Volume of the normal prostate gland in polish boys, aged 1-17 years: Based on transabdominal ultrasound - Prospective study.

BACKGROUND: Until now, there are no established norms for prostate size in children. Prostate volume during development has been analyzed in small study groups. In diagnostic imaging, transabdominal ultrasound and magnetic resonance imaging are used. AIMS: To establish prostate volume norms for individuals aged 1-17 years using transabdominal ultrasound. STUDY DESIGN: Between 2021 and 2023, transabdominal prostate ultrasound was performed on 482 Caucasian boys, aged 1-17 years, who were patients of the urology clinic. Normative data were based on results of 345 boys with normal lower urinary tract, urethral and penile structures. Patients with abnormal external genitalia, Prune Belly Syndrome, Myelomeningocele, chromosomal disorders, or prostate abnormalities found in ultrasound were excluded from the study. Patient eligibility was determined based on medical records and physical examinations. During ultrasound, height, anterior-posterior dimension, and width of prostate were assessed. Prostate volume was calculated using the ellipsoid formula VH x L(AP) x W x 0.523. Measurements were correlated with age, weight, and height. Results were analyzed using descriptive statistics, statistical significance tests for means, and correlation methods. After estimating preliminary results, taking into account the development periods, patients were divided into age groups: 1-4 years (n = 70), 5-10 years (n = 124), 11-12 years (n = 43), 13-15 years (n = 65), and 16-17 years (n = 43). RESULTS: The table and nomogram shows prostate volumes based on age. Prostate size remains stable up to the age of 8. We noticed a transitional phase at the age of 8-11 years. A significant increase in volume occurs over 11 years of age. There was a statistically significant relationship between prostate size, age, height, and weight. DISCUSION: Established norms can serve as a reference for prostate analysis in patients with defects of the genitourinary system. An interesting analysis would be a prostate size assessment in relation to stage of development on Tanner scale. CONCLUSION: Transabdominal ultrasound, being a non-invasive, painless, and readily accessible examination, allows assessment of prostate size even in boys aged 1 year old. A statistically significant relationship was found between prostate size, weight, and height. Norms for prostate size in boys were established according to age.

Trichotillomania, trichophagia, trichobezoar - summary of three cases. Endoscopic follow up scheme in trichotillomania.

AIM: Trichotillomania is a lack of control of one's hair pulling. It is estimated that about 1% of population develops trichotillomania. In up to 20% of patients with trichotillomania swollowing follows hair pulling. Trichobezoar forms in about 30% of patients with trichofagia. MATERIAL AND METHODS: In 2008-2014 3 patients were operated on trichobezoar. One patient has had a history of trichotillomania. On admission abdominal X-ray and ultrasonography revealed abdominal mass. Diagnosis was confirmed in abdominal computed tomography. RESULTS: All three trichobezoars were evacuated from the intestinal tract during laparotomy with wide gastric wall opening. In one case - Rapunzel syndrome - hair mass was evacuated also from the duodenum and small bowel. All patients were referred to psychiatrist after finishing of the surgical treatment. CONCLUSIONS: In patients operated for trichobezoar as well as other patients with trichotillomania control of hair accumulation in the gastrointestinal tract remains a problem. Authors propose endoscopic follow up scheme in 6, 12, and 24 months after the surgery as well as for other patients with trichotillomania.

Laparoscopic splenectomy for hereditary spherocytosis-preliminary report.

Splenectomy is considered standard surgical therapy in hereditary spherocytosis. The procedure is indicated in patients with severe anemia, recurrent hemolytic, and aplastic crises. The aim of the study was to assess treatment outcomes in patients with hereditary spherocytosis who underwent total or partial laparoscopic splenectomy. Fifteen patients aged 4-17 yr underwent laparoscopic splenectomy from 2009 to 2012. Partial and total splenectomies were performed (five and 10 children, respectively). Hematologic parameters, liver function tests, and splenic volume before and after the surgery were analyzed retrospectively. Total follow-up was 1-30 months. Hospitalization and operating time were similar in both groups. In partial splenectomy group, branches of splenic arteries gave better blood supply than short gastric vessels. In both groups, hematologic parameters were improved. Postoperative markedly elevated platelet count was maintained up to 6 months, and after that, platelet count gradually decreased to normal values. Bilirubin level was decreased in early postoperative period; however, it increased later to achieve levels lower than in preoperative period. No severe general infections were observed in both groups. Laboratory parameters (hemoglobin and bilirubin concentrations and RBC) after the surgery improved in all patients, and the effect was maintained during 12 months of follow-up. Platelet count increased significantly after the surgery and was maintained at high levels during the next 6 months. However, it returned to preoperative levels within a year after the surgery. Our study showed that partial splenectomy was not inferior to total splenectomy. However, full assessment requires longer follow-up and larger group of patients.

Solid pseudopapillary tumor of the pancreas (Frantz's tumor): two case reports and a review of the literature.

INTRODUCTION: Solid pseudopapillary tumor of the pancreas is extremely rare in children; it usually occurs in young women between 18 and 35 years of age. It comprises less than 3% of pancreatic tumors. It is of low malignancy; however, it may be locally aggressive. Surgical resection is the treatment of choice and its prognosis is excellent. CASE PRESENTATION: Two Caucasian girls, 15 and 12 years of age were diagnosed with tumor of the pancreas. The first patient had severe abdominal pain. In the second case the tumor was asymptomatic, detected incidentally during ultrasound. Computed tomography confirmed pancreatic mass. In the first case, apart from the tumor located in the head and the body of her pancreas, focal change in her right kidney was found, which was an indication to biopsy that confirmed solid pseudopapillary tumor. In the second patient the tumor was located in the body of her pancreas, with portal vein occlusion and well-developed collateral circulation. In the first patient a pancreatoduodenectomy (Traverso-Longmire) was performed; there was no mass in her right kidney. In the second case, distal pancreatectomy and splenectomy were performed. In both cases histopathology revealed solid pseudopapillary tumor resected radically. Our first patient's postoperative course was uneventful. In the second case, her postoperative course was complicated by necrosis of the remaining pancreatic head that needed pancreatoduodenectomy. Follow-up at 28 and 26 months revealed no evidence of tumor recurrence or metastases on magnetic resonance imaging. CONCLUSIONS: Typical radiological appearance of solid pseudopapillary tumor is an indication for surgery. The treatment of choice is tumor resection with sparing of pancreatic tissue. In one of our two cases we performed a preoperative biopsy because of an uncharacteristic mass in her right kidney. In our second patient, necrosis of her spared pancreatic head meant that we could not preserve pancreatic tissue. Our whole diagnostic process, treatment and possible complications analysis should be of interest and noteworthy not only to surgeons as the treatment of choice is radical resection, but also to pediatric oncologists because of differentiation from other pancreatic tumors in children.

Trichobezoar, rapunzel syndrome, tricho-plaster bezoar - a report of three cases.

BACKGROUND: Trichobezoar is an uncommon entity observed mostly in young women. Symptoms in presenting patients are usually due to the large mass of the bezoar or malabsorption of nutrients. Trichobezoar is almost always associated with trichotillomania and trichophagia. CASE REPORT: Three teenage girls, aged 13, 15, and 16, were diagnosed due to palpable epigastric masses. Additionally the oldest patient presented with symptoms of ileus while the other two patients had weight loss and anaemia. Besides the 15-year-old patient complained of paroxysmal abdominal pains. Patients were subjected to plain radiographic examinations of abdomen which revealed large epigastric tumours, with additional calcifications observed in the youngest girl. Subsequent gastroscopy (the 15-year-old patient) or ultrasonographic examination and computed tomography scans (13- and 16-year-old patients) allowed to establish the diagnosis of giant bezoars: trichobezoars in two older patients and tricho-plaster bezoar in the youngest one. All the tumours were surgically resected and psychiatric treatment was undertaken. CONCLUSIONS: 1. Trichobezoar should be taken into consideration in differential diagnosis of epigastric tumours in children, especially teenage girls. 2. The conventional ultrasonographic and radiographic examinations of the abdomen are insufficient for determination of the nature of the mass. A thorough medical history interview and clinical examination may give directions regarding the further diagnosis.3. Trichotillomania and trichophagia are obsessive-compulsive disorders, and therefore patients with trichobezoars should be under psychiatric care to prevent recurrence of the disease.