Date of birth: Aug 27 1950. Italian nationality. Baccalaureate Classic.
1976- Degree in Medicine and Surgery - M.D. (Univ. of Florence) 1977- Internship hospital (for titles) in General Surgery at Surgical Clinic (B) (Univ. of Florence) 1978- Internship hospital (for titles) in Pediatric Surgery at Anna Meyer'Children Teaching Hospital (Florence)
1979- Degree of Specialization in Urology (Univ. of Florence) 1980- Degree of Specialization in Medical Sexology (Univ. of Florence) 1984- Degree of Specialization in Pediatrics (Univ. of Florence) 1994- Degree of Specialization in Andrology (Univ. of Pisa) 2004- Degree of Master in Plastic and Aesthetic Surgery (Univ. of Padua)
From 1980- Professional Member of Technical Advisor's Board of Civil and Criminal Court of Florence.
1980-2005 - Pediatric Surgeon at Anna Meyer'Children Teaching Hospital in Florence (General,abdominal and urologic surgery, Surgical Emergency Room). 1998-2002 - Collaboration at same Hospital as Pediatric Neurosurgeon (Neurotraumatology,Neuroendoscopy) From 1995- Consultant sexologist (MD) at A.T.I.S.B. (Ass.Toscana Idrocefalo e Spina Bifida) From 2005- Nutritionist at Pediatric Nutritional Team of Tuscany Region at same Hospital and member of "GAIA "( Working Group against Child Abuse) From 2006- ADF(Professional on Teaching and Training) at same Hospital
Abstract: One of the most commonly shared characteristics of children with Down's syndrome is the effect on facial features. The vast majority of children with Down's syndrome have an epicanthal folds, a slanted palpebral fissures and a flattened nasal bridge. Another common feature is a protruding tongue with an open mouth. The surgeries can be categorized into two groups: techniques aimed at reducing the size of the tongue, and surgeries aimed at improving the appearance of the face, called "facial reconstruction". Indications and limits of these categories are discussed separately. Moreover, the tongue reduction presents further anesthesiological problems. Parents should be not pressured into consenting to plastic surgery, and plastic surgery should never be considered a stand-alone therapy. Parents should get all information about the procedures, including risks, performed on their children to best make an informed decision, also in order to avoid unnecessary pain to the children and the adolescents with Down's syndrome.
Abstract: Introduction: Home enteral nutrition (HEN) is the only
possible alternative to staying in hospital for patients with
malnutrition due to several diseases.
Purpose: To ensure at home the same standard of
nutrition than hospitalization
Material & Methods: In pediatric patients HEN is
usually requested by the specialty medical team or by the
general pediatrician. The nutritional team, pediatrician,
home care staff, and hospital specialists collaborate to
give the patient effective treatment. When dealing with
malnourished pediatric patients we must consider both
their metabolic and anabolic needs. In HEN-related risk
management, the nutrition method, device handling,
nutritional products, mechanical and septic complications
must be considered. With ‘‘Taking Charge’’ the child on
HEN and his or her family are provided with training in
feeding-tube management, pumps and nutritional products,
and they are controlled by a team of doctors, nurses
and dieticians (control of nutritional status, treatment of
complications, medications, replacement of devices, evaluation
and correction of the diet, etc.) through outpatient
visits, admission to day hospital and, if necessary, home
visits.
Results: The benefit for the family of the child on HEN
assisted in the manner of ‘‘Taking Charge’’ is to have a
single point of reference for both medical and dietary advice
and for the supply of products and devices.
Conclusions: ‘‘Taking Charge’’ ensures a better quality of
life not only to the patient but also his family.
Abstract: Infection is the most important clinical complication associated with the use of central
venous catheters, both in terms of incidence and gravity. This study aims to assess the incidence
of these infections in children receiving parenteral nutrition in a tertiary children’s hospital
and at home. A prospective cohort survey was carried out in a consecutive series of 671 children
during 8,689 catheter days over a period of 3 years. Only 4 central venous catheter-related infections
occurred in the observation period, with a rate of 0.46 per 1,000 catheter days. In order to
prevent central venous catheter-related infections it is important to follow certain standards both
during positioning of the catheter and in the subsequent assistance to the patient, also at home.
The very low incidence of catheter-related sepsis in our experience was achieved by strict adherence to established protocols of catheter management.
Abstract: Urethral duplication is a rare congenital anomaly, resulting from a wide range of malformations of the urogenital sinus. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. The duplication is defined as epispadic in the first case, and hypospadic in the second. In the medical literature approximately 150 cases have been reported. Relatively more frequent among males, it is often associated with other malformations of the urogenital tract or other organs. The authors present a case of a 4 year old child with a complete epispadic duplication, that is, two external meatus, one of which the dorsal aspect of the glans, and the other orthotopic. Clinically, duplication and weakening of the stream, urinary incontinence and UTI were present. US examination documented the normality of the upper urinary tract and of the bladder. Retrograde urethrocystography showed a completely permeable urethral duplication, with two external meatus. The excision of the accessory urethra was carried out together with the reconstruction of the hypospadic meatus with an "overlap anastomosis". The post-operatory period was uneventful, and one year after surgery the patient is asymptomatic, with normal uroflowmetric readings and echographically documented complete bladder emptying. In the opinion of the authors, the treatment is indicated in symptomatic forms and the surgical options varies, depending on the type and grade of malformation, its clinical manifestations and the presence of associated anomalies. Antibiotic treatment is not effective and other treatments, such as diathermocoagulation or the injection of caustic substances into the accessory duct have been abandoned.
Abstract: BACKGROUND: The authors present their personal experience of 3715 cases of head injury in pediatric patients, occurring during the last three years (1997-1999), admitted to the Emergency ward at the "Anna Meyer" children's hospital in Florence. METHODS: A prospective study was made, starting from the evaluation made by the paediatric surgeon and following the subsequent diagnostic and clinical course. Depending on the severity of injury, this took the form of immediate discharge with a written sheet of instructions, "short observation" (up to 12 hours) in an Emergency ward and/or admission to neurosurgery or general medicine or to intensive care. The authors also analyse the diagnostic and instrumental tests carried out at the various stages (cranial X-ray, direct cranial CT, EEG) and the specialist consultations required (neurosurgery, neurology, paediatrics, resuscitation). Data for injured children transferred from other hospitals for neurosurgery were excluded from the study which only included patients examined primarily at our hospital. If admitted for more than 48 hours, a neurosurgical outpatient check-up was programmed one week later. In more severe cases, patients were admitted to day hospital between six months and one year later. RESULTS: Injuries were minor in 91% of cases and the age of patients ranged between 5 days and 14 years; moreover, 60% of the patients observed were male. Only 1.5% of cases seen in Emergency were admitted to hospital and 8.4% of all head injuries, with a total stay of between 1 and 6 days. There were 4 deaths in severely polytraumatised patients. There was only one case of firearm injury which was not fatal. Head X-rays were performed in 13.4% of patients showing evidence of fracture in 19.1% of cases. Direct cranial CT was performed in 10.2% of cases with pathological findings in 23.9% of cases. Neurosurgery was performed in one of the 5.9% patients admitted to hospital. The late sequelae to head injury included one case of epilepsy that occurred 7 months after injury. CONCLUSIONS: Anamnesis showed that the most frequent reason leading to head injury was lack of adult supervision and that the majority of severe injuries were caused by road accidents, both as pedestrians and as passengers. Lastly, the authors emphasise the importance of recognising and correctly treating so-called secondary cerebral damage, which has a non-immediate onset but is potentially severe, and identifying the risk factors for head injury in order to reduce the incidence and severity.
Abstract: Sertoli cell tumour is an uncommon neoplasm, either in the adult and in the pediatric age groups. An intrascrotal, slowly growing, painless swelling generally represents its clinical onset. Orchiectomy definitively is successful in these patients, since Sertoli cell tumour very rarely metastatise elsewhere. The case of a two-month old baby in which an acute intrascrotal involvement (requiring immediate surgical therapy), was the atypical onset of a testicular Sertoli cell tumour, is described. The hystogenesis as well as the clinical and pathological peculiarities of this neoplasm in pediatric patients are discussed.
Abstract: The authors present their experience of 92 cases of anomalies of the penis, hypospadias excepted, occurring in children between 12 months and 10 years old, during the last 5 years, in their Pediatric Surgical Department. In the literature, there are reported only many single cases of these anomalies, for the most part associated in serious multiple malformations, or with hypospadias. The children included in this report present the anomalies of the penis as a sole malformations. The classification of these anomalies was made by embryological criteria and by the frequency of occurrence. In 41 cases there was congenital curvature of the penis, in 9 cases there was a webbed penis, in 6 cases a concealed penis. Torsion of the penis occurred in 6 cases (in 5 anticlockwise) the microphallus in 5 cases. The "hypospadias without hypospadias" occurred in 5 cases, in the others there was an association among these anomalies. The authors emphasize the importance of these malformations for the children and their families, also in order to prevent, also serious, psychological effects.
Abstract: The Authors present 362 cases of hypospadias, during 10 years, considering genetical aspects of the malformation. The mean frequency rate of hypospadias is 0.32%. In 60 of the examined patients (17.1%) there was another subject with hypospadias and in 12 cases (4.3%) there was a third subject with the malformation. In 32 cases (9.1%) the relationship was between brothers and in 15 cases (4.2%) the fathers were concerned. Thus, each group had a clean increasing risk in comparison with the mean frequency rate. From the analysis of the results appears a not mendelian inheritance and not even sex linked or single locus linked, in the transmission of the characters. The Authors emphasize the role of some hereditary predisposition in concomitance of environmental conditions, to date not well known. The hypospadias, thus, to fit in the "mid-line pathology", a recent chapter of genetics, characterized by a lack of coalescence, just in the mid-line of embryonal development, during organogenesis.
Abstract: The Authors report their experience about two cases of xanthogranulomatous pyelonephritis in childhood. The clinical history, diagnostic procedures and surgical treatment are described. The xanthogranulomatous pyelonephritis is a rare form of chronic inflammatory disease of the kidney, in which pre-operative differential diagnosis with renal cancer or with extra renal neoplastic and inflammatory diseases is very difficult. The signs and symptoms are not characteristic, such as renal tumour, recurrent UTI, abdominal pain, fever. Also non characteristic are the findings, performed with diagnostic ultra sound and computed tomography. The surgical treatment is always effective in the xanthogranulomatous pyelonephritis. About 500 cases are described in adults and about 80 cases in children, from the first description in 1963. The first of our cases, occurring in a boy 6 years old, was treated with nephrectomy, because of the pre-operatory aspect was like tumour. In the second of the cases described, occurring in a girl 11 years old, the nephrectomy was performed because the chronic purulent inflammatory process had involved all the kidney. In the post-operative, in the first case was performed a relaparotomy for intestinal occlusion in 12th day, in the second case the post-operative was uneventful. The Authors emphasize the importance of the xanthogranulomatous pyelonephritis in the differential diagnosis in children with recurrent UTI, renal masses, fever, in the clinical history.
Abstract: The Authors present their experience about 457 consecutive cases of acute scrotum, occurring from 1980 to 1990, at their Pediatric Surgery Unit. The condition is caused by torsion of the appendage of the testis (78.1%), torsion of the funicle (9.6%), acute idiopathic oedema of the scrotum (2.87%), and also tumours (1.17%). Also in their experience, the surgical approach is the correct treatment for the acute scrotum in order to prevent the irreversible damage of the testis. The surgical treatment present no problem and all the post-operatives were uneventful. In children under 2 years, the interventions were performed by inguinal incision, above 2 years by scrotal incision. The contralateral orchiopexy, in case of torsion of the funicle, was performed in the same session, or performed later, because of the anesthetic consideration.
Abstract: We compared in vitro heparin binding activity and in vivo intravascular clearance and aortic uptake in rabbits of native, reductively methylated and heparin-complexed low density lipoprotein (LDL) in order to explore the extracellular matrix binding vs cellular metabolism of LDL. Reductively methylated LDL formed soluble and insoluble complexes with heparin which was comparable to native LDL. Reductive methylation of LDL produced only 30% reduction in aortic uptake vs 60% reduction in plasma clearance, reflecting the relatively smaller contribution of receptor-mediated pathway in aortic tissue vs whole animal. The intravascular clearance of native and heparin-complexed LDL remained essentially the same, indicating similarities in cellular metabolism of LDL in both cases. But the aortic uptake of the heparin bound LDL was 30% less than the native LDL, suggesting an inhibition in binding of heparin-complexed LDL to tissue proteoglycans. Saline extraction accounted for only part (53-66%) of the LDL preparations that were retained by the tissue while subsequent collagenase and elastase treatments extracted 3-5% and 17-22% of the materials respectively. These results favor the contribution of arterial extracellular matrix components to the retention of LDL.
Abstract: Dynamics of lipoprotein-glycosaminoglycan interactions in aortas were studied in vivo using the atherosclerotic rabbit model. Severe hypercholesterolemia and atherosclerosis were produced by relatively long-term feeding of a high cholesterol diet. [35S]Sulfate uptake by aorta was measured to assess the sulfated glycosaminoglycan metabolism while the plasma and aorta distribution of 125I-labeled LDL after intravascular injection was determined to monitor aortic LDL uptake and complex formation with glycosaminoglycans. The retention and distribution of LDL as lipoprotein-glycosaminoglycan complexes in different extracellular connective tissue elements were evaluated by extracting the tissues with saline, collagenase and elastase. Hypercholesterolemia with atherosclerosis resulted in a several-fold increase in the uptake of LDL by aorta despite a marked reduction of 125I-labeled LDL in the plasma compartment and in a significant increase in glycosaminoglycan content of aorta coupled with an increased 35S incorporation into glycosaminoglycans. Elastase-solubilized fractions from normal aortas and collagenase-solubilized fractions from atherosclerotic aortas contained maximum labeled and nonlabeled glycosaminoglycan, suggesting alterations in the make-up of fibrous structures of connective tissue matrix in atherosclerosis. Saline extraction and collagenase and elastase digestions solubilized varied proportions of lipoprotein-cholesterol and 125I-labeled LDL, thereby representing different pools of extracellular matrixbound lipoproteins. A tendency for 125I-labeled LDL to increase in collagenase- and elastase-solubilized fractions with time (4 h vs. 24 h) was noted. The occurrence of both lipoproteins and glycosaminoglycan (labeled and nonlabeled) in the ultracentrifugal floating fraction at solvent density 1.063 g/ml demonstrated that the lipoproteins solubilized by different extraction procedures occur in part as lipoprotein-glycosaminoglycan complexes. The specific activities of glycosaminoglycan in the complexes obtained by different extraction procedures differed markedly (elastase greater than collagenase greater than saline), emphasizing the presence of different pools of complexes. Thus, besides arterial cell-mediated processes, extracellular matrix components are important in affecting the retention and accumulation of LDL in atherosclerosis.
Abstract: Infection is the most important clinical complication associated with the use of CVC, both in terms of incidence and gravity. This prospective and cohort study, aims to assess the incidence of these infections in children admitted in a tertiary children hospital and on home parenteral nutrition, during last three years. In a consecutive pediatric series of 672 cases, during 8793 catheter/days ,we observed only 4 CVC related infections, with a rate of 0,44 per 1000 catheter/days. No consensus exists on the best methods for diagnosis of CVC related infections, but methods studied show acceptable sensitivity and specificity, in clinical practice.In order to prevent the CVC related infections it’s important to follow some behavioural norms,both during the positioning of the catheters and in the subsequent assistance to the patient, also on home.According to the international guidelines and author’s experience, major points of emphasis, include 1) using maximal sterile barrier precautions during central venous catheters introduction, 2)admixing all parenteral fluids in the pharmacy 3) educating and training health –care providers who insert and maintain catheters.This very low incidence of catheter-related sepsis was achieved, in our experience,by strict adherence to established protocols of catheter management.
Abstract: Child abuse involve Female Genital Mutilations,and in Europe, and in particular in Italy, this phenomenon is of recent and hidden evidence,connected to the increase of the migratory flows.
In 1998, the American Academy of Pediatrics, recommended thats its members decline to perform any medically unnecessary procedure that alters the genitalia of female infants,girls,and adolescents, and in the 2004 ,Health Service of Tuscany has launched a project directed to a first appraisal of a worrisome and unknown phenomenon,in the submergeed world of the child abuse.
Abstract: Nel territorio fiorentino i delitti contro la persona sono intorno a 50-80 ogni 1000 abitanti e i casi di abuso su minori variano stabilmente fra 20 e 35 ogni anno, da circa 20 anni. I casi segnalati dal Pronto Soccorso Pediatrico dell'Ospedale Meyer, sempre in riferimento alla cosiddetta area
degli abusi,cioè segnalazioni di reati contro minori e contro la famiglia, sono variabili fra 19 e 35 l'anno, da ormai venti anni.La quota femminile rappresenta stabilmente la maggioranza del totale fra le vittime di abusi, dal 68% all'84% nel 2003.(dati ISTAT su statistiche giudiziarie penali,e dati Questura di Firenze).
Abstract: The Shaken Baby Syndrome, or more correctly Non -accidental Brain Injury , is a form of child abuse, perpetrated by an adult'power and it is the use of physical force on a vulnerable child, is a worlwide phenomenon.
Some children are presented as having been injuried but there is no explanation for how it happened and probably no witnesses. Many prevention campaignes, usually based on explaining what happens to a baby, have been evaluated.
Ther is probably a hidden group of children who are shaken but their injuries never assessed.
" The basis of prevention , investigation or medical knowledge of these tragic cases lies in a many people working together" (Wheeler, 2003 Child Abuse Review).
Abstract: One of the most commonly shared characteristic of children with Down' syndrome is the effect on facial features. The vast majority of children with Down'syndrome have an epicanthal folds, a slanted palpebral fissures and a flattened nasal bridge. Another common feature is a protruding tongue with an open mouth. The surgeries can be categorized into two groups: techniques aimed at reducing the size of the tongue, and surgeries aimed at improving the appareance of the face, called "facial reconstruction".
Indications and limits of these categories are discuss separately.
