Katerina Kambouri

Acute abdomen in children due to extra-abdominal causes.

Background: Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra‐abdominal organs or systems. The aim of the present study was to establish the most common extra‐abdominal causes of acute abdominal pain.

Suprapubic catheter knotting: an unusual complication.

We describe a case of true knotting of a suprapubic catheter in a 25-month-old boy who underwent surgery for urethrocutaneous fistula as a complication of a distal penile hypospadias repair. This unusual complication was probably attributable to an excessive length of catheter being inserted into the bladder, thereby allowing it to bend onto itself.

Effect of passive smoking on lung function and respiratory infection

ObjectiveTo study the effect of environmental tobacco smoke to children’s health and more specifically to the development of respiratory tract infections and also its influence to their respiratory function.MethodsWe studied 586 children from the district of west Thrace in Greece aged 5–14 years, randomly selected from 20 primary and 10 secondary schools in regards their exposure to tobacco smoke, and its possible relation with respiratory tract infections. We assessed respiratory function by spirometry. Epidemiological data were also analysed.ResultsChildren who were exposed to environmental tobacco smoke had higher risk for upper and lower respiratory tract infections in comparison to children who lived in a smoke free environment (3 fold and 2 fold, respectively. Their lung function was also reduced with decreased values of FEV1, FEF50, PFR (values p<0.001).ConclusionPassive smoking has an unfavorable effect in respiratory function of children and predisposes them to respiratory tract infections. Every effort should be undertaken in order to avoid exposure of children to environmental tobacco smoke.

Night Sweats, Stress Activation and Coeliac Disease

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits noncommercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Brief Report

Acute appendicitis in preschoolers: a study of two different populations of children

ObjectiveTo assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region.MethodsOver a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children) and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue.ResultsAcute appendicitis of preschoolers developed more frequently in Muslims (39.4%) than in Christians (17.7%; p < 0.001). The lack of inside toilet facilities at home, overcrowded living conditions, living in rural areas, and the amount of appendix lymphoid tissue were significantly more frequent among the Muslim preschool children (p < 0.05), while there were no statistically significant differences between Muslim and Christian children with regard to gender, the family history of acute appendicitis, or the vegetable consumption (p > 0.05).ConclusionsIn our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.

Local peritonitis as the first manifestation of Crohn's disease in a child.

Crohns disease (CD) can occur anywhere in the gastrointestinal tract from the mouth to the anus and sometimes it presents in a nonspecific manner. Herein we describe a case of local peritonitis as the first manifestation of CD in an 11-year-old girl, and the subsequent method of treatment.

Hematological Diagnostic Markers of Acute Appendicitis in Children

BackgroundWhite blood cell (WBC) and platelet indices are useful biomarkers in many inflammatory diseases. A study was made of possible WBC and platelet indices in children with acute appendicitis.MethodsWe reviewed the results of the complete blood count tests made on admission of 150 children with acute appendicitis (94 boys, 56 girls) and those of 74 healthy children (46 boys, 28 girls). We compared the WBC and platelet indices between the children with acute appendicitis and healthy children and between the complicated and uncomplicated cases of appendicitis.ResultsThe children with acute appendicitis had higher WBC, neutrophil count, neutrophil percentage and neutrophil/ lymphocyte ratio and lower lymphocyte count and lymphocyte percentage than the healthy children. Cases of appendicitis with complications had lower lymphocyte count, lymphocyte percentage and higher neutrophil to lymphocyte ratio than those without complications. In girls WBC, neutrophil count and neutrophil percentage were higher in complicated acute appendicitis. WBC, neutrophil count, neutrophil percentage, lymphocyte percentage and a neutrophil/lymphocyte ratio >2.5 were accurate markers for acute appendicitis in children, but not for detecting complicated cases. Girls with acute appendicitis had lower platelet distribution width than healthy girls, with high sensitivity and positive predictive value at platelet distribution width <12.4%, but moderate specificity and negative predictive value.ConclusionsThe Neutrophil/lymphocyte ratio can be used as an additional diagnostic marker of acute appendicitis in children, but cannot detect complications, and platelet distribution width can be an additional marker for confirming, but not excluding, acute appendicitis in girls.

Inguinal ectopic scrotum in a neonate: Case report and literature review

Ectopic scrotum (ES) is a particularly rare congenital malformation of the scrotum and commonly associated with other congenital malformations. The ectopic scrotal location is variable, and the testis may be present or not in the abnormal scrotum. A 2750-g boy was delivered by cesarean section at the 39th week of gestation after an uneventful pregnancy. He was the third child of a family with no history of any congenital anomaly. His prenatal ultrasound did not reveal any abnormalities. During the first day of this child’s life, the pediatrician noted a left inguinal ectopic scrotum (ES) without palpable testis. The contralateral scrotum, which exhibited no raphe, contained the right testis; this had a normal structure on palpation (Fig. 1). Prenatal, maternal, and paternal medical histories were unremarkable. Clinical examination of the neonate revealed no other congenital anomalies, and his karyotype was 46XY. The left testis was not disclosed by either ultrasound or magnetic resonance imaging (MRI) examination of the left ES, inguinal canal, and abdomen; similarly, no other intra-abdominal organ abnormality was found. The right testis had normal imaging pattern both in ultrasound and MRI examinations. The boy underwent laparoscopy at 1 year of age, which confirmed the absence of the left testis. Excision of the ES was performed. Histological examination of the excised specimen showed findings compatible with scrotal skin. ES occurs in various locations, ranging from the perineum and inguinal canal to the medial thigh, but is found mainly in the inguinal, suprainguinal, infrainguinal, or perineal area. It has been hypothesized that local disproportion of the size of the fetus and chorionic sac or oligohydramnios can lead to an abnormal flexed-limb position. In this position, the contralateral heel can press against the region of the developing scrotum, which may in turn lead to ES. ES has been associated with other genitourinary anomalies, such as cryptorchidism, renal agenesis, penile torsion, chordee, hypospadias, diphallia, renal dysplasia, and testicular atrophy. There have also been referred cases of nongenitourinary anomalies associated with ES. Our case was associated with anorchia on the affected side and no other congenital anomalies. Areview of the literature revealed few cases of inguinal ES and in the majority of them there were other congenital anomalies. In all of these cases, the testes ipsilateral to the inguinal ES existed either inside the malformed scrotum or not. Our patient thus represents the first reported case of ES and anorchia without any other congenital anomaly. In our case, the absence of any other associated anomaly supports the hypothesis that the abnormality was attributable to a direct mechanical effect, rather than to a genetic, chromosomal, or teratogenic effect. Although in our case ES was associated only with anorchia, this condition in most of the cases is related to other congenital malformations. For this reason, a thorough physical examination, complete urogenital and upper tract evaluation, and detailed assessment of other systems is recommended in cases of ES in order to exclude the congenital abnormalities that are commonly associated with this rare entity.

Effect of VEGF on angiogenesis in pedicle penile skin flaps: an experimental study of urethral reconstruction in rabbits.

INTRODUCTION The aim of this study was to investigate the expression of vascular endothelial growth factor (VEGF) in pedicle penile skin flaps (PPSFs) used for urethral reconstruction in rabbits and the effect of exogenous VEGF on the angiogenesis process in the PPSFs. METHODS We randomly divided 28 male New Zealand rabbits into two sets of animals. A ventral urethral defect was created in all animals. In the first set of animals (first experiment, n = 10), a PPSF was used for the repair and VEGF expression in the flap was estimated on days 1, 2, 3, 5, and 7 postoperatively. The second set of animals (second experiment, n = 18) included three groups: control, untreated, and VEGF groups. In control group (n = 6), the defect was repaired by simple closure. In untreated (n = 6) and VEGF (n = 6) groups, a PPSF was used for the reconstruction. In VEGF group, exogenous VEGF was injected subdermally on the postoperative day corresponding to the peak endogenous VEGF expression (first experiment results). The animals were sacrificed on the 21st postoperative day and the angiogenic activity was assessed. A p < 0.05 was considered statistically significant. RESULTS The highest expression of endogenous VEGF in PPSFs was noted on postoperative day 3. Angiogenesis in control, untreated, and VEGF groups was 23.06 ± 4.1, 30.00 ± 6.9, and 34.7 ± 6.9 (mean values ± standard deviation) vessels per optical field, respectively. There were statistically significant differences between control-untreated groups (p = 0.04) and untreated-VEGF groups (p < 0.0001), and indicative difference between untreated and VEGF groups (p = 0.064). CONCLUSIONS VEGF is expressed in PPSFs, used for urethral reconstruction in rabbits. Flap angiogenesis is much higher than angiogenesis in simple wound closure. VEGF injection on postoperative day 3 seems to enhance angiogenesis in flaps.

Handlebar hernia in children: a conservative approach. Case report and literature review

Abstract Handlebar hernias are very rare and occur after a blunt abdominal trauma by a bicycle handlebar or a handlebar-shape object. As a result the abdominal wall musculature and fascia are disrupted while the skin is still intact. A good history of the injury and physical examination are usually enough to pose a diagnosis. We report the case of bicycle-handlebar hernia in a 6-year-old boy who presented to our emergency department because of a reducible swelling above the left iliac crest after falling from his bicycle 3 days ago. The patient was treated conservatively with a weekly follow-up. Four weeks later the muscle disruption was healed. In pediatric patient in the absence of internal organ injuries, a handlebar hernia can successfully be managed conservatively.