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The COVID-19 pandemic and stay-at-home regulations have increased child home injuries. This study illustrates the type and frequency of child home injuries in Greece during the COVID-19 lockdown. Moreover, the survey reports the results on parents’ proposals regarding child injuries at home during the COVID-19 quarantine. A community-based, cross-sectional, descriptive study was conducted from November to December 2021 in Greece. Parents were asked to voluntarily complete an anonymous questionnaire, designed for the needs of the research. A statistical analysis of the data was performed using the Kolmogorov–Smirnov and Shapiro–Wilk tests for a normal distribution, a chi-squared (χ2) test to compare percentages among different groups and a non-parametric Mann–Whitney U test to determine the differences in Likert scale variables between two groups. A total of 130 parents with at least one child were questioned through an online questionnaire survey. Of the parents, 39.3%, stated that the number of accidents in their home increased. The most frequent accidents were injuries (49.3%). Most of the accidents occurred inside the house (75.8%) and were observed among children aged 0–4 years. A high percentage of children’s accidents was observed in rural/island areas or in the suburbs. Children who were with either their father or mother had one accident, and a higher number of accidents occurred when the children were with their grandparents, with the nanny or alone. For those parents who had difficulty supervising their child, child accidents increased compared to parents who had the ability to supervise. It was noticed that parents who knew how to provide a safe home stated that the number of accidents remained the same. Parents must organize a safer home. Authorities should educate parents on child injury prevention and provide them with financial facilities to provide a safer house.

BACKGROUND Hypospadias repair is a challenging type of urogenital reconstructive surgery for which different techniques are currently used. The purpose of this study is to determine the outcomes of distal, mid-shaft and proximal hypospadias repair using two new variations of tubularized incised plate (TIP) urethroplasty (TIP-δ and TIP-ελ) and to compare their complication rates with other already known operative techniques made from the same surgical team. METHODS This study included 269 boys with hypospadias. The preoperative meatal site was distal in 179 patients, mid-shaft in 44 and proximal in 46. The average age at the operation was 17 months. The technique applied in distal hypospadias was Mathieu in 77 patients, Snodgrass in 28 and (TIP)-δ in 74. The technique applied in mid-shaft hypospadias was a tubularized island flap (TIF) in 12 patients, onlay island flap (OIF) in 5 and TIP-ελ in 27. The operative technique for proximal hypospadias was TIF in 15 patients, OIF in 10 and TIP-ελ in 21. TIP-δ and TIP-ελ are two new variants of TIP operation that we have used in our clinic since 2010. Postoperative complications were recorded, and we compared the outcomes obtained by applying the techniques. RESULTS The use of TIP-δ in the distal hypospadias and long TIP-ελ in the mid-shaft and proximal hypospadias resulted in significantly fewer complications than the other surgical methods across all cases of hypospadias (p

Enostoses, also known as bone islands, are common benign sclerotic bone lesion that usually represent incidental findings. They constitute a small focus of compact bone within cancellous bone. Enostoses can be seen on radiographs, CT, and MRI, and are considered one of the skeletal do not touch lesions.

Animal bites are among the top causes of preventable traumatic injuries. We describe the case of an 8-month-old female infant who was brought to the emergency department by her grandfather with serious rodent bites on her eyes, nose, right cheek, upper right extremity, and other smaller bites all over her body. This case is another proof of child neglect, or a possible infanticide attempt, as the motives of leaving the child in a hut without proper care, are not cleared up to this date. Rodent bites could be associated with Streptobacillus moniliformis infection and rat-bite fever. If the bites are left untreated for hours, the infant may suffer from hypovolemic shock due to bleeding, a possible fatal situation. The emergency surgical treatment of wounds is of vital importance.

BACKGROUND The presence of heterotopic tissue in Meckel's diverticulum (MD) increases the incidence of future complications. Based on this concept, this study aimed to detect clinical and morphological parameters able to predict the probability of heterotopy in incidentally discovered uncomplicated MD and to develop a risk-based classification tool. METHODS The clinical records of 146 patients who underwent MD resection were reviewed. MD complications (bleeding, inflammation, perforation or involvement in pathological processes such as intussusception) and MD dimensions (width, length and the product width × length) were evaluated in association with heterotopy. Regression analysis was used to explore the discrete effect of clinically relevant parameters, which were subsequently combined in a Classification and Regression Tree. RESULTS The probability of heterotopy was higher in complicated MDs. The width of the base of the MD and the product width × length were also significant predictors of heterotopy. A stepwise combination (Classification and Regression Tree model) of (i) uncomplicated macroscopic presentation, (ii) width

Background From January 2020, coronavirus has caused more than three million deaths. Lockdown has been enforced in many countries worldwide, affecting the emergency department visits of many surgical specialties. Methods The purpose of this study was to present the difference in trends in pediatric emergency department visits from March 1 to May 30, 2020, compared to the same 3-month period in 2019 in a tertiary university hospital in Greece, which was one of the referral centers for COVID-19 patients. Results A 42.5% reduction in emergency department visits was observed. In 2020, only 196 patients visited the pediatric surgery emergency department, versus 341 patients in 2019 (p

Aim: The aim of our study is to evaluate the diagnostic ability of contrast-enhanced ultrasonography (CEUS) in pediatric population with history of blunt abdominal trauma (BAT). Materials and Methods: In an eight-year period (1/2012-1/2020) fifty-nine children (4-14 years old) were transferred to Emergency Department with referred BAT. The initial imaging method was ultrasound scan (US). Thirty-two children were discharged in good condition 24/hours after their admission. The rest 27 with moderate to severe injuries and according to their laboratory tests and US results, were evaluated with CEUS and contrast-enhanced computed tomography (CECT).Results: Five children were confirmed with splenic injury, two with liver lacerations, one with liver lacerations and right kidney contusion, while in nineteen, no visceral pathology was found by US, CEUS and CECT. The CEUS and CECT were in complete agreement. In contrary, unenhanced-US showed in eleven children free peritoneal fluid and in two possible parenchymal lesions. In two of the patients with negative US-study splenic contusions in CECT and CEUS were revealed. The CEUS study was also used as follow-up method. No adverse reactions were observed from CEUS contrast agent in all patients (27) follow-up in 1-week and in 6-months period. Furthermore, in 27 patients no adverse reactions were observed from CEUS contrast agent in a 1-year period. Conclusion: CEUS is effective, easily performed, low cost and radiation free, imaging method. It is ideal both for initial and follow up evaluation of trauma and thus we encourage the usage of the method in paediatric BAT cases.

No abstract available.

In this case, it is described the importance of ultrasound in children with sliding ovaries in inguinal hernias. If the child has no symptoms, an emergency ultrasound could suggest the manner of the operation, scheduled or emergency.

BACKGROUND The internet is a valuable tool for access to health-related information. There is limited literature regarding its use by parents of children with surgical conditions. AIM To investigate internet usage by parents seeking information about the surgical conditions of their offspring in relation to epidemiological factors such as family residential area and parental educational level and to subsequently review the literature regarding this topic. METHODS An anonymous questionnaire about internet usage was completed by eligible parents of children who were admitted to our clinic for minor surgical procedures during a six-month period. RESULTS Our results demonstrated that the internet has been mostly used by mothers for children’s health information. Google was the most commonly used search engine, while pediatricians were the first parental choice for ‘live’ information. Only one-quarter of the parents informed their doctor about the information found online. Nine of ten parents had a positive opinion of an official website managed by the doctors of our clinic. Our results mostly agreed with the international literature. CONCLUSION In conclusion, the establishment of official websites (designed and managed by specialists) that parents can access to receive appropriate health information is mandatory in the internet era.

White blood cell (WBC) and platelet indices are useful biomarkers in many inflammatory diseases. A study was made of possible WBC and platelet indices in children with acute appendicitis. We reviewed the results of the complete blood count tests made on admission of 150 children with acute appendicitis (94 boys, 56 girls) and those of 74 healthy children (46 boys, 28 girls). We compared the WBC and platelet indices between the children with acute appendicitis and healthy children and between the complicated and uncomplicated cases of appendicitis. The children with acute appendicitis had higher WBC, neutrophil count, neutrophil percentage and neutrophil/ lymphocyte ratio and lower lymphocyte count and lymphocyte percentage than the healthy children. Cases of appendicitis with complications had lower lymphocyte count, lymphocyte percentage and higher neutrophil to lymphocyte ratio than those without complications. In girls WBC, neutrophil count and neutrophil percentage were higher in complicated acute appendicitis. WBC, neutrophil count, neutrophil percentage, lymphocyte percentage and a neutrophil/lymphocyte ratio >2.5 were accurate markers for acute appendicitis in children, but not for detecting complicated cases. Girls with acute appendicitis had lower platelet distribution width than healthy girls, with high sensitivity and positive predictive value at platelet distribution width

A case of a 2-month-old boy with constipation and a localized abdominal distension in the right abdomen and hypogastrium is presented. Plain radiograph, ultrasound exam as well as a barium enema were suggestive of Hirschsprung’s disease (HD) (ultrashort segment disease). Nevertheless, rectal suction biopsy was negative for neuronal abnormalities and unexpectedly on plain radiograph vertebral abnormalities were noticed. Subsequently magnetic resonance imaging of the spine and abdomen was performed, to evaluate possible spinal cord lesions and potential abnormalities of the perineal region musculature. A syringe throughout medullary cone was noted. The well-known issue, that the diagnosis of HD does not depend on the imaging (radiological) findings, was confirmed. The step-bystep diagnostic approach from the initial thought of ultrashort segment HD to the later imaging-based diagnosis of syringomyelia is discussed in this present paper.

Handlebar hernias are very rare and occur after a blunt abdominal trauma by a bicycle handlebar or a handlebar-shape object. As a result the abdominal wall musculature and fascia are disrupted while the skin is still intact. A good history of the injury and physical examination are usually enough to pose a diagnosis. We report the case of bicycle-handlebar hernia in a 6-year-old boy who presented to our emergency department because of a reducible swelling above the left iliac crest after falling from his bicycle 3 days ago. The patient was treated conservatively with a weekly follow-up. Four weeks later the muscle disruption was healed. In pediatric patient in the absence of internal organ injuries, a handlebar hernia can successfully be managed conservatively.

INTRODUCTION The aim of this study was to investigate the expression of vascular endothelial growth factor (VEGF) in pedicle penile skin flaps (PPSFs) used for urethral reconstruction in rabbits and the effect of exogenous VEGF on the angiogenesis process in the PPSFs. METHODS We randomly divided 28 male New Zealand rabbits into two sets of animals. A ventral urethral defect was created in all animals. In the first set of animals (first experiment, n = 10), a PPSF was used for the repair and VEGF expression in the flap was estimated on days 1, 2, 3, 5, and 7 postoperatively. The second set of animals (second experiment, n = 18) included three groups: control, untreated, and VEGF groups. In control group (n = 6), the defect was repaired by simple closure. In untreated (n = 6) and VEGF (n = 6) groups, a PPSF was used for the reconstruction. In VEGF group, exogenous VEGF was injected subdermally on the postoperative day corresponding to the peak endogenous VEGF expression (first experiment results). The animals were sacrificed on the 21st postoperative day and the angiogenic activity was assessed. A p

The aim of this study was to determine the optimal timing for inguinal herniotomy in premature infants treated in the neonatal intensive care unit.A two-institutional-center retrospective study was performed including 41 prematures at gestational age 28-35 weeks who underwent herniotomy within 1 week of diagnosis [short-waiting group (SWG), median 5 days, n = 25] or more than 1 week after diagnosis [long-waiting group (LWG), median 30.55 days, n = 16]. Gestational age, birthweight, post-conceptional age at diagnosis, age at diagnosis, post-conceptional age at surgery, age at surgery, weight at surgery, timing of surgery, operative time, and occurrence of incarceration, postoperative apnea, hernia recurrence, testicular atrophy, and hospital stay were compared between the two groups. Statistical analysis was performed using one-way ANOVA.Twelve preoperative episodes of incarceration occurred: three in the SWG and nine in the LWG (P0.05). Six infants had apnea postoperatively: four in the SWG and two in the LWG (P0.05). Follow-up revealed five hernia recurrences, one in the SWG and four in the LWG (P0.05); four testicular atrophies were found, one in the SWG and three in the LWG (P0.05).Early elective herniotomy should be considered in prematures in order to avoid perioperative morbidity and to reduce the risk of incarceration and subsequent testicular ischemia, and hernia recurrence.

To study the effect of environmental tobacco smoke to children's health and more specifically to the development of respiratory tract infections and also its influence to their respiratory function.We studied 586 children from the district of west Thrace in Greece aged 5-14 years, randomly selected from 20 primary and 10 secondary schools in regards their exposure to tobacco smoke, and its possible relation with respiratory tract infections. We assessed respiratory function by spirometry. Epidemiological data were also analysed.Children who were exposed to environmental tobacco smoke had higher risk for upper and lower respiratory tract infections in comparison to children who lived in a smoke free environment (3 fold and 2 fold, respectively. Their lung function was also reduced with decreased values of FEV1, FEF50, PFR (values p0.001).Passive smoking has an unfavorable effect in respiratory function of children and predisposes them to respiratory tract infections. Every effort should be undertaken in order to avoid exposure of children to environmental tobacco smoke.

Buts: Une etude experimentale a ete entreprise pour estimer l'activite angiogenique dans differentes greffes libres ou pediculees dans la reconstruction uretrale chez l'animal. Methodes: 28 lapins blancs de Nouvelle-Zelande ont ete divises en 5 groupes (0, A, B, C et D). Un defect uretral ventral a ete cree dans tous les groupes. Dans le groupe O (n=4), une simple fermeture du defect a ete realisee. Une greffe libre de peau du penis (groupe A, n = 6), une greffe de muqueuse buccale (groupe B, n=6), une greffe de muqueuse vesicale (groupe C, n = 6), une greffe pediculee de peau de penis (groupe D, n = 6) etaient utilisees pour patcher le defect uretral. Les animaux ont ete euthanasies au 21 eme jour post-operatoire. L'activite angiogenique etait analysee par immuno-histochimie en utilisant l'anticorps monoclonal anti-CD31et le procede des phosphatases anti-alcalines. La vascularisation native de la peau du penis aussi bien que les greffes de muqueuse buccale ou vesicale etait analysee chez un lapin du groupe O (n=3). L'analyse statistique etait realisee utilisant la methode ANOVA. Resultats: L'angiogenese observee avec un agrandissement de 200 fois dans les groupes O, A, B, C et D etait de 34,1 ± 4,1, 61,7 ± 6,4, 94,3 ± 6,4, 91,5 ± 7,2, et 30,8 ± 5,2 respectivement par champ. II y avait une difference statistique significative (p 0,5) entre les groupes B et C et les groupes O et D. La vascularisation de la peau du penis, de la muqueuse buccale et de la muqueuse vesicale etait de 23,3 ± 3,0, 24,6 ± 3,7 et 17,0 ± 2,6 par champ. Conclusion: Les muqueuses buccales et vesicales developpent une activite angiogenique plus importante que les greffes libres ou pediculees de la peau du penis. Comme la muqueuse buccale a montre son activite angiogenique superieure et qu'elle est plus facile a prelever que la muqueuse vesicale, nous proposons dans les reconstructions uretrales la greffe de la muqueuse buccale qui donne les meilleurs resultats.

Annular pancreas is the rare congenital anomaly where the pancreas forms a full or incomplete ring around the second segment of the duodenum, causing various degrees of stenosis or atresia. It is estimated that it appears in 1 out of 12 000-15 000 births of living neonates and until now, in the literature, only 6 cases have been reported among individuals of the same family. We present the case of two siblings, a boy and a girl, with annular pancreas from consecutive pregnancies of the same couple. Both neonates had a prenatal diagnosis of duodenal obstruction and they underwent duodenoduodenal, proximal transverse to distal longitudinal anastomosis. Furthermore, the girl had a mobile ascending colon. Their postoperative condition was perfect. The case we are reporting is an addition to the other 6 cases of familial presentation of annular pancreas and is similar to one of them. In these families, a total of 16 persons present this congenital anomaly while 14 are seemingly healthy. Twelve of the affected persons are female and 4 male. In conclusion, it can be stated that female individuals seem to have a greater propensity to transmit the disease to their descendants, compared to males, suggesting the possible action of an autosomal recessive sex-influenced gene. The recording of such rare family cases should be encouraged, in order to fully recognize a possible type of inherited transmission.

Σκοπός: Η πειραματική αυτή μελέτη έγινε με σκοπό να εκτιμηθεί η αγγειογενετική δραστηριότητα των ελεύθερων μοσχευμάτων πόσθης, βλεννογόνου στόματος και βλεννογόνου ουροδόχου κύστεως, καθώς και του μισχωτού μοσχεύματος πόσθης στην αποκατάσταση ελλειμμάτων ουρήθρας σε πειραματικό μοντέλο κονίκλου. Μέθοδος: Χρησιμοποιήθηκαν 28 λευκά κουνέλια τύπου Νέας Ζηλανδίας τα οποία χωρίστηκαν σε 5 ομάδες (Ο, Α, Β, Γ και Δ) . Στις Ομάδες Α, Β, Γ και Δ στο κοιλιακό τμήμα της ουρήθρας δημιουργήθηκε έλλειμμα. Η βλάβη αποκαταστάθηκε με ουρηθροπλαστική επικαθήμενου τύπου, χρησιμοποιώντας ελεύθερο μόσχευμα πόσθης στην ομάδα Α (n=6), μισχωτό μόσχευμα πόσθης στην ομάδα Β (n=6) και με μοσχεύματα βλεννογόνου στόματος και ουροδόχου κύστεως στις ομάδες Γ (n=6) και Δ (n=6) αντίστοιχα. Στην ομάδα Ο (ομάδα ελέγχου n=4) έγινε απλή ουρηθροτομή και σύγκλειση. Την 21η μετεγχειρητική ημέρα τα ζώα υποβλήθηκαν σε ευθανασία. Η αγγειογενετική δραστηριότητα εξετάστηκε με τη βοήθεια της ανοσοϊστοχημικής μεθόδου - τεχνικής αλκαλικής αντιαλκαλικής φωσφατάσης (APAAP) και με τη χρήση του μονοκλωνικού αντισώματος αντι-CD31. Σε 3 ζώα από την ομάδα Ο λήφθηκε ιστός από το δέρμα πόσθης, τον βλεννογόνο του στόματος και της ουροδόχου κύστεως για να ελεγχθεί η προϋπάρχουσα αγγείωση των μοσχευμάτων. H στατιστική επεξεργασία των αποτελεσμάτων έγινε με τη χρήση του one - way ANOVA. Αποτελέσματα: H μέση τιμή ± SD της αγγειογένεσης ανά οπτικό πεδίο σε μεγέθυνση επί 200 ήταν για την ομάδα Ο: 34,16 ± 4,12, την ομάδα Α: 61,7 ± 6,4, την ομάδα Β: 30,8 ± 5,2, την ομάδα Γ: 94,3 ± 6,4 και την ομάδα Δ: 91,5 ± 7,22. Υπήρξε στατιστικά σημαντική διαφορά (p0,05) μεταξύ των ομάδων Γ και Δ και Ο και Β. Η αγγείωση που προϋπήρχε στο δέρμα πόσθης καθώς και στους βλεννογόνους στόματος και ουροδόχου κύστης ήταν 23,3 ± 3,0/ 24,6 ± 3,7 και 17,0 ± 2,6 αγγεία ανά οπτικό πεδίο αντίστοιχα. Συμπεράσματα: Oι βλεννογόνοι ουροδόχου κύστης και στόματος παρουσιάζουν την μεγαλύτερη αγγειογενετική δραστηριότητα σε σχέση τόσο με το ελεύθερο όσο και με το μισχωτό μόσχευμα πόσθης όταν τοποθετηθούν σε ελλείμματα ουρήθρας. Μια και το μόσχευμα από βλεννογόνο στόματος παρουσιάζει την μεγαλύτερη αγγειογενετική δραστηριότητα και η λήψη του είναι ευκολότερη από αυτή του βλεννογόνου ουροδόχου κύστης, προτείνεται ότι η χρήση αυτού του μοσχεύματος σε ελλείμματα ουρήθρας μπορεί να δώσει ικανοποιητικά αποτελέσματα.

Objective To prospectively evaluate the efficacy and safety of a perimeatal-based penile skin flap for neourethral coverage after repair of distal hypospadias with tubularized incised plate urethroplasty (TIPU). Methods In 12 New Zealand white rabbits a ventral urethral defect was created and reconstruction was accomplished with continuous suture. An epithelialized defect-based flap was harvested from the penile skin to cover the repaired defect. The animals were euthanized on the 28th postoperative day and their penises were processed for microscopic examination. In 32 children with distal hypospadias a TIPU was performed. A penile skin flap was created immediately below the distal end of the neourethra and used to cover the urethroplasty. Results Histological examinations revealed complete restoration of continuity of the stratified squamous epithelium without evidence of inflammation or fistula formation with full consistency with the underlying papillary reticular and corium. There were no cases of fistula formation. One patient developed meatal stenosis. All patients had a satisfactory cosmetic appearance and excellent functional results. Conclusion The formation of a perimeatal-based skin flap is a simple and safe method of providing additional cover for the constructed neourethra after TIPU, minimizing the fistula rate.

We describe a case of true knotting of a suprapubic catheter in a 25-month-old boy who underwent surgery for urethrocutaneous fistula as a complication of a distal penile hypospadias repair. This unusual complication was probably attributable to an excessive length of catheter being inserted into the bladder, thereby allowing it to bend onto itself.

We studied the late angiogenic activity of free grafts and a pedicle flap in a rabbit urethroplasty model to determine whether angiogenic activity plays a role in late outcomes of urethral reconstruction in rabbits. Twenty-eight rabbits were randomly divided into five groups according to the method used to bridge a urethral defect as an onlay patch: Control, simple closure of urethral defect (Group O1); free penile skin graft (FPSG, Group A1); buccal mucosal graft (BuMG, Group B1); bladder mucosal graft (BlMG, Group C1); and pedicle penile skin flap (PPSF, Group D1). Angiogenic activity of the patch on postoperative day 84 was assessed by immunohistochemistry. The angiogenic activity in Groups O1, A1, B1, C1, and D1 was 23.33 ± 4.92 (means ± SD), 42.89 ± 6.52, 55.78 ± 3.46, 53.61 ± 6.17, and 24.11 ± 9.07 vessels per optical field, respectively. There were statistically significant differences (p

A 3 years old boy with a history of surgery for orchidopexy was admitted to our hospital with fever and abdominal pain. Clinical examination and laboratory investigations revealed urinary tract infection with renal involvement. Ultrasonography demonstrated a solitary left kidney and raised the suspicion of a fusion anomaly. Voiding cystography disclosed grade III vesicoureteral reflux and technetium-99m dimercaptosuccinic acid scintigraphy revealed right to left crossed renal ectopia with fusion (L-shaped kidney). The patient is undergoing standard follow-up for the early detection of possible renal complications. In conclusion, L-shaped kidney is a rare entity and the (99m)Tc-DMSA scintigraphy played an important role on timely diagnosis.

Lipoblastoma is a rare benign pediatric tumor derived from embryonic fat, and only two cases of lipoblastoma located on the posterior side of the neck have been reported in the literature. Here, we present the third case of posterior neck lipoblastoma in a 13-month-old healthy girl, who presented with a firm, posterior cervical mass. The tumor was completely resected following ultrasonography, computerized tomography, and magnetic resonance imaging evaluations. Histological examination of the resected tissue showed the typical characteristics of lipoblastoma. The child's postoperative progress was uneventful and no recurrence was observed 27 months after the operation. The clinical manifestations, radiologic and histopathologic findings, and treatment of this lesion are discussed.

Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra-abdominal organs or systems. The aim of the present study was to establish the most common extra-abdominal causes of acute abdominal pain.The notes of all children (1 month-14 years of age) examined for acute abdominal pain in the Accident and Emergency (AE) Department of Alexandroupolis District University Hospital in January 2001-December 2005 were analyzed retrospectively. Demographic data, clinical signs and symptoms, and laboratory findings were recorded, as well as the final diagnosis and outcome.Of a total number of 28 124 children who were brought to the AE department, in 1731 the main complaint was acute abdominal pain. In 51 children their symptoms had an extra-abdominal cause, the most frequent being pneumonia (n = 15), tonsillitis (n = 10), otitis media (n = 9), and acute leukemia (n = 5).Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain.

In order to establish the most reliable marker for distinguishing urinary tract infections (UTI) with and without renal parenchymal involvement (RPI), we recorded the clinical features and admission leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum procalcitonin (PCT) in 57 children (including 43 girls) aged 2-108 months admitted with a first episode of UTI. RPI was evaluated by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. To establish cut-off points for ESR, CRP, and PCT, we used receiver operating characteristics curves and compared the area under the curve for ESR, CRP, and PCT. Twenty-seven children were diagnosed as having RPI based on positive renal scintigraphy. A body temperature of38 degrees C, a history of diarrhea, and poor oral intake were more common in patients with RPI. ESR, CRP, and PCT, but not leukocyte count, were significantly higher in patients with RPI (P0.001). PCT was more sensitive and specific for the diagnosis of upper versus lower UTI than ESR and CRP. Using a cut-off value of 0.85 ng/ml, PCT had the best performance, with sensitivity, specificity, and positive and negative predictive values of 89%, 97%, 96%, and 91% respectively. Serum PCT is a better marker than ESR, CRP, and leukocyte count for the early prediction of RPI in children with a first episode of UTI.

The literature contains only a few reported cases of spontaneous pneumothorax complicating acute bronchiolitis in infants. We present a case of a 5-month-old infant with a presentation of spontaneous pneumothorax 7 days after hospitalization for acute bronchiolitis. The characteristics of this particular manifestation are discussed.

The use of the Roux-en-Y procedure is limited in paediatric surgery practice, and is performed mainly in congenital hepatobiliary disorders either as an initial or permanent treatment. In this 18-year retrospective study, we present our experience of the Roux-en-Y procedure in childhood cases of biliary atresia (BA) and congenital choledochal cyst (CCC).Twenty-eight children (18 females and 10 males; age 25 days-12 years) with hepatobiliary disorders were treated in our clinics between 1986-2004. Twenty patients suffered from BA (11 females, 9 males) and eight from CCC (seven females, one male). The surgical approach in the patients with BA (mean age 2.1 months) was Roux-en-Y hepatic portoenterostomy (Kasai procedure) and in the patients with CCC (mean age 7.2 years) was cyst excision with Roux-en-Y hepaticojejunostomy. The mean follow up period was 9.3 years.The children with BA developed the follow postoperative complications: 12 cholangitis, 6 portal hypertension and 5 hepatic cirrhosis. Among the children with CCC, two presented post-operative cholangitis, which was treated conservatively, and one developed anastomotic stricture and underwent reoperative reconstruction. At the end of the follow-up period among the children with BA 6 had died, 3 had undergone liver transplantation, and 5 were on a waiting list for transplantation. All children with CCC were alive without sequelae.Roux-en-Y in BA, with timely diagnosis, is preferred as an initial procedure, followed by liver transplantation in cases with no bile drainage and is the only possible reconstruction in cases of CCC after excision of the biliary cyst.