Cystic lesions of the testis in infancy ­ case series of four patients / A here cysticus elváltozásai csecsemokorban - négy eset ismertetése.

Összefoglaló. Csecsemokorban a here cysticus elváltozásai ritka entitásnak számítanak. Az angol nyelvu szakirodalom kevés hasonló esetrol számol be, a 2000-es évek elejéig publikált esetek harmadában orchiectomia történt. A hisztológia a leggyakrabban teratomát, a legritkábban egyszeru cystát igazol. Mindkét elváltozás jóindulatú, egyéves kor alatt a leggyakoribb. Közleményünkkel arra szeretnénk felhívni a figyelmet, hogy ezen esetek kezelése során törekedni kell a here megtartására. A Pécsi Tudományegyetem Klinikai Központ Gyermekgyógyászati Klinikájának Manuális Tanszékén és a Heim Pál Országos Gyermekgyógyászati Intézet I. Gyermek Ssebészeti és Traumatológiai Osztályán 2015 és 2018 között 4 csecsemoben észleltük a here cysticus elváltozását. A betegek kórtörténeti adatainak részletes retrospektív elemzését és a szakirodalom áttekintését végeztük. Mind a 4 alkalommal a csecsemo féléves kora elott észleltek egyoldali, panaszokat nem okozó herezacskófél-megnagyobbodást. Az ultrahangvizsgálat 3 esetben szoliter cysticus képletet talált. 1 esetben szeptált, suru folyadékkal telt cysticus képletet véleményezett, számottevo hereállomány nem mutatkozott. Ennél a betegnél mágnesesrezonancia-vizsgálat is készült, mely teratoma lehetoségét vetette fel. A feltárás során mindegyik csecsemoben cysticus képletet találtunk. 3 betegnél hereszövet-megtartó mutétet (enucleatiót) végeztünk. 1 esetben az érdemben megtartható hereszövet hiánya, valamint teratoma gyanúja miatt orchiectomia történt. A kórszövettan két esetben egyszeru cystát, két esetben praepubertalis teratomát igazolt, melyek jóindulatú elváltozások. A here cysticus elváltozásai csecsemokorban dönto többségben benignusak. Az egyszeru cysta és a praepubertalis teratoma egyaránt jóindulatú elváltozás, malignus transzformációra nem hajlamosak. A képalkotó eljárások közül az ultrahangvizsgálat elegendo lehet a kezelési terv felállításához. Mindig törekedni kell a here megtartására, a leheto legtöbb hereszövet megkímélésére. Kórszövettani vizsgálat nélkül a here eltávolítása ebben az életkorban nem javasolt. Orv Hetil. 2020; 161(48): 2043-2048. Summary. Cystic lesions of the testis are rare in infancy. Few similar case-series were published in the English literature. Orchiectomy was reported in one-third of the cases until the early 2000s. Histology mostly confirms teratomas, rarely simple cysts. Both are benign and most common under the age of one year. Our aim is to draw attention to the importance of testicular sparing surgery (enucleatio), whenever possible. At the Medical Centre of the Department of Pediatrics of the Division of Paediatric Surgery, Pécs and at the Department of Pediatric Surgery and Traumatology of the Heim Pal Children's Hospital, Budapest, four cystic testicular lesions were treated in infancy between 2015 and 2018. We performed retrospective analysis and reviewed relevant literature. Our patients were under six months and an unilateral, painless scrotal enlargement appeared. Ultrasound described cystic lesion in the testis in three cases. In one case a septated, echogenic, liquid-filled cystic lesion was detected, with no significant amount of testicular tissue. Magnetic resonance imaging scan of this patient predicted the diagnosis of teratoma. During the surgeries, cystic lesions were found in all cases. Enucleatio was performed in three patients. Orchiectomy was carried out once due to the suspicion of teratoma and the lack of salvageable testicular tissue. Histopathology confirmed simple cysts in two babies and prepubertal teratomas in the others. Testicular cystic lesions are predominantly benign in infancy. Simple cysts and prepubertal teratomas are benign, not prone to malignant transformation. Ultrasound is reliable for preoperative planning. Testicular tissue sparing surgery must be considered and without histopathology orchiectomy should not be performed. Orv Hetil. 2020; 161(48): 2043-2048.

[Differential diagnosis of abdominal cysts in children]. / Hasi cysták és cystosus képletek differenciáldiagnózisa gyermekkorban.

19 children were diagnosed with abdominal cysts of different origin in the Surgical Unit of the Department of Pediatrics, Medical University of Pécs, Hungary between 2010 and 2013. The authors discuss the details of representative cases of a parovarial cyst, an intestinal duplication, and an omental cyst with emphasis on the clinical symptoms, diagnostic tools, and surgical interventions. The authors conclude that abdominal cysts often cause mild symptoms only, and they are discovered accidentally by ultrasound imaging performed for other reasons. In some cases, the cyst can cause severe complaints or even acute abdomen requiring emergency surgery. Laporoscopy may be a valuable method both in diagnosis and surgical therapy. Abdominal CT or MRI are not required in the majority of the patients.

[Diaphragmatic hernia or hiatus hernia: a diagnostic problem in 5-month-old infant]. / Congenitalis rekeszsérv vagy hiatus hernia: diagnosztikus problémák öt hónapos csecsemoben.

Authors present a case of a 5-month-old infant, in whom following an uneventful perinatal adaptation, symptoms of recurrent respiratory infections, vomiting and growth failure developed. Based on chest X-ray, right-sided diaphragmatic hernia was suspected. However, barium swallow examination delineated the stomach above the right diaphragm. The case report draws attention to the differential diagnostic difficulties between congenital diaphragmatic and hiatal hernia.

[Indication for and execution of rectal examination in children with suspected appendicitis]. / Szemlélet- és gyakorlatváltozás a rectalis digitális vizsgálat indikációjában és kivitelezésben appendicitis acuta gyanúja esetén gyermekkorban.

Digital rectal examination is considered a non-evident diagnostic procedure in suspected appendicitis. It is rather unpleasant for children and there is a wide range of laboratory and imaging modalities available to contribute to the decision making in case a surgical intervention is necessary. In recent years digital rectal examination is not routinely used prior to surgery, however it may remain a useful screening method for patients with unclear clinical diagnosis. In such cases considering the important moral and legal arguments about digital rectal examination, we consider performing it under general anaesthesia.

[Different clinical forms of adrenal abscess in two newborns]. / Mellékvesetályog különbözo megjelenési formái két ujszülöttben.

Adrenal abscess is a rare disease in the neonatal period. The classical symptoms are abdominal mass, anaemia and prolonged jaundice which are associated with fever, vomiting and feeding difficulties. The authors present the histories of two mature, male newborns with adrenal hemorrhage, where the size of the masses increased progressively and finally adrenal abscesses were developed. The first case showed the classical symptoms of adrenal abscess, however, the antibiotic treatment led to complete remission of the symptoms and laboratory infectious markers, therefore the baby was discharged. In a few day later he became septic and was admitted again. This time he was operated on and a large abscess was evacuated, which contained about 60 ml of pus. After this intervention multi-organ failure developed, but due to the intensive therapy the baby recovered. In the second newborn the increasing adrenal hemorrhage was accompanied by elevated infectious markers despite of the different antibiotic treatments, however, he showed no clinical signs of infection. Because of the discrepancies between the clinical and laboratory findings and also the imaging studies the possibility of neuroblastoma has also arisen. Urinary vanillylmandelic acid excretion was normal, but elevated neuron-specific enolase levels were measured. Surgical exploration was performed, pus was drained from the mass and anaerobic Bacteroides fragilis was cultured, therefore metronidazole therapy was started. After that the baby fully recovered.

[Association of occipital encephalocele with vesicoureteral reflux]. / Encephalokele társulása súlyos vesicoureteralis refluxszal.

Occipital encephalocele was associated with vesicoureteral reflux and agenesis of the os coccygeum in a small-for-gestational age newborn girl. The symptoms did not correspond to any of the syndromes with encephalocele. The present observation and data of the literature suggest that the significance of vesicoureteral reflux in syndrome diagnosis is generally underestimated.