RESUMEN
BACKGROUND: We sought to determine which demographic, clinical and ultrasonography characteristics are predictive of testicular torsion (TT) and to determine factors associated with time to treatment. METHODS: We retrospectively reviewed all medical records of patients (0-17 years) with acute scrotal syndrome (ASS) who were treated in our hospital in Lithuania between 2011 and 2020. We extracted patients' demographic data, in-hospital time intervals, clinical, US and surgical findings. TT was determined at surgery or clinically after manual detorsion. Test characteristics of demographic, clinical and US findings for the diagnosis of TT versus other causes of ASS were determined. We performed a multivariate analysis to identify independent clinical predictors of torsion, and factors associated with surgical delay. RESULTS: A search of medical records yielded 555 cases: 196 (35%) patients with TT and 359 (65%) patients with other ASS causes. Multivariate logistic regression analysis showed that age between 13 and 17 years (OR 8.39; 95% CI 5.12 to 13.76), duration of symptoms <7 hours (OR 3.41; 95% CI 2.03 to 5.72), palpated hard testis (OR 4.65; 95% CI 2.02 to 10.67), scrotal swelling (OR 2.37; 95% CI 1.31 to 4.30), nausea/vomiting (OR 4.37; 95% CI 2.03 to 9.43), abdominal pain (OR 2.38; 95% CI 1.27 to 4.45) were independent clinical predictors of TT. No testicular blood flow in Doppler US had a specificity of 98.2% and a positive predictive value of 94.6%. However, 75 (41.7%) patients with TT had normal testicular blood flow, yielding low sensitivity (58.3%) and negative predictive value of 81.3% for this US finding. In-hospital waiting time for surgery was longer in patients with TT with normal testicular blood flow by USS (195 min) compared with no blood flow (123 min), p<0.01. Higher orchiectomy rates were associated with longer duration of symptoms (p<0.001) and longer waiting time for USS (p=0.029) but not with false-negative US. CONCLUSIONS: Pubertal age, symptoms duration of <7 hours, nausea/vomiting, palpated hard testis, abdominal pain and scrotal swelling are predictive factors for TT. Time lost between symptom onset and seeking medical care, and between arrival and US are associated with the need for orchiectomy. Preserved blood flow in USS does not rule out TT and may contribute to delays to surgery.
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Torsión del Cordón Espermático , Adolescente , Humanos , Masculino , Dolor Abdominal , Estudios Retrospectivos , Factores de Riesgo , Torsión del Cordón Espermático/diagnóstico por imagen , Ultrasonografía DopplerRESUMEN
Tuberculosis (TB) remains a significant cause of morbidity and mortality in the modern world. Abdominal TB is a rare form of extrapulmonary TB that has been found to affect children without comorbidities in particular, although exact numbers are unavailable because of lack of data and its rarity. The diagnosis of abdominal TB remains a challenge because of its unspecific clinical features and unclear recommendations regarding the best diagnostic tools. We report 4 cases of children with abdominal TB diagnosed at The Hospital of Lithuanian University of Health Sciences Kaunas clinics from 2008 to 2018 at the Department of Paediatric Surgery. All these cases are exceptional. The final diagnosis of abdominal TB was confirmed only after diagnostic laparoscopy and biopsy. Moreover, we suggest that QuantiFERON test and ascitic fluid analysis with serum ascites albumin gradient and adenosine deaminase tests should be performed before more invasive interventions. Laparoscopy with biopsy should be performed only in unclear cases.
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Laparoscopía , Peritonitis Tuberculosa , Tuberculosis , Líquido Ascítico , Niño , Humanos , Morbilidad , Peritonitis Tuberculosa/diagnósticoRESUMEN
BACKGROUND: The purpose of the study was to analyze the incidence, causes, and management of vesicovaginal fistula (VVF) in adolescent girls. CASES: Three girls of adolescent age were diagnosed with VVF, caused by a vaginal foreign body (ie, an aerosol spray cap). Transvesical reconstruction was performed in 2 cases. After the diagnosis of VVF, the third girl was discharged home with Foley catheter drainage. Three months later, she presented with pregnancy and was lost to follow-up. SUMMARY AND CONCLUSION: Evaluation of unusual urinary symptoms in an adolescent should include vaginal examination and/or imaging. Aerosol spray caps remain the most common vaginal foreign body resulting in VVFs in adolescent girls in Lithuania. Transvesical reconstruction is safe and efficient.
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Cuerpos Extraños/diagnóstico , Procedimientos de Cirugía Plástica/métodos , Vagina/patología , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/etiología , Adolescente , Femenino , Cuerpos Extraños/etiología , Cuerpos Extraños/cirugía , Humanos , Incidencia , Fístula Vesicovaginal/cirugíaRESUMEN
PURPOSE: Optimal postoperative pain management following minimally invasive surgical repair of pectus excavatum is not established. We compared efficacy and adverse effects in patients treated with patient-controlled analgesia (PCA) with those treated with continuous infusion (CI) with morphine in addition to nonsteroidal anti-inflammatory drugs. METHODS: 33 patient records were examined retrospectively: 21 given PCA and 12 CI with morphine. Main outcome variables were used doses of morphine, pain scores every 3 h and adverse effects. RESULTS: Median (range) used morphine dose was 0.58 (0.21-1.12) and 0.52 (0.34-0.84) mg/kg on the day 1 and 0.3 (0.02-0.6) and 0.33 (0.09-0.53) mg/kg on the day 2 in PCA and CI groups, respectively (p > 0.05). Pain scores were within moderate and low levels during 42 h after surgery and did not differ between the groups. Median (range) oxygen saturation was 96.5 (93-100) and 97 (94-100) in PCA and CI groups, respectively (p > 0.05). Additional oxygen therapy was required in 14.3% in PCA group and 25% in CI group (p > 0.05). The incidence of pulmonary adverse effects was rare and did not differ between the groups. CONCLUSION: Both methods of systemic analgesia in addition to non-opioid analgesics were equally effective and resulted in a low incidence of pulmonary adverse effects.
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Analgesia Controlada por el Paciente/métodos , Analgésicos Opioides/administración & dosificación , Anestesia Intravenosa , Tórax en Embudo/cirugía , Morfina/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Adolescente , Antiinflamatorios no Esteroideos/uso terapéutico , Niño , Femenino , Humanos , Infusiones Intravenosas , Masculino , Dimensión del Dolor , Estudios Retrospectivos , Adulto JovenRESUMEN
UNLABELLED: The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. MATERIALS AND METHODS: Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. RESULTS: A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81+/-6.96 mm; 1 month after operation, 97.84+/-17.08 mm; 6 months, 110.55+/-13.85 mm; and 12 months, 113.6+/-14.61 mm. After removal of the bar, the distance was 105+/-11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1-6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3+/-12.86 mm, P=0.012). CONCLUSIONS: The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.
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Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Radiografía Torácica , Esternón/cirugía , Niño , Interpretación Estadística de Datos , Estudios de Seguimiento , Tórax en Embudo/diagnóstico , Humanos , Consentimiento Informado , Modelos Teóricos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To assess what degree of chest wall deformation changes statistically reliably after surgery, using pre- and postoperative radiological examination data. METHODS: Radiological chest examinations were performed for 88 children before and after remedial operations. Pre- and postoperative chest radiograph and CT were performed to measure transversal chest width; sagittal left chest side depth, sagittal right chest side depth, sternovertebral distance and vertebral body length. Derivative indices were also estimated: Vertebral index (VI), Frontosagittal index (FI), Haller index (HI) and asymmetry index. Computerized assessment of data was used. For statistical analysis, the software "Statistica 6.0" was used. RESULTS: Postoperatively VI increased approximately by 2.37+/-2.72, FI decreased by 4.60+/-4.34 and HI value increased approximately up by 0.45+/-0.49. Statistically significant deformation index difference before and after surgery was not detected when VI was below 26.2 (p=0.08), FI was above 32.9 (p=0.079) and HI was less than 3.12 (p=0.098). CONCLUSION: Preoperative CT and X-ray assessment of chest wall deformation degree is important for pediatric patients. The following deformation indices are indications for surgical treatment: VI>26, FSI< 33 and HI>3.1.
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Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Radiografía Torácica , Procedimientos Quirúrgicos Torácicos/métodos , Niño , Preescolar , Estudios de Cohortes , Países en Desarrollo , Femenino , Estudios de Seguimiento , Humanos , India , Masculino , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
A very rare case is being described; common pleural cavity was accidentally diagnosed in a 3-year-old boy operated for funnel chest (pectus excavatum). During 36 years 516 patients were operated in our department and we often notice pectus excavatum associated with other types of congenital pathology but only one had the common pleural space. In normal human beings pleural space is divided into left and right chambers separated by the mediastinum with no communication in between. In some mammals such as pigs, cows etc. a congenital communication is found between the pleural cavities, but this type of communication is very rare in humans and most often is of acquired origin. Pleural communication may also develop after major cardiothoracic surgery. In this case a 3-year-old male patient was admitted for the elective surgery on pectus excavatum. Clinical examination showed a very deep funnel chest. Both the heart and the mediastinum are left-shifted by the deformed breastbone; it is clearly demonstrated on a plain and lateral X-ray. On the left, beside the main vessels, an indistinct patch is noted. Typical M. Ravitch procedure was performed, by accident the pleural space was opened. Both pleural cavities had an evident communication along the anterior mediastinum. The torn pleura was sutured, the excess air removed by a puncture. Postoperative period was uneventful, additional treatment was not needed; currently the boy is feeling well. The postoperative X-ray showed the heart and the mediastinum to return to normal position.