Bladder urothelial carcinoma (UC) it is the fifth most prevalent carcinoma in humans, nevertheless in children and young adults it's very rare. It usually occurs in older adults. Literature on UC in pediatric population is limited and important information (risk factors, follow-up protocols, etc.) are poorly defined. We present an 11-year-old boy with a painful macroscopic hematuria. Ultrasound revealed a heterogeneous intravesical mass without extravesical extension, which was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The first biopsy was compatible with urothelial papilloma. After 1 year, he returned with a bigger mass. Transurethral resection of the bladder (TURB) was performed and immunohistochemistry showed low-grade papillary UC with a high-grade component, with tumor free margin. Tumor had mutations in the BRAF and KRAS genes. Two and a half years after the resection the patient has no recurrence. Less than 1% of bladder UC occur in the first two decades of life. Gross hematuria is a common symptom. Ultrasound is generally the first diagnostic tool. MRI is also helpful, but cystoscopy allows definitive diagnosis. Transurethral resection of the bladder (TURB) is the standard treatment, with good results and low recurrence rate, and it was the treatment of choice for our patient, that remains free of disease. The BRAF and KRAS gene mutations were never described before in pediatric UC. There are only few cases in literature of pediatric UC that present a tumor genetic profile; therefore, our case report adds more information to this very rare disease in children.
Phimosis is classically characterized by the impossibility of completely withdrawing the foreskin and exposing the glans. A distal preputial narrowing occurs, which may be congenital or acquired. Excess foreskin and the presence of balanopreputial adhesions may be components of this spectrum. Circumcision corresponds to foreskin excision, one of the most commonly performed surgeries in boys, whether for medical or religious reasons. Such a procedure is considered sacred by many peoples around the world as a symbol of faith or even as a ritual of tribal emancipation. The appearance of the procedure in several places and times allowed the development of the surgical technique, today adapted to minimize complications and provide evident medical benefits. We present fundamental physiological and histological concepts, classically described, knowing the natural history of a potential disease. We discuss the emergence and development of surgical techniques still used today and identify factors that interfere with the disease and influence the treatment.
Objective: to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals. Methods: prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized “best result”. Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications. Results: most of the patients obtained the “best result” regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications. Conclusion: the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.
HighlightsThe most common mechanism of urethral injury in children is trauma.Urethral trauma in children most commonly is due to pelvic fractures from car accidents.Urethral trauma can present in many forms.Possible options for management of urethral injuries are presented.The surgeon must keep in mind different techniques for urethral reconstruction.
Introdução: a taxa de mortalidade infantil é um indicador sensível às transformações sociais de uma região, sinaliza o desenvolvimento socioeconômico e as condições de vida, importando, por isso, aos profissionais da administração em saúde e da medicina preventiva e social. Objetivos: estabelecer a associação entre determinantes sociais e a taxa de mortalidade infantil nos municípios do Piauí em 2010. Metodologia: estudo ecológico de correlação e autocorrelação espacial entre a taxa de mortalidade infantil e os indicadores índice de desenvolvimento humano municipal e seus componentes longevidade, renda e emprego e educação, coeficiente de Gini e proporção de pobres em 2010. Os dados foram obtidos no sítio eletrônico do Atlas de Desenvolvimento Humano no Brasil. Realizou-se estatística descritiva, teste de correlação de Spearman e dependência espacial univariada e bivariada com o índice de Moran. Consideraram-se estatisticamente significante um valor p menor de 0,05 e um pseudo-p menor ou igual a 0,05 quando o módulo do valor z fosse maior ou igual a 1,96. Utilizaram-se os softwares MINITAB v.17, GeoDa e R Studio. Este trabalho foi aprovado pelo CEP da Universidade Federal do Piauí. Resultados: A taxa de mortalidade infantil correlacionou-se de modo complexo e nem sempre homogêneo com o IDHM, com os componentes do IDHM e com a proporção de pobres. Não houve correlação com o coeficiente de Gini. O IDHM renda e emprego foi o único determinante social que não exibiu dependência espacial. Apenas o IDHM longevidade correlacionou-se espacialmente com a taxa de mortalidade infantil, predominando a formação de outliers onde maior IDHM longevidade esteve associado com menor mortalidade infantil. Conclusões: Existiram correlação e autocorrelação espacial entre taxa de mortalidade infantil e determinantes sociais no Piauí em 2010. As áreas de maior risco, principalmente aquelas com piores indicadores sociais, são alvo das ações de planejamento estratégico em administração em saúde e em medicina preventiva e Social.Palavras-chave: Mortalidade Infantil. Determinantes Sociais da Saúde. Correlação de Dados. Análise Espacial. ABSTRACTIntroduction: infant mortality rate is a sensitive indicator to regional social transformations and indicates the socioeconomic development and the way of life, consequently it matters to health administration and to preventive and social medicine. Objectives: to establish the association between social determinants and the infant mortality rate in the cities of Piaui in 2010. Methodology: ecological study of correlation and spatial autocorrelation between the infant mortality rate and the human development index and their components (‘longevity’, ‘income and employment’ and ‘education’), Gini’s coefficient and proportion of poverty in 2010. Data were obtained from the website of Atlas of Human Development in Brazil. Descriptive statistics, Spearman's correlation test and univariate and bivariate spatial dependence with the Moran index were performed. A p-value less than 0.05 and a pseudo-p equals to or less than 0.05 with an absolute z-value equals to or greater than 1.96 were considered statistically significant. The software MINITAB v.17, GeoDa and R Studio were used. This paper was approved by the Research Ethics Committee of the Federal University of Piaui. Results: The infant mortality rate correlated in a complex and not always homogeneous way with the HDI, with the components of the HDI and with the proportion of poverty. There was no correlation with the Gini’s coefficient. The income and employment component of HDI was the only social determinant that did not demonstrate spatial dependence. Only the longevity component of HDI was spatially correlated with the infant mortality rate, with the formation of outliers predominating where greater longevity component of HDI was associated with lower infant mortality rate. Conclusions: There were correlation and spatial autocorrelation between infant mortality rate and social determinants in Piaui in 2010. The areas of greatest risk, especially those with the worst social determinants, are the target of strategic planning actions in health administration and preventive and social medicine.Keywords: Infant Mortality. Social Determinants of Health. Correlation of Data. Spatial Analysis.
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