Single-port laparoscopic ovarian transposition in an 11-year-old girl

Ovarian transposition was the first procedure proposed for children with cancer to preserve ovarian function from damage caused by abdominal and pelvic radiotherapy. In this paper, we describe the first paediatric case of single-port laparoscopic ovarian transposition.

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Enterobius vermicularis: A Cause of Abdominal Pain Mimicking Acute Appendicitis in Children. A Retrospective Cohort Study

BACKGROUND

Enterobius vermicularis (EV) is the most common helminthic infection in the world. This small parasite is predominant in the pediatric population. The presence of EV in the appendix can cause or mimick appendicitis. The aim of our study was to compare patients with EV infection and those without EV infection, and to identify predictive factors that may help the diagnosis of EV infection in patients presenting with right iliac fossa pain and avoid negative appendectomy.

METHODS

A retrospective analysis of all the appendices removed between January 2012 and December 2016 was conducted at the department of pediatric surgery, Hedi Chaker Hospital, Sfax, Tunisia. According to the final histopathological diagnosis, patients with EV infection were compared to those without EV infection. Data including age, sex, white blood cell (WBC) count, neutrophil count, eosinophil count, C-reactive protein, and ultrasound results for both groups were analyzed and compared. The study protocol was approved by the local hospital ethics committee. Statistical analysis was performed using IBM SPSS, version 20. Descriptive analysis in the form of mean and standard deviation was performed on demographic information. Differences between groups were assessed using the student t-test for continuous variables and the χ2 test and Fisher exact test where appropriate for categorical variables.

RESULTS

In total, 540 pediatric appendectomies were performed. Overall, 63.5% of patients were male and 36.5% were female. Mean age was 9.28 ± 2.77 years. 22.2% of procedures were completed laparoscopically, 76.5% were open and 1.3% were converted. The negative appendectomy rate was 11.1%. EV was present in 9.8% of cases. Comparison of clinical, biological, and ultrasound findings between two groups of patients with EV (EV+) and those without EV (EV-) shows a statistical significance for pruritus ani (P < 0.001), WBC count (P < 0.001), neutrophil count (P < 0.001), C-reactive protein (CRP) (P = 0.001), positive ultrasound (P < 0.001), perforation rate (P = 0.009), and negative appendectomy rate (P < 0.001). No significant difference between the two groups was seen when comparing gender (P = 0.271), vomiting (P = 0.130), eosinophil count (P = 0.915), and procedure (P = 0.536).

CONCLUSION

EV was seen in 9.8% of pediatric appendectomies in our study. Pruritus ani, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain.

Bilateral Testicular Torsion in a Neonate

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Laparo-Endoscopic Single-Site (LESS) Cutaneous Ureterostomy in a Neonate

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Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases

Introduction Hydroxychloroquine is an antimalarial agent widely prescribed in internal medicine, rheumatology and dermatology. Its use can be complicated by various side effects including skin pigmentation. Objectives The aim of the study is to review epidemiological, clinical features and risk factors of hydroxychloroquine-induced pigmentation. Materials and methods We performed a cross-sectional study conducted over a period of 5 months. During this period, patients who had been treated with hydroxychloroquine for over 6 months, in the internal medicine department, underwent a complete dermatological examination. All patients completed a structured questionnaire to collect demographic data, dosage and treatment duration of hydroxychloroquine, other drug intake, hydroxychloroquine indication, and presence of pigmentary changes on the skin, nail, hair, and mucosa. Results A total of 41 patients (38 women and 3 men) were included in the study. The mean age was 39.2 ± 15.4 years. The hydroxychloroquine was indicated for systemic lupus erythematosus in 73.2%, dermatomyositis in 12.2%, rheumatoid arthritis in 9.8%, actinic lichen and sarcoidosis each in 2.4%. Cutaneous pigmented lesions were found in 21 cases (51%), mucous pigmentation in 5 cases (12%) and nail pigmentation in 1 case (2.5%). In 12 of 41 (29%) of the hydroxychloroquine users, we conclude a hydroxychloroquine-induced pigmentation. There were 11 women and one man with a mean age of 43 years and all of them were systemic lupus erythematosus patients. Pigmented lesions were located on the lower limbs in seven cases, the face in two cases, lips in two cases and the gum in two cases. Pigmentation appeared after a median duration of hydroxychloroquine treatment of 32 months with a median cumulative dose of 361 g. Overall, two patients reported that the appearance of pigmented lesions was preceded by the occurrence of ecchymotic areas following microtrauma. Significant association was found between hydroxychloroquine-induced pigmentation and treatment with oral anticoagulants and/or antiplatelet agents ( p = 0.03). Conclusion Our systematic examination of patients demonstrated that hydroxychloroquine-induced pigmentation is not rare. The imputability of hydroxychloroquine in the genesis of this discoloration is difficult to establish. Our study supports the hypothesis that ecchymosis, platelet antiaggregants and oral anticoagulants may be the main predisposing factors to hydroxychloroquine-induced pigmentation.

Hybrid laparoendoscopic single-site (LESS) pyeloplasty: Initial experience in children

BACKGROUND AND OBJECTIVE

Mini-invasive surgery is still evolving to get better surgical conditions for patients with ureteropelvic junction obstruction. We used technical modifications (hybrid pyeloplasty) that simplify surgical steps of laparoendoscopic single-site pyeloplasty in children. Our aim was to compare hybrid pyeloplasty to laparoendoscopic single-site pyeloplasty and to open pyeloplasty.

PATIENTS AND METHODS

We retrospectively reviewed records of patients with ureteropelvic junction obstruction aged<14years undergoing pyeloplasty at our institute from January 2011 to December 2015. Demographic data, laterality, operative time, length of hospital stay, drainage tubes, and postoperative complications were recorded. Surgical outcomes were evaluated based on renal sonography and Lasix diuretic renography.

RESULTS

Among 38 patients, 17 underwent open pyeloplasty (group I), 10 had laparoendoscopic single-site pyeloplasty (group II) and 11 had hybrid pyeloplasty (group III). The mean age at the time of operation was 55 months. The operative time in group III was significantly shorter than that in group I and group II (P<0.001). The shortest median hospital stay was noted in the group III. The mean follow-up period was 26 months (range: 6-52 months).

CONCLUSION

The hybrid pyeloplasty using LESS combine the successful outcomes of open surgery and advantages of minimally invasive surgery. It offers small incision surgery, good working space, short operation time, secure anastomosis and good cosmetic results.

LEVEL OF EVIDENCE

5.