Neonatal haemostatic parameters in correlation to gestational age and birth weight.

INTRODUCTION: The aim of our study was to establish reference ranges for neonatal coagulation and fibrinolysis parameters and to investigate their relationship with gestational age (GA) and birth weight (BW). METHODS: A single-centre prospective study was conducted in all healthy neonates born in our hospital during the study period, excluding those with maternal or neonatal disorders and diseases that affect haemostasis. The following parameters were measured: fibrinogen, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT) as well as factors II, V, VII, VIII, IX, X, XI and XII, von Willebrand (vWF), protein C, free protein S, antithrombin (AT), activated protein C resistance (APCr), tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1). RESULTS: Study population consisted of 327 neonates. Fibrinogen, AT III, proteins C and S, PAI-1, vWF and factors II, V, VIII, IX, XI and XII were positively correlated, while PT, aPPT, INR, APCr and tPA were negatively correlated with GA and BW. Proteins C and S, factors II, VIII, IX, XI and vWF, as well AT III and PAI-1 had a significant positive linear correlation with GA, while aPTT had a significant negative one. Fibrinogen, and factors V, VII and XII had a significant positive linear correlation with BW, while factor VIII, tPA, as well PT and INR had a significant negative one. CONCLUSION: Fibrinogen, AT III, proteins C and S, PAI-1, vWF and factors II, V, VIII, IX, XI and XII increase with GA and BW.

Is intestinal stasis sufficient by itself in promoting enterocolitis in a non-genetic rat model of Hirschsprung's disease?

BACKGROUND: Hirschsprung's disease-associated enterocolitis (HE) is a life-threatening septic complication of Hirschsprung's disease (HD), leading to bacterial translocation (BT) and sepsis. Many factors, such as intestinal stasis, HD-related inherited immune disorders and abnormal mucosal secretion have been implicated in its pathogenesis. OBJECTIVES: To investigate the effect of intestinal stasis as an independent factor in the pathogenesis of HE intestinal lesions and its systematic effects. MATERIAL AND METHODS: The rectal ganglion cells of 46 Wistar rats were chemically ablated through local benzalkonium chloride (BAC) injection, in order to create a HD model (megacolon rats) that does not carry the possible genetic burden of HD. The animals were sacrificed either on the 20th or 25th day after ablation and were examined for histopathological changes on the wall of the small intestine, presence of bacterial translocation in body organs, body biometrics, and white blood cell count (WBC) and hemoglobin concentration. The results were compared to control animals. RESULTS: In the megacolon rats, severe damage on the small intestine as well as BT proportional to the extent of the intestinal damage and to the time elapsed after ablation was observed. Significant effects on the WBCs, hemoglobin concentration and biometric parameters were also observed. CONCLUSIONS: In megacolon rats, intestinal stasis can lead by itself to a full-blown HE. The HE lesions that promote BT are present even in regions distant from the aganglionic bowel and are proportional to the time elapsed under the influence of intestinal stasis. Systematic effects such as growth retardation are also produced.

Injury of the external genitalia in 10-year-old boy.

Degloving injury of penis and scrotum is very rare in child population and requires early reconstructive surgery for good outcomes. We report a 10-year-old boy with complete avulsion of the scrotum and partial of the penis caused by a bicycle chain due to off-road bicycling. The patient has been treated successfully with a single-staged surgery.

Antimesenteric gastrointestinal tract duplication undergoing non-ulcerative perforation.

Duplications of the gastrointestinal tract are rare malformations, most commonly presenting as cystic structures growing within the smooth muscle wall. Very rarely, they are completely detached from the tract. Several theories have been proposed regarding their embryological development, but no single one has been able to account for all of the described variants. The most common type of duplication is related to the small bowel and develops at its mesenteric border, assuming a spherical or tubular shape. Their clinical manifestations vary, depending mainly on their localization and size. Most commonly, they cause subacute abdominal pain and intestinal obstruction in children of less than two years of age. We present a case of an 8.5-year-old girl, investigated for right lower quadrant abdominal pain. On ultrasound scan, a cystic mass indicative of a duplication cyst was discovered and she underwent a laparotomy. A tense cystic spherical mass 2.2 cm in diameter was excised from the terminal ileum, 4 cm from the ileocecal valve. The cyst had the characteristics of a gastrointestinal tract duplication, except from the fact that it was located on the antimesenteric border of the intestine. On the other hand, the lesion did not present the characteristic features of a Meckel's diverticulum. According to our knowledge, this is the first report of an intestinal duplication cyst appearing on the antimesenteric intestinal border.

Proliferative Fasciitis in Childhood: A Review of Clinical Data Apropos of a Case.

Proliferative Fasciitis (PF) is a benign lesion with histologic and clinical features overlapping with those of malignant soft tissue tumours. Its occurrence in children is considered very rare. We present a case of PF appearing as a painful, red, gradually increasing in size lesion, during a period of a few weeks, on the finger of a five-year-old boy compromising the dermis and subcutaneous tissue. We were able to locate literature on 20 paediatric PF cases, which we review. Only five of these focus on the clinical data, the rest describing mainly histological findings. It is the first reported paediatric case appearing on the finger.

Multiparametric ultrasound findings in a patient with polyorchidism.

Polyorchidism is a rare condition usually incidentally discovered in young patients investigated with ultrasound for unrelated reasons. It is characterized by the presence of unilateral or, rarely, bilateral supernumerary testes which, depending on the type of polyorchidism, may have their own epididymis and vas deferens. Ultrasound, including B-mode and color Doppler technique, represents the primary imaging modality for the evaluation of scrotal diseases, including the characterization of supernumerary testes, which normally appear identical to the ipsilateral testicular parenchyma on every ultrasonographic technique performed. The role of MRI is thus limited to confirming ultrasonographic findings and excluding the presence of malignancy. Contrast-enhanced ultrasound is a recently introduced ultrasonographic technique providing detailed and sensitive visualization of the perfusion pattern of structures. It can thus be added to the conventional ultrasonographic examination in order to establish the diagnosis, negating the use of more expensive and time-consuming imaging modalities. We present a young patient with an incidentally found supernumerary testis, where new distinctive ultrasonographic findings, like the identification of transmediastinal vessels and a cystic appendage along with the perfusion pattern on contrast-enhanced ultrasound, established the diagnosis of polyorchidism.

Imperforate Anus with Fistula Exiting at the Penile Skin.

We present the case of a male neonate with imperforate anus and a fistula exiting on the penile skin. Anorectal malformations in boys often present themselves with an entero-perineal or entero-urinary tract fistula, the type of which is a key feature for the classification and the treatment plan. A fistula exiting in front of the scrotum, such as described in our case, is very rare and is not incorporated in the current classification and treatment algorithms. Scarce reports on misjudgment concerning the position of the blind rectal pouch in similar cases, led us to perform a colostomy instead of a one-stage correction. A posterior sagittal anorectoplasty was performed eight months later and the rectal pouch was found inside the levator sling, justifying the cautious approach. The colostomy was closed three months later and after six months the distal part of the fistula was excised. We believe that in cases with a rare fistula presentation, the position of the rectal pouch is not predictable and the surgeon should proceed with caution.

A combined preperitoneal and inguinal approach for redo orchiopexy.

INTRODUCTION: Redo orchiopexy involves a hazardous dissection inside the inguinal canal (IC) where scar tissue encircles the testicular vessels (TesV), vas deferens (VD), and the testis. OBJECTIVE: The aim was to describe and evaluate a combined preperitoneal and inguinal approach (CPI) through a single cutaneous incision and accomplish this task as safely as possible, at the same time permitting additional maneuvers for cord lengthening. MATERIAL AND METHODS: We prospectively studied eight patients aged from 2.7 to 13 years (mean 7 years) reoperated for failed orchiopexy using the CPI approach. Reoperation took place 12 months to 11 years (mean 4.4 years) after the initial operation. Through a single transverse skin crease incision over the IC, at the level of the deep inguinal ring (DIR), we gained access to both the preperitoneal space (PPS) and the IC. We first entered the PPS, the peritoneum is retracted, and the VD and TesV are seen entering the DIR. They are gently dissected and two vascular lacets are passed around them. We introduce the backside of an anatomic forceps through the DIR, just under the anterior IC wall, until it is impeded by adhesions and then incise above the forceps, thus protecting the cord structures. Through that opening we transpose one of the lacets that encircle the VD and TesV and exercise traction upon them (figure, 1), revealing step by step the points where adhesiolysis must take place (figure, 2). The testis is dissected last of all and delivered back, through the DIR, into the PPS. There, the TesV and VD are freed from their retroperitoneal attachments (figure, 3). Finally, the testis is fixed into a Dartos pouch. RESULTS: In all cases the testes were relocated to the scrotum without any mishaps. All testes were inside the scrotum at first month examination and with good consistency. At 6 months, one testis ascended at mid-scrotum. At 2 years they all retained their position and their good standing, according to clinical and ultrasonographic findings. DISCUSSION: Several procedures of redo orchiopexies have been published so far, most of them rely on the surgeon's dexterity for good results. The CPI procedure offers a practical maneuver to protect the cord elements while dissecting and also exposes all the regions where dissection will offer lengthening of the cord. CONCLUSION: Our results have demonstrated that the CPI can be considered as a safe and efficient procedure for redo orchiopexy.

Uncommon Surgical Causes Of Right Lower Quadrant Pain In Children. Single Center Experience.

Right lower quadrant pain is one of the major reasons of children reference at the emergency department. The most common surgical cause, which needs appropriate management, is acute appendicitis. The purpose of this study is to reveal uncommon surgical causes found during surgery in children who were misdiagnosed as acute appendicitis in our department during the last 10 y. Data of patients who have undergone appendicectomy during a ten year period (since Feb 2004 until Mar 2014) were collected retrospectively. Eight hundred twenty children have undergone appendicectomy in our department. In six children another uncommon cause of the symptoms was revealed during surgery. In one patient the cause was a duplication cyst of the terminal ileum, in two patients an omental torsion, in one patient a meckel diverticulum torsion, in one patient a splenic rupture and in one patient a retroperitoneal tumor. All of the patients were successfully managed during the first operation. The possibility of other uncommon causes of right quadrant abdominal pain should always be kept in mind, especially when there is a negative appendicitis. However, the transaction of further paraclinical examinations - ultrasonography or computed tomography- preoperatively is under discussion. Nevertheless a thoroughly taken case history is undoubtedly always necessary.

Prentiss orchiopexy applied in younger age group.

PURPOSE: To evaluate the efficacy and safety of the operative technique for the correction of cryptorchidism described by Prentiss in the 1950s, who conducted measurements on patients over 6 years of age, and on cadaveric specimens. We applied the technique in a younger age group. MATERIAL AND METHODS: We prospectively studied the results of 50 orchiopexies in children 8-59 months of age (mean 32.3 months), separated into three age groups: 8-18 (N=14), 19-36 (N=18), and 36-59 (N=18) months. The patients were selected for having their undescended testis in the inguinal canal and not reaching the scrotum after adequate inguinal and retroperitoneal dissection. We eliminated the anatomic angulation of the vas deferens and testicular vessels around the internal inguinal ring and inferior epigastric vessels, in order to improve distal scrotal positioning (Prentiss maneuver). We compared the position of the testis before and after the maneuver. We re-examined the children 1 year postoperatively for testicular position and quality. RESULTS: The average gain in scrotal positioning was 6-20 mm (mean 13 mm). At follow-up, 36 testes (78%) had retained a low scrotal position, 10 (20%) a middle scrotal position, and 4 (8%) presented in an upper scrotal position. CONCLUSIONS: The Prentiss maneuver is both safe and efficient when applied to the younger age group, in order to gain adequate intrascrotal cord length and to place the testis in a more distal scrotal position.