¿Sirven los hallazgos prequirúrgicos para interpretar las lesiones ováricas neoplásicas y no neoplásicas e influir en las decisiones quirúrgicas en niñas y adolescentes? / Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents?

Antecedentes. Las masas ováricas son frecuentes en la población pediátrica. Suele realizarse cirugía conservadora de los ovarios porque la mayoría son quistes benignos o funcionales. Objetivo. Investigar quéhallazgos prequirúrgicos sirven para diferenciar la patología de las lesiones ováricas, influir en las decisiones quirúrgicas y predecir la posibilidad de conservar los ovarios. Método. Se incluyeron pacientes operadas con diagnóstico de masa ovárica. Revisión retrospectiva de edad, síntomas, examen físico, marcadores tumorales, características radiológicas y resultados anatomopatológicos. Resultados. Durante el estudio, se operaron 98 pacientes y se incluyeron 86. Media de edad: 9,7 ± 5,62 años. Las patologías no neoplásicas representaron el 68,6 %, las neoplásicas, el 31,4 %, la tasa de malignidad, el 4,6 %. Las neoplasias incluyeron componente sólido, ausencia de torsión ovárica y diámetro >9 cm (p < 0,001;p < 0,001; p = 0,001).Se halló torsión anexial en el 34,9 %. El diámetro medio no difirió significativamente entre los grupos con o sin torsión; la incidencia de torsión fue mayor en las masas <6 cm (p = 0,019). Se realizó cirugía conservadora de los ovarios en 48 pacientes (55,8 %) y ooforectomía, en 38 (44,2 %). El tratamiento dependió de la naturaleza (p < 0,001) y del tamaño (p < 0,001) de la lesión pero no de la edad y la torsión. Conclusión. Una masa puramente quística <9 cm, con torsión y marcadores negativos indica masa no neoplásica. La presencia de un componente sólido y la ausencia de torsión están asociadas con riesgo de cáncer.

Background: Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. Method: Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. Results: During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter >9 cm were more commonly seen in neoplastic cases (p<0.001, p<0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses <6 cm (p=0.019). Ovarian-sparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p<0.001) and size (p<0.001) of the lesion; it was independent of age and presence of torsion. Conclusion: A purely cystic mass <9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.

Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents? / ¿Sirven los hallazgos prequirúrgicos para interpretar las lesiones ováricas neoplásicas y no neoplásicas e influir en las decisiones quirúrgicas en niñas y adolescentes?

BACKGROUND: Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. METHOD: Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. RESULTS: During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter > 9 cm were more commonly seen in neoplastic cases (p < 0.001, p < 0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses < 6 cm (p=0.019). Ovariansparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p < 0.001) and size (p < 0.001) of the lesion; it was independent of age and presence of torsion. CONCLUSION: A purely cystic mass < 9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.

Antecedentes. Las masas ováricas son frecuentes en la población pediátrica. Suele realizarse cirugía conservadora de los ovarios porque la mayoría son quistes benignos o funcionales. Objetivo. Investigar qué hallazgos prequirúrgicos sirven para diferenciar la patología de las lesiones ováricas, influir en las decisiones quirúrgicas y predecir la posibilidad de conservar los ovarios. Método. Se incluyeron pacientes operadas con diagnóstico de masa ovárica. Revisión retrospectiva de edad, síntomas, examen físico, marcadores tumorales, características radiológicas y resultados anatomopatológicos. Resultados. Durante el estudio, se operaron 98 pacientes y se incluyeron 86. Media de edad: 9,7 ± 5,62 años. Las patologías no neoplásicas representaron el 68,6 %, las neoplásicas, el 31,4 %, la tasa de malignidad, el 4,6 %. Las neoplasias incluyeron componente sólido, ausencia de torsión ovárica y diámetro > 9 cm (p< 0,001;p< 0,001; p = 0,001).Se halló torsión anexial en el 34,9 %. El diámetro medio no difirió significativamente entre los grupos con o sin torsión; la incidencia de torsión fue mayor en las masas < 6 cm (p = 0,019). Se realizó cirugía conservadora de los ovarios en 48 pacientes (55,8 %) y ooforectomía, en 38 (44,2 %). El tratamiento dependió de la naturaleza (p< 0,001) y del tamaño (p< 0,001) de la lesión pero no de la edad y la torsión. Conclusión. Una masa puramente quística < 9 cm, con torsión y marcadores negativos indica masa no neoplásica. La presencia de un componente sólido y la ausencia de torsión están asociadas con riesgo de cáncer.

Topical Ankaferd hemostat application for the management of oral cavity bleedings in children with hemorrhagic diathesis.

Ankaferd blood stopper (ABS) is a hemostatic agent used topically for controlling bleedings of skin or mucosal surfaces in Turkey. It is currently topically used in bleedings of body injuries, traumas, and minor or major surgical interventions. Here we have evaluated 12 pediatric patients with hemorrhagic diathesis on whom Ankaferd was used for oral bleedings. Topical Ankaferd was administered for hemorrhages of oral cavity during 15 bleeding attacks. ABS administrations successfully stopped the bleedings, except for one patient with oral hemorrhage who did not respond to ABS application. Ankaferd is effective for oral bleedings of children with bleeding diathesis especially when other measures have failed.

Formation of obstructing blood clot in the ureter in a patient with Glanzmann's thrombasthenia.

Glanzman thrombasthenia is a rare hematologic disorder characterized by qualitative thrombocyte abnormality. Patients present with episodic mucocutaneous bleeding. Thrombosis is a paradox phenomenon observed in patients with Glanzman thrombasthenia and generally considered as a treatment complication. We present a 16-year-old girl referred for severe flank pain beginning after treatment of hematuria due to Glanzman thrombasthenia. The patient underwent endoscopy for further diagnosis and treatment because of the failure of radiologic evaluation. Although the resolution of the large clots was obtained with streptokinase instillation via the ureteral catheter, clot was mobilized with gentle insertion of ureteral catheter in the present case.