Search for: [Affiliation = "Patoulias, Ioannis \: First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G Gennimatas”, Thessaloniki, Greece"]

Inguinal hernia management in preterm infants: addressing current issues of interest

Ioannis Patoulias Ioanna Gkalonaki Dimitrios Patoulias

Folia Medica Cracoviensia | 2020 | Vol. 60 | No 4 | 41-52 | DOI: 10.24425/fmc.2020.136203

Keywords preterm infant inguinal hernia postoperative apnea operative complications

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Abstract

We define as preterm any newborn born before 37 weeks of gestation. The incidence of inguinal hernia is 1–4.4% among full term neonates and older children. In preterm newborns it is significantly more often, with an incidence that raises up to 30%. In this comprehensive review of the literature we provide evidence-based answers in various questions concerning the optimal treatment of inguinal hernias in preterm neonates. Such questions include the proper time of intervention, the choice of optimal anesthesia, the necessity for contralateral investigation in case of an ipsilateral hernia, the prevention of post-operative apnea and the choice between classic and laparoscopic surgical techniques.

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Bibliography

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Authors and Affiliations

Ioannis Patoulias

1

Ioanna Gkalonaki

1

e-mail:

ORCID:

Dimitrios Patoulias

2

First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G Gennimatas”, Thessaloniki, Greece
First Department of Internal Medicine, General Hospital “Hippokration”, Thessaloniki, Greece

Pathogenesis and prognosis of intrarenal reflux

Ioanna Gkalonaki Evangelia Schoina Michail Anastasakis Ioannis Patoulias

Folia Medica Cracoviensia | 2023 | Vol. 63 | No 2 | 57-64 | DOI: 10.24425/fmc.2023.145913

Keywords intrarenal reflux renal scar renal papillae vesicoureteral reflux N-acetyl-beta-glycosamini-dase beta 2 microglobulin Pentraxin 3 Liver-type fatty-acid-binding protein

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Abstract

Scar development in the children’s renal cortex with vesicoureteral reflux (VUR) is one of the most important parameters of prognosis. It can develop regardless of the chosen treatment, even after the regression of VUR. The shape of the renal papillae, the ascending urinary tract infection, the greater than third-degree VUR, and finally the increased intra-calyceal pressure, induce the formation of renal scarring in the renal parenchyma. Renal scarring may complicate VUR independently of the therapeutic strategy (conservative or operative) and its regression. For restitution of this entity, many scientific terms have been used and the most common of them is intrarenal reflux (IRR). The effects of VUR on future renal function result from the limited ability of the affected kidney to grow (failure of renal growth) due to the existence of scars in the renal cortex, the worsening of these scars, or finally the creation of new scars. With the present study, we intend to clarify the etiology and the pathophysiology of IRR and the relation of VUR prognosis to newer biomarkers such as N-acetyl-beta-glycosaminidase, beta-2 microglobulin, Pen-traxin- 3 and Liver-type fatty-acid-binding protein.

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Authors and Affiliations

Ioanna Gkalonaki

1

e-mail:

ORCID:

Evangelia Schoina

1

Michail Anastasakis

1

Ioannis Patoulias

1

First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece

Hutch diverticulum: from embryology to clinical practice

Ioanna Gkalonaki Michail Anastasakis Christina Panteli Ioannis Patoulias

Folia Medica Cracoviensia | 2022 | Vol. 62 | No 4 | 57-62 | DOI: 10.24425/fmc.2022.144083

Keywords congenital diverticulum paraureteric (Hutch) Waldeyer’s fascia ureterovesical junction vesicoureteral reflux child

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Abstract

Hutch Diverticulum (HD) is defined as the protrusion of the mucosal and submucosal layer through the muscle bundles of the underlying detrusor muscle. HD is located at the vesicoureteral junction with a backward direction from the homolateral ureteral orifice. As far as its etiology is con-cerned, HD is caused either by a congenital muscle wall defect at the level where the Waldeyer’s fascia occupies the clefts between the vesical part of the homolateral ureter and the detrusor, or is associated with abortive ureteral duplication or defective incorporation of mesonephric duct into the bladder at the site of ureteral hiatus or finally is associated with the development of transient urethral obstruction. HD is usually unilateral and more common in male patients. It may be associated with the Ehlers-Danlos, Williams-Elfin and Menkes syndromes. HD usually occurs in childhood and rarely during adulthood. It is found in 0.2–13% of all children presenting with urinary tract infection. Through this short review article, we attempt to present in detail the most recent bibliographic data concerning this entity, focusing on pathophysiology, diagnostic approach, and treatment strategy.

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Authors and Affiliations

Ioanna Gkalonaki

1

e-mail:

ORCID:

Michail Anastasakis

1

Christina Panteli

1

Ioannis Patoulias

1

First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece

The challenging diagnosis of acute scrotum: remaining difficulties and further insights

Ioanna Gkalonaki Ioannis Patoulias Michail Anastasakis Christina Panteli Dimitrios Patoulias

Folia Medica Cracoviensia | 2022 | Vol. 62 | No 3 | 91-100 | DOI: 10.24425/fmc.2022.142371

Keywords acute scrotum spermatic cord torsion acute epididymitis appendiceal torsion

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Abstract

The main target during management of a male pediatric patient with clinical signs of acute scrotum is the timely diagnosis, in order not to jeopardize the viability of the affected testicle. Thorough evaluation of the patient’s medical history, symptomatology, clinical and ultrasonographic findings, con-stitutes the basis of the diagnostic procedure. After comprehensive research of the relevant literature, we highlight the remaining difficulties in the evaluation of the clinical and ultrasonographic findings for the accurate diagnosis of the acute scrotum. In conclusion, it is worth emphasizing on the following: a. the most common diseases that come under the diagnosis of the acute scrotum may present with similar symptoms, b. in neglected cases the diagnostic approach becomes more difficult, constituting the evalua-tion of the pathognomonic clinical signs challenging, and c. inability to exclude the diagnosis of spermatic cord torsion should be an indication for the surgical exploration of the affected hemiscrotum.

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Authors and Affiliations

Ioanna Gkalonaki

1

e-mail:

ORCID:

Ioannis Patoulias

1

Michail Anastasakis

1

Christina Panteli

1

Dimitrios Patoulias

2

First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece
First Department of Internal Medicine, General Hospital “Hippokration”, Thessaloniki, Greece

Symptomatic Intraparenchymal Epididymal Cysts: Description of 11 cases

Evangelia Schoina Ioanna Gkalonaki Ioannis Trevlias Christina Panteli Ioannis Patoulias

Folia Medica Cracoviensia | 2023 | Vol. 63 | No 4 | 49-55 | DOI: 10.24425/fmc.2023.148757

Keywords cyst epididymis painful scrotum male adolescence

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Abstract

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adoles-cence or early adulthood. Their frequency doubles after the age of 14–15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11–16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis oc-curred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approxi-mately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review ,of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24–48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epi-didymis.

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Authors and Affiliations

Evangelia Schoina

1

Ioanna Gkalonaki

1

e-mail:

ORCID:

Ioannis Trevlias

1

Christina Panteli

1

Ioannis Patoulias

1

First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece

Urachal remnants: from embryology to clinical practice

Ioanna Gkalonaki Ioannis Patoulias Michail Anastasakis Christina Panteli Dimitrios Patoulias

Folia Medica Cracoviensia | 2023 | Vol. 63 | No 4 | 81-88 | DOI: 10.24425/fmc.2023.148760

Keywords patent urachus urachal sinus urachal cyst urachal diverticulum urachal remnants bladder outlet obstruction malignancy

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Abstract

The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the normal regression procedure, the urachus remains as the median umbilical ligament.
Urachal remnants are present in 1.03% of paediatric patients while in 92.5% of cases represent incidental findings. Urachal anomalies are classified in four types as patent urachus (50–52%), urachal sinus (15%), urachal cyst (30%) and urachal diverticulum (3–5%). Ultrasound scan is the most commonly performed diagnostic imaging study.
In case of symptomatic urachal remnants, surgical excision is indicated. Asymptomatic urachal remnants that are diagnosed at the neonatal period or early infancy should be watched up to 6 months of age, as they are likely to resolve. In persistent or symptomatic urachal remnants there is a risk of inflammation or even malignancy development, therefore we believe that there is indication for preventive surgical excision that may be performed either open or laparoscopically or by robot-assisted laparoscopy.

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Authors and Affiliations

Ioanna Gkalonaki

1

e-mail:

ORCID:

Ioannis Patoulias

1

Michail Anastasakis

1

Christina Panteli

1

Dimitrios Patoulias

2

First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece
First Department of Internal Medicine, General Hospital “Hippokration”, Thessaloniki, Greece

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Inguinal hernia management in preterm infants: addressing current issues of interest

Abstract

Bibliography

Authors and Affiliations

Pathogenesis and prognosis of intrarenal reflux

Abstract

Authors and Affiliations

Hutch diverticulum: from embryology to clinical practice

Abstract

Authors and Affiliations

The challenging diagnosis of acute scrotum: remaining difficulties and further insights

Abstract

Authors and Affiliations

Symptomatic Intraparenchymal Epididymal Cysts: Description of 11 cases

Abstract

Authors and Affiliations

Urachal remnants: from embryology to clinical practice

Abstract

Authors and Affiliations