Efficacy of Strain Elastography in Diagnosis and Staging of Acute Appendicitis in Pediatric Patients.

BACKGROUND In the present study, the role and efficiency of strain elastography (SE) were evaluated in diagnosis and staging of acute appendicitis in pediatric patients. MATERIAL AND METHODS We enrolled 225 pediatric patients with suspected clinical and laboratory findings of acute appendicitis. Gray-scale sonographic findings were recorded and staging was made by the colorization method of SE imaging. Appendectomy was performed in all patients and the results of the surgical pathology were compared with the imaging findings. The sensitivity, specificity, and accuracy of SE imaging were determined in terms of evaluating the "acute appendicitis". RESULTS Sonographic evaluation revealed acute appendicitis in 100 patients. Regarding the SE analysis, cases with appendicitis were classified into 3 groups as: mild (n=17), moderate (n=39), and severe (n=44). The pathological evaluation revealed 95 different stages of appendicitis and normal appendix in 5 cases: acute focal (n=10), acute suppurative (n=46), phlegmonous (n=27), and perforated (n=12), regarding the results of surgical pathology. Five patients with pathologically proven "normal" appendix were noted as "mild stage appendicitis" based on gray scale and SE analysis. In total, when gray-scale and SE results were compared with pathology results regardless of the stage of appendicitis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96%, 96%, 95%, 96.8%, and 96%, respectively. No statistically significant difference was detected between other groups (P<0.05). CONCLUSIONS In acute appendicitis, the use of SE imaging as a supportive method for the clinical approach can be useful in diagnosis, and its results are closely correlated with the histopathologic stage of appendix inflammation.

Renal sparing surgery using focus ultracision harmonic scalpel in patients with bilateral wilms' tumor: case report.

BACKGROUND: Bilateral Wilms' tumor is rare and surgical treatment requires an individual approach. Surgical approach to the tumors located in the central part of the kidney represents a major challenge and nephrectomy is usually essential. Renal sparing surgery is difficult in such cases. CASE REPORT: We describe a 3 year-old female patient with bilateral Wilms' tumor arising in the central localisation of the right and foci in the left kidney enucleated successfully with a simple and comfortable renal preserving operative technique using Focus Ultracision Harmonic Scalpel. CONCLUSION: In cases when tumors are located in the central part of the kidney and partial nephrectomy is consequently very difficult, the use of a Focus Ultracision Harmonic Scalpel provides easy dissecting, enucleation, and excision of the tumor.