The authors report their experience with one-trocar transumbilical laparoscopic assisted appendectomy (TULAA). From January 1998 to June 2000, 150 patients underwent appendectomy using this technique. Ages ranged from 2.5 to 17.4 years. The procedure was completed using only one trocar in 116 cases (77.3%); in 28 patients (18.7%) one or two additional cannulas were needed. Conversion to open surgery became necessary in 6 cases (4%). Mean operative time was 35 minutes, mean hospital stay 3.5 days. There were no major complications and no mortality in this series. The advantages of a one-trocar appendectomy compared with open surgery are the same as those reported for conventional laparoscopic appendectomy: i.e., excellent exploration of the abdominal cavity, the possibility of discovering extra-appendiceal lesions, easy and rapid localization of the appendix and a shorter hospital stay. The additional advantages of TULAA compared with conventional laparoscopic appendectomy are a low rate of intraoperative incidents, minimal scarring, less postoperative pain and a more rapid return to unrestricted activities.

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A short course of intracavitary treatment with thiotepa is highly effective and well tolerated in the treatment of malignant pericardial effusion.

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Cystic neuroblastoma (CN) is highly unusual; since 2005 only 55 cases have been reported in the medical literature. The authors report a case of pelvic (presacral) CN in a 2-month-old boy. Computed tomography scan confirmed a cystic, septated, and encapsulated mass. Complete tumor excision was achieved. Histopathology diagnosed a stroma-poor and undifferentiated neuroblastoma with multiple calcifications. meta-iodobenzylguanidine scan, radionuclide bone, and a bone marrow aspiration were normal. N-myc amplification was absent. The infant was classified stage I neuroblastoma and received no further therapy (4 y of follow-up). To the authors' knowledge, this is the first report of a CN in a pelvic-presacral location.