Alessandro Crocoli | "Tor Vergata" University of Rome (original) (raw)

Papers by Alessandro Crocoli

Research paper thumbnail of Congenital Askin tumor with favorable outcome: case report and review of the literature

Journal of Pediatric Surgery, 2012

Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and... more Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.

Research paper thumbnail of Symptomatic Vocal Cord Paresis/Paralysis in Infants Operated on for Esophageal Atresia and/or Tracheo-Esophageal Fistula

The Journal of Pediatrics, 2011

Objectives To describe the prevalence and pathogenesis of symptomatic vocal cord paresis/paralysi... more Objectives To describe the prevalence and pathogenesis of symptomatic vocal cord paresis/paralysis (VCP) in patients treated for esophageal atresia (EA), tracheo-esophageal fistula (TEF) or both.

Research paper thumbnail of Mediastinal Germ Cell Tumors in Pediatric Patients: A Report From the Italian Association of Pediatric Hematology and Oncology

Pediatric blood & cancer, Jan 14, 2016

Primary mediastinal germ cell tumors (GCTs) are rare in children and still represent a challenge ... more Primary mediastinal germ cell tumors (GCTs) are rare in children and still represent a challenge for both adult and pediatric oncologists because of their worse outcome compared to their gonadal counterpart. Prospectively collected data concerning patients enrolled in the Italian Association of Pediatric Haematology and Oncology study on malignant GCTs (AIEOP TCGM 2004) protocol for the treatment of GCTs were analyzed. Patients with malignant mediastinal primary GCTs were included in this study. Data regarding patients with newly diagnosed mediastinal teratoma were also collected. From 2005 to 2013, 20 children diagnosed with mediastinal GCTs were registered in AIEOP TCGM 2004 protocol. With a median follow-up of 89 months (range 35-123), the overall survival (OS) and event free survival (EFS) rates were 100% for teratoma and 90% for malignant GCTs. We confirm the favorable outcome of children affected by mediastinal teratoma and malignant GCTs. For malignant tumors, further studies...

Research paper thumbnail of Prenatal Features of Bladder Agenesis in a Female Fetus with Genital Transposition

Fetal and Pediatric Pathology, 2015

Bladder agenesis is a rare condition, mostly affecting females, where diagnosis is usually made i... more Bladder agenesis is a rare condition, mostly affecting females, where diagnosis is usually made in infancy when investigating urinary incontinence. Neonatal cases are uncommon, and none have been reported antenatally. The few male patients with this condition rarely survive: among associated anomalies, different degrees of penoscrotal transposition are the most evident feature. The association of genital transposition in a female infant with prenatal description of bladder agenesis has not been previously reported. Early diagnosis is important, enabling planning of surgical reconstruction early in life and appropriate parental counseling.

Research paper thumbnail of Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Associat...

Annals of Hematology, 2015

Central venous catheters (CVC), used for the management of children with hemato-oncological disor... more Central venous catheters (CVC), used for the management of children with hemato-oncological disorders, are burdened by a significant incidence of mechanical, infective, or thrombotic complications. These complications favor an increasing risk in prolongation of hospitalization, extra costs of care, and sometimes severe life-threatening events. No guidelines for the management of CVC-related occlusion and CVC-related thrombosis are available for children. To this aim, members of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) reviewed the pediatric and adult literature to propose the first recommendations for the management of CVC-related occlusion and CVC-related thrombosis in children with hemato-oncological disorders.

Research paper thumbnail of Modified Limberg's transposition flap for pilonidal sinus. Long term follow up of 216 cases

Annali italiani di chirurgia

to report our results in a large series of patients with chronic pilonidal sinus (PS) at long ter... more to report our results in a large series of patients with chronic pilonidal sinus (PS) at long term follow up. Two hundred sixteen patients underwent excision and rhomboid flap transposition (RFT) from 1986 to 2004 for PS, and followed for more than two years. Clinical presentation includes: pilonidal abscess treated by drainage (33%), chronic discharge (48%) and simple infected sinus (19%). Mean follow-up was 74.4 months (range: 24-96). Minimal flap necrosis occurred in 5 pts (2.3%), post operative infection in 2 pts (0.9%), 4 pts (1.8%) had a seroma, 18 pts (8.3%) anesthesia or hypoesthesia on the upper portion of the flap. The mean hospitalization was 3.1 +/- 0.30 days and return to work was 10.8 +/- 2.4 days. Recurrences occurred in 5 pts (7.4%) in our initial 87 pts. Since we modified the technique no recurrences were seen. The Limberg's technique is a very effective procedure for chronic or recurrent PS with a low complications rate, a short hospital stay, a rapid return to...

Research paper thumbnail of A rare case of acute cecal necrosis

Techniques in coloproctology, 2007

Research paper thumbnail of Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology

The Journal of Vascular Access, 2012

a VAD with technical features which increase its stability in time, with an expected duration in ... more a VAD with technical features which increase its stability in time, with an expected duration in the range of months and years: this category includes tunneled cuffed catheters and totally implantable venous ports. MTVA are VADs appropriate for a prolonged but not unlimited time (weeks or months) and for a discontinuous use (1): they include tunneled noncuffed central catheters, peripherally inserted central catheters (PICCs) and midline catheters.

Research paper thumbnail of Acute abdomen after allogenic haematopoietic stem cell transplantation

Pediatric Reports, 2011

We report a case of a patient who underwent allogenic hematopoietic stem cell transplantation com... more We report a case of a patient who underwent allogenic hematopoietic stem cell transplantation complicated by acute colonic pseudo obstruction who required surgery after failure of conservative therapy.

Research paper thumbnail of A dedicated protocol and environment for central venous catheter removal in pediatric patients affected by onco-hematological diseases

The Journal of Vascular Access, 2014

Research paper thumbnail of Sclerotherapy of primary aneurysmal bone cysts: comment to Lambot-Juhan et al

Pediatric Radiology, 2013

Research paper thumbnail of Immediate use of an arteriovenous prosthetic graft for life-saving dialysis in a child

Pediatric Nephrology, 2012

Background Autologous arteriovenous fistulas (AVFs) are the current gold standard for vascular ac... more Background Autologous arteriovenous fistulas (AVFs) are the current gold standard for vascular access in hemodialysis (HD). However, in pediatric patients, specific clinical settings may contraindicate the procedure, thus mandating the use of a prosthetic graft (PG). Case-Diagnosis/Treatment We report a case of successful polycarbonate urethane graft implantation and subsequent resumption of HD 12 h after the procedure in a young girl with end-stage renal disease (ESRD), challenging vascular anatomy and the absence of vascular access. Conclusions The use of polycarbonate urethane PGs in children with ESRD and difficult vascular accesses may represent a valid alternative for early resumption of HD.

Research paper thumbnail of Trimming long-term tunneled central venous catheters in pediatric patients

Pediatric Blood & Cancer, 2013

Research paper thumbnail of Central venous catheter placement in children: evaluation of electrocardiography using J-wire

Pediatric Anesthesia, 1999

Introduction: Treatment of is progressively more implying the tion of multimodal therapies. A lon... more Introduction: Treatment of is progressively more implying the tion of multimodal therapies. A long-Iasting venous access represents one of the criticai requirements for the success of those treatments. Recent technical innovations-such as minimally invasive procedures for new devices and novel materials-have rapidly for clinical use in adult patients, but are stili not used in the population. Methods: The Supportive Therapy Working Group of Italian Association of and Oncology reviewed medicalliterature on new aspects of centrai venous access devices (VADs) in pediatric affected by oncohematological diseases. Results:

Research paper thumbnail of Microwave Thermoablation Treatment of Chest Wall Chondroid Hamartoma in a Child

Journal of Vascular and Interventional Radiology, 2011

shunt is routinely kept inflated for several hours after sclerosant administration to prevent sys... more shunt is routinely kept inflated for several hours after sclerosant administration to prevent systemic embolization. We opted to perform coil embolization of the main draining vein after administration of the sclerosant in lieu of leaving the occlusion balloon in place for several hours.

Research paper thumbnail of Peripheral medulloepithelioma: a rare tumor with a potential target therapy

Journal of Translational Medicine, 2014

Background: Medulloepithelioma (ME) is a rare embryonal tumor predominantly located in the eye or... more Background: Medulloepithelioma (ME) is a rare embryonal tumor predominantly located in the eye or in the central nervous system without an established treatment.

Research paper thumbnail of Congenital Askin tumor with favorable outcome: case report and review of the literature

Journal of Pediatric Surgery, 2012

Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and... more Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.

Research paper thumbnail of Synchronous bilateral Wilms tumor

Cancer, 2013

On behalf of the AIEOP Wilms Tumor Working Group BACKGROUND: The optimal management of bilateral ... more On behalf of the AIEOP Wilms Tumor Working Group BACKGROUND: The optimal management of bilateral Wilms tumor (BWT) is challenging, and their survival is lower than for unilateral tumors. This report discusses a large series of BWTs treated in Italy in the last 2 decades. METHODS: This analysis concerns patients with synchronous BWT registered at Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) centers between 1990 and 2011; details on their treatment and outcome are presented and discussed. RESULTS: Ninety BWTs were registered in the AIEOP Wilms tumor database. Preoperative chemotherapy was given for a median 12 weeks before definitive tumor resection was attempted. Fortyeight percent of the patients had preservation of bilateral renal parenchyma. The proportion of bilateral nephron-sparing surgeries was not higher in the 37 patients initially given doxorubicin/vincristine/actinomycin D (32%) than in the 43 children receiving vincristine/actinomycin D alone (58%). The 4-year disease-free survival rate was 66.5% AE 5% and overall survival was 80% AE 5% for the cohort as a whole. The 4-year disease-free survival (overall survival) for 18 children with diffuse anaplasia or postchemotherapy blastemal-type tumors was 51% AE 13% (62% AE 13%), as opposed to 72% AE 3% (88% AE 4%) for 68 children with a favorable histology (logrank P ¼ .04 [P ¼ .007]). CONCLUSIONS: These results provide further evidence that the optimal duration and choice of drugs for preoperative chemotherapy remain an open question. Outcome remained significantly worse for BWT than for unilateral Wilms tumor. To enable the conservative treatment of as many affected kidneys as possible, only centers with experience in BWT should manage V C The long-term disease-free survival (DFS) rate for patients with localized Wilms tumor (WT) is now approaching 90%, and approximately 70% for those with metastatic disease. 1,2 This excellent outcome is the result of collaborative efforts by different specialists in national or international cooperative studies. WT may present with bilateral synchronous kidney involvement in 5% to 7% of affected children, 3 and their DFS (in the range of 60%-70%) is not as good as that for unilateral WT 4 ; furthermore, the risk of end-stage renal disease remains high in this subgroup of patients. 5 Bilateral WT (BWT) is likely to be associated with the presence of nephrogenic rests, congenital malformations, or predisposing syndromes as well. 3,6 A major challenge in BWT management is to achieve cure rates as high as in unilateral cases while preserving a renal function sufficient for normal growth and development.

Research paper thumbnail of Central venous catheter placement in children with thrombocytopenia

Minerva pediatrica

AIM: The use of central venous catheter (CVC) is essential in the management of chronically ill c... more AIM: The use of central venous catheter (CVC) is essential in the management of chronically ill children. Thrombocytopenia is a common haematological finding in these patients, with an increased risk of bleeding during the insertion of CVC. No clear guidelines are reported regarding the CVC positioning in patients with disorders of hemostasis, and prophylactic platelet (PLT) transfusions are still controversial. Aim of this study was to report the bleeding risk in pediatric patients with thrombocytopenia who underwent positioning of CVC. METHODS : A retrospective single-center study of all CVCs surgically inserted over a 2-year period (April 2011 - April 2013) at our institution was performed. Age, gender, diagnosis, type of CVC, haematological values (haemoglobin and PLT count, prothrombin international normalized ratio, active partial thromboplastin time) and post-operative bleeding complications were compared 9 between patients with PLT count below (group A) and above 50 x 10 /L ...

Research paper thumbnail of Local control in metastatic neuroblastoma in children over 1 year of age

BMC cancer, 2015

Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to... more Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to evaluate the impact of radical surgery on survival in children over 1 year of age. Fifty-eight patients older than 1 year of age with metastatic NBL were treated with conventional plus high-dose chemotherapy with or without addition of local radiotherapy (RT, 21Gy). Surgery was classified as radical surgery (complete resection and gross total resection) or non-radical surgery. The Kaplan-Meier method and the Cox proportional hazard model were used to calculate the probability of progression free and overall survival (PFS and OS) and for multivariate analysis. The 5-year PFS and OS for patients with radical surgery were 26% (95% CI 14-40%) and 38% (95% CI 23-53%) respectively, while the PFS and OS for patients without radical surgery were 33% (95% CI 10-59%) and 31% (95% CI 10-55%) (respectively, P 0.85 and P 0.42). The 5-year PFS and OS for patients who received RT were 36% (95% CI 19-5...

Research paper thumbnail of Congenital Askin tumor with favorable outcome: case report and review of the literature

Journal of Pediatric Surgery, 2012

Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and... more Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.

Research paper thumbnail of Symptomatic Vocal Cord Paresis/Paralysis in Infants Operated on for Esophageal Atresia and/or Tracheo-Esophageal Fistula

The Journal of Pediatrics, 2011

Objectives To describe the prevalence and pathogenesis of symptomatic vocal cord paresis/paralysi... more Objectives To describe the prevalence and pathogenesis of symptomatic vocal cord paresis/paralysis (VCP) in patients treated for esophageal atresia (EA), tracheo-esophageal fistula (TEF) or both.

Research paper thumbnail of Mediastinal Germ Cell Tumors in Pediatric Patients: A Report From the Italian Association of Pediatric Hematology and Oncology

Pediatric blood & cancer, Jan 14, 2016

Primary mediastinal germ cell tumors (GCTs) are rare in children and still represent a challenge ... more Primary mediastinal germ cell tumors (GCTs) are rare in children and still represent a challenge for both adult and pediatric oncologists because of their worse outcome compared to their gonadal counterpart. Prospectively collected data concerning patients enrolled in the Italian Association of Pediatric Haematology and Oncology study on malignant GCTs (AIEOP TCGM 2004) protocol for the treatment of GCTs were analyzed. Patients with malignant mediastinal primary GCTs were included in this study. Data regarding patients with newly diagnosed mediastinal teratoma were also collected. From 2005 to 2013, 20 children diagnosed with mediastinal GCTs were registered in AIEOP TCGM 2004 protocol. With a median follow-up of 89 months (range 35-123), the overall survival (OS) and event free survival (EFS) rates were 100% for teratoma and 90% for malignant GCTs. We confirm the favorable outcome of children affected by mediastinal teratoma and malignant GCTs. For malignant tumors, further studies...

Research paper thumbnail of Prenatal Features of Bladder Agenesis in a Female Fetus with Genital Transposition

Fetal and Pediatric Pathology, 2015

Bladder agenesis is a rare condition, mostly affecting females, where diagnosis is usually made i... more Bladder agenesis is a rare condition, mostly affecting females, where diagnosis is usually made in infancy when investigating urinary incontinence. Neonatal cases are uncommon, and none have been reported antenatally. The few male patients with this condition rarely survive: among associated anomalies, different degrees of penoscrotal transposition are the most evident feature. The association of genital transposition in a female infant with prenatal description of bladder agenesis has not been previously reported. Early diagnosis is important, enabling planning of surgical reconstruction early in life and appropriate parental counseling.

Research paper thumbnail of Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Associat...

Annals of Hematology, 2015

Central venous catheters (CVC), used for the management of children with hemato-oncological disor... more Central venous catheters (CVC), used for the management of children with hemato-oncological disorders, are burdened by a significant incidence of mechanical, infective, or thrombotic complications. These complications favor an increasing risk in prolongation of hospitalization, extra costs of care, and sometimes severe life-threatening events. No guidelines for the management of CVC-related occlusion and CVC-related thrombosis are available for children. To this aim, members of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) reviewed the pediatric and adult literature to propose the first recommendations for the management of CVC-related occlusion and CVC-related thrombosis in children with hemato-oncological disorders.

Research paper thumbnail of Modified Limberg's transposition flap for pilonidal sinus. Long term follow up of 216 cases

Annali italiani di chirurgia

to report our results in a large series of patients with chronic pilonidal sinus (PS) at long ter... more to report our results in a large series of patients with chronic pilonidal sinus (PS) at long term follow up. Two hundred sixteen patients underwent excision and rhomboid flap transposition (RFT) from 1986 to 2004 for PS, and followed for more than two years. Clinical presentation includes: pilonidal abscess treated by drainage (33%), chronic discharge (48%) and simple infected sinus (19%). Mean follow-up was 74.4 months (range: 24-96). Minimal flap necrosis occurred in 5 pts (2.3%), post operative infection in 2 pts (0.9%), 4 pts (1.8%) had a seroma, 18 pts (8.3%) anesthesia or hypoesthesia on the upper portion of the flap. The mean hospitalization was 3.1 +/- 0.30 days and return to work was 10.8 +/- 2.4 days. Recurrences occurred in 5 pts (7.4%) in our initial 87 pts. Since we modified the technique no recurrences were seen. The Limberg's technique is a very effective procedure for chronic or recurrent PS with a low complications rate, a short hospital stay, a rapid return to...

Research paper thumbnail of A rare case of acute cecal necrosis

Techniques in coloproctology, 2007

Research paper thumbnail of Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology

The Journal of Vascular Access, 2012

a VAD with technical features which increase its stability in time, with an expected duration in ... more a VAD with technical features which increase its stability in time, with an expected duration in the range of months and years: this category includes tunneled cuffed catheters and totally implantable venous ports. MTVA are VADs appropriate for a prolonged but not unlimited time (weeks or months) and for a discontinuous use (1): they include tunneled noncuffed central catheters, peripherally inserted central catheters (PICCs) and midline catheters.

Research paper thumbnail of Acute abdomen after allogenic haematopoietic stem cell transplantation

Pediatric Reports, 2011

We report a case of a patient who underwent allogenic hematopoietic stem cell transplantation com... more We report a case of a patient who underwent allogenic hematopoietic stem cell transplantation complicated by acute colonic pseudo obstruction who required surgery after failure of conservative therapy.

Research paper thumbnail of A dedicated protocol and environment for central venous catheter removal in pediatric patients affected by onco-hematological diseases

The Journal of Vascular Access, 2014

Research paper thumbnail of Sclerotherapy of primary aneurysmal bone cysts: comment to Lambot-Juhan et al

Pediatric Radiology, 2013

Research paper thumbnail of Immediate use of an arteriovenous prosthetic graft for life-saving dialysis in a child

Pediatric Nephrology, 2012

Background Autologous arteriovenous fistulas (AVFs) are the current gold standard for vascular ac... more Background Autologous arteriovenous fistulas (AVFs) are the current gold standard for vascular access in hemodialysis (HD). However, in pediatric patients, specific clinical settings may contraindicate the procedure, thus mandating the use of a prosthetic graft (PG). Case-Diagnosis/Treatment We report a case of successful polycarbonate urethane graft implantation and subsequent resumption of HD 12 h after the procedure in a young girl with end-stage renal disease (ESRD), challenging vascular anatomy and the absence of vascular access. Conclusions The use of polycarbonate urethane PGs in children with ESRD and difficult vascular accesses may represent a valid alternative for early resumption of HD.

Research paper thumbnail of Trimming long-term tunneled central venous catheters in pediatric patients

Pediatric Blood & Cancer, 2013

Research paper thumbnail of Central venous catheter placement in children: evaluation of electrocardiography using J-wire

Pediatric Anesthesia, 1999

Introduction: Treatment of is progressively more implying the tion of multimodal therapies. A lon... more Introduction: Treatment of is progressively more implying the tion of multimodal therapies. A long-Iasting venous access represents one of the criticai requirements for the success of those treatments. Recent technical innovations-such as minimally invasive procedures for new devices and novel materials-have rapidly for clinical use in adult patients, but are stili not used in the population. Methods: The Supportive Therapy Working Group of Italian Association of and Oncology reviewed medicalliterature on new aspects of centrai venous access devices (VADs) in pediatric affected by oncohematological diseases. Results:

Research paper thumbnail of Microwave Thermoablation Treatment of Chest Wall Chondroid Hamartoma in a Child

Journal of Vascular and Interventional Radiology, 2011

shunt is routinely kept inflated for several hours after sclerosant administration to prevent sys... more shunt is routinely kept inflated for several hours after sclerosant administration to prevent systemic embolization. We opted to perform coil embolization of the main draining vein after administration of the sclerosant in lieu of leaving the occlusion balloon in place for several hours.

Research paper thumbnail of Peripheral medulloepithelioma: a rare tumor with a potential target therapy

Journal of Translational Medicine, 2014

Background: Medulloepithelioma (ME) is a rare embryonal tumor predominantly located in the eye or... more Background: Medulloepithelioma (ME) is a rare embryonal tumor predominantly located in the eye or in the central nervous system without an established treatment.

Research paper thumbnail of Congenital Askin tumor with favorable outcome: case report and review of the literature

Journal of Pediatric Surgery, 2012

Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and... more Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.

Research paper thumbnail of Synchronous bilateral Wilms tumor

Cancer, 2013

On behalf of the AIEOP Wilms Tumor Working Group BACKGROUND: The optimal management of bilateral ... more On behalf of the AIEOP Wilms Tumor Working Group BACKGROUND: The optimal management of bilateral Wilms tumor (BWT) is challenging, and their survival is lower than for unilateral tumors. This report discusses a large series of BWTs treated in Italy in the last 2 decades. METHODS: This analysis concerns patients with synchronous BWT registered at Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) centers between 1990 and 2011; details on their treatment and outcome are presented and discussed. RESULTS: Ninety BWTs were registered in the AIEOP Wilms tumor database. Preoperative chemotherapy was given for a median 12 weeks before definitive tumor resection was attempted. Fortyeight percent of the patients had preservation of bilateral renal parenchyma. The proportion of bilateral nephron-sparing surgeries was not higher in the 37 patients initially given doxorubicin/vincristine/actinomycin D (32%) than in the 43 children receiving vincristine/actinomycin D alone (58%). The 4-year disease-free survival rate was 66.5% AE 5% and overall survival was 80% AE 5% for the cohort as a whole. The 4-year disease-free survival (overall survival) for 18 children with diffuse anaplasia or postchemotherapy blastemal-type tumors was 51% AE 13% (62% AE 13%), as opposed to 72% AE 3% (88% AE 4%) for 68 children with a favorable histology (logrank P ¼ .04 [P ¼ .007]). CONCLUSIONS: These results provide further evidence that the optimal duration and choice of drugs for preoperative chemotherapy remain an open question. Outcome remained significantly worse for BWT than for unilateral Wilms tumor. To enable the conservative treatment of as many affected kidneys as possible, only centers with experience in BWT should manage V C The long-term disease-free survival (DFS) rate for patients with localized Wilms tumor (WT) is now approaching 90%, and approximately 70% for those with metastatic disease. 1,2 This excellent outcome is the result of collaborative efforts by different specialists in national or international cooperative studies. WT may present with bilateral synchronous kidney involvement in 5% to 7% of affected children, 3 and their DFS (in the range of 60%-70%) is not as good as that for unilateral WT 4 ; furthermore, the risk of end-stage renal disease remains high in this subgroup of patients. 5 Bilateral WT (BWT) is likely to be associated with the presence of nephrogenic rests, congenital malformations, or predisposing syndromes as well. 3,6 A major challenge in BWT management is to achieve cure rates as high as in unilateral cases while preserving a renal function sufficient for normal growth and development.

Research paper thumbnail of Central venous catheter placement in children with thrombocytopenia

Minerva pediatrica

AIM: The use of central venous catheter (CVC) is essential in the management of chronically ill c... more AIM: The use of central venous catheter (CVC) is essential in the management of chronically ill children. Thrombocytopenia is a common haematological finding in these patients, with an increased risk of bleeding during the insertion of CVC. No clear guidelines are reported regarding the CVC positioning in patients with disorders of hemostasis, and prophylactic platelet (PLT) transfusions are still controversial. Aim of this study was to report the bleeding risk in pediatric patients with thrombocytopenia who underwent positioning of CVC. METHODS : A retrospective single-center study of all CVCs surgically inserted over a 2-year period (April 2011 - April 2013) at our institution was performed. Age, gender, diagnosis, type of CVC, haematological values (haemoglobin and PLT count, prothrombin international normalized ratio, active partial thromboplastin time) and post-operative bleeding complications were compared 9 between patients with PLT count below (group A) and above 50 x 10 /L ...

Research paper thumbnail of Local control in metastatic neuroblastoma in children over 1 year of age

BMC cancer, 2015

Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to... more Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to evaluate the impact of radical surgery on survival in children over 1 year of age. Fifty-eight patients older than 1 year of age with metastatic NBL were treated with conventional plus high-dose chemotherapy with or without addition of local radiotherapy (RT, 21Gy). Surgery was classified as radical surgery (complete resection and gross total resection) or non-radical surgery. The Kaplan-Meier method and the Cox proportional hazard model were used to calculate the probability of progression free and overall survival (PFS and OS) and for multivariate analysis. The 5-year PFS and OS for patients with radical surgery were 26% (95% CI 14-40%) and 38% (95% CI 23-53%) respectively, while the PFS and OS for patients without radical surgery were 33% (95% CI 10-59%) and 31% (95% CI 10-55%) (respectively, P 0.85 and P 0.42). The 5-year PFS and OS for patients who received RT were 36% (95% CI 19-5...