scholarly journals 116 An Assessment of Current Practice for Suspected Paediatric Testicular Torsion

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Gibb ◽  
O Babawale ◽  
D Hodgson ◽  
R Harrison
Keyword(s):  
Testicular Torsion ◽  
Current Practice ◽  
Late Presentation ◽  
Paediatric Surgery ◽  
Late Presenters ◽  
Number Of Children ◽  
Atypical Features ◽  
Senior Clinician ◽  
Atypical Presentations ◽  
Immediate Surgery

Abstract Aim British Paediatric surgery guidelines (2019) state ‘immediate surgery should be performed if testicular torsion is suspected’. However, imaging ‘may be considered for a small number of children under the guidance of a senior clinician in late presenters or in those with atypical features. This study reviewed current practice in our hospital. Method Boys aged 16 and under in 2017-2019 who underwent scrotal exploration for suspected testicular torsion were reviewed. Outcomes assessed were number having ultrasound prior to theatre, pathological findings, number who had an orchidectomy, and post-op complications. Additionally, all testicular ultrasounds in those aged under 16 were screened to establish how many were requested for possible or missed torsion. Results 46 patients underwent surgical exploration of which 18 had a confirmed torsion. Six patients had imaging prior to surgery, of which five suggested torsions and four of these were confirmed in theatre. 202 boys under 16 had a testicular ultrasound; 26 of these were for late presentation or those with atypical features of torsion. Three underwent scrotal exploration two of whom had reports suggestive of torsion which was confirmed on exploration. Conclusions Most testicular torsions occur around the age of puberty with no torsion identified in patients under 10. Ultrasound is a useful tool for identification of vascularity or alternative pathology in late or atypical presentations of torsion; but does not replace clinical judgement. Imaging may have prevented unnecessary exploration in 23 cases, although negative imaging did not always preclude exploration.

Atypical presentations of non-familial anterior megalophthalmos: a rare disease

2021 ◽  
Vol 14 (10) ◽  
pp. e244350
Author(s):  
Aparna Rao ◽  
Rakhi P Dcruz
Keyword(s):  
Family History ◽  
Late Onset ◽  
Positive Family History ◽  
Late Presentation ◽  
Optic Nerve Damage ◽  
Atypical Features ◽  
The Family ◽  
Anterior Megalophthalmos ◽  
Advanced Glaucoma ◽  
Atypical Presentations

Anterior megalophthalmos usually presents early in life with megalocornea, deep anterior chamber, raised intraocular pressure, glaucomatous optic nerve damage and iridodonesis/stromal thinning with positive family history. We report atypical features and presentations in two patients (four eyes) with non-familial megalophthalmos. While the first patient, a male, presented at 51 years of age with megalocornea, cataract, phacodonesis, normal pupillary dilatation/normal iris and advanced glaucoma, the second patient presented with iridodonesis with stromal thinning, aphakia and advanced glaucoma. The family history was negative in both patients. The vitreous index was unusually high, >70% in all four eyes, owing to aphakia in the second patient and possible late presentation/variant phenotype in the first patient. Thus, atypical features such as greater vitreous length, absent iris involvement and late-onset adult presentation are common in non-familial anterior megalophthalmos. Clinical surprises due to varied phenotypes should be kept in mind in such cases.

scholarly journals Determinants of HIV-1 Late Presentation in Patients Followed in Europe

Pathogens ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 835
Author(s):  
Mafalda N. S. Miranda ◽  
Marta Pingarilho ◽  
Victor Pimentel ◽  
Maria do Rosário O. Martins ◽  
Anne-Mieke Vandamme ◽  
...  
Keyword(s):  
Late Presentation ◽  
World Health ◽  
Prevention Measures ◽  
Demographic Information ◽  
Late Presenters ◽  
Major Threat ◽  
Immunodeficiency Virus ◽  
Mode Of Transmission ◽  
Health Organization ◽  
Hiv 1

To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm3 or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0–41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.

Failed salvage of late presentation adult testicular torsion: cases discovered on serial testicular scintigraphy

BJUI ◽  
2012 ◽  
Author(s):  
Young Hwii Ko ◽  
Gi Joeng Cheon ◽  
Tae Young Par ◽  
Sung Gu Kang ◽  
Du Geon Moon ◽  
...  
Keyword(s):  
Testicular Torsion ◽  
Late Presentation ◽  
Testicular Scintigraphy

scholarly journals General Paediatric Surgical Provision of Percutaneous Endoscopic Gastrostomy in a District General Hospital – A 12-Year Experience

2009 ◽  
Vol 91 (5) ◽  
pp. 404-409 ◽  
Author(s):  
T Sathesh-Kumar ◽  
Hazel Rollins ◽  
Sarah Cheslyn-Curtis
Keyword(s):  
General Hospital ◽  
Percutaneous Endoscopic Gastrostomy ◽  
District General Hospital ◽  
Late Complications ◽  
General Anaesthetic ◽  
Paediatric Surgery ◽  
Number Of Children ◽  
Endoscopic Gastrostomy ◽  
Local Access ◽  
The Uk

INTRODUCTION A small, but significant, number of children require long-term nutritional support. The aim of this study was to demonstrate the safety and efficacy of providing a percutaneous endoscopic gastrostomy (PEG) service for children in a district general hospital and to raise awareness of the suitability of the procedure to be performed on paediatric surgery lists in similar hospitals across the UK. PATIENTS AND METHODS A multidisciplinary paediatric nutrition team was established and all children accepted for PEG insertion between 1995 and 2007 were entered onto a database prospectively and are included in this study. PEG tubes were inserted by the standard pull-through technique under general anaesthetic. RESULTS A total of 172 procedures were performed in 76 children. The median age at first tube insertion was 3 years (range, 0.5–18 years). Length of follow-up ranged from 1 month to 12.6 years. Fifty-eight children (76%) had a neurological abnormality, the commonest being cerebral palsy. All but one procedure were performed successfully, of which 63 (37%) were new insertions, 99 change of tube, 4 changed from surgical gastrostomy and 6 from PEG to button gastrostomy. The median hospital stay was 2 days (range, 2–7 days) for new insertions and 1 day for tube changes. There were 10 (6%) early complications within 30 days, the commonest being peritubal infection (6). The 39 late complications included 16 peritubal infection/granulomata, 9 ‘buried bumpers’, 4 worsening of gastro-oesophageal reflux disease, 2 gastrocolic fistulae, 3 gastrocutaneous fistulae and 4 tubal migration. There was no mortality. CONCLUSIONS We have demonstrated that paediatric PEG procedures and continuing management by a supporting team can be successfully and efficiently provided in the district general hospital. It should be possible for the majority of similar hospitals to provide local access and increase the availability of PEG feeding for children.

scholarly journals P082 Appendicular syndrome revealing Kawasaki-like syndrome: a case report

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Hanane Hajaj ◽  
Aziza El Ouali ◽  
Ayad Ghanam ◽  
Maria Rkain ◽  
Noufissa Benajiba ◽  
...  
Keyword(s):  
Heart Failure ◽  
White Blood Cells ◽  
Cervical Lymphadenopathy ◽  
Abdominal Ultrasound ◽  
Number Of Children ◽  
Bilious Vomiting ◽  
Erythematous Skin ◽  
Anti Inflammatory ◽  
Atypical Presentations ◽  
Inflammatory Syndrome

Abstract Background With the wide spread of the current SARS-CoV-2, It was found that about 2% of children was affected according to several studies, However, a small number of children with Covid-19 develop a significant systemic inflammatory response similar to Kawasaki disease, a new disease entity called multisystem inflammatory syndrome. Methods A 12-year-old child, without a notable pathological history, who presented to the emergency, during the SARS-CoV-2 pandemic, for management of a pseudo-appendicular syndrome. Our patient was initially assessed by the surgical team due to his query acute abdomen. The pain had been evolving for 3 days associated with several episodes of bilious vomiting in a context of fever at 38.5°. Abdominal examination noted abdominal tenderness and defence. Extradigestive signs were not reported, The Lab Testing objectified a CRP at 235, elevated white blood cells at 18 180, an abdominal ultrasound was requested returning without particularities. Faced with the persistence of bilious vomiting, surgical exploration was indicated objectifying a catarrhal appendix. A pediatric opinion was requested, the clinical examination shows conscious child who presents infra cervical lymphadenopathy with a fever at 38 associated with an erythematous skin rash on the back and aseptic conjunctivitis. The Lab Testing objectified an important inflammatory syndrome, a acute kidney and heart failure a Covid 19 serology was requested with positive IGG, négative IGM, PCR covid test was negative, given the unavailability of In immunoglobulins, the treatment was based on corticosteroid bolus then relay by oral corticosteroid associated with an anti-inflammatory treatment, gastric protection by proton pump inhibitors, treatment of heart and acute kidney failure. The evolution was marked by clinical and biological improvement Discussion Coronavirus 2 (SARS-CoV-2) infection among children and adolescents, is mainly responsible for mild respiratory symptoms, in contrast to the severe forms reported in adults [7]. A systemic inflammatory syndrome mimicking kDa, temporally associated with infection with SARS-CoV-2 (Kawa-COVID-19) has recently been described as a serious illness sometimes requiring intensive care (44%). The median age is older (&gt; 5 years), the frequency and severity of myocarditis are very different from classic kDa, abdominal pain and/or diarrhea were more frequently (81%) reported than in classic kDa, heart failure, pneumonia, neurological and renal impairment, associated with elevated CRP, hyperferritinemia are more common in Kawasaki-Like syndrome [10]. Some investigations must be systematically realized urgently to diagnose potentially fatal complications. These include testing for myocarditis, patients should benefit from careful monitoring and treatment with IV Ig 2 g/kg should be administered rapidly and seems to be effective in the majority of cases, associated anti-inflammatory therapy, such as steroids is necessary Conclusion Pediatricians should be aware of these atypical presentations of COVID-19 infection for early diagnosis.

scholarly journals Neurotropic Melanoma: The Management of Localised Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Jeremy Croker ◽  
Bryan Burmeister ◽  
Matthew Foote
Keyword(s):  
Current Practice ◽  
Diagnostic Delay ◽  
Neck Region ◽  
Distant Metastases ◽  
Late Presentation ◽  
Salvage Treatment ◽  
Diagnostic Dilemma ◽  
Head And Neck Region ◽  
Disseminated Disease ◽  
The Brain

Neurotropic melanoma is a rare subtype of cutaneous malignant melanoma. Compared with conventional melanoma, it is more locally aggressive with an increased tendency for local recurrence but less likely for nodal or distant metastases. These tumours can be a diagnostic dilemma with a variety of morphological, histopathological, and immunophenotypical expressions. The often amelanotic, benign appearance may lead to treatment issues such as late presentation, diagnostic delay, misdiagnosis, insufficient surgical margins, and recurrence with resulting poor outcome. The neurotropic nature of the disease and prevalence in the head and neck region can result in perineural and neural invasion along named large nerves into the brain with resulting neuropathies. Wide local excision with adjuvant radiotherapy where indicated remains the current practice for treatment with chemotherapy predominately being reserved as a salvage treatment for patients with disseminated disease.

scholarly journals The Direct Medical Costs of Late Presentation (<350/mm3) of HIV Infection over a 15-Year Period

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Hartmut B. Krentz ◽  
M. John Gill
Keyword(s):  
Cost Savings ◽  
Medical Costs ◽  
Late Presentation ◽  
Hiv Care ◽  
First Year ◽  
Late Presenters ◽  
Cd4 Counts ◽  
Direct Medical Costs ◽  
Southern Alberta ◽  
Routine Hiv Testing

We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm3(“late presenters”). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm3despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.

Paediatric surgery

2012 ◽  
Author(s):  
Matthew D. Gardiner ◽  
Neil R. Borley
Keyword(s):  
Testicular Torsion ◽  
Hypertrophic Pyloric Stenosis ◽  
Anorectal Malformations ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Abdominal Wall Defects ◽  
Paediatric Surgery ◽  
Basic Principles ◽  
Anatomy And Physiology ◽  
Congenital Abdominal Wall Defects ◽  
Case Based

This chapter begins by discussing the basic principles of paediatric anatomy and physiology and paediatric abdominal pain before focusing on the key areas of knowledge, namely congenital abdominal wall defects, anorectal malformations, miscellaneous neonatal conditions, infantile hypertrophic pyloric stenosis, intussusception, penile conditions, testicular torsion, epididymitis and orchitis, infantile inguinal hernia and hydrocele, and testicular maldescent. The chapter concludes with relevant case-based discussions.

scholarly journals Does the source of referral affect outcomes for paediatric testicular torsion?

2019 ◽  
Vol 101 (6) ◽  
pp. 411-414 ◽  
Author(s):  
R Peeraully ◽  
M Jancauskaite ◽  
S Dawes ◽  
S Green ◽  
N Fraser
Keyword(s):  
Primary Care ◽  
Testicular Torsion ◽  
Paediatric Surgery ◽  
Single Centre ◽  
Significant Difference ◽  
Single Centre Study ◽  
The Difference ◽  
Surgery Department ◽  
Surgical Unit ◽  
Do So

Introduction This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. Methods All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. Results Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). Conclusions Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.

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