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Background/purpose: The aims of this study were to evaluate survival and ovarian prognosis in patients treated for ovarian germ cell tumor (OGCT) and to propose a decision-making protocol., Methods: Charts of girls operated on for OGCT from 1976 up to 2009 were reviewed retrospectively. Tumor characteristics were assessed by tumor markers, imaging, and pathology., Results: Charts were available in 71 children presenting 75 OGCT. Tumors were benign in 58 cases and malignant in 17 cases. The average of the largest diameter of benign OGCT was significantly lower than that of malignant OGCT (76.5 +/- 49 mm versus 169 +/- 54 mm, P < .0001). Ovarian-sparing tumorectomy was carried out in 27 benign OGCT; 23 (85%) preserved ovaries were follicular. Malignant OGCTs were managed according to the protocols of the French Society for Pediatric Oncology. Bilateral oophorectomy had to be performed in 2 children. One patient presented a recurrence and 1 died., Conclusions: In our series, both benign and malignant OGCTs have a good prognosis. A 75-mm cutoff size is proposed as an important criterion to preoperatively differentiate between benign and malignant tumors. In benign OGCT, ovarian-sparing tumorectomy leads to preserve ovaries in approximately 85% of cases, and in malignant OGCT, high survival rate has been obtained., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background/purpose: Ovarian torsion in childhood and adolescence is a rare entity. Traditionally, treatment is oophorectomy. The aim of this study was to evaluate ovarian outcome and to propose a decision-making protocol for suspected ovarian torsion., Methods: Between January 1986 and December 2007, 45 ovarian torsion cases in 40 girls were operated on. In all the cases, when the ovary was preserved, patients were clinically and ultrasonographically followed up for several months., Results: Median age was 11 years. Median delay between the first symptoms and surgical procedure was 3 days. There was a statistical difference (P = .0003) between the mean of the largest diameter of twisted normal ovary and the mean of the largest diameter of twisted diseased ovary. Underlying pathology was benign in 22 cases and low-grade malignancy in 2 (one grade II immature teratoma and one steroid cell tumor). Conservative management was performed in 26 cases. At follow-up, 17 ovaries were follicular, 7 being black-bluish during surgery., Conclusions: Conservative approach after detorsion of black-bluish ovaries is safe and effective in children. Although very unlikely, the fear of missing malignancy must incite to proceed with caution and can lead, when the size of the twisted ovary is greater than 75 mm, to prefer laparotomy to laparoscopy.

Purpose: The mechanism of left recurrent laryngeal nerve palsy after cervical mediastinoscopy remains unclear. Our aim is to describe the anatomical bases of this complication., Methods: Video-assisted mediastinoscopy was performed on ten fresh human cadavers with simultaneous dissection of the left recurrent nerve., Results: Three dissection areas could be described regarding the risk of left recurrent nerve damage: a low risk area, along the right wall and before the upper part of the anterior wall of the trachea; an area at high risk of indirect stretch-induced lesions, between the lower part of the anterior wall of the trachea and the aorta; -an area at high risk of direct injury, against the lower part of the left wall of the trachea., Conclusions: Dissection between the trachea and the aorta causes traction on the left recurrent nerve. Indirect stretch-induced injury is probably a frequent mechanism of left recurrent nerve palsy during mediastinoscopy.

Background/purpose: Fetal ovarian cysts are frequently complicated by intracystic hemorrhage without associated clinical signs, which is often secondary to ovarian torsion leading to loss of the ovary. The aim of this study was to evaluate ovarian outcome and the place of prenatal management and surgery in the first few days of life in order to save the ovary., Methods: Between January 1987 and June 2006, 82 fetal ovarian cysts in 79 patients were managed and clinically and ultrasonographically followed up for several months (median, 11 months; range, 6 months to 10 years) in all of the cases where the ovary was not removed. The ultrasonographic results regarding the ovarian parenchyma were broken down into 3 categories: follicular ovary, homogeneous ovary, and undetected ovary., Results: Twenty-seven cysts remained simple throughout their evolution, and 55 were complicated by intracystic hemorrhage usually several weeks before birth. Overall, after disappearance of the cyst, a follicular ovary was detected in only 39% of the cases (32/82) and more often when the cyst was simple than when it presented an intracystic hemorrhage (85% vs 16.4%, chi(2), P < .0001)., Conclusions: A review of our series confirms the poor ovarian outcome linked to ultrasonographic signs of intracystic hemorrhage. Preventive action by puncture of "simple" cysts is still being studied. The presence of a bilateral cyst can, if pulmonary maturity has been reached, be an argument for inducement of premature birth with a view to performing conservative surgery. After birth, surgery in the first few days of life is only justified if the signs of intracystic hemorrhage appeared in the period very close to birth.

Objective: The objective of this study is to present the results of a preliminary series of 24 upper pole nephrectomies performed by retroperitoneoscopy in children between 1995 and 2000., Material and Methods: The patient was placed in the lateral supine position and 3-4 trocars were inserted. Parenchymal section was performed by ultrasound or unipolar scalpel. This series of 24 children consisted of 15 girls and 9 boys with a mean age of 22 months., Result: Three cases (12.5%) required open conversion. Nine intraoperative complications (37%) were observed and repaired intraoperatively. Five postoperative complications (20%) consisted of residual perirenal collections, requiring drainage under anaesthesia in only one case. The mean operating time was 2 hours 40 minutes. The mean hospital stay was 3.4 days. The mean follow-up was 32 months. No cases of secondary atrophy of the lower pole were observed., Conclusion: Overall, these preliminary results are comparable to those of conventional open surgery. The advantage of this method is a reduction of skin and musculo-aponeurotic scars.

Objective: The objective of this study is to present the results of 24 upper pole nephrectomies performed by retroperitoneoscopy in children between 1995 and 2000., Material and Methods: This series of 24 children consisted of 15 girls and 9 boys with a mean age of 22 months. The patient was placed in the lateral supine position and 3 to 4 trocars were inserted. Parenchymal section was performed by ultrasound or unipolar scalpel., Result: Three cases (12.5%) required open conversion. Nine intraoperative complications (37%) were observed and repaired intraoperatively. Five postoperative complications (20%) consisted of residual perirenal collections, requiring drainage under anaesthesia in only one case. The mean operating time was 2 hours 40 minutes. The mean hospital stay was 3.4 days. The mean follow-up was 32 months. No cases of secondary atrophy of the lower pole were observed., Conclusion: Overall, these preliminary results are comparable to those of conventional open surgery. The advantage of this method is a reduction of skin and musculo-aponeurotic scars.

Background: Mycobacterial infections are extremely complex diseases, either due to the various clinical manifestations, or to the various involved kind of mycobacteria, or to the different sensibility to antibiotics. The authors review retrospectively their series, evaluating the management of pediatric cervical lymphadenitis due to mycobacterical etiology., Methods: From 1975 to 1998, at the Department of Pediatric Surgery of the university of Siena, 88 children were evaluated for laterocervical lymphadenopathy. Among these, 29 children, aged from 14 months to 13 years, were diagnosed as affected with lymphoadenopathy due to mycobacteria. Therapy of choice was the association of surgery and antibiotics. This behaviour allowed us to approach both advanced lesions, in active colliquation, and progressive ones., Results: Results were unquestionably positive, with a complete resolution and good esthetical results in 93.2% of cases. In 6.8% of cases there was a recurrence, which required reintervention., Conclusions: On the basis of our series, we agree with the international literature in affirming that, in cases of mycobacterial lymphadenopathy, a combined antibiotic and surgical therapy is necessary. However, controversy about such a complex and difficult pathology is opened and unsolved.

Attention is called to the risks of gas myelography and two cases of complications are described. One of these, observed personally, was fatal and its possible pathogenetic mechanisms are illustrated. Stress is laid on certain rules and precautions that should be respected in radiological and anaesthesiological practice. Insufflation pressure and volumes of injected air deserve particular attention and scrupulous intraoperative control cut of vital parameters must be carried and appropriate attention paid to patient hydration during the postoperative period.