Complications of Serious Pediatric Conditions in the Emergency Department: Definitions, Prevalence, and Resource Utilization.

OBJECTIVES: To define and measure complications across a broad set of acute pediatric conditions in emergency departments using administrative data, and to assess the validity of these definitions by comparing resource utilization between children with and without complications. STUDY DESIGN: Using local consensus, we predefined complications for 16 acute conditions including appendicitis, diabetic ketoacidosis, ovarian torsion, stroke, testicular torsion, and 11 others. We studied patients under age 18 years using 3 data years from the Healthcare Cost and Utilization Project Statewide Databases of Maryland and New York. We measured complications by condition. Resource utilization was compared between patients with and without complications, including hospital length of stay, and charges. RESULTS: We analyzed 27 087 emergency department visits for a serious condition. The most common was appendicitis (n = 16 794), with 24.3% of cases complicated by 1 or more of perforation (24.1%), abscess drainage (2.8%), bowel resection (0.3%), or sepsis (0.9%). Sepsis had the highest mortality (5.0%). Children with complications had higher resource utilization: condition-specific length of stay was longer when complications were present, except ovarian and testicular torsion. Hospital charges were higher among children with complications (P < .05) for 15 of 16 conditions, with a difference in medians from $3108 (testicular torsion) to $13 7694 (stroke). CONCLUSIONS: Clinically meaningful complications were measurable and were associated with increased resource utilization. Complication rates determined using administrative data may be used to compare outcomes and improve healthcare delivery for children.

Factors Associated with Delayed Presentation and Misdiagnosis of Testicular Torsion: A Case-Control Study.

We identified factors associated with delay in presentation and misdiagnosis of testicular torsion. Compared with acute cases, delayed presentations were more likely to report isolated abdominal pain, developmental disorders, and history of recent genital trauma. Failure to perform a genitourinary examination or scrotal imaging was associated with misdiagnosis.

Protective effects of abdominal electroacupuncture on oxidative stress and inflammation due to testis torsion/detorsion in rats.

PURPOSE: To evaluate the effects of acupuncture (Ac) and electroacupuncture (EAc) on oxidative stress and inflammation in testis torsion/detorsion (T/D) model in rats. METHODS: Thirty male Wistar rats were randomized into five groups. G1 Group (Sham) served as control. The remaining groups were submitted to spermatic cord torsion (720°) for 3 hours, followed by detorsion and reperfusion for 4 hours. Before detorsion G3, G4 and G5 rats were treated with Ac, EAc 2Hz and EAc 10 Hz, respectively, applied to acupoint Gulai (S-29) bilaterally under anesthesia for 5 minutes. Next, the testes were detorsioned and reperfused for 4 hours. Afterwards, blood samples and the right testis were collected for biochemical assays: reduced Glutathione (GSH), Malonaldehyde (MDA), Myeloperoxidase (MPO). RESULTS: EAc stimulation (2 and 10 Hz) promoted significant increase in concentrations of GSH in plasma and testis of G4-G5 rats, compared with G1. There was significant increase of tissue MDA in groups G4-G5 and plasma MDA in all groups, compared with G1. There was a significant reduction in MPO activity in groups G4-G5 compared with G1. CONCLUSION: Electroacupuncture stimulation (2 and 10 Hz) attenuates oxidative stress and inflammatory response in rats subjected to testicular torsion/detorsion.

Protective effects of abdominal electroacupuncture on oxidative stress and inflammation due to testis torsion/detorsion in rats

PURPOSE: To evaluate the effects of acupuncture (Ac) and electroacupuncture (EAc) on oxidative stress and inflammation in testis torsion/detorsion (T/D) model in rats. METHODS: Thirty male Wistar rats were randomized into five groups. G1 Group (Sham) served as control. The remaining groups were submitted to spermatic cord torsion (720°) for 3 hours, followed by detorsion and reperfusion for 4 hours. Before detorsion G3, G4 and G5 rats were treated with Ac, EAc 2Hz and EAc 10 Hz, respectively, applied to acupoint Gulai (S-29) bilaterally under anesthesia for 5 minutes. Next, the testes were detorsioned and reperfused for 4 hours. Afterwards, blood samples and the right testis were collected for biochemical assays: reduced Glutathione (GSH), Malonaldehyde (MDA), Myeloperoxidase (MPO). RESULTS: EAc stimulation (2 and 10 Hz) promoted significant increase in concentrations of GSH in plasma and testis of G4-G5 rats, compared with G1. There was significant increase of tissue MDA in groups G4-G5 and plasma MDA in all groups, compared with G1. There was a significant reduction in MPO activity in groups G4-G5 compared with G1. CONCLUSION: Electroacupuncture stimulation (2 and 10 Hz) attenuates oxidative stress and inflammatory response in rats subjected to testicular torsion/detorsion. .

Protective effects of abdominal electroacupuncture on oxidative stress and inflammation due to testis torsion/detorsion in rats

PURPOSE: To evaluate the effects of acupuncture (Ac) and electroacupuncture (EAc) on oxidative stress and inflammation in testis torsion/detorsion (T/D) model in rats. METHODS: Thirty male Wistar rats were randomized into five groups. G1 Group (Sham) served as control. The remaining groups were submitted to spermatic cord torsion (720°) for 3 hours, followed by detorsion and reperfusion for 4 hours. Before detorsion G3, G4 and G5 rats were treated with Ac, EAc 2Hz and EAc 10 Hz, respectively, applied to acupoint Gulai (S-29) bilaterally under anesthesia for 5 minutes. Next, the testes were detorsioned and reperfused for 4 hours. Afterwards, blood samples and the right testis were collected for biochemical assays: reduced Glutathione (GSH), Malonaldehyde (MDA), Myeloperoxidase (MPO). RESULTS: EAc stimulation (2 and 10 Hz) promoted significant increase in concentrations of GSH in plasma and testis of G4-G5 rats, compared with G1. There was significant increase of tissue MDA in groups G4-G5 and plasma MDA in all groups, compared with G1. There was a significant reduction in MPO activity in groups G4-G5 compared with G1. CONCLUSION: Electroacupuncture stimulation (2 and 10 Hz) attenuates oxidative stress and inflammatory response in rats subjected to testicular torsion/detorsion. (AU)

Protective effects of melatonin on testicular torsion and detorsion damage in sprague-dawley rats / Efectos protectores de la melatonina en el daño por torsión y destorsión testicular en ratas prague-dawley

In this study, we evaluated the ultrastructural findings of testis with systemic administration of different doses of melatonin during ischemic period in a rat model of testicular torsion/detorsion (T/D). Testis ischemia-reperfusion (I/R) injury was induced by torsion of the left testis, with a 720 degrees twisting of the spermatic cord so as to produce a total occlusion of testis for 2.5 hours. Subsequently, the same testis was then detorsioned. According to surgical procedure in each group, unilateral orchiectomies were performed for histopathologic examination. The groups were labelled as control group, torsion group (T), torsion and detorsion group (T/D), torsion-detorsion and melatonin group (T/D+20,50 and 100 mg/kg melatonin). For the histological examination, testicular tissues were fixed in 2.5 percent glutheraldehyde and postfixation 1 percent osmic acid solutions. They were examined under transmission electron microscopy after application of contrast stained. In torsion group testis cross-sections, cytoplasm residues of mature sperms and large vacuole-like structures were noticeable. In detorsion group testis cross-sections, dissociations in spermatocide nuclei, many vacuoles and residual particles resulting from organelle degeneration, local voids in cytoplasms of spermatogonia, dilatation in granulated endoplasmic reticulum, large lipid droplets, chromatid particles, along with mitochondrial crystalisis were determined. In the testis cross-sections of the group of T/D+50 mg/kg melatonin administration, sertoli and spermatogonia cells that showed membrane-like structures and cytoplasmic voids were observed. Testis cross-sections of rats that were administered with T/D+50 mg/kg melatonin showed small mitochondrions and vacuole-like structures placed on the edge. Testis cross-sections of rats that were administered with T/D+100 mg/kg melatonin resulted in views similar to those of controls in the microstructural level. As a result, the most effective...

Se evaluaron, en un modelo de torsión/detorsión (T/D) testicular en rata, los cambios ultraestructurales producidos en los testículos, posterior a la administración sistémica de diferentes dosis de melatonina, durante el período de isquemia. La lesión de isquemia-reperfusión (I/R) testicular fue inducida por la torsión del testículo izquierdo, con un giro de 720 grados del cordón espermático con el fin de producir una oclusión total de los testículos durante 2,5 horas. Posteriormente, los mismos testículos fueron detorsionados. De acuerdo con el procedimiento quirúrgico en cada grupo, fueron realizados exámenes histopatológicos de las orquiectomías unilaterales. Los grupos fueron divididos en grupo control, grupo torsión (T), grupo torsión/destorsión (T/D), y grupo torción/destorsión con melatonina (T/D +20, 50 y 100 mg/kg de la melatonina). Para el examen histológico, los tejidos testiculares fueron fijados en soluciones de glutaraldehído al 2,5 por ciento y postfijados al 1 por ciento en ácido ósmico. Luego fueron examinados, después de la aplicación de contrastes de colores, a través de microscopía electrónica de transmisión. En las secciones transversales del grupo con torsión testicular, fueron visibles residuos citoplas-máticos de espermatozoides maduros y grandes estructuras vacuolares. En las secciones transversales del grupo con destorsión testicular, se observaron disociaciones en los núcleos espermáticos, numerosas vacuolas y partículas residuales derivadas de la degeneración de organelos; además de espacios localizados en el citoplasma de las espermatogonias, dilatación en el retículo endoplasmático rugoso, grandes gotas de lípidos y partículas de cromátidas, junto con cristálisis mitocondrial. En las secciones transversales del grupo T/D +50 mg/kg de administración de melatonina, células sustentaculares y espermatogonias mostraron estructuras tipo membrana y vacíos citoplasmáticos. Las secciones transversales del grupo con torsión en la que fue ...

Diagnóstico diferencial y manejo del escroto agudo en niños / Differential diagnosis and management of the acute scrotum in children

Acute scrotum is a common entity found in pediatric emergency rooms all over the world. This is a syndrome in which fast and accurate diagnosis is vital to perform an effective treatment of the underlying disease. Testicular torsion is the first diagnosis that has to be discarded. Torsion of appendix testis and epididymitis or orchitis must also be considered. If clinical signs are compatible with testicular torsion, and especially if the condition has not passed the six hours threshold, surgical exploration has to be perform at once. Radiological tests cannot delaysurgical exploration. Detorsion must be achieved as soon as possible to prevent irreversible ischemia and necrosis of the testicle that could lead to an orchiectomy. Once the torsion is relieved, the testicle must be placed in warm, moist sponges to test for adequate perfusion. If the testicle has acceptable blood supply, both testicles have to be fixed to prevent similar events in the future. If health providers are familiarized with the clinical presentation of these conditions, testicular torsion and other causes of acute scrotum could be diagnosed and treated rapidly and therefore important complications, such as fertility impairment, could be prevented.

Manejo de urgencias genitourinarias en cirugía pediátrica / Management of genitourinary surgical emergencies

Las urgencias en pediatría siempre han constituido un problema frecuente y, muchas veces, difícil de resolver, ya sea por la poca historia aportada por los padres -lo que es propio de la preocupación y ansiedad de la situación-, como también por la falta de información en relación a algunas maniobras simples que pueden ser realizadas por cualquier médico. Las lesiones genitourinarias suelen desestimarse en una evaluación de urgencia, a pesar de la trascendencia que éstas pudieran tener a futuro, por lo que suelen pesquisarse en una evaluación secundaria, o luego de la aparición de complicaciones. El presente artículo tiene como objetivo dar a conocer los conceptos que componen el manejo de urgencias genitourinarias en cirugía pediátrica, haciendo énfasis en aquellas que ocurren con mayor frecuencia y que implican un riesgo de complicaciones deletéreas, así como también en las que, por simplicidad de maniobras, pueden ser realizadas en cualquier servicio de atención de urgencia. Los temas expuestos son: torsión testicular, torsión de hidátide testicular, parafimosis, lesiones del tracto urinario y atrapamiento de prepucio en cremallera del pantalón.

Efeito do alopurinol sobre a morfologia do testículo do rato submetido a isquemia, pela torção do cordão espermático seguida de reperfusão / Effect of allopurinol on rat testicles morfology, submited to ischaemia for spermatic cord torsion followed by reperfusion

OBJETIVO: Estudar o efeito do alopurinol no fenômeno de isquemia-reperfusão em testículos de ratos. MÉTODOS: Foram utilizados 80 ratos Wistar, adultos, distribuídos em 4 grupos: controle sem alopurinol, controle com alopurinol, torção do cordão espermático sem alopurinol e torção do cordão espermático com alopurinol. Os testículos foram retirados após 60 dias do ato operatório e processados para exame histológico à microscopia óptica, onde os túbulos seminíferos e as células espermatogênicas foram objeto de estudo. RESULTADOS: A comparação entre os grupos demonstrou que houve atrofia dos testículos que foram submetidos à torção, inclusive o grupo que recebeu o alopurinol. CONCLUSÃO: O alopurinol não protegeu as gônadas dos efeitos da isquemia reperfusão.

[Effect of allopurinol on rat testicles morphology, submitted to ischaemia for spermatic cord torsion followed by reperfusion]. / Efeito do alopurinol sobre a morfologia do testículo do rato submetido a isquemia, pela torção do cordão espermático seguida de reperfusão.

PURPOSE: In this investigation has been studied the effect of the allopurinol on the reperfusion injury phenomenon in testicles of rats. METHODS: Eighty adults Wistar rats were divided in 4 groups: sham without allopurinol, sham with allopurinol, right testicular torsion for one hour without allopurinol and right testicular torsion for one hour with allopurinol. Bilateral orchiectomy was performed 60 days of the experiment and the testis were processed for optical microscopy, and examined to asses the seminiferous ducts and the spermatogenic cells. RESULTS: There was significant atrophy and histological damage of the right testis. CONCLUSION: Allopurinol did not protected the testis against the effects of the reperfusion injury.