Peritoneal dialysis (PD) for acute kidney injury (AKI) in children has a long track record and shows similar outcomes when compared to extracorporeal therapies. It is still used extensively in low ...

https://journals.sagepub.com/doi/pdf/10.1177/0896860820970834

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics).

This systematic review and meta-analysis compares incidence rates of diabetes and diabetic ketoacidosis among children and adolescents before and during the COVID-19 pandemic.

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2806712/dsouza_2023_oi_230628_1687536375.45897.pdf

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

The management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution. A prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction. The age range was 3 months to 48 months with a mean of 10.8 ± 9.1 months. Forty percent (N = 18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N = 38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p > 0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p = 0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment. Our study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.

/pdf/sonographic-guided-hydrostatic-saline-enema-reduction-of-vgr3kwfbrq.pdf

Sonographic guided hydrostatic saline enema reduction of childhood intussusception: a prospective study

OBJECTIVES
There is controversy surrounding the optimal management of the testicular remnant associated with the vanishing testes syndrome. Some urologists advocate the need for surgical exploration, whereas others believe this is unnecessary. These differing opinions are based on the variable reports of viable germ cell elements found within the testicular remnants. To better understand the pathology associated with this syndrome and the need for surgical management, we reviewed our experience regarding the incidence of viable germ cell elements within the testicular remnant.


METHODS
An institutional review board-approved, retrospective review was performed of all consecutive patients undergoing exploration for a nonpalpable testis at Eastern Virginia Medical School and Geisinger Medical Center between 1994 and 2006. Patients who were found to have spermatic vessels and a vas deferens exiting a closed internal inguinal ring were included in this analysis.


RESULTS
Fifty-six patients underwent removal of the testicular remnant. Patient age ranged from 11 to 216 months. In 8 of the specimens (14%), we identified viable germ cell elements. In an additional 4 patients (7%), we identified seminiferous tubules without germ cell elements.


CONCLUSIONS
In our review, we identified that a significant number of testicular remnants associated with the vanishing testes syndrome can harbor viable germ cell elements or seminiferous tubules. The exact fate of these residual elements remains unknown; however, there may exist the potential for malignant transformation. Given the potential for malignant degeneration, we believe that these remnants should be removed.

Iconografías adicionales del artículo : Histologic Evaluation of the Testicular Remnant Associated with the Vanishing Testes Syndrome: Is Surgical Management Necessary?

Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. Leonard B. Glick. New York: Oxford University Press, 2005. 370 pp.

Marked in Your Flesh: Circumcision from Ancient Judea to Modern America

BackgroundThe aim of this retrospective study is to evaluate clinical characteristics and outcomes of very low birth weight (VLBW) neonates with acute kidney injury (AKI) treated with peritoneal di...

Peritoneal Dialysis in Very Low Birth Weight Neonates.

Medical experts are still at issue over the most suitable management of simple neonatal ovarian cysts exceeding 40mm and complex cysts of any size. The authors present surgical treatment of these cysts by classical laparotomy and laparoscopy. The study included 13 newborn babies surgically treated for 6 simple and 7 complex ovarian cysts. The diameter of the cysts ranged from 29 to 102mm. The age of children was from 2 days to 10 months. The open classical laparotomic approach was performed in 8 babies. In the laparotomy group, cystectomy was done in 3 infants with simple cysts. The other 5, presented with ovarian torsion, required salpingo-oophorectomy. Video-assisted cystectomy was the procedure for 3 simplex and one complex cyst with torsion. Laparoscopic adnexectomy was applied in one case with auto-amputated cyst. Our small study demonstrates that laparoscopy is as safe and effective as classical laparotomy in managing neonatal ovarian cysts, but with better cosmetic results.

/pdf/surgical-treatment-of-neonatal-ovarian-cysts-56f9nf3i63.pdf

Surgical treatment of neonatal ovarian cysts.

Introduction. Patellar tendon rupture is a rare injury which, if missed,
 leads to delayed surgical treatment and may result in the loss of the knee
 joint function. The aim of this study was to report our results of operative
 treatment of the patellar tendon rupture and point out the significance of
 timely diagnosis and surgical procedure. Material and Methods. This
 retrospective tenyear study included 20 patients, 15 males and 5 females,
 their mean age being 42 (20-84) years. Seven participants had an injury on
 the right side and 13 had an injury on the left side. Thirteen participants
 had the diagnosis set in the first seven days after the injury. The applied
 techniques were surgical suture of the tendon, bone-tendon-bone
 ligamentoplasty using allograft from a bone bank and bone-tendon-bone
 ligamentoplasty using contralateral autograft, and they were performed in 12,
 5 and 3 patients, respectively. The treatment results were assessed by using
 the Lysholm score, measuring the range of movement in the knee joint and
 measuring the girth of the thigh 10 cm above the patella. Results. The
 follow-up period after the surgery was 4 years on average (1-10 years) and
 the average value of the Lysholm score was 83 (27-100). The result was found
 to be excellent in 11 cases, satisfactory in 5 cases and unsatisfactory in 4.
 A statistically significant difference (p=0.0197 p<0.05) was found in the
 average values of the Lysholm score between the group of patients with risk
 factors (71.78) and the subjects without risk factors (92.18). A
 statistically significant difference (p=0.008 p<0.01) was found in the
 Lysholm score between the patients with timely diagnosis (91.62) and cases of
 chronic tendon tear (67). Conclusion. Timely diagnosis and early surgical
 reparation are the basic imperatives in the treatment of this injury.
 Comorbidity and risk factors are related to a poorer postoperative Lysholm
 score. The method of choice is early surgical treatment.

/pdf/patellar-tendon-rupture-treatment-results-ygzvafqvre.pdf

Patellar tendon rupture--treatment results

Introduction. The aim of this study is to present our treatment protocol for impalpable testis. Material and Methods. In a retrospective study we analyzed clinical data including diagnostic procedures, intraoperative findings, final diagnosis, treatment modality, and outcome of patients with impalpable testis who underwent surgery from January 2010 until December 2015. Results. Ninety-one patients were admitted under the diagnosis of impalpable testis. In 39 patients ultrasound detected testis in the inguinal canal and orchidopexy was done. In 25 patients (48.08%) laparoscopy showed the entrance of the spermatic cord into the inguinal canal. Open exploration of the inguinal canal was done, testicular remnant removed, and appropriate testicular prosthesis implanted. Twenty patients (20/52) underwent orchidopexy of the abdominal testis (46.51%), 4 of which underwent Fowler-Stevens procedure in two stages, and in 16 patients deliberation of the testis and spermatic cord was sufficient to place the testis into the scrotum. Conclusions. Excision of the testicular nubbin is highly recommendable, as well as implantation of the testicular prosthesis at the time of orchiectomy.

/pdf/impalpable-testis-evaluation-of-diagnostic-and-treatment-qgpfx7h20y.pdf

Impalpable Testis: Evaluation of Diagnostic and Treatment Procedures and Our Treatment Protocol

Background and Objectives: The COVID-19 pandemic has led to significant changes globally, which has also affected patients with type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of T1DM and the characteristics of diabetic ketoacidosis (DKA) during the pandemic comparing it to pre-pandemic period. Materials and Methods: Data from patients <19 years with newly diagnosed T1DM between 1st January 2017 and 31st December 2021 from four regional centers in Vojvodina were retrospectively collected and analyzed. Results: In 2021, the highest incidence of T1DM in the last five years was recorded, 17.3/100,000. During the pandemic period (2020–2021), there were 99 new-onset T1DM, of which 42.4% presented in DKA, which is significantly higher than in the pre-pandemic period (34.1%). During the pandemic, symptom duration of T1DM lasted significantly longer than before the COVID-19 period. At the age of 10–14 years, the highest incidence of T1DM and COVID-19, the highest frequency rate of DKA, and severe DKA were observed. Conclusions: The pandemic is associated with a high incidence rate of T1DM, longer duration of symptoms of T1DM, a high frequency of DKA, and a severe DKA at diagnosis. Patients aged 10–14 years are a risk group for the occurrence of T1DM with severe clinical presentation. Additional studies are needed with a longer study period and in a wider geographical area, with data on exposure to COVID-19 infection, the permanence of new-onset T1DM, and the psychosocial impact of the pandemic.

/pdf/incidence-of-type-1-diabetes-mellitus-and-characteristics-of-1cry7qlr.pdf

Incidence of Type 1 Diabetes Mellitus and Characteristics of Diabetic Ketoacidosis in Children and Adolescents during the First Two Years of the COVID-19 Pandemic in Vojvodina

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