The EXIT for Prenatally Diagnosed Cervical Cystic Teratoma: A Case Report

The Ex-utero intrapartum treatment (EXIT) is a procedure performed during caesarean section while on fetal-placental circulation. We present a prenatally diagnosed cervical cystic mass causing tracheal compression which was managed successfully with the EXIT procedure.

The EXIT for Prenatally Diagnosed Cervical Cystic Teratoma: A Case Report

The Ex-utero intrapartum treatment (EXIT) is a procedure performed during caesarean section while on fetal-placental circulation. We present a prenatally diagnosed cervical cystic mass causing tracheal compression which was managed successfully with the EXIT procedure.

Pure gonadal dysgenesis (Swyer syndrome) due to microdeletion in the SRY gene: a case report

46,XY complete gonadal dysgenesis (Swyer syndrome) is a rare cause of disorder of sexual development. This syndrome is caused by a defect in the determination of sex during embryogenesis and is characterised with female external genitalia, normal or rudimentary uterus, and streak gonads, despite the presence of the 46,XY karyotype. Most of the studied cases presented with leak of secondary sex characteristics and primary amenorrhea during adolescence. Laboratory findings reveal hypergonadotropic hypogonadism. Herein we present the case of a female with a 46,XY karyotype who was admitted with delayed puberty and detected to have a microdeletion in the SRY gene and diagnosed to have Swyer syndrome. We highlight the importance of karyotype analysis in patients with delayed puberty and primary amenorrhea. Once the diagnosis of 46,XY complete gonadal dysgenesis is established, early laparoscopic removal of the dysgenetic gonads is crucial to prevent the development of gonadal malignancy.

Single center experience in patients with unilateral multicystic dysplastic kidney

OBJECTIVE

To determine the clinical features, long-term outcomes, and additional urological anomalies of patients treated for multicystic dysplastic kidney (MDK).

MATERIALS AND METHODS

Patients with MDK who were followed between January 2004 and October 2012 were reviewed retrospectively. Demographic, clinical, laboratory, and radiological data were evaluated.

RESULTS

A total of 68 patients with MDK were followed for a mean period of 46.8 ± 32.4 months. MDK was detected by antenatal ultrasound in 64 (94.1%) of the patients. Ten patients had (14.7%) additional urological anomalies in contralateral kidney. Vesicoureteral reflux was found in five patients (7.3%). Other urological anomalies were megaureter (two), cortical renal cyst (two), ureteropelvic junction obstruction (one), and renal ectopy (one). Urinary tract infection was detected in 14 (20.5%) patients. Four (5.9%) patients had hypertension. Compensatory hypertrophy was detected in 29 (42.6%) patients. Eight (11.8%) of these 29 patients had glomerular hyperfiltration and three (4.4%) of these eight patients also had proteinuria. Follow-up ultrasound revealed complete involution in 19 (35.8%) patients. Nephrectomy was performed in 15 (22.0%) patients. Indications of nephrectomy were, recurrent urinary infection (four), hypertension (three), ureterocele (two), renal calculi (one), flank pain (one), hematuria (one), persistent large cystic kidney (three), and atypical US findings (two).

CONCLUSION

In patients with MDK, depending on the clinical, laboratory, and radiological findings, appropriate timing of operation by multidisciplinary approach is important for early detection and treatment of any possible complications.

Paraurethral Skene's duct cyst in a newborn

Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage.

Liver abscess: increasing occurrence in premature newborns

Neonatal liver abscess is a very rare condition associated with high morbidity and mortality rates. There seems to be an increasing trend of this rare condition amongst the newborns admitted to neonatal intensive care units. We report a case of liver abscess in a premature newborn and briefly review the literature and discuss its management.

Spectrum of Etiologies Causing Hydrometrocolpos

Background: Hydrometrocolpos (HMC) develops as a result of vaginal outflow obstruction and the accumulation of secretions. It might be secondary to persistent cloaca, urogenital sinus, some syndromes, presence of the vaginal septum, vaginal atresia, and imperforate hymen. Each of them has different treatment options and follow-up protocols. This study was performed to identify the etiology and the related management of patients with HMC.Materials and Methods: A descriptive series of patients with HMC managed in our hospital between 2004 and 2011 is being presented. The medical record of these patients was analyzed for etiology, management, and outcome.Results: Eight patients with HMC were managed during 7 years at our department. Underlying etiologies included urogenital sinus (n=3), and 1 each of imperforate hymen, transverse vaginal septum, Herlyn-Werner-Wunderlich syndrome, persistent cloaca, and a variant of the cloaca. Four patients were prenatally diagnosed. The patient with imperforate hymen was managed successfully with incision and drainage. Abdominal vaginostomy was done in three patients with urogenital sinus as initial procedure. In patient with persistent cloaca, a colostomy and abdominal vaginostomy were performed. Patient with cloaca variant died due to persistent acidosis and salt wasting.Conclusion: HMC may have different etiological factors which may dictate different surgical management. Etiology of HMC can be as simple as imperforate hymen to the most severe cloacal malformations.

Type IV Sacrococcygeal Teratoma Associated with Urogenital Sinus: Difficulties in the Prenatal Differential Diagnosis

Sacrococcygeal teratoma (SCT) is being more often detected due to availability of prenatal ultrasonography. Type IV SCT could be misdiagnosed as cloacal abnormalities due to the pelvic midline cystic mass associated with renal malformations and obstructive uropathy during the pregnancy. We discuss difficulties in the prenatal differential diagnosis of SCT and urogenital sinus in a 26-year-old pregnant woman, admitted to our prenatal diagnosis centre for a detailed US for a pre-sacral mass.

Diagnostic Difficulties in a Case of Persistent Cloaca with Hydrocolpos

Pelvic midline cystic mass associated with renal malformation represents typical imaging features of a cloacal anomaly. We report a case of persistent cloaca that was diagnosed antenatally with fetal ultrasonography and MRI.

The most commonly cited articles in pediatric surgical journals

AIM

This study aimed to investigate the characteristics of the most frequently cited articles published in 3 main journals dedicated to the field of pediatric surgery (Journal of Pediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery).

MATERIAL AND METHODS

A search was initiated using the database (1985 - 2006) of the Science Citation Index of the Institute for Scientific Information. The total number of publications and their citation numbers were found and the most cited articles were investigated in detail. A total of 600 (200 from each journal) most cited articles were identified and chosen for further analysis.

RESULTS

The total number of citations in these 3 journals was 20 271. The citations of the most cited articles ranged from 10 to 224. The articles were published between 1985 and 2003 and the mean number of citations/article was 33.78. Articles originated from 39 counties and 256 institutions. The leading countries were the United States (203 articles from 75 institutions), Germany (50 articles from 21 institutions), Japan (34 articles from 17 institutions), Switzerland (34 articles from 8 institutions), United Kingdom (32 articles from 19 institutions), and Canada (28 articles from 7 institutions). Of the institutions with the highest number of cited articles, four institutions were from the USA followed by Switzerland with two institutions. The leading topics were the gastrointestinal system (n = 239), respiratory system (n = 94), urology (n = 61) and oncology (n = 56), and diaphragmatic hernia (n = 41) was the most common special topic. There were 42 case reports (7 %) and 75 experimental research articles (12.5 %). Thirty-four authors from 14 countries and 30 institutions had articles in more than one journal. The most cited author was N. S. Adzick from the USA with 224 citations.

CONCLUSION

In this study, we found that the Journal of Pediatric Surgery predominated with the greatest number of cited articles. The most cited articles, authors and institutions originated from the USA and English-speaking countries. The gastrointestinal system, respiratory system, urology and oncology were the leading topics and diaphragmatic hernia was the most common special topic.

An infrequent cause of misdiagnosis in esophageal atresia

Inability to pass an oral tube in infants with esophageal atresia often leads to the diagnosis of this anomaly. This report describes an infant with a delay in diagnosis resulting from initial passage of an oral tube through a distal tracheoesophageal fistula into the stomach.

Posterior sagittal approach for treatment of presacral masses in infancy

There are very few reports on the surgical management of presacral masses (PSM) via a posterior sagittal (PS) approach. Between 1994 and 2000, we followed five girls who had been operated upon for PSMs via a PS approach. The mean age was 28.8 +/- 16.6 months (6-48 months). The mean follow-up was 3 +/- 1.6 years (1-5 years). Although two patients had yolk-sac tumors, all patients are still alive. We believe that this is a safe and satisfactory method for resection of PSMs.

The role of surgery in the treatment of instussusception in celiac disease

Small bowel intussusceptions comprise fewer than 10% of all pediatric patients with intussusceptions and most of them are secondary to another pathology. In this report, we discuss the role of surgery in the treatment of intussusception in celiac disease. A 13-month-old girl was admitted with a three day history of progressive abdominal distention and vomiting of bile. There were air-fluid levels on supine abdominal X-ray and ultrasonographic examination demonstrated an intussusception. At surgery, two separate small bowel intussusceptions were encountered. The postoperative course was uneventful. Due to a history of frequent diarrhea and mild abdominal distention developing after the age of seven months, further studies for celiac disease were initiated. Antigliadin and antiendomysium antibodies were found to be strongly positive. Celiac disease was also confirmed by endoscopic small bowel biopsy. Children who present with chronic or transient intestinal obstruction should also be evaluated for underlying celiac disease. Nevertheless, the surgical decision should be based upon clinical observation in this group of patients.

A critical observation about the pathogenesis of abdominoscrotal hydrocele

Abdominoscrotal hydrocele is a very rare anomaly. Although various theories about this condition have been proposed, controversy still continues on the etiology of this lesion. The authors present two consecutive cases of abdominoscrotal hydrocele in infancy. On their first examination, these patients only had inguinoscrotal hydroceles. After a 2-month period of observation, these inguinoscrotal hydroceles developed into abdominoscrotal hydroceles. These findings also were confirmed by ultrasonography. The authors question the currently proposed theories of abdominoscrotal hydrocele development.

Timing of surgery in perineal ectopic testes: analysis of 16 cases

Between 1993 and 1998, 16 patients with perineal ectopic testes (PET) (1%) were diagnosed among the 1,576 patients operated upon for undescended testes (UDT) in two pediatric surgical centers. The mean age was 23 +/- 22.5 months. The clinical presentation was an empty scrotum with an ipsilateral palpable perineal mass in 16 patients and an inguinal hernia in 5. In all except 1 patient whose atrophic testis was removed, orchiopexy into the dartos pouch was easily performed through a standard inguinal skin-crease incision. The length of the testicular vessels and vas deferens was adequate and retroperitoneal dissection was not required. Although the complications of UDT are the same as for PET, the timing of surgery should be different. It is generally accepted that children must not be below 6 months of age for surgical correction of UDT, but there is no need to delay surgery in PET, which can easily be diagnosed by physical examination in the neonatal period. Surgery is indicated even if there is no hernia present.

Congenital muscular torticollis: early and intensive treatment is critical. A prospective study

BACKGROUND

Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of this outcome, such as treatment duration and exercise frequency. The aim of the present study was to define factors related to treatment duration, to compare different frequencies and intensities of home treatment programs and their effect on the speed of recovery.

METHODS

The present study was a prospective study of 45 infants (26 male, 19 female) with congenital muscular torticollis referred to the pediatric surgical outpatient during a I year period. Following a standardized initial assessment, parents were taught our intensive home treatment protocol, consisting of passive stretching exercises repeated every 3 h.

RESULTS

The mean age at initial assessment was 38.6 days (range 15-120 days). Mean treatment duration was found to be 3.2 +/- 1.3 months. All patients were treated by use of our intensive protocol of passive stretching exercises (100% success). No surgery was necessary.

CONCLUSIONS

In patients with early treated congenital muscular torticollis, there is no place for surgical treatment. This group of patients can be successfully treated using an intensive protocol of passive stretching exercises. In addition, this treatment protocol has a very short treatment duration compared with other standardized protocols. A successful outcome depends primarily on good cooperation with the parents, especially in developing countries.

Hydatid disease of the liver in childhood

The records of 100 children with hydatid disease were reviewed retrospectively from 1978 to 1997; 43 were girls and 57 were boys. The mean age was 9.14 years; 61 patients had 124 hepatic cysts. Presenting symptoms were asymptomatic abdominal masses, found masses incidentally during ultrasonography (US), or acute abdomen. Plain X-ray films, US, or computerized tomography (CT) are sufficient for diagnostic evaluation in endemic areas. In the differential diagnosis, laboratory investigations such as the Casoni and Weinberg tests, indirect hemagglutination, eosinophilia, and ELISA were also used. These tests may give negative results, however, in some patients with hydatid disease. The mean follow-up time was 10.5 years (range 1-18 years), the mean duration of hospitalization 7 days. The complication rate was 3.6%. Mortality was 3.27% and occurred after the administration of formaldehyde and hypertonic scolicidal agents. Hydatid disease of the liver can be treated medically in selected patients; conservative surgical approaches that save as much parenchyma as possible, such as partial cystectomy and capitonnage, are indicated in the other cases.