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Kudela G, Kowalczyk K, Drosdzol-Cop A, Wiernik A, Olczak Z, Górska M, Machnikowska-Sokołowska M, Koszutski T. Laparoscopic uterine preservation and vaginal reconstruction in a 13-year-old girl with uterus didelphys, bilateral vesicovaginal fistulas and transverse vaginal septum. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00183-9. [PMID: 38401801 DOI: 10.1016/j.jpag.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Karolina Kowalczyk
- Department of Endocrinological Gynecology, Medical University of Silesia, Katowice, Poland.
| | - Agnieszka Drosdzol-Cop
- Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Wiernik
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Olczak
- Department of Diagnostic Imaging, Medical University of Silesia, Katowice, Poland
| | - Magdalena Górska
- Student Society at the Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | | | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
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Koszutski T, Mielańczyk Ł, Kucharska G, Matysiak N, Wiernik A, Kudela G, Hyla-Klekot L. Presence of tubuloreticular inclusions in ultrastructural studies of renal biopsies in children with lupus nephropathy - one-center preliminary study. Cent Eur J Immunol 2023; 48:26-34. [PMID: 37206592 PMCID: PMC10189577 DOI: 10.5114/ceji.2023.125237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/09/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Juvenile systemic lupus erythematosus (jSLE) is an autoimmune disease that develops as a result of multi-level immune dysregulation, including the interferon pathway. Nephropathy develops at an early stage and eventually affects 90% of patients. A renal biopsy allows one to classify lupus nephritis and determine the proper treatment. Biopsy assessment should be done not only in a light microscope but also in a transmission electron microscope (TEM). Its usage may reveal the presence of intracellular tubuloreticular inclusions (TRIs), considered as a morphological marker of interferon hyperactivity. Material and methods Renal biopsies of 10 children with jSLE and nephropathy were analyzed in TEM. The location, structure, and size of TRIs were assessed. Demographic data, nephropathy manifestation, non-renal symptoms, and serological activity of lupus were analyzed. Results All the patients were female with an average onset at 12.7 years of age and met SLE criteria. Nephropathy manifested with proteinuria (n = 10) and hematuria (n = 6). Glomerular filtration rate (GFR) was normal in all patients. In three children with early disease onset, it manifested with hematological disorders. TRIs were revealed in 7 biopsies, with the highest expression in the youngest children, with peripheral cytopenia, membranous glomerulonephritis, and lupus nephritis. Conclusions Demonstration of TRIs in renal biopsies of children with juvenile systemic lupus may confirm the diagnosis of lupus nephritis and is a sign of involvement of the interferon pathway at the early stage of the disease.
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Affiliation(s)
- Tomasz Koszutski
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Łukasz Mielańczyk
- Department of Histology and Cell Pathology, FMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Grażyna Kucharska
- Department of Pediatric Nephrology, Team of Municipal Hospitals in Chorzów, Poland
| | - Natalia Matysiak
- Department of Histology and Cell Pathology, FMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Wiernik
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Lidia Hyla-Klekot
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
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Drosdzol-Cop A, Mizia-Malarz A, Kudela G, Skowronek K, Wilk K, Stojko R. Uterine corpus rhabdomyosarcoma in 13-year-old girl. Ginekol Pol 2022:VM/OJS/J/89013. [PMID: 35419801 DOI: 10.5603/gp.a2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Embryonal rhabdomyosarcoma (RMS) is the most common malignant tumor of the genitourinary system in children. The most common symptoms in girls include vaginal bleeding, abdominal pain, urinary and/or stool incontinence and hematuria. Treatment includes primary resection of the tumor and adjuvant therapy or neoadjuvant chemotherapy, resection of the tumor and adjuvant therapy.
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Affiliation(s)
- Agnieszka Drosdzol-Cop
- Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia in Katowice, Poland
| | - Agnieszka Mizia-Malarz
- Department of Pediatrics, Upper Silesia Children's Care Health Centre, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kudela
- Chair and Department of Pediatric Surgery and Urology, Upper Silesia Children's Care Health Centre, Medical University of Silesia, Katowice, Poland
| | - Kaja Skowronek
- Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia in Katowice, Poland.
| | - Krzysztof Wilk
- Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia in Katowice, Poland
| | - Rafal Stojko
- Chair and Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia in Katowice, Poland
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Skoczyński S, Kudela G, Brożek G, Lawson J, Tobor S, Skoczyńska A, Swinarew A, Trejnowska E, Winnicki IR, Repetowska K, Paluch J, Barczyk A, Koszutski T. Pulmonary function, exercise capacity and dyspnea in patients 7 years after Nuss surgery. Adv Med Sci 2022; 67:179-186. [PMID: 35306355 DOI: 10.1016/j.advms.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Pectus excavatum is a frequent thoracic malformation increasingly treated with minimally invasive methods (MIRPE), which are performed for cardio-respiratory problems and in some centers also for esthetic considerations. Theoretically, MIRPE may increase thoracic elastic recoil, work of breathing and cause emphysema. The aim of the present study was to determine whether teenagers who underwent MIRPE may expect normal thoracic cage development, cardio-respiratory function, exercise capacity and asymptomatic functioning. MATERIAL AND METHODS Fifty five patients (21.1 ± 3.0 years) who underwent MIRPE between 2000 and 2010 were assessed 6.8 (±2.4) years after surgery. Controls were matched for sex, age and height to the intervention participants. Spirometry, body plethysmography, diffusion capacity and the 6 min walking test (6MWT) were performed. Anteroposterior (AP) and transverse chest diameters were measured. RESULTS Participants who underwent MIRPE had normal pulmonary function, and exercise capacity. After adjustment for potential confounders, the intervention group had lower mean BMI [-1.88 ± 0.56 (kg/m2); p = 0.001] and chest AP diameter [-2.79 ± 0.57 (cm); p < 0.001], but higher residual volume (RV%) [12.98 ± 5.31 (%); p = 0.001], RV% total lung capacity (TLC) [5.56 ± 0.92 (%); p < 0.001], forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) [2.64 ± 1.28 (%); p = 0.039] and 6MWT distance [29.10 ± 13.02 (m); p = 0.025]. CONCLUSIONS Young adults who undergo MIRPE may expect normal pulmonary function and exercise capacity. Observed differences in air trapping require further assessment in terms of emphysema development risk.
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Kudela G, Wiernik A, Drosdzol-Cop A, Machnikowska-Sokołowska M, Gawlik A, Hyla-Klekot L, Gruszczyńska K, Koszutski T. Multiple variants of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome - one clinical center case series and the systematic review of 734 cases. J Pediatr Urol 2021; 17:653.e1-653.e9. [PMID: 34274235 DOI: 10.1016/j.jpurol.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/10/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare female urogenital tract malformation. STUDY OBJECTIVE To present 10 patients with OHVIRA treated at the clinical center. To perform a systematic review of OHVIRA case series related to the prevalence of anatomical variants, surgical interventions and endometriosis, and to compare them with our case series. MATERIALS AND METHODS Medical records from 10 OHVIRA patients treated between 2016 and 2020 were retrospectively reviewed. For the systematic review, PubMed and Web of Science were used to search for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed. RESULTS The most common anatomical variant includes left obstructed hemivagina (50.7%) with isolated hematocolpos or hydrocolpos (55.9%), uterus didelphys (82.9%), and ipsilateral renal agenesis (92.2%). Vaginal septectomy was the most common surgical approach (86.5%). Hemivaginectomy (2.2%), hemihysterectomy (4.2%), or total hysterectomy (0.7%) were also performed in several patients. Some subjects required salpingectomy (3.3%) or oophorectomy (1.8%). 7.5% of patients, mainly infants, did not require surgery due to the spontaneous resolution of hydrocolpos. Endometriosis was fortuitously found in 13.6% of the selected cases who underwent laparoscopy or laparotomy. DISCUSSION The most common variant of OHVIRA includes isolated hematocolpos and a thick vaginal septum between adjacent hemivaginas. Endometriosis was present in approximately 14% of OHVIRA patients, but this number is probably underestimated. Routine laparoscopy is not required. However, all patients need further monitoring due to a higher risk of endometriosis. Based on the analyzed studies and our case series, vaginal septectomy is a sufficient surgical technique to relieve symptoms and prevent possible complications in most OHVIRA patients.
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Affiliation(s)
- Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland.
| | - Agnieszka Wiernik
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Drosdzol-Cop
- Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Lidia Hyla-Klekot
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | | | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
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Koszutski T, Smyczek Krakowczyk D, Pastuszka A, Tobor S, Kudela G, Hyla-Klekot L. 28 years of functioning of the ileal ureter - own experience and systematic review. J Pediatr Urol 2021; 17:692-699. [PMID: 34162519 DOI: 10.1016/j.jpurol.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
A SHORT INTRODUCTION Irreversible ureteral damage is a rare and challenging problem for pediatric urologists. Ileal replacement has become one of the limited surgical options for ureteral reconstruction. Only a few papers have examined the results of the ileal ureter and renal function outcomes. Furthermore, there are even fewer papers showing patients with the intestinal ureter, which is used to drain urine from a solitary kidney in early childhood. AN OBJECTIVE To perform a systematic review and analyze available cases of the long-term function of the "neoureter" and differences in the surgical approach. To present the case of a 29-year-old female with a history of ileal replacement of the ureter in a solitary kidney which was performed in this patient at the age of 14 months. STUDY DESIGN PubMed and Scopus were used to search for eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed. Based on the titles, abstracts, and full-text reviews, 77 articles were analyzed, of which only 23 were directly related to pediatric cases of our interest. Medical records of the female patient, who has been treated in our center since 1991, were retrospectively described and reviewed. RESULTS Of 23 papers, we identified 75 cases of children who underwent ureteral substitution. The outcomes of the procedure are satisfactory and acceptable. The presented case of the female patient shows a good therapeutic option. CONCLUSION Ileal ureteral reconstruction is a safe and effective therapeutic option (even in a long-term follow-up). Despite many problems and complications, it allows preservation of renal and bladder function and social dryness.
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Affiliation(s)
- T Koszutski
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - D Smyczek Krakowczyk
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland.
| | - A Pastuszka
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - Sz Tobor
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - G Kudela
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
| | - L Hyla-Klekot
- Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, Pediatric Surgery and Urological Department, Katowice, Poland
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Matusik P, Gach A, Zajdel-Cwynar O, Pinkier I, Kudela G, Gawlik A. A Novel Intronic Splice-Site Mutation of the CYP11A1 Gene Linked to Adrenal Insufficiency with 46,XY Disorder of Sex Development. Int J Environ Res Public Health 2021; 18:ijerph18137186. [PMID: 34281122 PMCID: PMC8295740 DOI: 10.3390/ijerph18137186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022]
Abstract
A novel CYP11A1: c.1236 + 5G > A was identified, expanding the mutation spectrum of the congenital adrenal insufficiency with 46,XY sex reversal. In a now 17-year-old girl delivered full-term (G2P2, parents unrelated), adrenal failure was diagnosed in the first year of life based on clinical picture of acute adrenal crisis with vomiting, dehydration, weight loss, hypotension, and electrolyte disturbances. At the time, hormonal tests revealed primary adrenocortical insufficiency and steroid profiles showed lack of products of steroidogenesis, and since then the patient has been treated with substitution doses of hydrocortisone and fludrocortisone. At the age of 14, considering the absence of puberty symptoms, extended diagnostic tests revealed elevated LH levels (26.5 mIU/mL) with pre-puberty FSH levels (4.9 mIU/mL), low estradiol (28 pmol/L), testosterone (<2.5 ng/mL), and extremely high levels of ACTH (4961 pg/mL). A cytogenetic study revealed a 46 XY karyotype. A molecular examination confirmed the missense mutation and a novel splice-site mutation of CYP11A1 gene. Compound heterozygosity for the CYP11A1 gene with a known pathogenic variant in one allele and a novel splice site mutation in the second allele is most probably responsible for congenital adrenal insufficiency with 46,XY sex reversal. We discuss the necessity of cytogenetic test in the case of early onset of adrenal failure in the absence of steroidogenesis metabolites in the steroid profile.
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Affiliation(s)
- Pawel Matusik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-207-1654
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (A.G.); (I.P.)
| | | | - Iwona Pinkier
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (A.G.); (I.P.)
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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Morawiecka-Pietrzak M, Dąbrowska E, Gliwińska A, Góra A, Geisler G, Gawlik A, Kudela G, Ziora K. A rare case of primary amenorrhoea and breast development in a 46,XY 15-year-old girl. Pediatr Endocrinol Diabetes Metab 2021; 27:62-67. [PMID: 33599439 PMCID: PMC10227485 DOI: 10.5114/pedm.2020.101803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/08/2020] [Indexed: 06/07/2023]
Abstract
A disorder of sex development (DSD) is defined as a congenital condition in which development of chromosomal, gonadal, or anatomical sex is atypical. Swyer syndrome is an example of 46,XY DSD with a female phenotype. It usually becomes apparent in adolescence with delayed puberty and amenorrhoea. Spontaneous breast development is very rare. A 15-year-old girl was presented due to primary amenorrhoea with breast development compatible with Tanner stage V. Hormonal tests revealed hypergonadotropic hypogonadism with low level of oestradiol. Pelvic ultrasound and magnetic resonance imaging revealed a small uterus, and no ovaries were found. In the right lower abdomen, a structure of unknown origin was visible. The chromosome analysis revealed a 46,XY karyotype. The patient was qualified for a laparoscopic bilateral gonadectomy. Postoperative histopathological examination revealed gonadoblastoma. We underline the need to consider DSD 46,XY in the presence of primary amenorrhoea, even when pubertal development is present. Germ cell tumors have a tendency to grow and metastasize rapidly. Delayed diagnosis may increase the risk of malignant transformation and cause a poor diagnosis.
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Affiliation(s)
| | - Ewelina Dąbrowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Gliwińska
- Paediatric Nephrology Ward with Dialysis Division for Children, Public Clinical Hospital No. 1 in Zabrze, Poland
| | - Anna Góra
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Gabriela Geisler
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aneta Gawlik
- Department of Paediatrics and Paediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kudela
- Department of Paediatric Surgery and Urology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Ziora
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Badeński A, Bjanid O, Badeńska M, Chmiela B, Adamczyk P, Kudela G, Moskal G, Szczepańska M. A "mysterious ghost kidney stone" in an 8-year-old boy with a solitary right kidney, obstructive megaureter, and ureterostomy: Answers. Pediatr Nephrol 2021; 36:865-868. [PMID: 32696263 PMCID: PMC7910256 DOI: 10.1007/s00467-020-04709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Andrzej Badeński
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800, Zabrze, Poland.
| | - Omar Bjanid
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Marta Badeńska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Bartosz Chmiela
- Department of Advanced Materials and Technologies, Faculty of Materials Engineering, Silesian University of Technology, ul. Krasińskiego 8, 40-019 Katowice, Poland
| | - Piotr Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, ul. Medyków 16, 40-752 Katowice, Poland
| | - Grzegorz Kudela
- Department of Paediatrics Surgery and Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, ul. Medyków 16, 40-752 Katowice, Poland
| | - Grzegorz Moskal
- Department of Advanced Materials and Technologies, Faculty of Materials Engineering, Silesian University of Technology, ul. Krasińskiego 8, 40-019 Katowice, Poland
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
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Badeński A, Bjanid O, Badeńska M, Chmiela B, Adamczyk P, Kudela G, Moskal G, Szczepańska M. A "mysterious ghost kidney stone" in an 8-year-old boy with a solitary right kidney, obstructive megaureter and ureterostomy: Questions. Pediatr Nephrol 2021; 36:863-864. [PMID: 32696262 PMCID: PMC7910233 DOI: 10.1007/s00467-020-04707-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Andrzej Badeński
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800, Zabrze, Poland.
| | - Omar Bjanid
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Marta Badeńska
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Bartosz Chmiela
- grid.6979.10000 0001 2335 3149Department of Advanced Materials and Technologies, Faculty of Materials Engineering, Silesian University of Technology, ul. Krasińskiego 8, 40-019 Katowice, Poland
| | - Piotr Adamczyk
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, ul. Medyków 16, 40-752 Katowice, Poland
| | - Grzegorz Kudela
- grid.411728.90000 0001 2198 0923Department of Paediatrics Surgery and Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, ul. Medyków 16, 40-752 Katowice, Poland
| | - Grzegorz Moskal
- grid.6979.10000 0001 2335 3149Department of Advanced Materials and Technologies, Faculty of Materials Engineering, Silesian University of Technology, ul. Krasińskiego 8, 40-019 Katowice, Poland
| | - Maria Szczepańska
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
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Tobor S, Kudela G, Korecka K, Koszutski T, Hyla-Klekot L. Spontaneous recovery from uncomplicated acute appendicitis. Pediatr Med Rodz 2020. [DOI: 10.15557/pimr.2020.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Historically, acute appendicitis requires surgical treatment. In recent years, there has been an increased interest in treating uncomplicated cases in a conservative way. The development in radiological and laboratory diagnosis has allowed for better possibilities of identification and watchful waiting of simple appendicitis. Objectives: The aim of the study was a retrospective evaluation of the efficacy of conservative treatment of uncomplicated acute appendicitis in children diagnosed based on clinical, laboratory and sonographic signs. Materials and methods: The diagnosis of uncomplicated acute appendicitis was based on the clinical signs, laboratory tests and ultrasound findings. Two clinical criteria, one laboratory criterion and two sonographic criteria, were assumed as a clear diagnosis of appendicitis. the retrospective assessment was conducted among 382 children who were hospitalised for suspected appendicitis. In those we identified a group of 66 children who met the criteria of acute appendicitis. The efficacy of conservative treatment in patients who met the criteria mentioned above was evaluated. Results: Within the period of at least one year, 89.4% of patients (59/66) were not re-hospitalised for recurrent symptoms. Eventually, 92.4% of patients (61/66) included in the study did not require surgical treatment. Conclusion: Uncomplicated acute appendicitis should be initially treated conservatively with watchful waiting. The vast majority of uncomplicated appendicitis cases can resolve spontaneously.
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Gruszka M, Kudela G, Wolny A, Koszutski T, Hyla-Klekot L. Perinatal hospice care in the opinion of nurses and midwives. Ginekol Pol 2020; 90:702-706. [PMID: 31909463 DOI: 10.5603/gp.2019.0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/01/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Perinatal medicine is a relatively new, dynamically developing branch of medicine. Its main purpose is taking care of a woman in the pre-conception period, pregnancy and delivery, as well as taking care of a newborn baby. The main aim of the study was to assess the state of knowledge and opinion on hospice perinatal care of professionally active nurses and midwives. MATERIAL AND METHODS An original and anonymous questionnaire containing 30 questions was used for the study. 572 nurses and midwives from the Silesian Voivodeship took part in the study. The obtained data were analyzed. RESULTS Only 31.6% of respondents defined the level of their knowledge of pregnancy and neonatal care as high. 12.8% of respondents were able to indicate the definition of perinatal care and accurately determine its goals. The women participating in the study were in favor of enclosing the information about not attempting resuscitation (DNAR) in medical record of children with incurable disease diagnosed in fetal life (99.3%). CONCLUSIONS The study showed deficits in practical and theoretical knowledge of nurses and midwives in the area of hospice perinatal care. Lack of proper preparation is also one of the most frequently mentioned difficulties in taking care of a child and family with poor prognosis.
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Affiliation(s)
- Martyna Gruszka
- Department of Pediatric Surgery and Urology; The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, Poland. .,Doctoral studies, School of Health Sciences of the Medical University of Silesia in Katowice, Poland.
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology; The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, Poland
| | - Agnieszka Wolny
- Department of Pediatric Surgery and Urology; The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, Poland
| | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology; The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, Poland
| | - Lidia Hyla-Klekot
- Department of Pediatric Surgery and Urology; The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, Poland
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Kudela G, Gawlik A, Koszutski T. Early Feminizing Genitoplasty in Girls with Congenital Adrenal Hyperplasia (CAH)-Analysis of Unified Surgical Management. Int J Environ Res Public Health 2020; 17:ijerph17113852. [PMID: 32485822 PMCID: PMC7312042 DOI: 10.3390/ijerph17113852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022]
Abstract
AIM To analyze a single-centre experience in feminizing genitoplasty in virilized girls with congenital adrenal hyperplasia (CAH). METHODS Review of medical records of all 46, XX CAH patients undergoing single stage feminizing genitoplasty between 2003 and 2018 was performed. RESULTS A total of 31 girls aged from 4 months to 10 years were included in the study. The majority (n = 26/31, 84%) were operated before 2 years of age (median 8 months). External virilization was rated as Prader 3 (n = 7/31), Prader 4 (n = 21/31) and Prader 5 (n = 3/31). The urethrovaginal confluence location was low in 19 and high in 12 girls with a percentage distribution similar in Prader 4 and 5 (p > 0.05) but significantly different in Prader 3 (p = 0.017). The follow-up ranged from 12 months to 15 years. All parents assessed the cosmetic result as satisfactory. Perioperative complications occurred in two patients and included rectal injury (n = 1/31) and prolonged bleeding (n = 1/31). Three patients developed late complications including labial atheromas (n = 2/31) and vaginal stricture requiring surgical dilatation (n = 1/31). Low confluence did not decrease the risk of complications. CONCLUSIONS Early feminizing genitoplasty in girls with congenital adrenal hyperplasia, irrespective of virilization severity, gives satisfactory cosmetic results and is characterized by low and acceptable surgical risk. Nevertheless, the most important determinant of the effectiveness of such management would be future patients' satisfaction.
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Affiliation(s)
- Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-501 460 285
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology, Medical University of Silesia, 40-752 Katowice, Poland;
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Kudela G, Bialka A, Koszutski T, Drosdzol-Cop A. Use of holmium laser for OHVIRA syndrome treatment. Ginekol Pol 2019; 90:289-290. [PMID: 31111461 DOI: 10.5603/gp.a2019.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Grzegorz Kudela
- Department of Paediatric Surgery and Urology; John Paul II Upper Silesian Child Health Centre, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Bialka
- Department of Pregnancy Pathology, Medical University of Silesia, Katowice, Poland.
| | - Tomasz Koszutski
- Department of Paediatric Surgery and Urology; John Paul II Upper Silesian Child Health Centre, Medical University of Silesia, Katowice, Poland
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Kudela G, Smyczek D, Springer A, Korecka K, Koszutski T. No Appendix is Too Short-Simultaneous Mitrofanoff Catheterizable Vesicostomy and Malone Antegrade Continence Enema (MACE) for Children with Spina Bifida. Urology 2018; 116:205-207. [PMID: 29578043 DOI: 10.1016/j.urology.2018.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present the results of simultaneous creation of both Mitrofanoff stoma and Malone antegrade continence stoma (MACE) using simple division of the appendix and a cecal extension method. MATERIALS AND METHODS Between June 2011 and November 2016, simultaneous Mitrofanoff and MACE was performed in 16 children (12 children-simple division of the appendix, 4 children-appendicovesicostomy and cecal extension of the appendix). Extension of the appendix was achieved by tubularization of the excised cecal flap next to the short appendicular stump. The new extended channel was then wrapped by cecal wall. RESULTS Follow-up was 40 months (10-74 months). Currently, in all children, both stomas are easily catheterizable. Obstruction of MACE occurred in 5 children (4 with split appendix, 1 with extended appendix); Mitrofanoff stomal stenosis occurred in 1 child. Endoscopic revision and prolonged catheterization of stenotic stomas were effective in all cases. Wound infection and dehiscence was noted in 2 children (both with split appendix). Drainage and intravenous antibiotics were effective. All Mitrofanoffs are continent. In 4 children there is incident minor leakage of the MACE (3 with split appendix and in 1 with extended appendix). CONCLUSION The split appendix procedure is feasible. Cecal extension of the appendix seems to be a good option when the appendix is too short for a simple split procedure.
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Affiliation(s)
- Grzegorz Kudela
- Department of Paediatric Surgery and Urology, John Paul II Upper Silesian Child Health Centre, Medical University of Silesia in Katowice, Katowice, Poland.
| | - Dominika Smyczek
- Department of Paediatric Surgery and Urology, John Paul II Upper Silesian Child Health Centre, Medical University of Silesia in Katowice, Katowice, Poland
| | - Alexander Springer
- Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
| | - Klaudia Korecka
- Department of Paediatric Surgery and Urology, John Paul II Upper Silesian Child Health Centre, Medical University of Silesia in Katowice, Katowice, Poland
| | - Tomasz Koszutski
- Department of Paediatric Surgery and Urology, John Paul II Upper Silesian Child Health Centre, Medical University of Silesia in Katowice, Katowice, Poland
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Gawlik AM, Hankus M, Szeliga K, Antosz A, Gawlik T, Soltysik K, Drosdzol-Cop A, Wilk K, Kudela G, Koszutski T, Malecka-Tendera E. Late-Onset Puberty Induction by Transdermal Estrogen in Turner Syndrome Girls-A Longitudinal Study. Front Endocrinol (Lausanne) 2018; 9:23. [PMID: 29472893 PMCID: PMC5810248 DOI: 10.3389/fendo.2018.00023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/18/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Estrogen replacement therapy (ERT) for Turner syndrome (TS) is a widely discussed topic; however, the optimal model of ERT for patients with delayed diagnosis and/or initiation of therapy is still unclear, mainly due to insufficient data. We present the results of a prospective observational single-center study in which the efficacy of late-onset puberty induction by one-regimen transdermal ERT in TS girls was evaluated. METHODS The analysis encompassed 49 TS girls (63.3% with 45,X) with hypergonadotropic hypogonadism in whom unified transdermal ERT protocol was used for puberty induction (first two months 12.5 μg/24 h, thereafter 25.0 μg/24 h until breakthrough bleeding). Clinical visits for examination and therapy modification took place every 3-6 months. Transabdominal pelvic ultrasound examinations were performed at least twice: at the beginning and at the end of follow-up. RESULTS The mean (SD) age at ERT induction was 15.1 (1.3) years. The duration of follow-up was 2.4 (1.1) years. Half of all the patients had at least B2 after 0.57 years, B3 after 1.1 years, B4 after 1.97 years, and menarche after 1.82 years from ERT initiation. With earlier initiation of ERT (≤14 years), B2 (p = 0.059) was achieved faster and B4 (p = 0.018) significantly slower than with the later start of ERT. Thirty-four (94.4%) patients had at least stage B3 at menarche. The karyotype, initial weight, and body mass index had no impact on puberty tempo during ERT. The uterine volume increased significantly during ERT in all the study group (p < 0.0001), and in half of the patients, the increase was at least 12.4-fold. It did not correlate with the duration of treatment (p = 0.84) or the dose of estradiol per kilogram (p = 0.78), nor did it depend on karyotype (p = 0.71) or age at ERT initiation (p = 0.28). There were no differences in ΔhSDS during ERT (p = 0.63) between the two age groups (ERT ≤14 and >14 years). CONCLUSION The presented easy-to-use fixed-dose regimen for late-onset puberty induction allowed for a satisfactory rate of achieving subsequent puberty stages and did not influence the growth potential.
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Affiliation(s)
- Aneta Monika Gawlik
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Hankus
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Kamila Szeliga
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Antosz
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Gawlik
- Nuclear Medicine and Endocrine Oncology Department, Maria Skłodowska-Curie Memorial Institute and Cancer Center, Gliwice Branch, Gliwice, Poland
| | - Kamil Soltysik
- Department of Anatomy and Molecular Cell Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Krzysztof Wilk
- Department of Obstetrics and Gynecology, The Boni Fratres Catoviensis, Katowice, Poland
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Malecka-Tendera
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Koszutski T, Kawalski H, Kudela G, Wróblewska J, Byrka-Owczarek K, Bohosiewicz J. Babies with myelomeningocele in Poland: parents' attitudes on fetal surgery versus termination of pregnancy. Childs Nerv Syst 2009; 25:207-10. [PMID: 18560842 DOI: 10.1007/s00381-008-0653-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 03/25/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recent surgical advances have resulted in fetal surgery becoming an option for children with myelomeningocele (MMC). However, there is little information about the parents' attitudes towards such therapy. METHODS Following a lecture on the current status and problems of fetal surgery for MMC, a 12-item questionnaire was administered to 58 parents of children with MMC. Questionnaire topics included knowledge of the disease and treatment options, as well as attitudes and concerns towards fetal surgery or termination of pregnancy. RESULTS Following the lecture, 14 (out of 58) parents felt that knowledge of the disease would allow for abortion to be an option, while 18 were uncertain. Once informed of potential risks and benefits of fetal surgery, 34 parents had a positive or rather positive attitude towards this procedure. CONCLUSIONS On the basis of these results, it was concluded that this population is potentially interested in the use of fetal surgery.
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Affiliation(s)
- Tomasz Koszutski
- Department of Paediatric Surgery, Silesian Medical University, ul. Medykow 16 , 40-752, Katowice, Poland.
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Koszutski T, Kudela G, Mikosiński M, Utrata W. Quadruplication of dystopic kidney in combination with ureteral cyst. J Pediatr Surg 2008; 43:e13-5. [PMID: 19040913 DOI: 10.1016/j.jpedsurg.2008.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 08/22/2008] [Accepted: 08/26/2008] [Indexed: 11/16/2022]
Abstract
A case of ureteral quadruplication associated with renal dystopia is described. Four ureters drained into ureteric cyst and distal monoureter opened into the bladder. The literature concerned this extremely rare malformation is reviewed.
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Affiliation(s)
- Tomasz Koszutski
- Department of Pediatric Surgery, Division of Pediatric Urology, Upper Silesian Center for Child's Health, Silesian Medical University, Katowice, Poland
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Pastuszka A, Slusarczyk K, Koszutski T, Kudela G, Kawalski H. Intravesical vaccination against Helicobacter pylori in patients with chronic cystitis may confer protection against MALT-type lymphoma of the bladder. Med Hypotheses 2007; 69:1160-1. [PMID: 17825999 DOI: 10.1016/j.mehy.2007.01.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 01/31/2007] [Indexed: 11/28/2022]
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Pastuszka A, Slusarczyk K, Koszutski T, Kawalski H, Kudela G. Alpha-lipoic acid may be a clinically useful therapy in interstitial cystitis. Med Hypotheses 2007; 69:957-8. [PMID: 17451887 DOI: 10.1016/j.mehy.2007.01.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 01/31/2007] [Indexed: 11/22/2022]
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Abstract
Four cases of ureteral triplication in children are described. In one case ureteral triplication was detected incidentally and it was not accompanied by any other pathology of the urinary tract. In the three remaining cases there were pathologies of the urinary system (reflux, obstruction) that demanded surgical treatment. The literature concerning this rare anomaly is reviewed.
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Affiliation(s)
- G Kudela
- Department of Pediatric Surgery, Division of Pediatric Urology, Silesian University of Medicine, Katowice, Poland.
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Abstract
INTRODUCTION The principle of the Nuss procedure is remodulation of the chest using a steel bar inserted by means of two small skin incisions along the axillary lines. PURPOSE OF THE STUDY The assessment of the outcome after treatment. MATERIAL AND METHODS Between July 1998 and March 2003 66 children were operated on by Nuss technique to correct pectus excavatum in our department. Age ranged from 1 to 19 years (mean 11.8 years). The evaluation prior to surgery included chest X-ray and CT, pulmonology consultation with pulmonary function tests and cardiology consultation. We used a modified technique in which we inserted the supporting bar directly from the right side, with no thoracoscope, no sharp tools and no guiding tape. Intrapleural or epidural bupivacaine was used for postoperative pain control. RESULTS Duration of the operation was between 20 and 60 min. Complications included wound infections in six children, haemothorax in three and pneumonia in one. In 56 children the early cosmetic results were very good. In 5 children the excavation of the lower part of the sternum has persisted, in 5 children the excavation of the sternum was corrected but asymmetric thickening in the parasternal region persisted. In all cases the results were satisfactory for both the children and their parents. In 24 children the supporting bar was removed two years after the first operation. Postoperative courses were uneventful and the cosmetic results were good. In one child we observed a recurrence of the deformity six months after bar removal. CONCLUSIONS The early results of the new operation for pectus excavatum are good in most children. The minimal invasiveness of this method suggests that this procedure is indicated in cases where the defects are only cosmetic.
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Affiliation(s)
- J Bohosiewicz
- Department of Paediatric Surgery, Upper-Silesian Child and Mother's Health Centre, Silesian Medical University, Katowice, Poland
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Koszutski T, Bohosiewicz J, Kudela G, Owczarek K. [Diagnostics and treatment of chronic constipation in children--the experience of the department of paediatric surgery]. Wiad Lek 2004; 57:193-6. [PMID: 15307534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The chronic constipation in children can pose a big problem both in pediatric and surgical practice. The purpose of this work is to present diagnostic and treatment procedures in children with chronic constipation. For over three years 70 children with defecation problems have been referred to the Department of Pediatric Surgery in Katowice (Poland). As a result of diagnostic procedures (anorectal manometry, barium enema and rectal biopsy) Hirschsprung disease was diagnosed in 21 cases and chronic constipation in 49. Children with Hirschsprung disease were treated surgically. Children with diagnosed chronic constipation were treated conservatively (cleansing enemas, oral laxatives, diet) and good results were obtained in 30 patients. 19 children underwent anal divulsion and 16 improved. In 2 cases sphincter myotomy was performed and good result was obtained in both of them. The diagnostics and treatment of chronic constipation in pediatric surgical ward is advantageous, because: Hirschsprung disease can be excluded, cleansing of colon sometimes requires general anesthesia and in selected cases surgical procedure is necessary.
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Affiliation(s)
- Tomasz Koszutski
- Z Katedry i Kliniki Chirurgii Dzieciecej Slaskiej Akademii Medycznej w Katowicach
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Koszutski T, Bohosiewicz J, Kudela G. [Our experiences in the surgical treatment of vesico-ureteral reflux]. Wiad Lek 1998; 51 Suppl 3:83-6. [PMID: 9814112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In the years 1995-1997 18 patients (20 ureters) were treated by modified Lich Gregoir's technique for vesicoureteral reflux. In this group 3 children had neurogenic bladder. The age of the patients was 2-18 years, on an average 10 years. In the group of operated ureters there were three with reflux grade II, six-grade III, eight-grade IV and three-grade V. Postoperative period was uneventful in all cases. Control imaging studies (voiding cystourethrography and intravenous pyelography) were done after 8-18 months. These studies were performed in 15 patients. In 14 cases complete resolution of the reflux was found and in one case the improvement from grade III to I. No operated child had stricture of the ureterovesical junction and urinary retention in upper urinary tract. In our opinion extravesical modified Lich-Gregoir's antireflux procedure is effective method, with low probability of complication and less aggressive for patients in comparison to intravesical procedures.
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Affiliation(s)
- T Koszutski
- II Katedry i Kliniki Chirurgii Dzieciecej Slaskiej, Akademii Medycznej w Katowicach
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