Paola Midrio - Academia.edu (original) (raw)

Papers by Paola Midrio

Research paper thumbnail of Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

Journal of Pediatric Surgery

Research paper thumbnail of Incidental finding of thyroglossal duct cyst in a neonate during endotracheal intubation: a case report

BMC pediatrics, Apr 23, 2024

Background Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from ... more Background Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient. Case presentation a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk's procedure to avoid future complications and anesthesia. Conclusions even if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk's procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.

Research paper thumbnail of Dermoid cyst in floor of mouth of adolescent

Research paper thumbnail of Peristeen<sup>®</sup>transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study

Colorectal Disease, 2016

AimIn paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colo... more AimIn paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colon has gained popularity due to the introduction of a specifically designed device. The aim of this pilot study was to present the results of TAI using the Peristeen® TAI system in a group of paediatric patients with anorectal malformation (ARM) and congenital or acquired spinal cord lesions (SCLs).MethodEight Italian paediatric surgery and spina bifida centres participated in the study. The inclusion criteria were age between 6 and 17 years, weight above 20 kg and unsatisfactory bowel management. Patients with chronic inflammatory bowel disease, mental disability and surgery within the previous 3 months were excluded. At the beginning of treatment (T0) and after 3 months (T1) the Bristol scale, a questionnaire assessing bowel function, and two questionnaires on quality of life (QoL) for patients aged 6–11 years (CHQ‐pf50) and 12–17 years (SF36) were administered.ResultsEighty‐three patients were enrolled, and seventy‐eight completed the study (41 ARMs, 37 SCLs). At T1, constipation was reduced in ARMs from 69% to 25.6% and in SCLs from 92.7% to 41.5%, faecal incontinence in ARMs from 50% to 18.6% and in SCLs from 39% to 9.8% and flatus incontinence in ARMs from 20.9% to 9.8% and in SCLs from 31.7% to 10%. At T0, the Bristol Stool Scale types were 1–2 in 45% of ARMs and 77.5% of SCL patients, whereas at T1 types 1–2 were recorded in only 2.5% of SCL patients. QoL improved in both groups. In the younger group, a significant improvement in QoL was recorded in ARM patients for eight of nine variables and in SCL patients for seven of nine variables.ConclusionThis study showed that Peristeen TAI resulted in a significant time reduction in colonic cleansing, increased independence from the carer and improved QoL in paediatric patients with ARMs and SCLs.

Research paper thumbnail of VY anoplasty for ectropion of anal mucosa in an adult with anorectal malformation

Journal of pediatric surgery case reports, Apr 1, 2019

Ectropion of anal mucosa (AME) is a possible complication following anorectal surgery and it is o... more Ectropion of anal mucosa (AME) is a possible complication following anorectal surgery and it is often cause of symptoms such as soiling, pain and bleeding affecting the patients' quality of life. Two-flaps anoplasty has been previously described for the correction of AME. We herein report a case of an adult patient who underwent a successful double V/Y-flaps for mucosal ectropion as consequence of repair of anorectal malformation (ARM). A 25 year-old woman with history of ARM presented with an extensive AME causing bleeding, pain, soiling, and dyspareunia. This condition prevented her from an effective rectal nursing and a satisfactory social life. The patient underwent the resection of ectopic mucosa and the creation of two V-shaped skin flaps to cover the skin gap. A minor dehiscence of one of the flaps was treated conservatively. At two years follow up the patient is symptoms free, has a good quality of life and can perform an effective bowel management. AME is a possible complication after anorectal surgery for ARM and the multiple V-Y plasty is a viable procedure for its treatment. A multidisciplinary approach in these cases is recommended. Level of Evidence V.

Research paper thumbnail of Management of Congenital Urethral Strictures In Infants. Case Series

PubMed, Feb 21, 2019

Purpose: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. C... more Purpose: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants. Materials and methods: We reviewed our experience with 7 patients treated at our institution for CUS <age of 1-year. The study is a retrospective review of 7 patients treated for CUS diagnosed <age 1-year during a 10-year period. Result: In a single patient, the urethral stricture was an isolated condition, 3 had a Prune Belly Syndrome (PBS) and the remaining 3 had an Ano-Rectal Malformation (ARM). Four patients had upper tract dilatation detected on prenatal ultrasound. Five patients had upper tract dilatation on postnatal ultrasound. Five patients had impaired renal function at diagnosis and 3 required renal transplantation eventually. On micturating cystourethrography, all strictures were located in the anterior urethra and 4 cases had associated vesicoureteral reflux. In all cases, but one urinating via a patent urachus, initial management included insertion of a supra-pubic catheter. Subsequently, the CUS could be treated by dilatation or endoscopic incision in the 3 patients with Prune belly syndrome, whereas 3 of the remaining 4 required a formal urethroplasty. Conclusion: Diagnosis and treatment of CUS in infants and children remain difficult to standardize. At presentation, urinary diversion is key to avoid progressive renal damage in infants that can already have an impaired renal function. Anterior strictures in patients with PBS are likely to be fixed with progressive dilatation. In other patients, instead, urethroplasty should be considered. A formal vesicostomy or, if possible, an urethrostomy can allow temporizing final surgery. A major problem we experienced in the treatment of CUS is that the small endoscopicinstruments required in this age group make urethral instrumentation more difficult and less effective than in olderchildren and adults.

Research paper thumbnail of Ongoing care for the patient with an anorectal malfromation; transitioning to adulthood

Seminars in Pediatric Surgery, Dec 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Testicular function and sexuality in adult patients with anorectal malformation

Journal of Pediatric Surgery, Sep 1, 2020

To collect data on sexual and fertility issues in adult male patients with history of anorectal m... more To collect data on sexual and fertility issues in adult male patients with history of anorectal malformations (ARM). Materials and methods: Thirty adult males born with ARM, cared for at the Pediatric Surgery of Treviso and Padua Hospitals, were enrolled and interviewed about sexual habits and relationships. Testicular ultrasound, evaluation of male sex hormones and semen analysis were performed to assess testicular function and compare data with 15 fertile controls. Presence of erectile dysfunction was evaluated with IIEF-5 questionnaire. Results: Cryptorchidism and recurrent orchiepididymitis were reported in 33% and 40% of patients, respectively. Average testicular volume resulted significantly lower than fertile controls (11.1 vs 14.3 mL, p = 0.002) and 53.5% presented testicular hypotrophy (b 10 mL). Erectile dysfunction was reported by a single patient and ejaculatory anomalies by 46.5%. Thirteen patients were azoospermic/cryptozoospermic; 6 of them presented a reduced peripheral sensitivity to androgens (ASI N 139). Coital debut resulted delayed at 18 years old (vs 15 years in the control group). Overall 63.5% reported their condition did not affect their sexual sphere. Conclusions: Evaluation of testicular function is recommended in ARM patients to detect and treat possible infertility disorders, to recognize the clinical conditions which could affect the spermatogenesis since childhood, and to guarantee psychological support. Level of evidence rating: Prognosis study. Level III (case-control study).

Research paper thumbnail of Rectal atresia and rectal stenosis: the ARM-Net Consortium experience

Pediatric Surgery International, Jul 28, 2023

Purpose To assess the number, characteristics, and functional short-, and midterm outcomes of pat... more Purpose To assess the number, characteristics, and functional short-, and midterm outcomes of patients with rectal atresia (RA) and stenosis (RS) in the ARM-Net registry. Methods Patients with RA/RS were retrieved from the ARM-Net registry. Patient characteristics, associated anomalies, surgical approach, and functional bowel outcomes at 1 and 5-year follow-up were assessed. Results The ARM-Net registry included 2619 patients, of whom 36 (1.3%) had RA/RS. Median age at follow-up was 7.0 years (IQR 2.3-9.0). Twenty-three patients (63.9%, RA n = 13, RS n = 10) had additional anomalies. PSARP was the most performed reconstructive surgery for both RA (n = 9) and RS (n = 6) patients. At 1-year follow-up, 11/24 patients with known data (45.8%, RA n = 5, RS n = 6) were constipated, of whom 9 required stool softeners and/or laxatives. At 5-year follow-up, 8/9 patients with known data (88.9%, RA n = 4, RS n = 4) were constipated, all requiring laxatives and/or enema. Conclusion RA and RS are rare types of ARM, representing 1.3% of patients in the ARM-Net registry. Additional anomalies were present in majority of patients. Different surgical approaches were performed as reconstructive treatment, with constipation occurring in 46% and 89% of the patients at 1 and 5-year follow-up. However, accurate evaluation of long-term functional outcomes remains challenging.

Research paper thumbnail of 226 Sexuality in Adult Male Patients with Anorectal Malformations

The Journal of Sexual Medicine, Jul 1, 2018

Research paper thumbnail of Resolution of Fetal hydrops-not a favorable outcome in congenital pulmonary malformation type 1: A case report with review of literature

Indian pediatrics case reports, 2023

Background: Congenital pulmonary airway malformations(CPAMs) comprise a spectrum of anatomical an... more Background: Congenital pulmonary airway malformations(CPAMs) comprise a spectrum of anatomical anomalies of the lungs and respiratory tree. The natural history of prenatally diagnosed CPAM varies from in utero resolution to progression to hydrops and intrauterine death. The majority of fetuses (90%) have a good outcome. However, in a minority (10%), the mass may grow so large that it is associated with complications and becomes life‐threatening to the fetus. Clinical Description: Prenatal diagnosis of giant left CPAM type 1 was made at 24 weeks of gestation in a 29‐year‐old primigravida woman. The lesion consisted of multiple large cysts with a CPAM volume ratio of 4.7. Since the diagnosis, the mass was associated with nonimmune fetal hydrops and polyhydramnios which got worse throughout the following 4 weeks of gestation. Doppler studies remained normal until term. Management: The family received prenatal counseling. Parents refused termination of pregnancy and any other invasive or pharmacological therapy in light of the bad prognosis. The pregnancy was strictly monitored using standard fetal lung parameters. By 31 weeks’ gestation, hydrops spontaneously improved to resolution but without any change in the size of the cysts. A baby girl was delivered at term, with birth asphyxia, who, despite all efforts by a multidisciplinary team, could not be revived. Autopsy and histopathological findings were compatible with type 1 CPAM. Conclusion: Hydrops is a well‐known complication in fetuses with congenital cystic adenomatoid malformation. The present case reminds the possibility of its spontaneous resolution during pregnancy, even though the cyst size remains unaltered. The eventual neonatal survival depends not on the presence of hydrops but on the cyst volume and underlying lung hypoplasia.

Research paper thumbnail of Amnioscambio nella terapia fetale della gastroschisi

Research paper thumbnail of Nutrition/Metabolism

Intensive Care Medicine, Jun 1, 1996

Research paper thumbnail of Rare Complications during Surgical Vein Cannulation in Extremely Low Birthweight Neonates

Journal of Vascular Access, Jul 1, 2000

Extremely low birthweight neonates often require total parenteral nutrition by central venous cat... more Extremely low birthweight neonates often require total parenteral nutrition by central venous catheterization. The technique of choice is the percutaneous cannulation via the basilica or cephalic vein; in particular cases, these peculiar patients need a cut down catheterization. This paper describes some unusual complications of this surgical approach.

Research paper thumbnail of Early onset food protein-induced enterocolitis syndrome in two breastfed newborns masquerading as surgical diseases: case reports and literature review

Journal of Maternal-fetal & Neonatal Medicine, Apr 25, 2019

Lago (2019): Early onset food protein-induced enterocolitis syndrome in two breastfed newborns ma... more Lago (2019): Early onset food protein-induced enterocolitis syndrome in two breastfed newborns masquerading as surgical diseases: case reports and literature review,

Research paper thumbnail of Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?

Pediatric Nephrology, Jan 20, 2015

We reviewed our experience with renal transplantation (RTx) in children weighing &amp;amp;amp... more We reviewed our experience with renal transplantation (RTx) in children weighing &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15 kg to determine if the presence of lower urinary tract dysfunction (LUTD) influenced the outcome. Between 1987 and 2012, 68 RTx were performed in patients weighing less than 15 kg, including 17 with associated LUTD and 51 without. We detailed the lower urinary tract management in these patients, and compared graft survival rates and estimated clearance 12 and 60 months after RTx between groups. None of the patients without LUTD required any lower urinary tract surgery vs 8 out of 17 (47 %) with LUTD (p = 0.0001). The latter included a temporary incontinent urinary diversion in 5 cases (29 %), namely 2 vesicostomies and 3 cutaneous ureterostomies. After comparable follow-ups, there was no difference in patient survival, graft survival, and glomerular filtration rates between groups. Provided that there is appropriate bladder management, a concomitant LUTD does not adversely influence the outcome of RTx in patients weighing less than 15 kg. However, 50 % of our patients required lower urinary tract reconstruction and, in 30 %, a temporary incontinent urinary diversion was placed at RTx, since lower urinary tract function could not be assessed reliably, the patient was not collaborative enough to be involved in a voiding program, and/or the RTx was prioritized.

Research paper thumbnail of Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium

Pediatric Surgery International, Jul 3, 2017

Purpose The goal of this study was to determine the degree of consensus in the management of spin... more Purpose The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers. Methods A survey was sent to pediatric surgeons (one per center) members of the ARM-Net Consortium. Results Twenty-four (86%) from ten different countries completed the survey. Overall prevalence of TC was: 21% unknown, 46% below 15, and 29% between 15 and 30%. Ninety-six agreed on screening all patients for TC regardless the type of ARM and 79% start screening at birth. Responses varied in TC definition and diagnostic tools. Fifty percent of respondents prefer ultrasound (US), 21% indicate either US or magnetic resonance (MRI) based on a pre-defined risk of presenting TC, and 21% perform both. Discrepancy exists in complementary test: 82% carry out urodynamic studies (UDS) and only 37% perform somatosensory-evoked potentials (SSEP). Prophylactic untethering is performed in only two centers (8%). Conclusions Survey results support TC screening in all patients with ARM and conservative management of TC. There is discrepancy in the definition of TC, screening tools, and complementary test. Protocols should be developed to avoid such variability in management.

Research paper thumbnail of A Quality Assessment of the ARM-Net Registry Design and Data Collection

Journal of Pediatric Surgery

Research paper thumbnail of Talking about sexuality with your own child. The perspective of the parents of children born with arm

Pediatric Surgery International

Research paper thumbnail of Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy

Journal of Pediatric Urology

Research paper thumbnail of Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

Journal of Pediatric Surgery

Research paper thumbnail of Incidental finding of thyroglossal duct cyst in a neonate during endotracheal intubation: a case report

BMC pediatrics, Apr 23, 2024

Background Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from ... more Background Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient. Case presentation a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk's procedure to avoid future complications and anesthesia. Conclusions even if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk's procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.

Research paper thumbnail of Dermoid cyst in floor of mouth of adolescent

Research paper thumbnail of Peristeen<sup>®</sup>transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study

Colorectal Disease, 2016

AimIn paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colo... more AimIn paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colon has gained popularity due to the introduction of a specifically designed device. The aim of this pilot study was to present the results of TAI using the Peristeen® TAI system in a group of paediatric patients with anorectal malformation (ARM) and congenital or acquired spinal cord lesions (SCLs).MethodEight Italian paediatric surgery and spina bifida centres participated in the study. The inclusion criteria were age between 6 and 17 years, weight above 20 kg and unsatisfactory bowel management. Patients with chronic inflammatory bowel disease, mental disability and surgery within the previous 3 months were excluded. At the beginning of treatment (T0) and after 3 months (T1) the Bristol scale, a questionnaire assessing bowel function, and two questionnaires on quality of life (QoL) for patients aged 6–11 years (CHQ‐pf50) and 12–17 years (SF36) were administered.ResultsEighty‐three patients were enrolled, and seventy‐eight completed the study (41 ARMs, 37 SCLs). At T1, constipation was reduced in ARMs from 69% to 25.6% and in SCLs from 92.7% to 41.5%, faecal incontinence in ARMs from 50% to 18.6% and in SCLs from 39% to 9.8% and flatus incontinence in ARMs from 20.9% to 9.8% and in SCLs from 31.7% to 10%. At T0, the Bristol Stool Scale types were 1–2 in 45% of ARMs and 77.5% of SCL patients, whereas at T1 types 1–2 were recorded in only 2.5% of SCL patients. QoL improved in both groups. In the younger group, a significant improvement in QoL was recorded in ARM patients for eight of nine variables and in SCL patients for seven of nine variables.ConclusionThis study showed that Peristeen TAI resulted in a significant time reduction in colonic cleansing, increased independence from the carer and improved QoL in paediatric patients with ARMs and SCLs.

Research paper thumbnail of VY anoplasty for ectropion of anal mucosa in an adult with anorectal malformation

Journal of pediatric surgery case reports, Apr 1, 2019

Ectropion of anal mucosa (AME) is a possible complication following anorectal surgery and it is o... more Ectropion of anal mucosa (AME) is a possible complication following anorectal surgery and it is often cause of symptoms such as soiling, pain and bleeding affecting the patients' quality of life. Two-flaps anoplasty has been previously described for the correction of AME. We herein report a case of an adult patient who underwent a successful double V/Y-flaps for mucosal ectropion as consequence of repair of anorectal malformation (ARM). A 25 year-old woman with history of ARM presented with an extensive AME causing bleeding, pain, soiling, and dyspareunia. This condition prevented her from an effective rectal nursing and a satisfactory social life. The patient underwent the resection of ectopic mucosa and the creation of two V-shaped skin flaps to cover the skin gap. A minor dehiscence of one of the flaps was treated conservatively. At two years follow up the patient is symptoms free, has a good quality of life and can perform an effective bowel management. AME is a possible complication after anorectal surgery for ARM and the multiple V-Y plasty is a viable procedure for its treatment. A multidisciplinary approach in these cases is recommended. Level of Evidence V.

Research paper thumbnail of Management of Congenital Urethral Strictures In Infants. Case Series

PubMed, Feb 21, 2019

Purpose: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. C... more Purpose: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants. Materials and methods: We reviewed our experience with 7 patients treated at our institution for CUS <age of 1-year. The study is a retrospective review of 7 patients treated for CUS diagnosed <age 1-year during a 10-year period. Result: In a single patient, the urethral stricture was an isolated condition, 3 had a Prune Belly Syndrome (PBS) and the remaining 3 had an Ano-Rectal Malformation (ARM). Four patients had upper tract dilatation detected on prenatal ultrasound. Five patients had upper tract dilatation on postnatal ultrasound. Five patients had impaired renal function at diagnosis and 3 required renal transplantation eventually. On micturating cystourethrography, all strictures were located in the anterior urethra and 4 cases had associated vesicoureteral reflux. In all cases, but one urinating via a patent urachus, initial management included insertion of a supra-pubic catheter. Subsequently, the CUS could be treated by dilatation or endoscopic incision in the 3 patients with Prune belly syndrome, whereas 3 of the remaining 4 required a formal urethroplasty. Conclusion: Diagnosis and treatment of CUS in infants and children remain difficult to standardize. At presentation, urinary diversion is key to avoid progressive renal damage in infants that can already have an impaired renal function. Anterior strictures in patients with PBS are likely to be fixed with progressive dilatation. In other patients, instead, urethroplasty should be considered. A formal vesicostomy or, if possible, an urethrostomy can allow temporizing final surgery. A major problem we experienced in the treatment of CUS is that the small endoscopicinstruments required in this age group make urethral instrumentation more difficult and less effective than in olderchildren and adults.

Research paper thumbnail of Ongoing care for the patient with an anorectal malfromation; transitioning to adulthood

Seminars in Pediatric Surgery, Dec 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Testicular function and sexuality in adult patients with anorectal malformation

Journal of Pediatric Surgery, Sep 1, 2020

To collect data on sexual and fertility issues in adult male patients with history of anorectal m... more To collect data on sexual and fertility issues in adult male patients with history of anorectal malformations (ARM). Materials and methods: Thirty adult males born with ARM, cared for at the Pediatric Surgery of Treviso and Padua Hospitals, were enrolled and interviewed about sexual habits and relationships. Testicular ultrasound, evaluation of male sex hormones and semen analysis were performed to assess testicular function and compare data with 15 fertile controls. Presence of erectile dysfunction was evaluated with IIEF-5 questionnaire. Results: Cryptorchidism and recurrent orchiepididymitis were reported in 33% and 40% of patients, respectively. Average testicular volume resulted significantly lower than fertile controls (11.1 vs 14.3 mL, p = 0.002) and 53.5% presented testicular hypotrophy (b 10 mL). Erectile dysfunction was reported by a single patient and ejaculatory anomalies by 46.5%. Thirteen patients were azoospermic/cryptozoospermic; 6 of them presented a reduced peripheral sensitivity to androgens (ASI N 139). Coital debut resulted delayed at 18 years old (vs 15 years in the control group). Overall 63.5% reported their condition did not affect their sexual sphere. Conclusions: Evaluation of testicular function is recommended in ARM patients to detect and treat possible infertility disorders, to recognize the clinical conditions which could affect the spermatogenesis since childhood, and to guarantee psychological support. Level of evidence rating: Prognosis study. Level III (case-control study).

Research paper thumbnail of Rectal atresia and rectal stenosis: the ARM-Net Consortium experience

Pediatric Surgery International, Jul 28, 2023

Purpose To assess the number, characteristics, and functional short-, and midterm outcomes of pat... more Purpose To assess the number, characteristics, and functional short-, and midterm outcomes of patients with rectal atresia (RA) and stenosis (RS) in the ARM-Net registry. Methods Patients with RA/RS were retrieved from the ARM-Net registry. Patient characteristics, associated anomalies, surgical approach, and functional bowel outcomes at 1 and 5-year follow-up were assessed. Results The ARM-Net registry included 2619 patients, of whom 36 (1.3%) had RA/RS. Median age at follow-up was 7.0 years (IQR 2.3-9.0). Twenty-three patients (63.9%, RA n = 13, RS n = 10) had additional anomalies. PSARP was the most performed reconstructive surgery for both RA (n = 9) and RS (n = 6) patients. At 1-year follow-up, 11/24 patients with known data (45.8%, RA n = 5, RS n = 6) were constipated, of whom 9 required stool softeners and/or laxatives. At 5-year follow-up, 8/9 patients with known data (88.9%, RA n = 4, RS n = 4) were constipated, all requiring laxatives and/or enema. Conclusion RA and RS are rare types of ARM, representing 1.3% of patients in the ARM-Net registry. Additional anomalies were present in majority of patients. Different surgical approaches were performed as reconstructive treatment, with constipation occurring in 46% and 89% of the patients at 1 and 5-year follow-up. However, accurate evaluation of long-term functional outcomes remains challenging.

Research paper thumbnail of 226 Sexuality in Adult Male Patients with Anorectal Malformations

The Journal of Sexual Medicine, Jul 1, 2018

Research paper thumbnail of Resolution of Fetal hydrops-not a favorable outcome in congenital pulmonary malformation type 1: A case report with review of literature

Indian pediatrics case reports, 2023

Background: Congenital pulmonary airway malformations(CPAMs) comprise a spectrum of anatomical an... more Background: Congenital pulmonary airway malformations(CPAMs) comprise a spectrum of anatomical anomalies of the lungs and respiratory tree. The natural history of prenatally diagnosed CPAM varies from in utero resolution to progression to hydrops and intrauterine death. The majority of fetuses (90%) have a good outcome. However, in a minority (10%), the mass may grow so large that it is associated with complications and becomes life‐threatening to the fetus. Clinical Description: Prenatal diagnosis of giant left CPAM type 1 was made at 24 weeks of gestation in a 29‐year‐old primigravida woman. The lesion consisted of multiple large cysts with a CPAM volume ratio of 4.7. Since the diagnosis, the mass was associated with nonimmune fetal hydrops and polyhydramnios which got worse throughout the following 4 weeks of gestation. Doppler studies remained normal until term. Management: The family received prenatal counseling. Parents refused termination of pregnancy and any other invasive or pharmacological therapy in light of the bad prognosis. The pregnancy was strictly monitored using standard fetal lung parameters. By 31 weeks’ gestation, hydrops spontaneously improved to resolution but without any change in the size of the cysts. A baby girl was delivered at term, with birth asphyxia, who, despite all efforts by a multidisciplinary team, could not be revived. Autopsy and histopathological findings were compatible with type 1 CPAM. Conclusion: Hydrops is a well‐known complication in fetuses with congenital cystic adenomatoid malformation. The present case reminds the possibility of its spontaneous resolution during pregnancy, even though the cyst size remains unaltered. The eventual neonatal survival depends not on the presence of hydrops but on the cyst volume and underlying lung hypoplasia.

Research paper thumbnail of Amnioscambio nella terapia fetale della gastroschisi

Research paper thumbnail of Nutrition/Metabolism

Intensive Care Medicine, Jun 1, 1996

Research paper thumbnail of Rare Complications during Surgical Vein Cannulation in Extremely Low Birthweight Neonates

Journal of Vascular Access, Jul 1, 2000

Extremely low birthweight neonates often require total parenteral nutrition by central venous cat... more Extremely low birthweight neonates often require total parenteral nutrition by central venous catheterization. The technique of choice is the percutaneous cannulation via the basilica or cephalic vein; in particular cases, these peculiar patients need a cut down catheterization. This paper describes some unusual complications of this surgical approach.

Research paper thumbnail of Early onset food protein-induced enterocolitis syndrome in two breastfed newborns masquerading as surgical diseases: case reports and literature review

Journal of Maternal-fetal & Neonatal Medicine, Apr 25, 2019

Lago (2019): Early onset food protein-induced enterocolitis syndrome in two breastfed newborns ma... more Lago (2019): Early onset food protein-induced enterocolitis syndrome in two breastfed newborns masquerading as surgical diseases: case reports and literature review,

Research paper thumbnail of Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome?

Pediatric Nephrology, Jan 20, 2015

We reviewed our experience with renal transplantation (RTx) in children weighing &amp;amp;amp... more We reviewed our experience with renal transplantation (RTx) in children weighing &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15 kg to determine if the presence of lower urinary tract dysfunction (LUTD) influenced the outcome. Between 1987 and 2012, 68 RTx were performed in patients weighing less than 15 kg, including 17 with associated LUTD and 51 without. We detailed the lower urinary tract management in these patients, and compared graft survival rates and estimated clearance 12 and 60 months after RTx between groups. None of the patients without LUTD required any lower urinary tract surgery vs 8 out of 17 (47 %) with LUTD (p = 0.0001). The latter included a temporary incontinent urinary diversion in 5 cases (29 %), namely 2 vesicostomies and 3 cutaneous ureterostomies. After comparable follow-ups, there was no difference in patient survival, graft survival, and glomerular filtration rates between groups. Provided that there is appropriate bladder management, a concomitant LUTD does not adversely influence the outcome of RTx in patients weighing less than 15 kg. However, 50 % of our patients required lower urinary tract reconstruction and, in 30 %, a temporary incontinent urinary diversion was placed at RTx, since lower urinary tract function could not be assessed reliably, the patient was not collaborative enough to be involved in a voiding program, and/or the RTx was prioritized.

Research paper thumbnail of Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium

Pediatric Surgery International, Jul 3, 2017

Purpose The goal of this study was to determine the degree of consensus in the management of spin... more Purpose The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers. Methods A survey was sent to pediatric surgeons (one per center) members of the ARM-Net Consortium. Results Twenty-four (86%) from ten different countries completed the survey. Overall prevalence of TC was: 21% unknown, 46% below 15, and 29% between 15 and 30%. Ninety-six agreed on screening all patients for TC regardless the type of ARM and 79% start screening at birth. Responses varied in TC definition and diagnostic tools. Fifty percent of respondents prefer ultrasound (US), 21% indicate either US or magnetic resonance (MRI) based on a pre-defined risk of presenting TC, and 21% perform both. Discrepancy exists in complementary test: 82% carry out urodynamic studies (UDS) and only 37% perform somatosensory-evoked potentials (SSEP). Prophylactic untethering is performed in only two centers (8%). Conclusions Survey results support TC screening in all patients with ARM and conservative management of TC. There is discrepancy in the definition of TC, screening tools, and complementary test. Protocols should be developed to avoid such variability in management.

Research paper thumbnail of A Quality Assessment of the ARM-Net Registry Design and Data Collection

Journal of Pediatric Surgery

Research paper thumbnail of Talking about sexuality with your own child. The perspective of the parents of children born with arm

Pediatric Surgery International

Research paper thumbnail of Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy

Journal of Pediatric Urology