Christopher P. Driver

Operative management of testicular torsion: current practice within the UK and Ireland.

Several methods have been described and are currently used for fixation of testes in the operative treatment of testicular torsion. Although recurrence of torsion is generally viewed as a technical failure, the factors contributing to this failure remain unclear. This survey was conducted to establish current practice amongst paediatric surgeons in the UK and Ireland, in relation to testicular fixation, in an attempt to reflect the level of concern over the potential for recurrence as expressed in choice of procedure. The questionnaire survey indicated that 85% of paediatric surgeons use suture fixation of the testis alone or in combination with additional steps, such as eversion of the tunica vaginalis or creation of a dartos pouch, and 15% use a sutureless technique. The great majority (95%) fix the contralateral testis routinely and 85% routinely excise the appendix testis. Of the respondents, 17% have operated on a torted testis that had been previously fixed. In the absence of data from comparative trials, the method used for fixation remains a matter of personal preference. It was not possible to identify the definitive risk factors for recurrence from this study, but the use of absorbable sutures accompanied recurrence in most instances.

An unusual cause of massive gastric bleeding in a child

The authors report a case of massive upper gastrointestinal bleeding in a child, originating from a Dieulafoy lesion. The intermittent nature of the hemorrhage may lead to considerable diagnostic difficulty.

Bilateral congenital diaphragmatic hernia

Bilateral congenital diaphragmatic hernia (CDH) is a rare condition, with the literature suggesting a bleak prognosis. We describe a case of bilateral CDH that, despite confirming the challenges of diagnosis, demonstrates that the condition can have a favourable outcome.

When does ultrasonography influence management in suspected appendicitis

Accurate diagnosis of appendicitis is challenging, particularly in children. Moreover, opinion is divided over the role of ultrasonography (US) in its diagnosis and how US may influence management. This study compares the use of US in two tertiary paediatric hospitals and how it influenced the management of suspected appendicitis.

Psoas abscess associated with renal pathology in children

Pyogenic psoas abscess in children is most commonly a primary disease process associated withStaphylococcus aureus. We report three cases of secondary psoas abscess associated with underlying renal pathology.

The risk of failure after primary orchidopexy: an 18 year review.

OBJECTIVE To review the primary orchidopexy failure rate and outcome of repeat orchidopexy in a tertiary paediatric surgical centre and identify risk factors. METHODS A prospectively collected and validated audits system was used to identify all boys having a repeat orchidopexy from August 1990 to December 2008 (18 years). RESULTS In total, 1538 boys underwent orchidopexy with 1886 testicles operated on. Of these 348 (22.6%) patients had bilateral cryptorchidism. A need for repeat orchidopexy was identified in 31 boys resulting in a primary failure rate of 1.6% over the 18 years. Unilateral orchidopexy as the primary operation had a 1.5% failure rate. The failure rate for bilateral cryptorchidism was 1.87% per testicle rising to 1.93% per testicle when the primary operation was synchronous bilateral orchidopexy. Orchidopexy failure occurred in 9 patients (1.97%) who were under 24 months, 15 (2.67%) who were between 24 and 72 months and 7 (0.8%) over 72 months at time of first operation. CONCLUSION Possible risk factors for primary orchidopexy failure are bilateral operation and older age at time of operation. Failure in achieving a satisfactory scrotal position (and testicular loss) following orchidopexy has been postulated as a potential surgical standard for revalidation of paediatric surgeons. This study adds important contemporary data to inform that process.

Adenocarcinoma of the appendix in a child

Adenocarcinoma of the appendix is unusual at any age but occurs mostly in an elderly population. The authors report a unique case presenting in a 10-year-old child and emphasize the importance of subjecting all resected specimens to histological examination.

Demographic and geographical characteristics of pediatric trauma in Scotland.

BACKGROUND Trauma systems reduce mortality and improve functional outcomes. The aim of this study was to analyse the demographic and geospatial characteristics of pediatric trauma patients in Scotland, and determine the level of destination healthcare facility which injured children are taken to, to determine the need for, and general feasibility, of developing a pediatric trauma system for Scotland. METHODS Retrospective analysis of incidents involving children aged 1-14 attended to by the Scottish Ambulance Service between 1 November 2008 and 31 October 2010. A subgroup with physiological derangement was defined. Incident location postcode was used to determine incident location by health board region, rurality and social deprivation. Destination healthcare facility was classified into one of six categories. RESULTS Of 10,759 incidents, 72.3% occurred in urban areas and 5.8% in remote areas. Incident location was associated with socioeconomic deprivation. Of the patients, 11.6% were taken to a pediatric hospital with pediatric intensive care facilities, 21.8% to a pediatric hospital without pediatric intensive care service, and 50.2% to an adult large general hospital without pediatric surgical service. CONCLUSIONS The majority of incidents involving children with injuries occurred in urban areas. Half were taken to a hospital without pediatric surgical service. There was no difference between children with normal and deranged physiology.

The use of PET/CT in evaluating disease recurrence following Ewing's tumour resection of the chest wall

Limitations exist with the use of computer tomography (CT) in evaluating tumour recurrence at the site of previous chest wall reconstruction due to poor differentiation between inflammatory change and tumour recurrence. This case highlights the value of combined positron emission tomography and CT, which generates detailed anatomical and metabolic profiles in this diagnostic dilemma.

Urinary enzyme excretion patterns in children

The need for a sensitive marker of renal parenchymal damage in children remains extant. The detection of renal scarring is presently dependant upon imaging modalities with the implicit problems of exposure to radiological investigation. We describe and evaluate urinary enzymology as a technique that may identify injury to the renal parenchyma from a variety of patho-physiological conditions.