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.

The adverse consequences of pyoderma gangrenosum in a 13 year old child.

INTRODUCTION: Pyoderma gangrenosum (PG) is an uncommon, but serious, non infectious, neutrophilic dermatosis that causes cutaneous necrosis with a characteristically rapid evolution. PRESENTATION OF CASE: A 13 year-old girl was admitted with a postoperative infected wound, which was surgically debrided. A new more aggressive lesion on the left upper extremity led the patient to the intensive care unit. Clinical diagnosis of pyoderma gangrenosum was introduced with a crucial delay. An immediate clinical improvement after immunosuppressive therapy with systemic corticosteroids and cyclosporine was observed. The extensive cutaneous deficits were covered with keratinocyte cultured cells with an aesthetically good outcome. DISCUSSION: Diagnosis of PG in young children is very difficult, especially without dermatological evaluation. This deforming ulcerative skin disease is probably a result of altered immunologic reactivity. Its early recognition may prevent unnecessary surgical treatment which leads to dangerous complications. CONCLUSION: To our knowledge this is the first case of PG with such a widespread distribution reported in a child, as a consequence of iatrogenic pathergy.

Liver trauma in children: Our experience.

AIMS AND OBJECTIVES: The purpose of this study was to determine the percentage, etiology, associated injuries and outcome of the children with liver trauma. MATERIALS AND METHODS: In a retrospective review all children below 15 years of age who had sustained abdominal trauma were included. the study duration was January 1994 to December 2004. RESULTS: Out of a total number of 436 trauma patients 34 were identified to have liver trauma (including one death). The median age was 5.89 and range: 1 to 14 years). Boys accounted for 76.4% (n = 26), and the most common cause was motor vehicle injuries, accounting for 41.17% (n = 14). Nine children underwent surgery (26.4%). Head injuries were the most common associated injuries, and the mortality rate was 2.94% (n = 1). CONCLUSIONS: The liver remained the second most commonly injured intraabdominal organ and nonoperative management is the preferred treatment for hemodynamically stable patients.