[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.

Changing Authorship Patterns and Publishing Habits in the European Journal of Pediatric Surgery: A 10-Year Analysis.

AIM: The aim of this study is an analysis of the changing authorship patterns and publishing habits encountered in papers published in the European Journal of Pediatric Surgery (EJPS) over the past 10 years. Furthermore, it seeks to anticipate the trends in the years ahead. MATERIALS AND METHODS: We conducted a retrospective review of articles published in the EJPS during a 10-year period (January 1, 2003-December 31, 2012). Each article was classified as an Original Report/Original Article (OR/OA) or as a Case Report/Case Gallery (CR/CG), and they were analyzed separately. For investigation of the percentage distribution of publications according to the number of authors per articles, papers were combined and into three groups (1-2, 3-5, and 6 ≤ authors). The analysis focused on whether the work was done by members of one institution, or in collaboration with other units of the same institution, or in collaboration with other national or multinational institutes. RESULTS: In the past 10 years, the EJPS published 996 articles (616 ORs/OAs, 380 CRs/CGs). The one and two authored publications (125) have not decreased, the three to five authored articles (552) changed minimally, whereas the number of 6 ≤ authored publications (319) has increased. Of 996 publications, 348 were from single institutes and 648 were written in collaboration with two or more other institutes. In addition, in this 10-year period, the number of multinational articles has increased significantly from 24 to 59. CONCLUSION: Increase in cooperation within and between institutions is a positive trend, aiming with the goal of improving quality of publications.

Subcutaneous granuloma annulare of the penis associated with a urethral anomaly: case report and review of the literature.

Granuloma annulare (GA) is an uncommon benign inflammatory skin condition, most often found on the extremities of young females. The subcutaneous variant of GA involving the penis is very rare. We report a case of subcutaneous GA associated with a urethral anomaly in a 15-year-old boy that persisted for a year. Treatment options are discussed with a review of the current literature.

Changing trends in authorship patterns in the JPS: publish or perish.

AIM OF STUDY: To examine changes in authorship patterns in the articles published in the Journal of Pediatric Surgery (JPS) over the last three decades (1981-2010), and to analyze why they took place. METHODS: Data for analysis were obtained from the JPS over three five-year periods (1981-1985, 1991-1995, and 2006-2010). All original papers (3740), case reports (884), and correspondence (236) were separately examined and analyzed. For investigation of percentage distribution of publications (original papers and case reports), combined groups of papers, with 1 to 3, 4 to 5, 6 to 9, and over nine authors were formed. Justified (ethical, acceptable) and unjustified (unethical, unacceptable) reasons for authorship changes were defined according to the International Ethical Guidelines. Comparisons among groups were made with Kruskal-Wallis tests, taking p<0.05 as significant. RESULTS: The number of authors of original papers and case reports increased significantly in consecutive periods (p<0.001). The same pattern was observed in letters (p<0.01). The percentage of papers with less than 3 authors significantly declined, whereas those with 4 to 5 authors did not change. Manuscripts with more than 6 authors significantly increased, and a similar pattern was seen in case reports. CONCLUSIONS: This striking increase in the number of authors per article was evident in other medical journals as well, and reflects a progressive complexity in academic work along with the need for building resumes rich in publications. It can be anticipated that this tendency will continue in the future.

[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.

Complications after bladder augmentation or substitution in children: a prospective study of 86 patients.

OBJECTIVE: • To evaluate complications after urinary bladder augmentation or substitution in a prospective study in children. PATIENTS AND METHODS: • Data of 86 patients who underwent urinary bladder augmentation (80 patients) or substitution (6 patients) between 1988 and 2008 at the authors' institute were analysed. • Ileocystoplasty occurred in 32, colocystoplasty in 30 and gastrocystoplasty in 18. Urinary bladder substitution using the large bowel was performed in six patients. • All patients empty their bladder by intermittent clean catheterization (ICC), 30 patients via their native urethra and 56 patients through continent abdominal stoma. Mean follow-up was 8.6 years. • Rate of complications and frequency of surgical interventions were statistically analysed (two samples t-test for proportions) according to the type of gastrointestinal part used. RESULTS: • In all, 30 patients had no complications. In 56 patients, there were a total of 105 complications (39 bladder stones, 16 stoma complications, 11 bowel obstructions, 5 reservoir perforations, 7 VUR recurrences, 1 ureteral obstruction, 4 vesico-urethral fistulae, 4 orchido-epididymitis, 4 haematuria-dysuria syndrome, 3 decreased bladder capacity/compliance, 3 pre-malignant histological changes, 1 small bowel bacterial overgrowth and 7 miscellaneous). • In 25 patients, more than one complication occurred and required 91 subsequent surgical interventions. Patients with colocystoplasty had significantly more complications (P < 0.05), especially more stone formation rate (P < 0.001) and required more post- operative interventions (P < 0.05) than patients with gastrocystoplasty and ileocystoplasty. CONCLUSIONS: • Urinary bladder augmentation or substitution is associated with a large number of complications, particularly after colocystoplasty. • Careful patient selection, adequate preoperative information and life-long follow-up are essential for reduction, early detection and management of surgical and metabolic complications in patients with bladder augmentation or substitution.

Bicycle injuries in children: an analysis based on demographic density.

INTRODUCTION: The purpose of this study was to investigate the characteristics and the outcome of bicycle injuries in paediatric patients according to the living environment, and to create guidelines for injury prevention. PATIENTS: The evaluation was performed in part based on hospital database of 1803 in- and out-patient children treated at the Paediatric Surgical Department of Pécs/Hungary between 2000 and 2006, and at the Department of Paediatric Surgery at the Heim Pal Hospital Budapest between 2004 and 2006. Additionally questionnaires were mailed to the patients' families to gain follow-up information. We analysed three groups according to demographic density (village, midsize town and large town). RESULTS: We found, that poor road quality played an important role as a contributing factor of injuries in villages. The number of bicycle spoke-injuries was higher in villages (13%), than in midsize towns (4.6%) and the large town (9.9%). In villages, 5% of children injured wore a helmet; this rate was 9% in midsize towns and 9.1% in the large town. Head injury was more common in villages, while in midsize towns and the large town arm injuries proved to be predominant. DISCUSSION: Prevention strategies targeting bicycle injuries in children should take into account the population density. This analysis revealed a substantial difference in the use of safety devices, and in the characteristics of injuries occurring in villages, indicating that there is a need for special attention regarding this higher risk population.

[Are bicycle helmets necessary for children? Pros and cons]. / Szükséges-e bukósisak viselése gyermekkorban kerékpározás során? Ervek és ellenérvek.

UNLABELLED: Prevalence of severe head injuries and deaths in children due to bicycle accidents is high in Hungary. The aim of this review was to investigate the effectiveness of bicycle helmets in preventing head injuries in children. METHODS: Review of literature was based on Hungarian and international studies published on MEDLINE. Furthermore, we used official statistical databases and investigations of some international child safety organizations. RESULTS: The effectiveness of bicycle helmets in reducing the number of severe head injuries and bicycle deaths is very well established. Several countries have mandatory helmet laws, which lowered bicycle deaths and severe head injuries. It was proved that helmets are effective only if worn properly. Otherwise the risk of head injuries might increase. In spite of the findings, counter-arguments question the effectiveness of helmets; moreover, give account of a helmet's risk growing effect. CONCLUSIONS: Upon the literature, the number of studies proving the necessity of helmets is higher than those objecting to them. However, this positive effect can be achieved only if several factors are present at the same time. In Hungary there is a need for effective prevention strategies such as the popularization of properly-worn helmets.

Analysis of horse-related injuries in children.

PURPOSE: The purpose of the present study was to investigate factors affecting the nature, characteristics, severity and outcome of horseback and horse care injuries in paediatric patients and to create guidelines for injury prevention. METHODS: Detailed clinical records of 265 children sustained horse-riding related injuries have been analysed. Questionnaires were mailed to provide follow-up information for patients who have been treated in either Department of Paediatric Surgery in Pécs, Hungary, or Department of Paediatric Surgery in Graz, Austria between 1999 and 2003. Those 112 children (42%) who answered the questionnaire were included in the study and further analyses were performed. RESULTS: Female to male ratio of the 112 patients was 101/11. Trauma occurred during horseback riding accounted for 76.8% of all cases; these injuries represented more severe cases comparing to those which happened while handling a horse (23.2%). The mechanism as well as the localisation of injury displayed a close association with age. CONCLUSIONS: Prevention strategies targeting horse-related injuries at children should appreciate the age-dependent nature of injury as well as the fact that injury severity is not necessarily associated with the experience of the rider.

[Magnetic resonance urography in the diagnosis of the ectopic ureters]. / Mágneses rezonancia urográfia az ectopiás ureterek kórismézésében.

INTRODUCTION: Ectopic ureters are often very difficult to diagnose with conventional diagnostic modalities (physical examination, ultrasound, intravenous urography, cystography, urethro-cystoscopy, isotop examinations) in children. AIM OF THE STUDY: The authors report their experience with a relatively new method, the magnetic resonance urography (MRU) diagnosing ectopic ureters in childhood. METHOD: MRU was used in 7 girls to detect an ectopic ureter in the last 3 years. On the basis of typical clinical signs, an ectopic ureter was suspected in all patients, but it could not be demonstrated by conventional diagnostic methods. Thus, MRU was done to confirm the suspected diagnosis. RESULTS: In all of the 7 patients, the examinations demonstrated ectopic ureters with the intraoperative findings further confirming the pre-operative diagnosis. In 2 patients, the intraoperative findings of the upper urinary tract anomalies were slightly different from the MRU report. CONCLUSION: The MRU is a reliable diagnostic method to diagnose ectopic ureters which are not easily detectable with conventional diagnostic modalities.

Posterior sagittal approach with perirectal dissection for reconstructive surgery of severe urogenital anomalies.

There are many approaches for surgery of complicated congenital and acquired urogenital anomalies in children with intact rectum. Pena advocates the mid-sagittal division of the sphincter mechanism posterior and anterior to the rectum, along with opening of the posterior and anterior rectal walls. The aim of this study is to determine whether the posterior sagittal approach with perirectal dissection (PSAPD) and elevation of the mobilized rectum would impair fecal continence when used for correction of complicated urogenital anomalies in children with normal rectum. Between 1988 and 1994 the authors performed PSAPD in eight infants and children with an intact anorectum. Indications for PSAPD were high vaginal atresia, Mullerian duct remnants, prostatic rhabdomyosarcoma, and traumatic vesicovaginal fistula. After a mean 10-year follow-up the bowel habits were assessed. Anorectal and uromanometric studies and a detailed questionnaire (modified Holschneider's scoring) sent to children or parents were evaluated. Three patients who preoperatively were clinically fecal continent had soiling only at the time of diarrhea. Early postoperative low anorectal pressure profile normalized during the follow-up. Seven patients had a fecal continence score above 23, two of them with maximum points of 26. Only one girl had a low score of 15. The authors conclude the PSAPD which offers a few advantages over the sagittal division of the rectum provides an alternative approach for selected lesions of the genitourinary tract in children with a normal rectum. Our results suggest that fecal continence is either preserved or partially affected.

[Posterior cloaca with accessory urethra]. / Hátsó cloaca járulékos urethrával.

The authors present a case of posterior cloaca in an 8-year-old girl. The diagnosis of this rare anomaly requires meticulous examination of the female genitalia and detailed radiological investigation. She underwent total urogenital mobilization (TUM) without opening the anal canal and the rectum. Eighteen months of follow up period she continues to have full bowel and urinary control with almost normal looking genitalia.

[Emesis after pyloromyotomy in congenital hypertrophic pyloric stenosis: incomplete pyloromyotomy, recurring pyloric stenosis or gastric outlet obstruction?]. / Pyloromyotomia utáni hányás congenitalis hypertrophiás pylorusstenosisban: inkomplett pyloromyotomia, visszatéró pylorusstenosis vagy gyomorkimeneti obstructio?

The authors present a case of an infant who was treated for recurrent vomiting following pyloromyotomy. Gastroscopic examination showed a polypoid tumour of 4-5 mm in diameter located at the antral region. The patient recovered following re-pyloromyotomy.

[Late reconstructive surgery for cloaca malformations]. / Nem kielégítóen kezelt cloaca malformációk késói rekonstrukciós mútétei.

The rarity of cloacal anomalies, the wide range of anatomical variants, and the number of different operations mean that successful management of a patient (neonate or child) with this condition is one of the greatest challenges for paediatric surgeons. The authors describe the complex corrections of 3 patients with cloacal malformation (age 10-13 years). The cloacal malformations were not diagnosed at neonatal age and therefore only the anorectal agenesis was corrected at the first stage. The authors strongly recommend that all components of this anomaly (urethra, vagina and anorectum) should be managed in one step. Because of the rarity and complexity of cloacal malformations, the anomaly should be operated on only in specialised centres.