Crossed testicular ectopia: Report of six cases.

Crossed testicular ectopia or transverse testicular ectopia is an extremely rare anomaly characterised by migration of one testis towards the opposite inguinal canal, usually associated with unilateral inguinal hernia. This report describes six cases of crossed ectopic testes, one of the largest series, and with unusual clinical histories.

A comprehensive analysis of 51 neonates with congenital intestinal atresia.

OBJECTIVE: To determine contemporary patterns of presentation and trends in the management and outcome of 51 newborn infants with intestinal atresia. METHODS: We retrospectively reviewed 51 cases of intestinal atresia between January 1983 and February 2003. Clinical data included antenatal history, age, gender, weight, presenting symptoms and signs, diagnostic procedures, location and type of atresia, associated abnormalities, surgical treatment, associated problems, morbidity, mortality and plans of treatment. RESULTS: Twenty children had duodenal obstruction, 24 had jejunoileal atresia, and 7 had colonic atresia. Approximately one-fourth of patients associated with duodenal atresia had preterm delivery and all patients with jejunoileal and colonic atresia were full term. Clinical features such as vomiting, abdominal distention, delayed meconium passage and jaundice were more frequent in jejunoileal atresia patients. Other associated organ anomalies particularly Down's syndrome were more frequent in duodenal atresia patients. A duodeno-duodenostomy was preferred in most of the patients with duodenal atresia and annular pancreas; duodenotomy and web excision for those with duodenal webs; and resection with end-to-end anastomosis for those with jejunoileal atresia. In all patients with colonic atresia, colostomy procedure was performed as the first step of surgery. CONCLUSION: Experienced neonatal care and prompt total parenteral nutrition by placing central line during surgery may improve the outcome of such patients.

Effects of specific inhibition of cyclooxygenease-2 on kidney in bilateral adrenalectomized rats.

In the kidney, prostaglandins represent important physiological modulators of renal hemodynamics and salt and water homeostasis. In this experimental study of bilaterally adrenalectomized (ADX) rats, we aimed to investigate whether the administration of selective (celecoxib) inhibitor of COX-2 would alter the morphological and functional changes in rat kidney tissue. Twenty-one male Sprague-Dawley rats weighing 225-250 g were used. The animals were divided into three groups. Group 1 rats (Sham-control, n = 7) did not receive any treatment. In group 2 rats (ADX/Untreated, n = 7), bilateral ADX was performed via a single dorsal incision. In group 3 (ADX/COX-2) rats, the same operation was performed as described for group 2 and then the COX-2 inhibitor celecoxib was administered by gavage for a period of 7 days. On the 7th day of the study, renal function was assessed by measurements of blood urea nitrogen (BUN) and serum creatinine levels. Biopsies were obtained from the remaining left kidneys before killing the rats. There was no significant difference in the BUN and creatinine values between the groups. In ADX/Untreated group, capillary congestion in glomerule, inflammation, hemorrhage and congestion in intertubular area, and cytoplasmic vacuolation in renal tubules was observed. Mild damage was observed in the ADX/COX-2 group. The number of macrophages was significantly decreased in ADX/COX-2 group when compared to ADX/Untreated group (P < 0.0001). Our study indicates that celecoxib may be an important factor affecting renal morphological changes after the bilaterally ADX.

Genital trauma in children: classification and management.

OBJECTIVES: To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population. METHODS: A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system. RESULTS: The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, II for 19, III for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V. CONCLUSIONS: The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome.

Gastric perforation in neonates: analysis of five cases.

The aetiology of neonatal gastric perforation (NGP) remains unknown and the mortality rate is still very high. We have treated five cases of gastric perforation over the past 17 years, and analysed them retrospectively to present our experience. Clinical data included age, sex, weight, maternal complication, fetal complication, gestational age, type of delivery, admission time, associated pathologies, localization of perforation, perforation age, operative procedures and outcome. There were four boys and one girl. Three of the infants were full-term, while two were premature. All of the infants were septic prior to rupture. Two infants had acute respiratory distress syndrome (ARDS); one due to prematurity and low gestational weight, and one due to meconium aspiration. Perforation was located at major curvature and anterior wall of the stomach in four patients, while it was located in minor curvature and anterior wall in one. The rupture was closed in two layers. Histopathology revealed local chronic inflammation and ischemia. Mortality rate was 60%. In conclusions, gastric perforation is a life-threatening complication in neonates. In our limited series, sepsis, prematurity and corticosteroid treatment were likely to be predictive for development of NGP. Early diagnosis and prompt management before clinical deterioration of the metabolic status may improve the outcome of such infants with NGP.