Riadh Mhiri

Neoadjuvant Gonadotropin-releasing Hormone Therapy Before Surgery and Effect on Fertility Index in Unilateral Undescended Testes: A Prospective Randomized Trial

OBJECTIVES To investigate, in a prospectively randomized trial, whether preoperative gonadotropin-releasing hormone (GnRH) therapy improves the fertility index in primary cryptorchidism. Cryptorchidism is a common condition with a high risk of infertility. Treatment with GnRH appears to improve fertility later in life by inducing germ cell maturation. METHODS A total of 24 boys, 12-123 months old (median 34.5), with 24 undescended testes were prospectively assigned to 2 groups during a 24-month period. The patients were randomized to receive either orchiopexy alone (n = 12) or orchiopexy combined with neoadjuvant GnRH therapy (n = 12) as a nasal spray for 4 weeks at 1.2 mg/d. In both groups, testicular biopsies were performed at orchiopexy, and the histopathologic fertility index was determined. RESULTS The mean fertility index in the group treated with GnRH before surgery was significantly greater (0.88 +/- 0.31) than in the group without hormonal stimulation (0.49 +/- 0.52; P = .02). No significant correlation was found between the fertility index in the GnRH group and the patients age. CONCLUSIONS The results of our study have shown that neoadjuvant GnRH treatment improves the fertility index in prepubertal cryptorchidism and, consequently, should improve fertility in adulthood.

Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort.

PURPOSE To evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score. METHODS A prospective study was performed on children <14 years admitted for suspected acute appendicitis. Patients were categorized into three groups based on the Alvarado score: group I: score 7-10, group II: score 5-6, group III: score 0-4. RESULTS The difference between predictive values of Alvarado score alone and Alvarado score with CRP was not statically significant. The PPV increased from 74.29% (Alvarado score and CRP) to 93.75% (Alvarado score and US) in group 1 (P = .001) and the NPV increased from 64.86 and 79.69% (Alvarado score and CRP) to 82.6 and 88.2% (Alvarado score and US) in group 2 (P = .01) and group 3 (P = .001), respectively. CONCLUSIONS Alvarado score and ultrasound taken together improve the predictive value of diagnosing acute appendicitis in children.

Vaginal polyp in a newborn

Vaginal fibroepithelial polyp is a rare lesion, and although benign, it can be confused with malignant connective tissue lesions. Treatment is simple excision, and recurrence is extremely uncommon. We report a case of a newborn with vaginal fibroepithelial polyp. The authors suggest that vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls.

Iatrogenic neonatal bladder perforation

Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.

Neonatal Ovarian Lymphangioma

Ovarian cysts are primarily of follicular origin and ovarian lymphangioma is an extremely rare lesion. We report a case of prenatal diagnosis of unilateral ovarian cyst in which pathologic examination revealed an ovarian lymphangioma. Ovarian cystic lymphangioma should be included in the differential diagnosis of an ovarian cyst mass in neonate.

Rifamycin Lavage in the Treatment of Experimental Intra-Abdominal Infection

HYPOTHESIS Peritoneal lavage with rifamycin reduces the number of intraperitoneal bacteria and adhesions and improves the outcome of intra-abdominal infection (IAI). MATERIAL AND METHODS Experimental IAI was induced in Wistar rats. After 24 h, the animals underwent relaparotomy. A peritoneal fluid sample was obtained and lavage of the abdominal cavity was performed. Animals were randomly assigned to the three following groups: lavage with 0.9% sodium chloride solution (S group); lavage with rifamycin at the dose of 25 mg/kg (R25 group); and lavage with rifamycin at the dose of 12.5 mg/kg (R12.5 group). Mortality was recorded every 8 h for 7 d. All animals that died had a necropsy. Surviving rats were later sacrificed and also underwent a necropsy. At necropsy, intraperitoneal adhesions were noted and a peritoneal fluid sample was obtained for bacterial analysis. RESULTS Peritoneal lavage with rifamycin improved survival from 50% in the S group to 91.7 and 100% in the R25 group and R12.5 group, respectively. Adhesion formation was significantly reduced in the R25 group and R12.5 group compared with the S group (P < or = 0.01 and P < 0.01, respectively). There was a greater reduction in bacterial counts in peritoneal fluid in the R25 group compared with the S group (P = 0.003) but there was no significant difference in the reduction of bacterial count between R25 group and R12.5 group. CONCLUSION These results suggest that peritoneal lavage with rifamycin improves the outcome of IAI.

Pilomatrixoma of earlobe

Pilomatrixomas are uncommon in children and are frequently misdiagnosed preoperatively. We report a two-year-old female patient with an unusual localization in the earlobe. The lesion was treated by simple enucleation and in two years of follow-up there has been no evidence of recurrence. The case is being reported in view of its rarity and unusual location.

Single-port laparoscopic ovarian transposition in an 11-year-old girl.

Ovarian transposition was the first procedure proposed for children with cancer to preserve ovarian function from damage caused by abdominal and pelvic radiotherapy. In this paper, we describe the first pediatric case of single-port laparoscopic ovarian transposition.

Percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia: Review of three cases

Morgagni hernias are uncommon, accounting for only 1-2% of all congenital diaphragmatic hernia. Minimally invasive surgery is today the gold standard treatment. We present a technique using percutaneous suturing and single-site umbilical laparoscopic repair of Morgagni hernia in three children. Recovery was uneventful in all three patients. There was no recurrence and the chest radiograph remained normal during the postoperative follow-up. The percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia is an easy and effective alternative to standard laparoscopic repair.

A Difficult Recurrent Hypertrophic Pyloric Stenosis

A 20-day-old girl presented with increasing projectile vomiting over a period of one week and progressive weight loss. The diagnosis of hypertrophic pyloric stenosis (HPS) was made by sonography (Length of pyloric channel: 22 mm; muscle thickness: 5 mm). Open standard pyloromyotomy was performed. The postoperative course uneventful. On the 50th postoperative day, the girl was readmitted with projectile vomiting for a week. Contrast radiography proved a pyloric stenosis occlusive. Ultrasound confirmed recurrent pyloric stenosis (length of pyloric channel: 22 mm; thickness of the muscle: 4.8mm). At repeat surgery, the previous incision had been healed (Fig.1).