Proteomics of urinary small extracellular vesicles in early diagnosis of kidney diseases in children-expectations and limitations.

The primary function of the kidneys is to maintain systemic homeostasis (disruption of renal structure and function results in multilevel impairment of body function). Kidney diseases are characterized by a chronic, progressive course and may result in the development of chronic kidney disease (CKD). Evaluation of the composition of the proteome of urinary small extracellular vesicles (sEVs) as a so-called liquid biopsy is a promising new research direction. Knowing the composition of sEV could allow localization of cellular changes in specific sections of the nephron or the interstitial tissue before fixed changes, detectable only at an advanced stage of the disease, occur. Research is currently underway on the role of sEVs in the diagnosis and monitoring of many disease entities. Reports in the literature on the subject include: diabetic nephropathy, focal glomerulosclerosis in the course of glomerulopathies, renal fibrosis of various etiologies. Studies on pediatric patients are still few, involving piloting if small groups of patients without validation studies. Here, we review the literature addressing the use of sEV for diagnosis of the most common urinary disorders in children. We evaluate the clinical utility and define limitations of markers present in sEV as potential liquid biopsy.

Aggressive Angiomyxoma in an 11-Year-Old Boy - Diagnostic and Therapeutic Dilemmas: An Unusual Case Report and Review of the Literature.

Aggressive angiomyxoma (AAM) is a rare tumor with a high risk of local recurrence. Scrotal AAM mimics common pediatric pathologies including hernia or hydrocele. We present 11-year-old boy who underwent macroscopically radical excision of right scrotal AAM. The patient has been already followed up for 29 months utilizing US every 6 months and MRI every 2 years. Residual scrotal mass has been visualized in MRI 3 months after surgery however no further growth was reported. Long term follow up with reliable local imaging is mandatory.

No Appendix is Too Short-Simultaneous Mitrofanoff Catheterizable Vesicostomy and Malone Antegrade Continence Enema (MACE) for Children with Spina Bifida.

OBJECTIVE: To present the results of simultaneous creation of both Mitrofanoff stoma and Malone antegrade continence stoma (MACE) using simple division of the appendix and a cecal extension method. MATERIALS AND METHODS: Between June 2011 and November 2016, simultaneous Mitrofanoff and MACE was performed in 16 children (12 children-simple division of the appendix, 4 children-appendicovesicostomy and cecal extension of the appendix). Extension of the appendix was achieved by tubularization of the excised cecal flap next to the short appendicular stump. The new extended channel was then wrapped by cecal wall. RESULTS: Follow-up was 40 months (10-74 months). Currently, in all children, both stomas are easily catheterizable. Obstruction of MACE occurred in 5 children (4 with split appendix, 1 with extended appendix); Mitrofanoff stomal stenosis occurred in 1 child. Endoscopic revision and prolonged catheterization of stenotic stomas were effective in all cases. Wound infection and dehiscence was noted in 2 children (both with split appendix). Drainage and intravenous antibiotics were effective. All Mitrofanoffs are continent. In 4 children there is incident minor leakage of the MACE (3 with split appendix and in 1 with extended appendix). CONCLUSION: The split appendix procedure is feasible. Cecal extension of the appendix seems to be a good option when the appendix is too short for a simple split procedure.

[Congenital sternal cleft: a case report]. / Wrodzony rozszczep mostka ­ opis przypadku.

Sternal cleft is a very rare congenital defect of sternum, reported only in limited number of publications. Surgical treatment in neonatal period is preferred. The case of child with congenital sternal cleft operated in 17 month of life with successful outcome of repair was reported.

Foreign body aspiration in children: diagnostic and therapeutic role of bronchoscopy.

PURPOSE: Assessment of bronchoscopy usefulness for diagnosis and treatment in children suspected of foreign body aspiration. MATERIAL AND METHOD: There were 27 boys and 18 girls in the age from 15 month to 14 years (average 5.5 years). Rigid bronchoscopy was performed under general anaesthesia. Assessment of the respiratory tract was done and in cases with foreign body bronchoscopic evacuation was executed. Medical records and video recordings of bronchoscopy procedures were subjected to retrospective analysis. RESULTS: In 28 children (62.2%) during bronchoscopy, foreign body aspiration recognized in 17 (37.8%) bronchoscopy cases was negative. In 27 patients, foreign bodies were removed. In one child, foreign body was evacuated during second bronchoscopy after preparing proper instrumentation. There were no complications in post-bronchoscopic period. Operating time was from 5 to 90 min, average time was noted to be 24 min. Average time of hospital stay was 2-3 days. CONCLUSIONS: Aspiration of foreign body should be suspected in all cases of bronchopulmonary infection with atypical course. Bronchoscopy is the best diagnostic and therapeutic method in all suspicions of foreign body. In children rigid bronchoscopy is still the method of choice.