[Associated trauma with urinary tract injuries]. / Traumatismes généraux avec participation des voies urinaires.

The authors analyze the peculiarities in the diagnostic and curative behavior in cases of associated traumatic injuries with participation of the urinary system in adults and children. A trauma is defined as associated when one kind of traumatic agent affects more then one organ or system. The authors do not discuss the combined trauma where we observed different damaging agents as for example mechanical trauma plus radiation or burn. The experience of the treatment of 64 children and 109 adults suffering from associated traumatic injuries for the period 1981-1997 has been summarized. In cases of associated traumatic injuries the kidneys are the most common participants on the part of the urinary system (70.3% of the children and 51.4% of the adults). On the second place we witness bladder damages in adults and urethra damages in children. The data concerning the combination between urological trauma and other organs traumas are available in details--the most common are: bone fractures, lesions of intraabdominal organs, skull and brain traumas, etc. The three basic problems caused by such kind of trauma are also discussed--organizational, diagnostic and curative. At the end the authors present the most typical characteristics of associated traumatic injuries in children compared to those in adults.

[Germ-cell tumors of the testis in childhood]. / Germinativnokletuchni tumori na testisa v detskata vuzrast.

Germinative-cell tumors are the most common tumors of the testis in children. For a period of 15 years (1975-1989) the authors have observed 12 children with these tumors. Leading symptoms in all children was a gradual painless enlargement of one testis; the symptomatic hydrocele may delay the correct diagnosis for several months. In young children the mothers noticed the testicular changes earlier, while in older children the diagnosis was delayed. Three quarters of the tumors were in the left testis, seldom in the right and still more seldom bilaterally. Diagnostic methods were applied mostly when metastases or recurrence were suspected; most common were computer tomography and lymphography. The most common benign testicular tumors were the mature teratomas and malignant--endodermal sinus tumors. The modern operative approach to these patients is emphasized: radical orchiectomy with pre- and postoperative determination of AMP levels, periodic control computer tomography and echography of the retroperitoneum and thorax with 2-year observation in stage I and modified lymphadenectomy in stage II. As a result of the complex surgical and oncologic therapy, the late results were good in 7 children, 2 died and 3 were lost from control.