Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary

OBJECTIVE

To determine management of pediatric ovarian masses and identify the factors associated with ovarian preservation.

METHODS

From January, 2002 to January, 2019 the case records of 72 patients (median age 14 y), who underwent surgery for ovarian tumors were retrospectively reviewed.

RESULTS

Tumors were most common in the age group 14-17 yrs (58.3%) and most (91.7%) were benign. The most common presenting symptom was abdominal pain (80.5%) followed by vomiting, elevated body temperature, nausea and palpable abdominal mass. 25 (34.7%) patients had an ovarian torsion. Six out of 72 (8.3%) patients had malignant tumors. Of the patients with malignant tumors, 75% had abnormal alpha-fetoprotein and 50% had abnormal b-human chorionic gonadotropin levels (P<0.001). Ovarian-preserving surgery was successfully performed in 74.3% of the benign lesions and two patients (25%) with malignant tumors (P=0.004).

CONCLUSION

Factors associated with ovarian-preserving surgery are benign tumor, normal tumor markers levels, and smaller size of tumor.

An unusual presentation of testicular torsion in children: a single - centre retrospective study

INTRODUCTION

The aim of this study was to investigate demographic and clinical characteristics and outcomes of the treatments of the patients with an unusual presentation of the testicular torsion (TT) and to clarify their peculiarities.

MATERIAL AND METHODS

From January 1999 until December 2017, the case records of 149 patients who underwent surgery for TT were retrospectively reviewed. Out of that number, 25 patients were identified with unusual presentation of an acute scrotum (14 patients who presented with an abdominal pain only, and 11 who presented with testicular torsion in inguinal canal).

RESULTS

The median age of all children with TT at the time of surgery was 14 years. The duration of the symptoms varied substantially and ranged from 1 hour to 120 hours with a median of 6 hours, with only 63 (42.3%) out of the 149 patients staying below the golden 6 hours. Only 2/11 (18.2%) children of the inguinal group and 5/14 (35.71%) children of the abdominal group presented within 6 hours. In the group with inguinal TT the median age was 13 years with the median duration of symptoms of 24 hours. The symptoms were mostly abdominal pain (90.9%), followed by groin pain (45.5%) and nausea (45.5%). In 6 out of 11 children, the first physical examination did not include a genital examination. In the group with abdominal pain, the a median age was 13 years, with median duration of symptoms of 17 hours. The symptoms were limited, besides the abdominal pain, to groin pain (42.8%) and nausea (50%). In 9 out of 14 children, the first physical examination did not include a genital examination. The rate of orchidectomy in the inguinal TT group was 54.5%, while in the abdominal group 57.1%.

CONCLUSION

Testicular torsion, particulary in regard to torsion in the inguinal canal or presenting dominantly with abdominal pain can be easily misdiagnosed, but needs to be recognized on time, to salvage the affected testicle. The complete physical examination, including the genital examination, needs to be performed in each male patient presenting with lower abdominal or groin pain.

Laparoscopic Versus Open High Ligation for Adolescent Varicocele: A 6-year Single Center Study

OBJECTIVE

The aim of this study was to compare the outcomes of high ligation in adolescents with varicocele between open and laparoscopic surgical approaches.

DESIGN

Retrospective study.

SETTING

The study was conducted from January 2012 to January 2018, with median follow-up of 36 months, in the division of pediatric surgery at tertiary-care hospital.

PATIENTS

Data of 537 adolescents who underwent varicocelectomy were classified into two groups, depending on surgical approach.

INTERVENTION

Open or laparoscopic varicocelectomy.

MAIN OUTCOME MEASURES

Indications for surgery, complications, duration of surgery, hospital stay, and recurrences rate.

RESULTS

The median age of the patients was 15 years. The median (IQR) duration of surgery was 12 (11,15.3) min in laparoscopic and 25 (10,30) min in open group (P<0.001). The most common complication was hydrocele (n=29), which was more common in open group (6.8% vs 1.4%; P=0.01). A total of 16 recurrences were recorded, all in open group (P=0.049). In both groups, sperm concentration (P<0.001), morphology (P<0.001) and motility (laparoscopy, P=0.001; P=0.02; open varicocelectomy, P=0.001; P=0.04) improved six months after surgery in patients with varicocele stage I and II. In stage III there was an improvement in sperm concentration (P=0.002; P=0.001) and morphology (P=0.03; P=0.06), while sperm motility (P=0.15; P=0.2) did not significantly recover in either of the groups.

CONCLUSION

Laparoscopic and open varicocelectomy are equally effective and result in significant improvement of testicular volume, disappearance of pain, and sperm parameters in adolescents. Based on our findings laparoscopic varicocelectomy is associated with shorter operating time, shorter hospitalization, faster recovery, and fewer complications and recurrences.

Comparison of Open and Laparoscopic Appendectomy in Children: A 5-year Single Center Experience

OBJECTIVE

To compare the outcomes of treatment in children with acute appendicitis between laparoscopic and open surgical approaches.

DESIGN

Retrospective study.

SETTING

Division of Pediatric Surgery at a tertiary-care hospital in Croatia between January 2012 to December 2016.

PATIENTS

834 children [median (IQR) age 13 (11,15)] who underwent appendectomy; 301 in the laparoscopic group and 533 in the open group.

MAIN OUTCOME MEASURES

Postoperative complications, duration of hospitalization, re-operation, and the quantity of analgesics used.

RESULTS

The median length of hospital stay was 3 days in laparoscopic group compared to 6 days in open group (P<0.001). The amount of analgesics used was lower in patients with laparoscopic appendectomy compared to patients who underwent open procedure (P=0.042). Significantly higher number of wound infections was recorded in the open group (n=21; 3.9%) compared to laparoscopic group (n=3; 1%) (P=0.014). The frequency of re-operation in both groups was equal (1.3%). The median duration of surgery was shorter in the group of patients with laparoscopic appendectomy compared to the open approach (30 vs. 45 min; P<0.001). In five-year period, the proportion of laparoscopic appendectomies increased by 21.5%.

CONCLUSIONS

Laparoscopic appendectomy was safe and effective in children. Advantages of laparoscopic approach were shorter hospital stay, lower number of wound infections and lower usage of analgesics.

Tension plate for treatment of olecranon fractures: new surgical technique and case series study

BACKGROUND

Our aim was to determine the effectiveness of a new surgical technique for olecranon fractures using a tension plate (TP) designed by the operating surgeon.

METHODS

We included patients with olecranon fractures treated between September 2010 and August 2013 in our study. Treatment involved a new implant and operative technique, which combined the most favourable characteristics of 2 frequently used methods, tension band wiring and plate osteosynthesis, while eliminating their shortcomings. The new method was based on the newly constructed implant.

RESULTS

Twenty patients participated in our study. We obtained the following functional results with our TP: median flexion 147.5° (interquartile range [IQR] 130°- 155°), median extension 135°/deficit 10° (IQR 135°-145°), median pronation 90° (IQR 81.3°-90°), median supination 90° (IQR 80°-90°). Implant-related complications were noted in 1 patient, and implants were removed in 3 patients. The mean functional Mayo elbow performance score was 94.8 (range 65-100). The removal of the implant was considerably less frequent in patients operated using the new method and implant than in patients operated using conventional methods at our institution (p < 0.001). Mean duration of follow-up was 8 months.

CONCLUSION

Our TP for the treatment of olecranon fractures is safe and effective. Functional results are very good, with significantly decreased postoperative inconveniences and need to remove the implant. Less osteosynthetic material was used for TP construction, but stability was preserved.

Abstract P4-04-04: Immunohistochemical analysis of Cancer Testis antigens and Topoisomerase 2-alpha expression in triple negative breast carcinomas: a retrospective study

Aim. The aim of this study is to assess the expression of cancer testis (C/T) antigens in the TNBC group, expression of topoisomerase 2-alpha (TOPO2A), basal-like (BL) immunophenotype defined by basal markers (CK5/6, CK14, and EGFR), BL morphology and conventional clinicopathologic factors as well as to demonstrate their prognostic relevance with respect to this group of tumours.

Methods. The study includes 83 patients who underwent surgery between January 2003 and December 2009. Slides were stained immunohistochemically with CK5/6, CK14, EGFR, Ki-67, TOPO2A, MAGE-A1, MAGE-A10, NY-ESO and multi-MAGE. Survival-time and multivariate survival analyses were performed for the purpose of identifying prognostic markers for tumours with more aggressive behaviour.

Results. Of the 83 triple negative tumours, 55 (66.3%) have BL immunophenotype and 40 (48.2%) BL morphology. MAGE-A1 show the most frequent expression (69.0%), followed by multi-MAGE (58.0%), NY-ESO (27.1%) and MAGE-A10 (13, 2%). MAGE-A10 expression is significantly correlated with tumour size (p = 0.026). The expressions of MAGE-A1, MAGE-A10 and multi-MAGE are significantly correlated with clinical stage (p = 0.024, p = 0.041, p = 0.031, respectively). A significant correlation has been found between the expressions of MAGE-A10 and NY-ESO and the expression of TOPO2A (p = 0.005, p = 0.013). There is no significant correlation between the expression of C/T antigens and disease-free survival (DFS) or overall survival (OS).

Conclusions. High expression levels of MAGE and NY-ESO observed in TNBC are of potential clinical relevance, especially in the adjuvant setting of treatment, and may be of therapeutic value as a vaccine-based treatment in the TN group of breast tumours for which therapeutic options are limited.

Key words: triple negative breast cancer, basal-like breast cancer, cancer-testis antigen, topoisomerase 2-alpha, prognosis, survival analysis.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-04-04.

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

BACKGROUND

There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach.

METHODS

We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.

RESULTS

During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group.

CONCLUSION

The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves.

Squamous metaplasia of the peritoneum: report of a case

The ability of the peritoneum to undergo metaplasia, especially to Müllerian-type epithelium has been recognized for a long time. The ability of mesothelial cells to modulate cytoskeletal filaments and shape is provided through the distinct form of subserosal cells, called multipotential subserosal cells, that have the function of replicative cells that differentiate into surface epithelium when affected by various stimuli. Rare forms of peritoneal metaplasia include squamous and cartilaginous metaplasia. This report presents a case of fully developed, mature peritoneal squamous metaplasia in an 85-year-old woman who underwent surgery because of small bowel perforation leading to diffuse peritonitis. This rare incidental finding almost always occurs in the background of chronic peritoneal irritation as a response to mesothelial injury. Squamos peritoneal metaplasia should not be interpreted as metastatic squamous cell carcinoma. The most important distinguishing criteria are the lack of nuclear atypia, mitoses, necrosis, and desmoplastic stromal response.

Unusual cause of palpable mass in upper abdomen--giant gastric trichobezoar: report of a case

A trichobezoar is a ball of swallowed hair that accumulates in the stomach and fails to pass through the intestines. Usually a trichobezoar presents in early satiety and malnutrition. Obstructive symptoms and manifestations of gastric outlet obstruction may occur. While small gastric trichobezoars may be removed via gastroscopy, large trichobezoars require surgical removal by gastrotomy through abdominal incision. We present a case of a successful mini-laparotomy removal of a giant gastric trichobezoar in a 15-year-old girl with a history of trichophagia for a long time and marginal psychological disturbances.

High-pressure injection injuries of the hand--report of two cases

High-pressure injection injuries to the hand are work-related injuries that can take a devastating toll on the functionality of the affected extremity. We present two cases of high-pressure injection hand injuries due to paint and sand. The patients were managed operatively and switch to intensive physiotherapeutic training, with excellent outcome.