Radoica Jokic

Stethoscope vs. ultrasound probe - which is more reliable in children with suspected pneumonia?

OBJECTIVE To compare lung ultrasound (LUS) with auscultation findings in children with clinical suspicion of pneumonia. PATIENTS AND METHODS A prospective study including 95 patients (age: from 2 months to 17.5 years; mean age: 5.1 y, SD 4.5 y) with referral diagnosis of suspected pneumonia. In all patients LUS and auscultatory examinations were performed within an hour. These findings were compared separately in each hemithorax. The radiologist performing LUS was blinded to the patients clinical information. Positive auscultatory findings included: crackles and/or abnormal breath sounds (decreased, asymmetric, absent, or bronchial). For LUS examinations a combined transthoracic - transabdominal approach was used. A pneumonia-positive LUS finding included subpleural consolidation with air-bronchogram, or an adjacent area of interstitial edema. For each subpleural consolidation the cranio-caudal (CC) diameter was measured, and 95% confidence intervals (CI) of the sizes of subpleural consolidations for positive and negative auscultatory findings were compared. The p-value between LUS and auscultation was calculated using McNemars test. RESULTS LUS and auscultation showed pneumonia-positive findings in 98 and 64 hemithoraces, i.e. in 67 and 45 patients respectively. In positive auscultatory findings the CI for CC diameters of subpleural consolidations ranged from 32.46 to 54.14 mm, and in negative auscultatory findings the CI was between 16.52 and 29.83 mm, which showed a statistically significant difference. McNemars test showed a statistically significant difference between LUS and auscultation. CONCLUSIONS LUS showed positive findings in more hemithoraces than auscultation in children with suspected pneumonia. A cranio-caudal size of subpleural consolidation of less than 30 mm significantly reduces the possibility of auscultatory detection.

Ectopic Adrenocortical Tissue: An Incidental Finding During Inguinal Surgery in Children

Adrenal rests are usually unrecognized during operation, and the incidence of ectopic adrenal cortical tissue in pediatric patients during inguinal surgery procedures is unknown. We performed 3028 groin surgical explorations in 2680 patients aged 1 month to 17 years. Ectopic adrenal tissue was found in 69 inguinal operations (2.2%): 37 during 1.524 orchiopexy (2.4%), 23 during 1.115 herniectomy (2.0%), and 9 during 389 hydrocoela operation (2.3%). Statistically there were no significant differences among those three groups. No adrenal rests were detected in females. Although a few reported cases with hormonal activity of ectopic adrenocortical tissue (EACT), the recommendation is to remove them if found.

Vaginal Outlet Obstruction - A Review of Cases

Vaginal Outlet Obstruction - A Review of Cases The paper focuses on anatomical varieties of developmental anomalies of female vagina’s outlet, emphasizing the role of their early recognition in preventing retrograde menstruation by surgical treatment at the beginning of puberty. Three different types of vaginal outlet obstruction are described: imperforate hymen - from the group of hymen misdevelopment, transversal vaginal septum - from the group of failed transverse Mullerian fusion, and vaginal atresia - from the Mullerian aplasia group of disorders.

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

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.

Simultaneous combined laparoscopic-endoscopic removal of a large gastric trichobezoar and gastric polypectomy

The purpose of this work is to present our positive experience using combined laparoscopicendoscopic procedure and to review current literature in resolving joint appearance of trichobezoars and gastric polyps. A formation of undigested material in the gastrointestinal tract is bezoar [1]. In a situation of a longterm ingestion of hair, i.e. trichophagia, this type of bezoar is called trichobezoar, which is at the same time the most common form of bezoar [2]. Hair cannot be digested and due to its smooth nature also cannot be propulsed by peristalsis, which causes formation of a bezoar within the stomach over a certain period. The hair in a trichobezoar always appears black because of the influence of gastric acid on hair proteins [1, 3]. In literature, the association between bezoars and gastric polyps is relatively frequently described; however, it is not so widely appreciated. Even though biopsies of gastric polyps usually show an inflammatory origin, in some cases their malignant alteration was found [4]. A multidisciplinary approach with early diagnosis and surgical removal of gastric bezoars and polyps are essential [1, 3, 5]. CASE REPORT

Paracardial cyst in an infant with pleural effusion: A case report

Paracardial cysts are rare lesions adjacent to the heart, commonly of congenital origin. They include pericardial and neural cysts, bronchogenic cysts, esophageal duplication cysts, neurenteric cysts, and cysts of other origin. These formations are mostly located behind the heart, and usually found incidentally upon chest ultrasound, radiography, computed tomography, magnetic resonance imaging, cardiac ultrasound, or on thoracoscopy and thoracic surgery. The differential diagnosis includes lymphangioma, congenital diaphragmatic hernia or thymic cyst [1].

Sonographically detected free appendicolith as a sign of retrocecal perforated appendicitis in a 2‐year‐old child

Prompt and accurate diagnosis of perforated appendicitis is crucial for proper and timely treatment. The appendix, however, cannot always be identified with sonography (US). We report the case of a 2‐year‐old child with atypical clinical presentation, and US detection of a free appendicolith as a sign of perforated appendicitis, without visualization of the appendix itself. Laparoscopy revealed a retrocecal, gangrenous, perforated appendix with autoamputation, fibrinopurulent peritonitis, and a free appendicolith within the abdominal fluid. US detection of a free appendicolith in a child is a very rare, but unequivocal sign of perforated appendicitis, which should be sought.