Background: Overall five-year survival rate of Wilm’s Tumor (WT) in developing countries is still poor. Delayed diagnosis is one of the contributing factors, whereas early diagnosis is an important thing for the outcome. It is caused by the WT burden in developing countries that was not comparable with the number of facilities for diagnosis and treatment. Ultrasonography (USG) is the mandatory first-line imaging modality in children with a suspected abdominal mass and an overall sensitivity of 76%. Additionally, it can be found in many health facilities at a lower cost, quick, non-invasive, and carries no risk of radiation. Therefore, the relationship between USG and histopathology should be measured. Materials and Methods: A cross-sectional study with an analytical approach was performed in pediatric (0 untill 18 year of age) renal malignancy and neuroblastoma that admitted to Dr. Hasan Sadikin Hospital, Bandung between 2015-2018. Data were collected from medical records. Statistical analyses using Fisher exact test were done to determine the significance of the relationship between USG and histopathology. Results: Forty-three samples were obtained based on inclusion criteria, such as WT (n=33), neuroblastoma (n=6), renal clear cell carcinoma (n=2) and no specific type of renal malignancy (n=2). Fisher exact test revealed no-significant relationship between USG and histopathology with p-value > 0.05 Conclusion: There is no significant relationship between USG and histopathology. Therefore, centralized unity for USG interpretation is recommended.
Introduction and importance Esophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms. Case presentation A 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully. Clinical discussion Foreign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children. Conclusion High index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together.
Introduction: Testicular nubbin is the most common case of impalpable testis found by pediatric urologists. Diagnostic and surgical management, including long-term follow-up, is still a debate, especially in cases of bilateral testicular nubbin. Case presentation: A 5-year-old boy with bilateral impalpable testis was brought to a hospital. A diagnostic laparoscopy was performed, and both internal inguinal rings were closed with testicular blood vessels, and the vas deferens had entered the inguinal canal. We found bilateral testicular nubbin on inguinal exploration and subsequently performed only right orchidopexy because it was larger than the left testis. Conclusion: Evidence-based medicine, comprehensive management, and consultation between doctor and patient are needed in bilateral management of testicular nubbin for a good patient outcome.
Background. Appendicitis is the most common cause of acute abdomen in children. Complicated appendicitis due to perforation associated with high morbidity. Several perioperative conditions fascilitated systemic inflammation and postoperative infectious complication. Synbiotic has a potential effect on reducing inflammatory response which reflected with lower serum c-reactive protein (CRP) level, so that the infectious complication could be avoided. Aim.This study aimed to observe the effect of synbiotic on postoperative serum CRP level reduction in children with complicated appendicitis. Method. A randomized double blind study was done in 26 children with com- plicated appendicitis. The subjects were divided into synbiotic and placebo groups. Synbiotic was given 1 time preoperatively and continued 5 days afer surgery. Serum CRP level were examined preoperatively (CRP 0), postoperative day 1 (CRP 1), and 6 (CRP 6). Statistical analysis was done with Independent-t test (p<0,05 considered significan)t. Result. The mean age of the patients was 9,85 years. The onset of abdominal pain was 3,92 days. The mean reduction of CRP 0 –CRP 6 between synbiotic and placebo group was 65,21% ± 31,37 SD vs 78,29% ± 12,39 SD, p=0,073; and the mean reduction of CRP 1–CRP 6 was 73,54% ± 22,04 vs 74,56% ±17,58, p=0,897. Wound infection was lower in synbiotic group (7,69% vs 38,46%). Conclusion. There was no difference in postoperative serum CRP level reduction between synbiotic therapy and placebo in children with compli- cated appendicitis
Background: Disorders of sex development (DSD) is a congenital condition in which there are disorders of sex development on chromosomes, gonads, and anatomy. The spectrum of these disorders is very broad, so that its incidence and characteristics are difficult to identify. The aim was to describe the characteristics of DSD patients at our institution. Methods: This is a retrospective descriptive of patients diagnosed with DSD in the period January 2017 -December 2019. Data were taken from medical records including ages, type of DSD and their management. Results: There were 70 patients with DSD, with a mean age of 6,74 years (range 0-19 years). Sixty four patients (91,42%) were raised as boys, with genotype 46 XY 90,62%, 46 XX 4,68%, 45 XO-46 XY 3,12%, and 47 XXY 1,56%. A total of 6 patients with genotype 46 XX (8,57%) were raised as girls. Four cases were DSD 46 XX (CAH 2,8%), DSD 46 XY was present in 54 cases, while chromosomal DSD was present in 4 cases including ovotesticular type, testicular type, Klinefelter Syndrome, embryogenic testis regression, and persistent Mullerian Tract Syndrome. A total of 2,8% experienced gender reassignment to become girls and 2,8% become boys. There were 78,57% who had undergone masculinized genitoplasty, 7,14% had undergone feminization genitoplasty, 14,28% had not undergone surgery, and 2,8% had not yet determined their gender. Summary: DSD patients at our institution presented in preschool, with a predominantly 46 XY genotype, most of whom did not undergo gender reassignment, and surgical management was gender-adjusted.
Amebiasis is caused by the protozoan Entamoeba histolytica. Extraintestinal amebiasis manifestation includes liver abscess and other rare manifestations involving the lungs, heart and brain. Liver abscess is the most common extraintestinal manifestation. Only few cases of amebic splenic abscess and two cases of gall bladder abscess have been reported. Typhoid fever is an infection caused by Salmonella typhi. It can cause extraintestinal complications such as myocarditis, endocarditis, pneumonia, empyema, osteomyelitis, arthritis, cholecystitis, spleen abscess and liver abscess. Choledocal cyst is a congenital dilation of the biliary branch. If left untreated, it can cause morbidity from cholangitis, cyst perforation, liver failure and malignancy. Until now, there is no publication about double infection of amebic and salmonella infection in a child with choledocal cyst.
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