Gastroschisis: a ten year review.

From 1983 to 1993, 30 cases of gastroschisis were managed at the Mayaguez Medical Center. Ninety percent of these patients underwent primary closure of their abdominal wall defect. Three of 30 patients (10%) required silastic or goretex silos with final closure in an average of 8 days. There was no sex predilection, the average birth weight was 2.4 kg and the mean gestational age was 36 weeks. Thirty percent had associated anomalies, the majority were intestinal atresia, and/or undescended testicles. Twenty one (70%) of infants were delivered vaginally. Nine children (30%) were delivered via cesarean section. Four cesarean sections were done solely after prenatal ultrasonic identification of gastroschisis. There was no improvement in hospital stay, complications, or days until enteral feeds were tolerated when vaginally delivered patients were compared to those born by c-sections. In seven patients mesh sheeting (Marlex) was used for closure of late hernia defects. The mean hospital stay was 50 days and the mean time to enteral feedings 20 days. All patients required postoperative mechanical ventilation for an average of 4 days. There was no mortality. Our data and review of the literature do not support gastroschisis prenatal diagnosis as a sole indication for cesarean section. Our data showed favorable prognosis for most babies. Primary fascial closure can be accomplished safely in the majority of patients. No single operative strategy is ideal for all patients, and treatment of individual defects should be tailored to the degree of visceroabdominal disproportion.

Pediatric thyroid nodules: insights in management.

BACKGROUND: Multiple diagnostic studies are utilized to unveil malignancy in pediatric thyroid nodules and determine whether surgical therapy is needed. PURPOSE: The aim of this report was to determine whether management of pediatric thyroid nodules has changed with the current use of diagnostic modalities such as ultrasonography (US), radionuclear scans (RNS) and fine needle aspiration biopsy (FNAB). MATERIAL/METHODS: Twenty-four children with thyroid nodules managed during a ten-year period comprised the study group. Demographic characteristics, clinical manifestations, US and RNS imaging findings, FNAB results, surgical therapy, complications and pathological reports were retrospectively reviewed. US, RNS and FNAB results were categorized as either benign, malignant, suspicious or insufficient. RESULTS: Females outnumbered males by a five to one ratio. Mean age was 14.9 years. Nineteen nodules were benign (79%) and five malignant (21%). All children were euthyroid. Benign nodules were soft, movable, solitary and nontender. Malignant nodules were characterized by localized tenderness, a multiglandular appearance, and fixation to adjacent tissues. US and RNS gave no clue toward management since cystic and hot nodules figured among malignant cases respectively. US achieved 86% accuracy, 80% sensitivity and 88% specificity; RNS showed 26% accuracy, 80% sensitivity and 11% specificity; FNAB achieved 80% accuracy, 60% sensitivity and 90% specificity. Suppressive thyroid hormone therapy was useless in the few cases tried. Physical examination findings, persistence of the nodule, progressive growth and cosmetic appearance where the most common indications for surgery. CONCLUSIONS: Present diagnostic modalities played a minor role in the decision to withhold surgery. US was useful for aiming aspiration of cystic nodules. RNS decided the functionality of the nodule, but its accuracy was far from ideal. FNAB is a safe procedure whose greatest help was to resolve in case of suspicious or malignant cytology that a more radical procedure is needed. Clinical judgement as determined by serial physical findings and suspicion continues to be the most determinant factors in the management of thyroid nodules in children.

Primitive peripheral neuroectodermal tumors Mayagüez Medical Center experience.

Primitive neuroectodermal or neuroepithelial tumors are names used to describe neoplasias composed of undifferentiated cells resembling germinal cells of the embryonic neural tube. These tumors are small round cell malignancies of the neural crest origin arising outside the central and sympathetic nervous system. They are described as peripheral and central neuroectodermal tumors related to the original malignant cell. A great number of tumors are described under this classification in spite of the fact that there is no an universal acceptance that these small-cell neoplasms, regardless of their primary site, are derived from immature neuroectoderm tissue. Because one tumor resembles others in terms of its phenotypic expression, multiple specific studies such as clinical profile, ultrastructural, immunocytochemical, and cytogenetic features should be studied, since no single clinical or laboratory marker is by itself diagnostic. However, there is a chromosomal reciprocal translocation, t(11;22)(q24;q12), which is unique to Primitive Neuroectodermal Tumor (PNET).

Solid and papillary neoplasm of the pancreas: a case presentation.

Solid and papillary tumors of the pancreas are very rare malignancies, more commonly occurring in young women. They usually present as asymptomatic, large abdominal masses, and different from the most common neoplasm of the pancreas, which is the adenocarcinoma, these tumors have a high percentage of curability when treated by complete surgical resection. (6) For this reason, when the diagnosis of Frantz's tumor is made or strongly suspected, every attempt should be made for complete surgical excision since curability is high and radiotherapy and, or chemotherapy are of no use for its treatment.

Bifid scrotum, perineal hamartoma and high imperforate anus: a case report.

This is a case report of a newborn patient with imperforate anus, urethro-colonic fistula, perianal hamartoma, and bifid scrotum. Successful staged repair of these anomalies is described together with review of the embriology related to the case.

Uretero-arterial fistula: a case report and review of the literature.

We report the case of a uretero-arterial fistula (UAF) formation in a 68 years old male who had previously undergone an Aortobifemoral graft. He got complicated with occlusion and infection of the right lower extremity requiring a right hip disarticulation for its management. This was followed by groin infection and graft protusion, managed by transabdominal resection of the right graft limb, at which time the right ureter was lacerated and repaired. Several months later, he presented with gross hematuria found to be secondary to UAF. The diagnostic and management steps leading to this patient care will be reviewed, together with a review of the literature pertinent to this case report.

Acute appendicitis: as a predisposing factor for acute glomerulonephritis--report of two cases.

This is a review of two children who developed acute glomerulonephritis (AGN) following acute gangrenous appendicitis (AGA) with periappendicular collections. The first patient presented with AGN during the course of appendicitis. The second patient developed AGN after appendectomy. Both patients did not have any other predisposing factors. AGN resolved in both patients after massive intravenous antibiotics. This is the first report of acute appendicitis as a predisposing factor for AGN.

Unusual case of Meckel's diverticulum: a case report and review of an atypical form of presentation.

This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Diverticulum (MD). The patient presented with multiple complications, such as: neoplasia, occult chronic bleeding, giant size MD, partial intestinal obstruction and severe symptomatic anemia. There was complete resolution of the condition after resection and ileo-ileal anastomosis. After revision of the literature, this case is the first report of MD occurring concomitantly with such a myriad of signs and symptoms.

Pediatric thyroid nodules: management in the era of fine needle aspiration.

BACKGROUND/PURPOSE: Thyroid nodules are rare in children. The need to uncover malignancy is the most challenging dilemma in management. The aim of this report was to determine whether management of pediatric thyroid nodules has changed in the era of fine-needle aspiration (FNA) cytology. METHODS: Twenty-four children with thyroid nodules comprised the study group. Demographic characteristics, clinical manifestations, imaging results, FNA cytology results, surgical therapy, complications, and pathological reports were reviewed retrospectively. FNA cytology results were categorized as either benign, malignant, suspicious, or insufficient. RESULTS: Girls outnumbered boys (five to one) with a mean age of 14.9 years. Nineteen nodules were benign and five malignant. Malignancy was characterized by localized tenderness, multiglandular appearance, and fixation to adjacent tissues. Ultrasound scans and nuclear scans gave no clue toward management because cystic, hot, and warm nodules figured among malignant cases. FNA in 18 children achieved 80% accuracy, 60% sensitivity, 90% specificity, 75% positive, and 81% negative predictive value. Physical examination findings, persistence of the nodule, and progressive growth decided for surgery in most children. CONCLUSIONS: FNA is a safe adjunctive test that plays a minor role in the decision to withhold surgery. Its greatest strength is to resolve, in case of suspicious or malignant cytology, that a more radical procedure will be needed. Clinical judgement as determined by serial physical findings continues to be the most important factor in the management of thyroid nodules in children.

Bifid scrotum, perineal hamartoma and high imperforate anus: a case report

This is a case report of a newborn patient with imperforate anus, urethro-colonic fistula, perianal hamartoma, and bifid scrotum. Successful staged repair of these anomalies is described together with review of the embriology related to the case

Solid and papillary neoplasm of the pancreas: a case presentation

Solid and papillary tumors of the pancreas are very rare malignancies, more commonly occurring in young women. They usually present as asymptomatic, large abdominal masses, and different from the most common neoplasm of the pancreas, which is the adenocarcinoma, these tumors have a high percentage of curability when treated by complete surgical resection. (6) For this reason, when the diagnosis of Frantz's tumor is made or strongly suspected, every attempt should be made for complete surgical excision since curability is high and radiotherapy and, or chemotherapy are of no use for its treatment

Uretero-arterial fistula: a case report and review of the literature

We report the case of a uretero-arterial fistula (UAF) formation in a 68 years old male who had previously undergone an Aortobifemoral graft. He got complicated with occlusion and infection of the right lower extremity requiring a right hip disarticulation for its management. This was followed by groin infection and graft protusion, managed by transabdominal resection of the right graft limb, at which time the right ureter was lacerated and repaired. Several months later, he presented with gross hematuria found to be secondary to UAF. The diagnostic and management steps leading to this patient care will be reviewed, together with a review of the literature pertinent to this case report

Primitive peripheral neuroectodermal tumors Mayagüez Medical Center experience

Primitive neuroectodermal or neuroepithelial tumors are names used to describe neoplasias composed of undifferentiated cells resembling germinal cells of the embryonic neural tube. These tumors are small round cell malignancies of the neural crest origin arising outside the central and sympathetic nervous system. They are described as peripheral and central neuroectodermal tumors related to the original malignant cell. A great number of tumors are described under this classification in spite of the fact that there is no an universal acceptance that these small-cell neoplasms, regardless of their primary site, are derived from immature neuroectoderm tissue. Because one tumor resembles others in terms of its phenotypic expression, multiple specific studies such as clinical profile, ultrastructural, immunocytochemical, and cytogenetic features should be studied, since no single clinical or laboratory marker is by itself diagnostic. However, there is a chromosomal reciprocal translocation, t(11;22)(q24;q12), which is unique to Primitive Neuroectodermal Tumor (PNET)

Pediatric thyroid nodules: insights in management

BACKGROUND: Multiple diagnostic studies are utilized to unveil malignancy in pediatric thyroid nodules and determine whether surgical therapy is needed. PURPOSE: The aim of this report was to determine whether management of pediatric thyroid nodules has changed with the current use of diagnostic modalities such as ultrasonography (US), radionuclear scans (RNS) and fine needle aspiration biopsy (FNAB). MATERIAL/METHODS: Twenty-four children with thyroid nodules managed during a ten-year period comprised the study group. Demographic characteristics, clinical manifestations, US and RNS imaging findings, FNAB results, surgical therapy, complications and pathological reports were retrospectively reviewed. US, RNS and FNAB results were categorized as either benign, malignant, suspicious or insufficient. RESULTS: Females outnumbered males by a five to one ratio. Mean age was 14.9 years. Nineteen nodules were benign (79%) and five malignant (21%). All children were euthyroid. Benign nodules were soft, movable, solitary and nontender. Malignant nodules were characterized by localized tenderness, a multiglandular appearance, and fixation to adjacent tissues. US and RNS gave no clue toward management since cystic and hot nodules figured among malignant cases respectively. US achieved 86% accuracy, 80% sensitivity and 88% specificity; RNS showed 26% accuracy, 80% sensitivity and 11% specificity; FNAB achieved 80% accuracy, 60% sensitivity and 90% specificity. Suppressive thyroid hormone therapy was useless in the few cases tried. Physical examination findings, persistence of the nodule, progressive growth and cosmetic appearance where the most common indications for surgery. CONCLUSIONS: Present diagnostic modalities played a minor role in the decision to withhold surgery. US was useful for aiming aspiration of cystic nodules. RNS decided the functionality of the nodule, but its accuracy was far from ideal. FNAB is a safe procedure whose greatest help was to resolve in case of suspicious or malignant cytology that a more radical procedure is needed. Clinical judgement as determined by serial physical findings and suspicion continues to be the most determinant factors in the management of thyroid nodules in children

Gastroschisis: a ten year review

From 1983 to 1993, 30 cases of gastroschisis were managed at the Mayaguez Medical Center. Ninety percent of these patients underwent primary closure of their abdominal wall defect. Three of 30 patients (10%) required silastic or goretex silos with final closure in an average of 8 days. There was no sex predilection, the average birth weight was 2.4 kg and the mean gestational age was 36 weeks. Thirty percent had associated anomalies, the majority were intestinal atresia, and/or undescended testicles. Twenty one (70%) of infants were delivered vaginally. Nine children (30%) were delivered via cesarean section. Four cesarean sections were done solely after prenatal ultrasonic identification of gastroschisis. There was no improvement in hospital stay, complications, or days until enteral feeds were tolerated when vaginally delivered patients were compared to those born by c-sections. In seven patients mesh sheeting (Marlex) was used for closure of late hernia defects. The mean hospital stay was 50 days and the mean time to enteral feedings 20 days. All patients required postoperative mechanical ventilation for an average of 4 days. There was no mortality. Our data and review of the literature do not support gastroschisis prenatal diagnosis as a sole indication for cesarean section. Our data showed favorable prognosis for most babies. Primary fascial closure can be accomplished safely in the majority of patients. No single operative strategy is ideal for all patients, and treatment of individual defects should be tailored to the degree of visceroabdominal disproportion

Unusual case of Meckel's diverticulum: a case report and review of an atypical form of presentation

This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Diverticulum (MD). The patient presented with multiple complications, such as: neoplasia, occult chronic bleeding, giant size MD, partial intestinal obstruction and severe symptomatic anemia. There was complete resolution of the condition after resection and ileo-ileal anastomosis. After revision of the literature, this case is the first report of MD occurring concomitantly with such a myriad of signs and symptoms

Acute appendicitis: as a predisposing factor for acute glomerulonephritis--report of two cases

This is a review of two children who developed acute glomerulonephritis (AGN) following acute gangrenous appendicitis (AGA) with periappendicular collections. The first patient presented with AGN during the course of appendicitis. The second patient developed AGN after appendectomy. Both patients did not have any other predisposing factors. AGN resolved in both patients after massive intravenous antibiotics. This is the first report of acute appendicitis as a predisposing factor for AGN

Cecal volvulus after laparoscopic liver biopsy

Laparoscopic surgery has become widely accepted due to its benefits of less post-operative pain and shorter hospital stay. As with any other new technique, there are associated inherent complications. We present a case of cecal volvulus after laparoscopic liver biopsy. This is the first case reported in the literature of cecal volvulus secondary to laparoscopy

Squamous cell carcinoma of the prostate: case report and review of literature

Carcinoma of the prostate, that is adenocarcinoma, is one of the most common malignancies in the male with an estimated incidence for 1991 of 122,000 new cases. On the other hand, squamous cell carcinoma of the prostate, with a median incidence of .5%-1% of all prostatic malignancies, has a similar clinical presentation but differs in treatment response and prognosis. We herein present one case of this histological pattern and review the literature pertaining to it

Cecal volvulus after laparoscopic liver biopsy.

Laparoscopic surgery has become widely accepted due to its benefits of less post-operative pain and shorter hospital stay. As with any other new technique, there are associated inherent complications. We present a case of cecal volvulus after laparoscopic liver biopsy. This is the first case reported in the literature of cecal volvulus secondary to laparoscopy.