ABSTRACT
Vulvar masses in children are an unusual finding but their differential diagnosis is extensive. In case of solid masses, rhabdomyosarcoma (RMS) must always be considered due to the fact that it is the most common tumor in external genitals during childhood. However, RMS has a radiological appearance very similar to juvenile xanthogranuloma (JXG). We present a 16-month-old girl with a 2 cm solid mass on her left labia majora, with four overlying cutaneous papules. After imaging tests, an excisional biopsy was programmed due to high malignancy suspicion. Histopathology of the mass and one of the papules was diagnostic for JXG. After a 12-month follow-up, the patient shows no signs of relapse or complication. Deep JXG is an uncommon entity in childhood and exceptional in the genital area. Therefore, it must be included in the differential diagnosis of a solid vulvar mass, especially if accompanying yellowish xanthomatous cutaneous lesions are present.
ABSTRACT
Aim: Since the first description of laparoscopic herniorrhaphy (LH), a lot of studies have compared outcomes between LH and open herniorrhaphy (OH) with inconsistent results. We designed this study to assess outcomes between both techniques now that pediatric surgeons have enough confidence with it. Methods: We performed a systematic review and meta-analysis of articles published in the last 10 years. Results: Twenty-seven articles reporting on 91,653 patients (26,920 LH and 64,733 OH) were included. No significant differences were found in overall operative time (OT) (P = .07). Subgroup analysis revealed significantly shorter OT for LH in unilateral (-8.87 minutes, P = .03) and bilateral hernias (-16.86 minutes, P = .004), but longer in unilateral hernias in females (+7.47 minutes, P = .006). Recurrence rate was similar (odds ratio [OR] 1.05, P = .66). Less complications were reported in LH (OR 0.51, P = .03). Contralateral patent processus vaginalis average rate was 39.61% and its closure reported a significant decrease of contralateral metachronous hernia (OR 0.11, P < .00001). Conclusion: Although OH is still considered the gold standard by some authors, LH has proven to be not only as safe as OH but also to have additional advantages that should make pediatric surgeons implement it in their daily practice and not in selected cases alone.
Subject(s)
Hernia, Inguinal , Laparoscopy , Child , Female , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Humans , Laparoscopy/methods , Male , Retrospective Studies , Treatment OutcomeABSTRACT
Partial splenectomy allows preserving immune function in benign splenic lesions such as epidermoid cysts. Determining the plane of resection and perfusion of the spleen remnant can be difficult, especially in centrally located lesions. We present a 13-year-old girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out of the ICG allowed inspection of the peripheral vascular return of the splenic remnant through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound scan revealed a well-perfused small splenic remnant with no signs of recurrence. Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially in those cases of peripheral location. Fluorescence facilitates the safe dissection of the splenic hilum, the visualization of the transection plane of the spleen and the perfusion of the remnant in cases of anatomically and technically complicated partial splenectomies.
ABSTRACT
La ingesta accidental de más de un imán puede producir complicaciones graves. Los protocolos actuales recomiendan la extracción endoscópica de ser posible. El objetivo de este trabajo es presentar un caso clínico de una ingesta de dos imanes y la técnica endoscópica de extracción. Niño de 11 años que acudió a Urgencias tras la ingesta de dos imanes, asintomático. En la radiografía de abdomen, se identificaron dos cuerpos extraños radiopacos, aparentemente unidos, en la cámara gástrica. Se realizó una endoscopía bajo anestesia general en quirófano. Para facilitar la extracción, se colocó, encima de la pared abdominal, a nivel gástrico, un imán de neodimio. En la endoscopía, se observaron dos pequeños imanes localizados y fijados en la cara anterior del estómago. Una vez localizados, se retiró el imán externo y se procedió a su extracción con cesta
The ingestion of more than one magnet can cause multiple complications. Current protocols recommend endoscopic extraction if possible. We report a patient who swallowed two magnets and the endoscopic extraction technique. An 11-yearold boy presented at the Emergency Room after ingesting two small magnets, being asymptomatic. In the abdominal x-ray two radiopaque bodies were identified at the gastric chamber, apparently together. A gastroscopy was done in the operating room under general anaesthesia. To enable the extraction, a neodymium magnet was placed externally at the abdominal wall. In the endoscopic image, the two magnets were fixed to the anterior gastric wall. Once located, the neodymium magnet was removed and the two magnets were retrieved with an endoscopic basket.
Subject(s)
Humans , Male , Adolescent , Magnets , Foreign Bodies/diagnostic imaging , Endoscopy, Digestive System , NeodymiumABSTRACT
The ingestion of more than one magnet can cause multiple complications. Current protocols recommend endoscopic extraction if possible. We report a patient who swallowed two magnets and the endoscopic extraction technique. An 11-yearold boy presented at the Emergency Room after ingesting two small magnets, being asymptomatic. In the abdominal x-ray two radiopaque bodies were identified at the gastric chamber, apparently together. A gastroscopy was done in the operating room under general anaesthesia. To enable the extraction, a neodymium magnet was placed externally at the abdominal wall. In the endoscopic image, the two magnets were fixed to the anterior gastric wall. Once located, the neodymium magnet was removed and the two magnets were retrieved with an endoscopic basket.
La ingesta accidental de más de un imán puede producir complicaciones graves. Los protocolos actuales recomiendan la extracción endoscópica de ser posible. El objetivo de este trabajo es presentar un caso clínico de una ingesta de dos imanes y la técnica endoscópica de extracción. Niño de 11 años que acudió a Urgencias tras la ingesta de dos imanes, asintomático. En la radiografía de abdomen, se identificaron dos cuerpos extraños radiopacos, aparentemente unidos, en la cámara gástrica. Se realizó una endoscopía bajo anestesia general en quirófano. Para facilitar la extracción, se colocó, encima de la pared abdominal, a nivel gástrico, un imán de neodimio. En la endoscopía, se observaron dos pequeños imanes localizados y fijados en la cara anterior del estómago. Una vez localizados, se retiró el imán externo y se procedió a su extracción con cesta.
Subject(s)
Foreign Bodies/diagnostic imaging , Foreign Bodies/therapy , Gastroscopy/methods , Magnets , Stomach/diagnostic imaging , Child , Eating , Gastroscopy/instrumentation , Humans , Male , RadiographyABSTRACT
AIM: Detection of cell-free fetal DNA in maternal blood is a type of noninvasive prenatal diagnosis test (NIPT), which has already been known for some time but has not yet been introduced in most of public hospitals in Spain. How the implementation of cell-free fetal DNA (cffDNA) in a contingent protocol has influenced the aneuploidy screening in our hospital is described. METHODS: Two cohorts of patients with positive combined screening were compared: the first one (years 2012-2013, 5747 patients) from a period of time in which the protocol valid until March 2016 - that included the use of invasive procedures - was applied; and the second one in which the current protocol - that included NIPT versus invasive procedures - was applied (first 7 months after protocol implementation, 898 patients). RESULTS: Comparison of both periods resulted in a 60.5% reduction of invasive procedures (P < 0,001) preserving the same chromosomopathy detection rate. The ratio of positive invasive procedures-indicated invasive procedures was improved by 15% in the first period to 50% in the second period (P = 0.01). CONCLUSION: NIPT introduction has caused a significant reduction of 60.5% of IP in high chromosomopathy risk patients after combined screening without modifying detection rate.
