How Does the COVID-19 Pandemic Affect Pediatric Patients with Intussusception Treated by Ultrasound-Guided Hydrostatic Enema Reduction?

BACKGROUND: The pandemic of COVID-19 has significantly influenced the epidemiology of intussusception. Nevertheless, the effects of the COVID-19 pandemic on the operation of ultrasound-guided hydrostatic enema reduction (USGHER) for intussusception have been largely unknown. METHODS: The data of pediatric patients with intussusception who were treated by USGHER from January to March of 2019 (Control Group), 2020 (Study Group 1), and 2021 (Study Group 2) in a large Chinese medical institution were retrospectively collected and analyzed. RESULTS: We enrolled 246 patients, including 90 cases in Control Group, 70 in Study Group 1, and 86 in Study Group 2 (p = 0.042). The time from the onset of symptoms to the hospital visit and the time from the hospital visit to performing the ultrasound in Study Group 1 was significantly longer than that in Control Group and Study Group 2 (p = 0.036, p = 0.031, respectively). The number of patients with bloody stool and the longest invaginated length of intussusception in Study Group 1 increased significantly compared with patients in the other two groups (p = 0.007, p = 0.042, respectively). Comparisons of neither the pressure of enema nor the time of duration when performing USGHER present statistical significance among the three groups (p = 0.091, p = 0.085, respectively). For all enrolled pediatric patients, there was no perforation case involved, and recurrence of intussusception occurred in few cases. CONCLUSIONS: Besides the negative impacts on the incidence of intussusception, the COVID-19 pandemic might have led to the diagnostic delay of intussusception and the deterioration of patients' clinical manifestations, but it did not significantly affect the operation of USGHER and patients' clinical outcome.

[Ultrasonic Manifestations of Desmoplastic Small Round Cell Tumor with Multiple Metastases: Case Report].

Desmoplastic small round cell tumor (DSRCT) is a rare malignant tumor, which is prone to occur in teenagers DSRCT is a rare malignant tumor that often occurs in adolescents. Early diagnosis is difficult and the prognosis is poor. In this case report, the ultrasonography of DSRCT showed that the huge solid mass was in the abdomen with unclear boundary, irregular shape, insufficient blood supply but without obvious liquefaction and calcification. The masses encircled the vessels, but no evidence of vascular invasion. Intrahepatic metastases with peripheral hypoechoic aureole and abdominal lymph node metastases were observed. The tumor mass compressed adjacent tissues and organs, causing bilateral hydronephrosis and bone erosion. In a word, the ultrasonographic characteristics could be used for diagnosing the DSRCT in the clinic.

A rare content of congenital inguinal hernia: a case report of splenogonadal fusion.

BACKGROUND: Splenogonadal fusion (SGF) is a rare congenital malformation that occurs during embryonic development. SGF typically presents as a left-sided scrotal swelling, left inguinal hernia, scrotal mass, or cryptorchidism. Therefore, it is easily misdiagnosed, and unnecessary orchiectomy may occur. This study aimed to report a rare case of SGF. CASE PRESENTATION: A 5-month-old male child presented with a history of obvious left scrotal swelling for 1 month, which progressively worsened 10 h before the hospital visit. The ultrasound examination exhibited a solid mass in the left scrotum, with echo quite similar to that in the testicle and went up into the abdominal cavity through an identical echogenic band structure. After surgical resection, the pathological examination confirmed that the submitted tissue was spleen tissue with extensive bleeding. CONCLUSION: Ultrasound can provide important information regarding the diagnosis of SGF. The possibility of SGF should be considered for further differential diagnosis in the case of similar patients.

[Ultrasound Manifestations of Eyes of Pediatric Patients with Morning Glory Syndrome].

OBJECTIVE: To analyze ultrasonic manifestations of eyes of pediatric patients with morning glory syndrome (MGS). METHODS: Clinical data and ultrasound (US) findings for six children (4 males and 2 females, 5-60 months old) diagnosed with MGS between 2005 and 2016 were reviewed. RESULTS: Of the 12 eyes, seven were diagnosed with MGS; one with cataract; the other four were normal. One child had both eyes diagnosed with MGS. Of the seven eyes with MGS (5 right, 2 left), one was small associated with persistent hyperplastic primary vitreous (PHPV); 2 had retinal detachment. Findings of high frequency ultrasound included local anechoic lesions with distinct boundary showing a convert bottle-neck shape that appeared in the area of optic disk of posterior pole. The lesions communicated with the vitreous caicy and extended to the optic nerves. The lesions had a maximum depth of 4-15 mm [(8.29±4.42) mm] and a maximum width of 4-11 mm [(6.86±2.67) mm]. Hypoecho material was found in the bottom of five of the seven lesions. The distance between the end of the optic nerves and the bottom of the lesions ranged from 0 to 4.5 mm. Lower levels (Adler 0-1 grade) of blood flow in the bottom of the lesions were found compared with those (3-5 grade) in the rim of the lesions. CONCLUSION: MGS is rare and usual occurs in young children, especially infants. It is often associated with various eye complications. The ultrasound manifestations of MGS are characterized with a local anechoic lesion mimicking a convert bottle-neck shape in the area of optic disk of posterior pole.

Ultrasound in diagnosis of intrascrotal metastasis of Wilms' tumor: first case report of a Chinese boy and review of the literature.

A 31-month-old boy with Wilms' tumor (WT), which primarily had originated from the left kidney, was treated with nephrectomy and adjuvant chemotherapy. 2 months after nephrectomy, a left scrotal mass was found at routine follow-up. High-frequency sonography examination revealed an enlarged left testis with a heterogeneous texture and a hypoechoic solid mass in the left scrotum. Moreover, hypervascular signals presented in both the left testis and the mass on color Doppler flow imaging. Left orchiectomy was performed for suspected intrascrotal metastasis of WT, which was confirmed by histopathology examination. This was the first case of intrascrotal metastasis of WT reported in China with a detailed ultrasound description. Meanwhile, this study also reviewed the comparable diagnostic methods of intrascrotal metastasis of WT found in the English literature.

The effect of CO2 pneumovesicum on upper urinary tract.

OBJECTIVE: Pneumovesicum allows minimal invasive intravesical surgeries. The possible deleterious effect of intravesical CO(2) pressure is not known. We assessed the effect of CO(2) pneumovesicum on the urinary tract and renal function. METHODS: Pneumovesicum was established and maintained with CO(2) at 10 mm Hg in 10 sows. Cohen cross-trigonal reimplantation was carried out on the left ureter by a vesicoscopic approach. The right ureter was cannulated and served as control. CO(2) pneumovesicum was maintained for 2 hours. Color Doppler measurements of the upper urinary tract and blood sampling were carried out 30 minutes before and 2 hours after establishing pneumovesicum, and 30 minutes after releasing the pneumovesicum. RESULTS: Compared with the preoperative values, the bilateral anteroposterior diameters of the renal pelves increased significantly after 2 hours of the pneumovesicum (P < .05). Thirty minutes after release of the pneumovesicum, the anteroposterior diameters decreased and showed no statistically significant difference compared with the preoperative values. No air embolus was detected in the ureters, renal pelves, renal veins, or renal arteries on either side 2 hours after establishing the pneumovesicum. There was no statistically significant change in arterial or venous blood flow. There was no significant change in the urea and creatinine levels 2 hours after establishing the pneumovesicum. CONCLUSION: CO(2) pneumovesicum at a pressure of 10 mm Hg for 2 hours did not result in any demonstrable deleterious effect.

Dynamic ultrasound study on urinary bladder in infants with antenatally detected fetal hydronephrosis.

UNLABELLED: To evaluate bladder function in infants with antenatally diagnosed hydronephrosis (ANH) using dynamic ultrasound protocol. Forty consecutive male infants (mean, 0.25 y) with ANH and 33 age-matched normal controls (mean, 0.49 y) were recruited. Anteroposterior (AP) diameter of renal pelvis (RP) and hydronephrosis index [HI = anteroposterior diameter of RP of kidney divided by urinary bladder volume (BV)] were calculated. Maximum BV (MaxBV) was determined just before voiding. Residual volume (RV) and bladder wall thickness (BWT) were measured after spontaneous voiding. Thirty-one infants (77.5%) showed persistently dilated RP postnatally in which 12 (39%) showed significantly high HI. In general, ANH infants had smaller MaxBV (30.71 versus 52.45 mL), larger residual volume (2.47 versus 1.93 mL), and larger BWT (4.4 versus 3.7 mm) than normal (p < 0.05, Mann-Whitney test). Infants with abnormally high HI had significantly more disturbed bladder parameters [smaller MaxBV (23.33 versus 33.49 mL) and larger BWT (4.67 versus 3.79 mm)] than the normal HI group (p < 0.05, Mann-Whitney test). Abnormal functional bladder parameters were evident in ANH infants. We postulated that immature function in the pelviureteric junction was associated with bladder dysfunction in these infants. Dynamic ultrasound protocol might help to understand the underlying pathophysiology of urinary system in ANH infants. ABBREVIATIONS: :

[Alteration of bladder function in response to surgical reduction in bladder capacity: conventional-fill cystometry in awake rabbit model].

OBJECTIVE: To investigate alteration of bladder function in response to surgically reduced bladder capacity by using an awake rabbit model. METHODS: Forty rabbits were divided into two groups, one was experimental group in which the rabbits underwent semi-cystectomy to reduce 50% bladder capacity (n=20), another was control group in which the rabbits received sham operation (n=20). A conventional-fill cystometric investigation was performed as the animal under awake condition at the times of 4 weeks and 8 weeks after operation. RESULTS: Compared with control subjects, the maximum cystometric capacity in experimental group was remarkably decreased at week 4 [(35.3 +/- 8.2) mL vs. (71.6 +/-12.9) mL, P < 0.05), and week 8 [(46.2 +/- 12.1) mL vs. (82.7 +/- 20.1) mL, P < 0.05] respectively; while the maximum voiding detrusor pressure was significantly enhanced at week 4 [(24.4 +/- 7.0) vs. (16.5 +/- 7.2) cm H2O, P < 0.05) and week 8[(27.7 +/- 8.0) vs. (16.8 +/- 7.5) cm H2O, P < 0.05) respectively. CONCLUSION: Alteration of bladder function, which mainly presented as the increase of maximum voiding detrusor pressure, was elicited at four to eight weeks after surgical reduction of bladder capacity in rabbit.

[The labral plicae entrapment syndrome of hip in children: an ultrasonography study].

OBJECTIVE: To study the ultrasonographic (US) features of labral plicae entrapment syndrome of hip (LPEH) in children and to evaluate the value of US in diagnosing LPEH. METHODS: (1) Twenty six LPEH models and 38 sham LPEH hips were established surgically from 32 children cadavers [15 male and 17 female, age from 2 to 8 years, mean age of (6.12 +/- 2.13) years]. US was performed on these hips double-blindly. The sensitivity, specificity, positive and negative predictive values were calculated. (2) A total of 21 children (17 male and 4 female, mean age (5.95 +/- 2.67) years) with unilateral LPEH and 21 age and gender matched children with normal hips were consecutively recruited. The 21 symptomatic hips, 21 asymptomatic hips and 42 normal hips were examined by the US (ATL 5000) using the high-frequency (7.5-12 MHz) linear array transducer. RESULTS: (1) The sensitivity, specificity, positive and negative predictive values of the US for the LPEH model were 88%, 84%, 79%, and 91%, respectively. (2) Fluids in hip joints were detected in all of the 21 symptomatic hips. No fluid was detected in the asymptomatic and normal hips (less than 2mm); The mean width of the inferomedial recess was significantly larger than that of the anterior recess (12.50 mm vs. 4.35 mm, P < 0.05) in the 21 symptomatic hip joints; The echogenic entrapped labral plicaes were demonstrated in the inferomedial recess of the 21 symptomatic hip joints, with a length ranging from 5.3 to 25.0 mm [mean(15.63 +/- 5.57) mm) and a width ranging from 4.0 to 17.0 mm [mean (8.90 +/- 7.81) mm], respectively; No color signal of blood flow was demonstrated in 90% of the 21 entrapped labral plicaes; With regard to the mean thickness of cartilage of femora head, anterior layer and posterior layer of the anterior capsule, there were no statistical significant differences between the three groups (P > 0.05). After manual reduction and conservative treatment, all of the entrapped labral plicae and fluids disappeared in the US follow-up examinations. CONCLUSION: The entrapped labral plicae in the inferomedial recess of hip joints could be visualized by the US. The US provides a useful diagnostic clue to LPEH in children.