Acute scrotum -etiology, clinical presentation and seasonal variation.

OBJECTIVE: The aim of the present study was to evaluate the etiology, history, physical examination findings, and seasonal variation of acute scrotal problems in children. METHODS: A retrospective review of all boys, presenting with acute scrotum to the Pediatric Surgery Clinic of the University Hospital Heraklion between January 1989 and December 2006 was performed. RESULTS: A total of 140 boys presented with scrotal pain were included. Overall the commonest cause of acute scrotum was epididymo-orchitis (35%, 95%CI: 27%-43%), followed by torsion of appendages. In contrast the most common cause in boys of preschool age was spermatic cord torsion (P<0.020). All cases of spermatic cord torsion were characterized by severe testicular pain and an absent cremasteric reflex. The interval between pain initiation and presentation to our clinic was 11.4 hours (SD:3.07) when the testis was salvaged by detorsion, and 19.0 hours (SD:6.32) when the testis was removed. The difference between means was statistical significant (p<0.001). The incidence of torsion of appendages (p<0.036) and/or spermatic cord (p<0.047) was increased in winter. CONCLUSION: The absence of cremasteric reflex in association with testicular tenderness strongly suggests testicular torsion. The low temperatures during winter may account for the increased incidence of the torsion of both the spermatic cord torsion and the appendages.

Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study.

AIM: The complex pathobiology of traumatic brain injury (TBI) offers numerous targets for potential neuroprotective agents. We evaluate the clinical benefit after creatine (Cr) administration in children and adolescents. METHODS: A prospective, randomized, comparative, open- labelled pilot study of the possible neuroprotective effect of Cr was carried out on 39 children and adolescents, aged between 1 and 18 years of age, with TBI. The Cr was administered for 6 months, at a dose of 0.4 g/kg in an oral suspension form every day. For categorical variables, we used the Chi-square test to identify differences between controls and cases. Statistical significance was defined as a p-value <0.05 and not statistically significant if p-value >0.1. RESULTS: The administration of Cr to children and adolescents with TBI improved results in several parameters, including duration of post traumatic amnesia (PTA), duration of intubation, intensive care unit stay. Significant improvement was recorded in the categories of headache (p<0.001), dizziness (p=0.005) and fatigue (p<0.001), aspects in all patients. No side effects were seen due to Cr administration. CONCLUSION: More specific examinations including brain spectroscopy for in vivo evaluation of Cr can be done, in order to draw conclusions for the optimal duration and manner of Cr supply, as well as its possible role for the prevention of TBI complications, in double blind studies.

Acute epididymitis in Greek children: a 3-year retrospective study.

The aim of the study was to compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis compared to testicular torsion and torsion of the appendix testes. A retrospective review of the medical records of 66 boys presenting with clinical aspects of acute scrotum over a 3-year period was performed. Sixty-six patients were included in the study (29 with epididymitis, 8 with testicular torsion and 12 with torsion of the appendix testis, 4 with scrotal abscesses, 5 with scrotal swelling, and 1 with inflamed epididymal cyst). The duration of symptoms ranged from 6 h to 4 days with a peak on the second day. Urine cultures and viral testes were negative in all patients. Color Doppler ultrasound was diagnostic for epididymitis in 28 patients (96.6%). Systemic intravenous antibiotics were given in all 29 patients with epididymitis. No patient showed signs of testicular atrophy in the follow-up. The increasing incidence of epididymitis should question the policy of routine exploration of the acute scrotum in children. The history and physical examination cannot reliably identify those boys who can be managed conservatively. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal but it can also be misleading.

Acute appendicitis in preschool-age children.

UNLABELLED: During the last 11 years, 122 children aged less than 5 years underwent appendectomy with a preoperative diagnosis of acute appendicitis. At surgery, 29 children (24%) presented with acute suppurative appendicitis, 64 children (52%) perforated appendices and 26 children (21%) with appendiceal abscess. In three cases (2%) there was no acute intra-abdominal process. In this study the following data were analysed: age, gender, symptoms, duration of symptoms, whether seen by a physician prior to admission and surgery, physical findings, stage of the disease at operation, histology, postoperative complications and mortality. CONCLUSION: The accurate diagnosis in early childhood appendicitis is still a difficult matter. The responsibility of the paediatric surgeon is mainly the clinical examination with all his clinical skills and facilities and if serious doubt still exists, to proceed with a laparotomy in order to reach a definite diagnosis.

Effects of ropivacaine infiltration on cortisol and prolactin responses to postoperative pain after inguinal hernioraphy in children.

BACKGROUND/PURPOSE: Painful interventions may have a serious adverse psychological impact, particularly in young patients. Inguinal hernia repair is the most common surgical outpatient procedure performed on infants and children. The aim of this study was to compare the effects of pre- and postincisional infiltration of the surgical area with ropivacaine on cortisol (C) and prolactin (PRL) release and postoperative pain in children undergoing inguinal hernia repair. METHODS: Forty-five school-age children, aged 6 to 10 years, undergoing outpatient inguinal hernia repair under general anesthesia were placed randomly into 3 groups. Preincisional wound infiltration of 3 mg/kg ropivacaine was performed in group I patients before surgery. Postincisional wound infiltration was performed in group II patients after hernia repair but before skin closure, and group III patients (controls) did not received any local anesthetic. In the postanesthesia care unit (PACU), objective pain assessments were performed every 5 minutes using a standardized 10-point objective pain scale. RESULTS: Plasma C concentrations increased at the end of the operation in all groups but significantly only in the control group (P <.001). There was no significant difference between the pre- and postincisional groups with regard to pre- and postoperative C alterations (P >.05). Although plasma PRL concentrations increased significantly at the end of the operation in the control group (P <.001), no significant difference was found between pre- and postoperative values in the infiltration groups (P >.05). The pre- and postoperative plasma PRL differences were significant between only groups I and III (P <.001). CONCLUSIONS: The findings of the current study suggest that wound infiltration with ropivacaine decreases the stress response to surgery and the postoperative pain.

Primary idiopathic segmental infarction of the greater omentum: two cases of acute abdomen in childhood.

Idiopathic segmental infarction of the greater omentum (ISIGO) is a rare cause of acute abdominal pain in childhood. The authors present the case histories of 2 children treated in their department. The children underwent surgery with preoperative diagnosis of acute appendicitis with atypical clinical presentation. The definitive diagnosis of segmental infarction of the great omentum was made intraoperatively and confirmed pathologically. Excision of the infracted omentum was curative.

A palpable right lower abdominal mass due to Yersinia mesenteric lymphadenitis.

Infection by Yersinia pseudotuberculosis has become of increasing pathological importance. This report describes the case of a 12-year-old female with mesenteric lymphadenitis due to Yersinia pseudotuberculosis. The patient presented with fever, abdominal pain, and a palpable right abdominal mass. Abdominal ultrasonic imaging and computerized axial tomography (CT) revealed a mass. An exploratory laparotomy was performed, followed by appendectomy and mesenteric lymph node biopsy. The diagnosis of Yersinia infection was confirmed by serology and bacterial culture of the biopsy material. This condition should be considered in patients with a right lower abdominal mass and symptoms similar to those of appendicitis.