http://elea.unisa.it/xmlui/handle/10556/4597 2026-04-20T15:22:44Z http://elea.unisa.it/xmlui/handle/10556/4605 Title: Pediatric anesthesia Authors: Tesoro, Simonetta; Marchesini, Vanessa; De Robertis, Edoardo 2019-01-01T00:00:00Z http://elea.unisa.it/xmlui/handle/10556/4604 Title: Congenital cystic adenomatoid malformation of the lung tipe II: three cases report Authors: Garzi, Alfredo; Ferrentino, Umberto; Ardimento, Gaetano; Brongo, Sergio; Rubino, Maria Serena; Calabrò, Eleonora; Clemente, Ennio; Di Crescenzo, Rosa Maria Abstract: Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung lesion. It may appear since birth (30-35%) with difficulty breathing or may have a late onset (60- 65%) with recurring pulmonary infections or growth failure; in a small percentage of cases, the lesion can be completely asymptomatic. Fetal or post-natal surgery can be used as surgical treatment of these lesions. Postnatal surgery consists of a lobectomy, bilobectomy or pneumonectomy, based on the size of the lesion. The best age to undergo this surgery is around 2 years, but only if the injury is stable and the child has no complications. The study describes three cases of CCAM, observed at the Pediatric Surgery Section of the University of Siena. We analyzed those 3 cases whose approach was defined by the onset of symptoms, age and clinical condition of patients. In the first case the surgery was performed a few hours after birth due to the worsening of the clinical conditions; in the other two cases it was delayed because the patients were asymptomatic. The purpose of this study is to review the management of patients with CCAM in relation to clinical onset and the type of injury. 2019-01-01T00:00:00Z http://elea.unisa.it/xmlui/handle/10556/4603 Title: Laparoscopic splenectomy: postero-lateral approach Authors: Garzi, Alfredo; Ardimento, Gaetano; Ferrentino, Umberto; Brongo, Sergio; Di Crescenzo, Rosa Maria Abstract: In paediatric population, the laparoscopic splenectomy has been preferred to the open surgery during the last years. Due to the improvement of the technique and the devices, the indications to the laparoscopic splenectomy have been increased, even though there is still a variety of conditions in which the execution of this technique is arduous. During the preoperative consult there is the need to carefully evaluate the existence of cholecystic lithiasis, the haemoglobin level in patients with SCA, platelet count in children with ITP and the vaccination status. An anterior and a lateral or hanging spleen approach are primarily used for laparoscopic splenectomy. In the last four years, near the Section of Pediatric Surgery of the Department of Pediatrics, Obstetrics and Medicine of the Reproduction of Siena University, 8 cases of splenomegaly have been treated, 7 by lateral videolaparoscopic splenectomy (5 males and 2 females, with medium age of 10,5 years) and 1 by anterior approach (10 years). The advantages shown by these techniques allow the laparoscopic splenectomy to be considered as a valid alternative to the open surgery. In children’s laparoscopic splenectomy, the rate of complications is considerably low and the the major problem is the intraoperative hemorrhage. With increasing surgical experience, the minimally invasive approach appears to be superior in terms of faster postoperative recovery, shorter hospital stay, perioperative and postoperative advantages. Therefore, the laparoscopic technique may soon be accepted as the standard method in patients requiring splenectomy. 2019-01-01T00:00:00Z http://elea.unisa.it/xmlui/handle/10556/4602 Title: Current ESPGHAN guidelines for celiac disease in pediatric age, tertiary care center experience: a proposal for further simplification Authors: Malamisura, Monica; Colantuono, Rossella; Salvati, Virginia M.; Croce, Roberta; D’Adamo, Grazia; Passaro, Tiziana; D’Angelo, Emanuela; Boffardi, Massimo; Garzi, Alfredo; Malamisura, Basilio Abstract: According to the 2012 ESPGHAN criteria for diagnosis of celiac disease (CD), duodenal biopsy (DB) can be avoided in children with a clear malabsorption syndrome, anti-tissue transglutaminase IgA (tTG2) ≥ 10x the cut-off, anti-endomysium IgA (EMA) and HLA DQ2/DQ8 genes. The aim of this study is to report our experience and evaluate the accuracy of the actual guidelines. Patients and methods: This is a retrospective study conducted on all patients diagnosed CD from 2012 to 2018 in our Center. For all patients enrolled were analyzed: data of family history, symptoms, serology, genetics, Marsh grade and follow-up. Results: A total of 481 children [mean age 6,4 yrs; F:M= 1.8:1] were included in the study. The mean age of patients who were not subject to DB was lower (4.51 yrs) comparing with patients that received DB (6.48 yrs). Out of the 256 patients with anti-tTG2 ≥ 10 fold, 121 underwent DB because of mild symptoms (84/121) or no symptoms (37/121). In all cases Marsh type 3 was found and HLA haplotypes was compatible with CD diagnosis. Conclusions: Our study confirms that the serology has a primary importance to diagnose CD, regardless of the symptoms. These data suggest that biopsy and HLA haplotypes search, in presence of anti-tTG2 IgA ≥ 10x the cut-off, are wasteful and unhelpful for the patients. 2019-01-01T00:00:00Z