29% had necrotizing enterocolitis with 40% mortality rate in rectosigmoid or subtotal forms and with 75% mortality rate in total colic or ileocolic forms. In the last group the mortality was higher related also to difficulties and complications of surgical treatment.

[Value of rectal sensitivity test in chronic childhood constipation].

The rectal sensitivity test evaluates the distension volume for which the initial transient sensation occurs on defecation (conscious rectal sensitivity threshold). The conscious rectal sensitivity threshold (S.S.

[Hepatitis B in pediatrics. Considerations on vaccination in leukemia].

The A.A. after briefly describing the epidemiology of B hepatitis in Italy, outline its particular incidence among all the leukemic children in Campania and stress its negative effects on the course and prognosis of the disease.