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Background and Aims: Hypospadias, a congenital anomaly, can have long‐term effects on sexual, urinary, and reproductive functions, making proper postoperative care essential for desirable outcomes, which could be facilitated through a mobile application for diseases with long‐term complications. The aim of this study was to investigate the data and functional requirements or minimum data set of a postoperative education mobile application for caregivers of children with hypospadias. Methods: A literature review of papers published until April 2023 using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement was conducted to determine the data and functional requirements of a mobile application that provides postoperative education to caregivers of children with congenital hypospadias. Based on the results, a questionnaire was prepared, and its content validity and reliability were evaluated by CVI and CVR. Additionally, data was examined by 30 residents, specialists, and subspecialists in pediatric surgery using the Delphi approach. Results: The study identified 28 data elements in three main categories: demographic data, clinical data, and application function. Functional requirements of the mobile application were suggested for use in designing the application. Also, the most critical data elements included the definition of disease, the importance of treatment, surgical preparation, bandage, hygiene, symptoms and infection, bleeding, and emergency condition. Conclusion: The study will pave the way for developing postoperative educational applications for caregivers of children with congenital hypospadias. M‐Health app developers and clinician specialists can utilize these findings to design practical applications that assist caregivers in managing the care of hypospadias patients. [ABSTRACT FROM AUTHOR]

Introduction: Classic bladder exstrophy (CBE) is a rare anterior midline birth defect that remains a challenge for pediatric surgeons. Despite multiple reconstructive methods, outcomes vary widely in various reports. This study aims to compare the success rate and complications of modern staged repair of exstrophy (MSRE) in each gender and compare together. Methods: This retrospective cross-sectional study included cases of CBE between 2010 and 2020 that underwent MSRE. Short-term follow-up results, including incontinence rate, vesicoureteral reflux (VUR), urinary infections, deformed genitalia, and so on, were measured in each gender, and their differences were reported. Results: Among the 40 newborns with CBE who underwent MSRE, 25 (62.5%) were boys, while the others had non-male genitalia. The rates of incontinence, VUR, dehiscence, and fistulas did not differ significantly between genders. However, chronic urinary tract infections (UTIs) were more frequent in girls, and boys were more likely to have malformed genitalia (p < .05). Conclusion: Our findings indicate a similar rate of complications in each gender. However, chronic UTIs and external genitalia deformities were significantly more common in girls and boys, respectively. Further large-sized controlled trials may be needed to corroborate these findings. [ABSTRACT FROM AUTHOR]

Background: Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery maybe required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined. Objectives: In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations. Methods: We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group. Results: Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028). Conclusions: Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively maybe decreased. [ABSTRACT FROM AUTHOR]

Background: Congenital hyperinsulinism (CH) is a well-known cause of the persistent neonatal hypoglycemic state that may lead to irreversible neurological damage. While medical therapy can improve the condition in some cases, refractory cases require further investigation to identify focal or diffuse pancreatic lesions. Surgery is the main treatment for refractory cases and can improve the neurological and glycemic status of patients. The study aimed to evaluate the short-term outcomes of surgical intervention in cases of CH who underwent surgical treatment. Methods: A multicenter cross-sectional survey was conducted to review cases of CH that underwent surgery between 2018 and 2020. Focal cases were treated with simple enucleation or distal pancreatectomy, while diffuse cases underwent near-total pancreatectomy. The glycemic and neurological states of the patients were evaluated and the results were analyzed. Results: Among the 56 neonates who underwent pancreatic surgery, 48 (85%) had diffuse disease, and the remaining cases suffered from focal lesions. All focal cases achieved normoglycemia, while 24 (50%) of the diffuse cases achieved normal glycemic levels (P≤0.003). Additionally, the incidence of irreversible neurological deficits was higher in the diffuse group (P=0.029). Conclusion: The focal form of CH seems to be totally curative by surgical operations. However, the proper management of diffuse form is still demanding. Although in our study, we had an acceptable success rate in the short-term, lifelong euglycemia may not be obtainable in these patients. [ABSTRACT FROM AUTHOR]

Background: Newparameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair. Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery. Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 ± 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 ± 2.07 mm. The mean P/C ratio before surgery was 7.56 ± 4.38. The mean preoperative split renal function was documented at 42.23%. The mean follow-up duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43mm. The mean kidney cortex diameter 6 months after surgery was 7.24mm. The mean P/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance halftime in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD > 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1. Conclusions: This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter. [ABSTRACT FROM AUTHOR]

Background. Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. Case Presentations. Here, we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultrasonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis, or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection. Conclusions. Infection with COVID-19 in children with antenatal hydronephrosis may exacerbate the degree of hydronephrosis and renal APD in ultrasonography, which itself may be mediated by the increase in inflammatory mediators. [ABSTRACT FROM AUTHOR]

Intussusception is uncommon in older patients, making its diagnosis challenging and necessitating a high level of clinical suspicion. While pediatric intussusception typically presents with a triad of symptoms including abdominal pain, bloody diarrhea, and an abdominal mass, the majority of adult patients experience chronic abdominal pain and partial obstruction. Consequently, the diagnosis of adult intussusception may be delayed due to the similarity in presentation with other conditions. In this article, we have presented a 13-year-old boy with chronic and refractory anal fissure. The patients also complained of constipation for a year, intermittent abdominal pain, and bloating. Although he was treated with conservative laxative medications, the constipation was not relieved. Incidentally, a colocolic intussusception was found through an MRI. We have provided a comprehensive description of an unexpected intussusception at an uncommon age which was found incidental. Medical literature was reviewed for better optimal planning in surgery. Intussusception in a teenager is unexpected, and this case shows the importance of considering it even in the presence of nonspecific symptoms. This case serves as a reminder to healthcare professionals to consider intussusception as a potential diagnosis in similar cases. • Consequently, the diagnosis of adult intussusception may be delayed due to the similarity in presentation with other conditions. • Lipomas, generally asymptomatic, but they can occasionally lead to complications such as intussusception. • Intussusception in an adolescent is less expected, and this case shows the importance of considering it even in the presence of nonspecific symptoms. • This case serves as a reminder to healthcare professionals to consider intussusception as a potential diagnosis in similar cases. [ABSTRACT FROM AUTHOR]

Introduction: Wilms tumor is the most common kidney cancer in children, but Wilms's tumors that extend by direct intravascular spread into the right side of the heart are rare and at this stage, they require the cardiac surgeons' intervention. Case Presentation: The patient was a 2-year-old girl who was hospitalized due to fever and abdominal pain that had started 2 weeks before admission. Patient's full abdominal exams revealed a large mass in the right kidney with a thrombus tumor in the entire inferior vena cava which was extended into the right atrium. Patient completed 8 weeks of neoadjuvant chemotherapy. After chemotherapy no changes was noted in renal mass and tumor thrombus. As, the thrombosis in the atrium was loose and there was a high risk of pulmonary embolism, emergency surgery was needed. Two pediatric and cardiac teams, simultaneously performed the surgery without cardiopulmonary bypass and cardiac arrest. Both kidney mass and the thrombus tumor were completely removed. Patient followed up for 5 years after surgery and no surgical complications, tumor recurrence, or metastasis were observed during that period. Conclusions: Although surgical intervention and tumor resection leads to good prognosis, multimodality management and multidisciplinary approach gives the best results. [ABSTRACT FROM AUTHOR]

Background: Wilms' tumor (nephroblastoma) is the major renal cancer in children. Objectives: The aim of this study was to assess the individuality of Wilms' tumor and the consequences of management attained in our referral subspecialty center. Methods: In this study, we composed the data of children with Wilms' tumor in 2 decades; 55 cases between 1992 and 2002 and 49 patients between 2006 and 2016 were diagnosed with Wilms' tumor. Demographic characters, a form of presentation, tumor stage, related underlying disease, histopathology consequences, type of management, and the survival rates were assessed. Results: In the first decade, 24 patients were females and 31 were males (M/F = 1.2); in the other groups, 30 were females and 19 were males (M/F = 0.61). The mean age was 45.2 months at the time of diagnosis for the first group and the mean age was 36 months for the other group. In the first decade, the surgical stage after the operation was as follows: stage I (32.7%), stage II (16.36%), stage III (38.1%), stage IV (9%), and stage V (1.8%) who did not operate. In second decade, 49 patients were as follows: stage I (14.3%), stage II (40.8%), stage III (24.5%), stage IV (10.2%), and stage V (10.2%). In 54.5% of the first group, histology was favorable, and in 43.6% of the first group, histology was unfavorable; in the second group, 95.4% were the favorable type. The patients were managed based on protocols of the National Wilms' Tumor Study. In the first decade, relapse-free was 71% and 4-year survival rates were estimated at 86%, and in the second decade, pulmonary metastasis was observed at 28.6%, liver metastasis in 2.3%, recurrence in 5%, and 4-year survival rates were estimated at 90%. Conclusions: This study demonstrated development in the management of children with Wilms' tumor in recent 20 years, with comparable relapse-free and survival rates to the National Wilms' Tumor study. But with more adjustment in treatment protocols, the superior outcome will be attainable. [ABSTRACT FROM AUTHOR]

Spontaneous bile duct perforation (SBDP) is an infrequent condition with no choledochal cyst, bile duct stenosis, or stone. Perforation of the bile duct usually occurs when, for some unexplained cause, the common bile duct becomes obstructed, usually at its distal end at the junction of the cystic duct and common hepatic duct. In most cases, it occurs in early infancy, especially during the first 3 months of age, the occurrence in older ages is very rare. Affected patients have jaundice, failure to thrive, and abdominal protrusion due to ascites, and marked acholic creamy stool which classically leads to the development of bile-stained inguinal or umbilical hernias. Here we report a case of SBDP in late infancy. This case can be an interesting experience. [ABSTRACT FROM AUTHOR]

Background: Congenital diaphragmatic hernia (CDH) is a common congenital anomaly with significant morbidity and mortality. Few surveys have been reported regarding the prenatal status, clinical course and postnatal outcome of CDH. The symptoms and prognosis depend on the location of the defect and associated anomalies. Objectives: The aim of this study was to examine the effect of clinical factors on the prognosis of CDH in our pediatric hospital. Methods: We analyzed 74 records of CDH neonates referred to our center for surgery between 2008 and 2015. We investigated the associated factors with the outcomes of CDH using the information extracted from the hospital records. The perinatal status, clinical course and the postnatal outcome were reviewed. Survival was defined as infants alive at hospital discharge. Results: A total of 74 CDH cases were identified. Of these, 27 (36.5%) cases were females and 47 (63.5%) males. The type of hernia in 73 (98.6%) cases was Bochdaleck and 1 (1.4%) case was Morgagni. Seventeen (23.9%) cases had right-sided CDH and 57 (76.1%) cases left- sided CDH. Also, 90.5% underwent open surgery and 9.5% thoracoscopic repair. Forty-seven (63.5%) cases survived and 27 (36.5%) cases succumbed. The survival rate had a significant statistical correlation with the place of delivery. The death rate was higher in neonates referred from other hospitals in our town in comparison to other cities (P = 0.008). Also, the resuscitation history, the status at admission (intubated or not intubated) (P = 0.00), existence of skeletal anomalies (P = 0.02) and brain hemorrhage (P = 0.045) had a significant correlation with the survival rate. The side of herniation, herniated organs, type of operation (open or thoracoscopic), cardiac and renal anomalies and age at the time of surgery had no significant correlation with outcome. Conclusions: The overall mortality rate in CDH was high in our series. Neonates with CDH should be delivered in institutes with the neonatal intensive care unit and surgery ward to prevent complications. To achieve better survival rates, pulmonary hypertension should intensively be controlled and the extracorporeal membrane oxygenation should be used in selected cases. [ABSTRACT FROM AUTHOR]

Introduction: Urethral duplication (UD) is a rare congenital anomaly with multiple anatomical variants. Case Presentation: In this article we present a four year-old child with complete UD. The patient was admitted for hypospadias repair, in evaluation we found type IIA1 UD according to Effmann classification. Patient underwent hypospadias repair saving complete UD. Conclusions: After one year follow-up he has normal and continent urination. [ABSTRACT FROM AUTHOR]

Background: Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications. Objectives: This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate. Patients and Methods: In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit’s dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty. Results: Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit’s dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance. Conclusions: This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate. Patients and methods In this prospective study between June 2012 and June 2014, we performed onlay island flap procedure for the repair of hypospadias with shallow urethral plate - less than 6 millimeters. This technique was selected for all types of hypospadias except subcoronal type. Nesbit's dorsal plication procedure was performed for chordee. In cases with very small glans, urethroplasty was performed without glansoplasty. Results Twenty three patients with mean age of 30 months (range 10-60 months) underwent onlay island flap repair; all had a shallow urethral plate of less than 6 mm, 3 had a very small glans and 18 had chordee. Meatus was located in distal shaft in 5 cases, midshaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit's dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients and all were repaired surgically. Mean follow up time was 13 months (range 3-20 months). All cases that had glansoplasty have excellent esthetic appearance. Conclusion This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and good esthetic outcome. [ABSTRACT FROM AUTHOR]

Hydatid cysts grow commonly in liver and lungs, but irregularly they are established in other sites. Occasionally few embryos run away the capillary filtrating systems of the liver and pulmonary and lead to hydatidosis of Peripheral organ. This case report expresses an uncommon case of subcutaneous hydatid cyst in the left thigh in child. Based on manuscript search, few cases are presented. [ABSTRACT FROM AUTHOR]

Toxocariasis is an extensive helminthic infection that leads to visceral larva migrans in humans. A 2.5-year-old girl referred for abdominal mass. She had history of pharyngitis for two weeks. There were no other symptoms. Abdominal examination revealed an irregular solid mass in right lower quadrant (RLQ). Abdominal ultrasonography revealed an echohetrogenic large mass in RLQ, liver, and retroperitoneal area. Abdominal CT scan showed a huge mass. At laparotomy a large retroperitoneal mass that involved right liver lobe, bladder, ileocecal valve, small and large intestines was found. At histopathology diagnosis of toxocariasis was made. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the outcome of germ cell tumors in patients admitted to our center during a ten year period. Methods: In a retrospective descriptive study, patients with the pathological diagnosis of germ cell tumor (GCT) were included. All records were evaluated and patients followed by personal visit in clinic or phone call. Data regarding age, sex, tumor site, bio-chemical assay, pathology, treatment and outcomes were gathered. For qualitative variables we computed frequency and percentage and for quantitative variables, mean and standard deviation. Survival analysis was performed using Kaplan-Meier. All statistical analyses were performed by SPSS version16.0. Findings: Forty four patients consisted of 32 girls (72.7%) and 12 boys (27.3%). Their median age was 23 months. The most common pathological tumor types were 18 (40.9%) mature teratomas and 14 (31.8%) yolk sac tumors. Extra gonadal tumors were more prevalent (32 cases) and consisted of 21 (47.7%) sacrcoccygeal, 7 (15.9%) retroperitoneal, 2 (4.4%) mediastinal and 2 (4.4%) cervical tumors. In gonadal tumors 9 patients had ovarian and 3 patients testicular involvement. Staging at the time of diagnosis revealed stage one in 23 (52.3%) cases. All patients were treated surgically and the most common procedure was total resection in 41 (93.2%) patients. Fifteen (34.1%) patients received chemotherapy. In follow-up 31 (77.5%) patients were in complete remission, 9 (22.5%) had died, and 4 cases did not appear to follow-up visits. The median survival was 16 months (IQR 4-49 months). The highest mortality rate was found in patients with yolk sac tumors (8 of 13 cases). Conclusion: The patients with extra-gonadal GCT and a high AFP level have the worst prognosis and lower survival rate. Combination of surgery and chemotherapy can lead to a better prognosis. [ABSTRACT FROM AUTHOR]

Objective: Temporary vesicostomy is a urinary diversion procedure for patients with upper urinary tract (UUT) dilatation, secondary to bladder outlet obstruction or dysfunction. The aim of this study was to evaluate our experience in children undergoing such diversion, analyzing its efficacy to prevent urinary tract infection (UTI), improve or resolve hydronephrosis, stabilize or improve kidney function and restore the health of UUT. Methods: In this retrospective study, patients who had vesicostomy by Blocksom technique due to bladder outlet obstruction or dysfunction were evaluated in Mofid Children's Hospital (in Tehran) from March 2007 to March 2012. The reason for applying this procedure was failure in clinical treatment. Data regarding gender, age, diagnosis, time of any surgical intervention, associated anomalies, primary/secondary complications and mortality were collected using a questionnaire, and evaluated by giving a grade that ranged from 0 (worst) to 10 (best) based on Lickert's scale. Findings: From a total number of 53 patients, (88.7% male and 11.3% female) with a mean age of 225 days, 66% had posterior urethral valve and 16 (30%) neurogenic bladder. UTI was present in all cases, hydronephrosis in 52 (98.1%), and vesico-ureteral reflux only in 45 (84.9%) patients. Valve ablation was performed in 17 cases, and clean intermittent catheterization in14 patients which were unsuccessful. We performed vesicostomy in all patients. Mortality rate was 7.5%. Vesicostomy was closed in 35 patients. Cure rate was 85% in UTI, 82.7% in hydronephrosis, 80% in VUR, and 86.5% in kidney function. Conclusion: Vesicostomy is a simple procedure that protects upper urinary tract, decreases hydronephrosis, and improves kidney function. The procedure is well tolerated and reversible, with less complication and should be considered in children in whom conservative and medical treatment has failed. [ABSTRACT FROM AUTHOR]

Objective: Successful results after one-stage trans-anal pull-through (OSTAPT) operation for Hirschsprung's disease (HD) depend on accurate identification of the aganglionic segment in intraoperative frozen section (FS). Misinterpretation of the findings of the rectal biopsy is an anxiety- evoking pitfall for the surgeon. This study aims to describe our experiences in comparing results of FS and permanent Section (PS) rectal biopsies in children with HD who were candidates for OSTAPT in a single-step operation. Methods: Subjects under the age of 14 years, admitted from March 2000 to July 2008 in a university-affiliated children's hospital for open rectal biopsy to diagnose HD were included in the study. Ml biopsies were taken 2-3 cm above the dentate line. 210 specimens of full-thickness rectal biopsy were obtained for both frozen section and permanent biopsy from all patients^ examined by two well experienced pédiatrie pathologists for ascertaining the presence of ganglion cells, and the results were compared. Analysis was performed by SPSS Software version 11.5. Findings: Two-hundred one infants and children underwent FS rectal biopsy to exclude HD. Positive results were seen in 63.8% of the specimens examined as PS and in 58.3% of FS samples. 93.9% of positive results in FS studies were confirmed by PS studies. 6.1% of FS reports were false positive and 21,7% were false negative (P<0.001). The sensitivity of FS was 85.8% and specificity 90.2%. Positive predictive value (PPV) was 93.9% and negative predictive value (NPV) was 78.3% in FS studies (P<0.001). The accuracy of FS was 80.4%. Conclusion: Although FS of the rectal biopsy is useful in defining the aganglionic segment during operation, according to this study, it cannot be used as the sole base fer perfetntingprfftiary pull» through operation before the results ofthe permanent sectionare önfcand, [ABSTRACT FROM AUTHOR]

Background: Diphallus is a rare anomaly and accompanying anomalies vary from bifid scrotum, bladder exstrophy, imperforate anus and colo-rectal anomaly such as duplication, and other associated anomalies. Case Presentation: A 2-day old infant is reported with imperforate anus and complete duplication of recto-sigmoid colon, rectal pouch, doubling of the genitalia with completely formed penis (diphallus), double bladder, urethra and hypospadias. No family history of abnormalities was noted. The patient underwent several operations: laparatory and colostomy at 3rd day of life, and after clinical and paraclinical investigations, cystoplasty, ureteral reimplantation and resection of left phallus were carried out when 4 months old. At the age of 1 year, after colostogram and total colon evaluation, laparatomy, resection of duplicated rectosigmoid colon, and pull-through was carried out; 3 months later colostomy closure was performed and the patient discharged without complications. Conclusion: The patients with diphallus have to be examined carefully because of the high incidence of other systemic anomalies. Treatment of diphallus usually includes excision of the duplicated penile structure, its urethra, and repair of associated anomalies. [ABSTRACT FROM AUTHOR]

The article presents a photoquiz on a 3-year old male with acute urinary retention is presented

A quiz concerning diagnosis for a 4-year-old male with acute abdominal pain is presented.

Background: Total colonic aganglionosis (TCA) is present in 4%-5% of the patients with Hirschsprung's disease and has a high surgical mortality rate between 13%-23%. Diagnosis and treatment of TCA is still a major challenge for pediatric surgeons. Many techniques with several advantages and disadvantages were established for its treatment. We have performed state's pull-through as total colectomy and ileo-proctostomy with long posterior rectal myotomy in TCA and severe dysmctility disorders. Methods: In this retrospective study, 13 patients with TCA were evaluated from1992 through 2012 in two pediatric surgery centers, which consisted of 10 TCA, one intestinal neuronal dysplasia (IN D), and two chronic intestinal pseudo-obstruction syndrome (CIP). All patients underwent total colectomy, resection of part of the involved small intestine, and rectal anastomosis in one layer with 4/0 vicryl with long posterior rectal myotomy. All patients had preoperative barium enema and rectal biopsy for diagnosis. Leveling ileostomy was performed in 12 patients and mid-jejunostomy in one patient. In two of 13 children, proximal diverting loop ileostomy was established after definitive operation. In three patients, trans-rectal myotomy was needed two weeks after the initial operation. Results: All patients were females with the age ranging from six months to six years. state's pull-through was carried out for all (the mean age of definitive procedure was 5.1 months). Rectal biopsy of 10 patients reported no ganglion cells of which one had extended aganglionosis to mid-jejunum, one had IND, and two had ganglionicbowel bowel with clinical presentation of CIP. The follow-up period was from six months to 10 years (the mean follow-up period was 10 months). There were no significant complications in 12 patients except episodes of diarrhea and severe dehydration which needed hospitalization. One patient with mid-jejunum aganglionosis had severe failure to thrive and needed repeated hospitalization for parenteral nutrition. All patients had acceptable bowel function following operation (two to six times a day). Now, five of the 13 patients are above the age of toilet training, having voluntary bowel movement with little or no medication (Leopromid). Conclusion: state's pull-through is recommended in all cases of TCA and severe dysmotility problems of the colon. This technique is less difficult to perform, and avoids the complications and disadvantages of removal of the rectum and has satisfactory results. [ABSTRACT FROM AUTHOR]

• A DC electric field based microfluidic chip was fabricated to enrich neoplastic cells in cytological samples. • Enrichment has been based on the tendency of abnormal cells to positive pole through their high negative membrane charges. • Promising results were achieved in clinical cervical smear and breast aspirations samples. A microfluidic electrical actuator in the form of a cytological slide has been developed to separate and relocate atypical/cancer cells of liquid cytology samples (such as fine needle aspiration, uterine cervical smear and bone marrow aspiration) in a limited space for fast and precise pathological evaluation. The mechanism of this system named smart cytological slide (SCS) was based on the tendency of atypical/neoplastic cells, which have significant negative membrane charges, to positive pole region of direct electric field applied by the patterned gold microelectrodes of the actuator. Results of SCS on cytological samples of 70 patients showed better separating profile with much greater efficacy and selectivity than conventional cytological slides (CCS). Moreover, SCS detected the false negative responses of CCS in 5% of the samples while we used from the residues of the samples in SCS tests. [ABSTRACT FROM AUTHOR]