Particularities of the management and the treatment in a rare sepsis with Candida tropicalis of a Collodion baby: Case report.

RATIONALE: Collodion baby is a rare autosomal recessive disorder. It can be the first expression of some forms of ichthyosis. PATIENT CONCERNS: The authors present the case of a newborn diagnosed with severe Collodion baby syndrome who required prolonged hospitalization in the intensive care unit because of infectious complications like the fungal sepsis and other bacterial superinfections. DIAGNOSES: The case has many diagnostic and therapeutic particularities and management difficulties. Skin culture, dermatological and genetic exam were required. INTERVENTIONS: The treatment required multidisciplinary involvement: neonatologist, pediatrician, geneticist, dermatologist, psychologist, ophthalmologist, audiologist. OUTCOMES: The evolution during hospitalization was slowly favorable, but later, after a few months, it developed some complications. LESSONS: In our case, skin injuries, total parenteral nutrition, aggressive and prolonged antibiotic therapy, intravenous devices, high hospitalization duration were risk factors for colonization and sepsis with fungi, especially in the neonatal period, sometimes with severe evolution and prognosis.

THE ACUTE SCROTUM IN CHILDREN.

The acute scrotum syndrome is a medical-surgical emergency and the recognition of this condition by both healthcare professionals and the general population may result into the patients' coming in earlier for medical examination and into the preservation of the gonad in case of torsion. The purpose of this retrospective analytical research is to point out specific epidemiological aspects in pediatric patients suffering from acute scrotum, and to review the existing diagnosis and treatment options. The study included 208 patients, of whom 16 with vanishing testis and 192 with acute scrotum (torsion of testis 25.5%, torsion of the hydatid of Morgagni 68.2%, epididymoorchitis 5.2%). The torsion of the hydatid of Morgagni occurs in boys with a mean age of 10 years and it involves both testes equally, whereas the torsion of testis usually occurs around the age of 13 and is twice more common in the left gonad. Another significant difference between the two conditions is the inflammatory syndrome, which occurs in 45.4% of the children with torsion of testis versus only 18.2% in the torsion of hydatid. Only one out of six testes torted during the neonatal period could be saved (16.6%); the gonad preservation rate was as high as 68.2% in the group of patients with testis torsion occurring outside the neonatal period. These alarming data are accounted for by the non-recognition of the severity of the condition and by the delayed surgical therapy, which occurs on the average 20 hours after the testis torsion has set in. If the asepsis and antisepsis standards are observed, patients with torsion of the hydatid of Morgagni or torsion of testis require neither fluid sampling from the tunica vaginalis for culture, nor antibiotic therapy.

Intussusception in infants--storm from a clear sky.

Intussusception is one of the most common causes of acute abdominal conditions requiring surgical therapy in infants and babies. Due to the breakthroughs of pediatric intensive care and imaging methods, which may sometimes replace therapeutic methods, this condition, which used to be associated with high morbidity and mortality rates, is now more easily detected and treated immediately, even by non-surgical means. Nevertheless, there still is a high percent of cases in whom the diagnosis is set relatively late and who require laborious surgical procedures and extensive intestinal resections. These cases have high morbidity rates, the condition sometimes has a negative course and the patients die. We conducted an analytical retrospective study on a group of 49 patients diagnosed with intussusceptions, hospitalized and treated in the Pediatric Surgery Ward of the Children's Hospital of Iasi City during 5 years. Although the demographics and clinical presentation of our patients is largely in agreement with literature data, we note that 69.4% of the patients came to the hospital 24 hours after the onset of their symptoms, which delayed diagnosis setting, ruled out non-surgical therapy and thus led to a high rate of postoperative complications (24.5%) and also to a high mortality rate (6.6%).