No abstract

Evaluation of acute painful scrotum is difficult and imaging studies have been reported to be unreliable in detecting testicular torsion. In order to assess the value of color Doppler sonography in acute scrotal disease, the authors reviewed 65 conseeutive boys, ranging in age from 1 to 16 years. The study demonstrated absent or diminished flow signals in 11 patients. All of them had a surgical intervention, and in 8 of them, a testicular torsion was confirmed. 54 boys had a symmetrical or increased f10w signal on the affected side. Just 5 boys among this group underwent surgical exploration. On follow up, none of the 54 patients with good f10w signals proved to have a testicular torsion. Sonography and color Doppler soriography helped to differentiate epididymitis and torsion of a testicular appendage as a basis for further investigations and correct conservative therapy. In detecting a testicular torsion, color Doppler sonography yielded a positive predictive value of 73 %, a sensitivity of 100 % and a negative predictive value oflOO%. We therefore conc1ude, that Doppler sonography can reliably rule out testicular torsion so that routine scrotal exploration in cases of acute scrotum is no longer necessary. By reducing the number of emergency operations and hospitalization days, color Doppler sonography can cut down the total cost of managing acute painful scrotum in boys.• Key words: Acute scrotum -Testicular torsion -Spermatic cord torsion -Color Doppler sonography -Epididymitis -Chi!-dren -Cost analysis Resume l'evaluation des scrotums aigus douloureux au niveau c1inique est difficile et les investigations radiologiques rapportees dans la litterature ont He decourageantes pour detecter les torsions testieulaires. Afin de dHerminer la valeur diagnostique de I'echo Doppler couleur dans les scrotums aigus, 65 garc;:ons consecutifs entre 1 et 16 ans ont He examines. 11 patients avaient un debit diminue ou absent. leurs testicules ont ete exEur J Pediatr Surg 2000; 10: 235 -241 © Georg Thieme Verlag Stuttgart, New York . Masson Editeur Paris ISSN 0939-7248 plores et le diagnostic d'une torsion testiculaire etait confirme pour 8 garc;:ons. 54 patients avaient un signal symetrique ou augmente sur le cöte douloureux. Seulement 5 garc;:ons de ce groupe ont eu une exploration chirurgicale. Par la suite, aucun des 54 garc;:ons avec un signal symetrique ou augmente en echo Doppler couleur n'a presente une torsion testiculaire. l'echographie et I'echographie Doppler couleur ont aide a differencier entre une epididymite et une torsion des appendices testiculaires pour I'indication d'investigations complementaires et un traitement conservateur correct. Pour le diagnostic d'une torsion testiculaire, I'echo Doppler couleur avait une valeur predictive positive de 73%, une sensitivite de 100% et une valeur predictive negative de 100%. Nous concluons que I'echo Doppler couleur peut correctement exelure une torsion testiculaire en eliminant par la meme la necessite d'explorer tous les scrotums aigus. la diminution du nombre d'ope...

ResumenMeconium periorchitis (MPO) is an uncommon entity associated with healed meconium peritonitis. The typical presentation is soft hydrocele at birth which becomes harder in weeks as the meconium calcifies. It mimics a scrotal mass, and, without knowledge of this rare disease, this may lead to unnecessary surgery. Both the masses and the calcifications have the tendency to resolve spontaneously without compromising the testide. Sonographie features together with an abdominal plain film are diagnostic, and visualization of the normal testide may be helpful in differentiating this tumor-Iike lesion from scrotal tumors. A case of a meconium periorchitis is reported on and the radiological and histological features are discussed with a literature review on the subject.• Key words: Meconium periorchitis -Seroturn -Infant -Ultrasound Resume La periorchite d'origine meconiale est une affection rare associee aJa peritonite meconiale guerie. Elle se presente ala naissance comme une hydrod~le molle qui devient plus dure en quelques semaines comme le meconium se calcifie. Elle peut imiter une tumeur scrotale et I'ignorance de cette affection rare peut aboutir aune operation inutile. Tant la tumeur que la calcification ont I'aptitude a la resolution spontanee sans que les testicules soient affectees. Les aspects ultrasoniques et I'abdomen sans preparation permettent le diagnostic, et la visualisation du testicule normal permet la differentiation de cette affection des tumeurs testiculaires. Nous presentons un cas de periorchite meconiale, precisons les aspects radiologiques et histologiques, et donnons une resurne de la bibliographie. • Mots-des: Periorchite meconiale -Bourse -Enfant -Ultrasons Eur JPediatr Surg 2000; 10: 404-407La periosquitis meconial (POM) es una entidad rara asociada a la peritonitis meconial. La presentacion tipica es un hidroceie blando al nacimiento que se va endreciendo a medida que se calcifica el meconio. Simula una masa escrotal y, si se ignora su existencia, puede conducir a operaciones innecesarias. Tanto la masa como las calcificaciones tienden aresolverse espontaneamente sin compromiso testicular. Las imagenes ecograficas junto a Ja placa simple dei abdomen son diagnosticas y la visualizadon dei testiculo normal puede ser util para diferenciar este falso tumor testicular de los verdaderos. Presentamos un caso de POM y discutimos los aspectos radiolgicos e histologicos aportando una revision de la literatura.• Palabras dave: Periorquitis meconial -Escroto -Nino -Ultrasonidos Zusammenfassung Mekoniumperiorchitis ist eine seltene Begleiterkrankung einer abgeheilten Mekoniumperitonitis. Das typische Erscheinungsbild ist eine weiche Hydrozele, die in einigen Wochen als Folge der Kalzifizierung des Mekoniums härter wird. Sie kann eine skrotale Masse vortäuschen, und so kann, ohne Kenntnis dieser seltenen Erkrankung, eine unnötige Operation angesetzt werden. Sowohl die Masse als auch die Kalzifikationen haben eine Tendenz zur spontanen Rückbildung, ohne den Testikel zu beeinträchtigen. Die sonogr...

We introduce a simple method of sonographic determination of femoral neck anteversion in children with which the even difficult angels in terms of measurement, those up to 70 degrees, can be measured with sufficient reliability: The examination was done with a defined internal 40 degree rotation of the legs reached by a supporting wedge. We proved this method on 55 children's hips of which we already had an existing radiologic determination of the anteversion angle. Compared to the radiological results we found an average deviation of 3.6 degrees (standard deviation = 3.2).

In a female premature baby an aberrant umbilical vein was identified after catheterization of the umbilical vessels. This rare variation of the umbilical vessels consists of a connection between the umbilical vein and the inferior vena cava.

Diagnosis of localised myositis ossificans is difficult in the initial stage. A history of trauma is frequently missing. Clinical symptoms point in the direction of osteomyelitis or soft tissue abscess. Sonotomography is useful for localisation and delineation of the lesion. Biopsy is the only reliable method to establish the diagnosis. Conservative treatment is recommended until the process is inactive. Radiographic follow-up will demonstrate the expected massive calcification and scintigraphic follow-up at 6-monthly intervals will eventually prove the metabolic inactivity of the lesion necessary for successful operation. Surgical removal of the calcified tumor will become necessary in cases of continued pain or significant functional limitations of the involved extremity.

No abstract

Between 1961 and 1989 twenty testicular tumours were treated at the Basel University Children's Hospital. Ten were non germ cell tumours (50%) and a further 10 (50%) were germ cell tumours. Of the germ cell tumours six were benign teratomas, two yolk sac tumours and a further two were teratocarcinomas. In the non germ cell group eight tumours originated from paratesticular structures, one of which was a malignant rhabdomyosarcoma. The remaining two neoplasms originated from the supporting testicular tissues. The clinical presentation, the protocol of treatment and the long-term outcome are discussed. We advocate local tumour excision in benign cases (proven by instant frozen section) if normal testicular tissue can be preserved. In malignant germ cell tumours primary orchiectomy and high spermatic cord ligation is the treatment of choice. Secondary chemotherapy and/or retroperitoneal lymph node dissection is only added if the tumour markers alpha-fetoprotein and beta-human chorionic gonadotropin remain present in high serum levels postoperatively. Rhabdomyosarcomas are treated by surgical excision, primary chemotherapy and radiotherapy. All of the five patients (25%) suffering from malignant testicular tumours survived. A long-term follow-up (mean 12 years) did not show any evidence of recurrent local or metastatic disease.