Advances in paediatric urology

© 2017 Elsevier Ltd Paediatric urological surgery is often required for managing congenital and acquired disorders of the genitourinary system. In this Series paper, we highlight advances in the surgical management of six paediatric urological disorders. The management of vesicoureteral reflux is evolving, with advocacy ranging from a less interventional assessment and antimicrobial prophylaxis to surgery including endoscopic injection of a bulking agent and minimally invasive ureteric reimplantation. Evidence supports early orchidopexy to improve fertility and reduce malignancy in boys with undescended testes. A variety of surgical techniques have been developed for hypospadias, with excellent outcomes for distal but not proximal hypospadias. Pelvi-ureteric junction obstruction is mostly detected prenatally; indications for surgery have been refined with evidence, and minimally invasive pyeloplasty is now standard. The outlook for patients with neurogenic bladder has been transformed by a combination of clean intermittent catheterisation, algorithms of diagnostic investigations, and innovative medical and surgical therapies. Posterior urethral valves are associated with considerable mortality; fetal diagnosis allows stratification of candidates for intervention, but ongoing bladder dysfunction in patients after valve ablation remains a cause of long-term morbidity

The status of the Quijote multi-frequency instrument

The QUIJOTE-CMB project has been described in previous publications. Here we present the current status of the QUIJOTE multi-frequency instrument (MFI) with five separate polarimeters (providing 5 independent sky pixels): two which operate at 10-14 GHz, two which operate at 16-20 GHz, and a central polarimeter at 30 GHz. The optical arrangement includes 5 conical corrugated feedhorns staring into a dual reflector crossed-draconian system, which provides optimal cross-polarization properties (designed to be < -35 dB) and symmetric beams. Each horn feeds a novel cryogenic on-axis rotating polar modulator which can rotate at a speed of up to 1 Hz. The science driver for this first instrument is the characterization of the galactic emission. The polarimeters use the polar modulator to derive linear polar parameters Q, U and I and switch out various systematics. The detection system provides optimum sensitivity through 2 correlated and 2 total power channels. The system is calibrated using bright polarized celestial sources and through a secondary calibration source and antenna. The acquisition system, telescope control and housekeeping are all linked through a real-time gigabit Ethernet network. All communication, power and helium gas are passed through a central rotary joint. The time stamp is synchronized to a GPS time signal. The acquisition software is based on PLCs written in Beckhoffs TwinCat and ethercat. The user interface is written in LABVIEW. The status of the QUIJOTE MFI will be presented including pre-commissioning results and laboratory testing

Investigation prior to thyroglossal duct cyst excision

Joseph J, Lim K, Ramsden J. Investigation prior to thyroglossal duct cyst. Ann R Coll Surg Engl 2012; 94: 181–18

Trauma hazards in children: An update for the busy clinician

Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma. Quad bikes remain highly dangerous with continuing reports of deaths in child riders due to their inherent lack of stability: a ban on their use by children would seem the most effective solution. The popularity of mobile devices and toys, coupled with the development of higher voltage, lithium button batteries have seen a surge in the number of cases and subsequent complications from ingestion. The problems seen in children following ingestion of high-powered, rare earth magnets in the late 1990s and 2000s has now receded due to legislation introduced in 2012. Inhaled, typically organic foreign bodies remain a diagnostic challenge with rigid bronchoscopy still the most effective diagnostic and therapeutic modality. Corrosive ingestion, now seen much less commonly, continues to be a potentially devastating injury when occurring as a result of caustic soda. Recent publicity concerning the problem of childhood drowning highlights the need for constant parental vigilance, the limitations of pool fencing and the importance of community cardiopulmonary resuscitation training, together with repeated education of the risk of rips when swimming in the sea

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury.

BACKGROUND:Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. METHODS:Burns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout. RESULTS:A total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5-6]) was 4 days longer than other Australian children (1 day [CI 1-2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection. CONCLUSION:Remoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health

The changing pattern of pediatric burns

After scalds, flame burns have been considered the next most common mode of burn injury in childhood. Recent experience in the authors' unit suggested that contact burns were becoming more frequent. The authors sought to determine the contemporary frequency of different burn modalities in children presenting to a burns unit. A retrospective review of 3621 children treated in the burns unit, both ambulatory and inpatient, at the authors' institution between January 2003 and December 2007 was performed. Patients were identified using the Burns Unit database. Data collected included age, gender, burn etiology and site, TBSA, and whether operative surgery was required. Of the 3515 patients eligible for inclusion, scalds accounted for 55.9%, contact 30.5%, and flame 7.9% of all burns. Contact burns were shown to be consistently more frequent than flame burns for every year of the study (z = 17.30, P <.001). No seasonal variation was demonstrated amongst contact burns, reflecting the variety of mechanisms involved. The data suggest a change in the historical pattern of pediatric burns previously reported in the literature. These findings have implications for public health awareness and burns prevention campaigns. Copyright © 2011 by the American Burn Association

Recurrent and metastatic congenital mesoblastic nephroma: where does the evidence stand?

© 2017, Springer-Verlag GmbH Germany. Purpose: Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unexpected aggressive clinical behaviors prompted a sub-classification based on histology. Recent molecular genetic evidence has identified the aggressive cellular variant to be the renal manifestation of congenital infantile fibrosarcoma. We submit a reappraisal and analysis of the available literature on recurrent and metastatic CMN. Methods: An electronic search of PubMed, MEDLINE, EMBASE, and Scopus yielded 38 children with local recurrence and/or metastases. Results: Of the 38 children with local recurrence and/or metastasis, 59% were girls. Median time to recurrence was 6 months (range 1–12 months). The commonest sites of metastases were the lung (39%) and liver (29%). Fifty percent of these children died of disease. The outcome of additional chemotherapy (p = 0.5) did not differ from that of surgery alone. The choice of chemotherapy did not influence the outcome (p = 0.6). Conclusions: Recurrence and metastasis in cellular CMN are much more common than described earlier and carry a high mortality. Children with cellular and mixed CMN require close clinical and radiological follow-up for a minimum of 12 months after primary surgery. Surgery is the mainstay of the treatment of recurrent and metastatic lesions. Neoadjuvant chemotherapy is recommended only if the lesion is inoperable. Targeted therapy may be an option in treatment of refractory cases