Treatment Approach of Cryptorchidism in Developing Country

The history of testicular descent is closely connected with the expression of masculinity and as such can be traced back to ancient Egypt. Research into testicular descent was initiated by Haller and Hunter. It was Hunter who discovered that the testes descend during embryonal life from dorsal abdominal wall into the scrotum.  In the study conducted by “John Radcliffe Hospital” the incidence of cryptorchidism is 1.58%, spontaneous descent occurred postnatal in the first three months, and beyond that time, it was rare[1, 2]. As with other pathologies treatment and timing had changed during the years.Very important part of modern medical infrastructure is a functioning informative system, where the data about patients are registered.  In the postwar developing country (Kosovo), rebuilding medical care and information system required a lot of effort and time. When the whole medical system needs to be rebuild and equipped, informative system is not in top priorities. What in normal circumstances can be one click away like history of patients, medical chart, lab exams, imagery studies, becomes lot of paper work that can easily be lost. Mainly difficulties were with patients in rural areas where awareness and access to specialist is not well covered. Providing medical care in these conditions can be quite challenging. The study was started after noticing that the patients that were diagnosed with cryptorchidism lost precious time until they were treated. In our series the mean age of patients was higher than recommended age for treating cryptorchidism.  Ideal age for treating cryptorchidism is from 6 month to 2 years of life. First signs of damage to testes are identified at about 6 month of age. We decided to study this pathology in 3 years period, after starting awareness program and systematic controls in schools and kindergartens.Conclusion: After starting systematic controls and awareness program, mean age of the patients diagnosed and treated for cryptorchidism is in decline. Keywords: Cryptorchidism, Testes, Orchiopexy, Hormones, Medical risks, Modern treatment

Role of Echo Doppler in Diagnosing the Testicular Torsion-Retrospective Study

Introduction: Acute scrotum is a wide term that is used for cases that presenting with scrotal swelling and pain. Etiology can be infectious or strangulation from torsion of the testis, depending on its clinical diagnosis, requires surgical intervention or medical treatment.Aim of study: Aim of this study was to determine the rate of accuracy of the Echo Doppler scanning in the diagnosis of the testicular torsion. Considering that there are different protocols in diagnosis, some suggest surgical exploration, while some Hospitals report 100% accuracy in diagnosis of testicular torsion with Doppler ultrasound.Materials and methods: We retrospectively evaluated 4 year period, from 2011-2014, during this time all the patients that were admitted as acute scrotum where evaluated excluding the cases that were incarcerated hernias. In all admitted patients, physical examination, lab analysis and Echo Doppler study were performed.Results: In total, there were 83 patients, based on physical examination, lab and Echo Doppler scan, 50 cases were diagnosed as epididymo-orchititis, 21 cases were patients with testicular torsion and 12 cases were torqued hydatid of Morgagni. In 3 patients false positive blood circulation in affected testis was detected with Echo Doppler scan. In following days they were operated and gangrene of testis was found.Discussion: Complete absence of intratesticular blood flow and normal extratesticular blood flow on color Doppler images is diagnostic, if the flow is normal in the contra lateral testis. Color Doppler has a very high accuracy in detecting the obstacles in blood flow, but as with other diagnostic techniques, this should be not taken as granted.Conclusion: Testicular torsion is real urological emergency. Delay in diagnosis and management can lead to the loss of the testis. If there any doubts are present, urgent surgical exploration is indicated. Keywords: Testicular torsion, acute scrotum, echo Doppler, diagnostic techniques, managemen

A pin in appendix within Amyand's hernia in a six-years-old boy: case report and review of literature

<p>Abstract</p> <p>Introduction</p> <p>Presence of vermiform appendix (non-inflamed or inflamed) in inguinal hernia is called Amyand's hernia in honor to surgeon C. Amyand who published the first case of perforated appendicitis within inguinal hernia in a boy caused by ingested pin. This presentation of foreign body Amyand's hernia appendicitis is very rare, and here we present such a case.</p> <p>Case presentation</p> <p>A 6-year-old boy, white Kosovar ethnicity, presented with right groin pain, swelling and redness. Two days before admission the patient was injured by football during a children game in the right lower abdomen and the next day he complained of pain in the right inguinal area.</p> <p>On admission patient had a painful non-reducible mass in the right inguinal region and cellulitis. Plain abdominal x-ray showed no fluid-air levels, but a metallic foreign body (pin) under right superior pubic ramus was apparent. With preoperative diagnosis of suspect incarcerated inguinal hernia with cellulitis the patient was operated on under general anaesthesia in December 2, 2006. Intraoperatively we found the inflamed vermiform appendix perforated by a pin in the hernial sac. Appendectomy and herniotomy were performed. The wound was primary closed, without any post-operative complications and follow up for the patient is three years long.</p> <p>Conclusion</p> <p>Foreign body (pin) Amyand's hernia appendicitis seems to be extremely rare, maybe once in a century (Amyand 1735, Hall 1886, and our case in 2006). In patients with clinical signs of incarcerated inguinal hernia, with locally inflammatory signs, but without signs of intestinal obstruction Amyand's hernia appendicitis in differential diagnosis must be considered. In our case, it is possible that the injury during the football game might have induced perforation of the vermiform appendix with the foreign body in it.</p

An unusual location of retroperitoneal epidermoid cyst in a child: case report and a review of the literature

We report the case of a 4-year-old girl presenting with the retroperitoneal epidermoid cyst. The lesion presented as an intra-abdominal cyst on physical examination and was followed up with more specific investigations by ultrasound and computed tomographic scanning. The final diagnosis was obtained only after laparotomy where the cystic mass was completely excised and pathological examination was done. The patient is well at 3-year follow-up. epidermoid cyst of the reteroperitoneal space, although rare, should be considered in the differential diagnosis of incidentally discovered intra-abdominal cysts during investigation of irrelevant illnesses or during routine abdominal ultrasound scan

Protruding urethral polypoid hemangioma

Hemangiomas are the most common tumours of infancy and early childhood. They are not usually present at birth but appear in the neonatal period. Urethral hemangiomas are rare benign vascular tumours varying in size and they present with symptoms like urethral bleeding and/or haematuria. Vascular anomalies are manifested clinically by a large and varying clinical discoloration to large debilitating lesions that can compromise an organ and sometimes result in a life-threatening condition. Treatment of these tumours depends on the size and location. We report a case of a one and a half year old Kosovo Albanian boy presenting with a protruding tumour through external urethra that after pathology was confirmed to be a urethral polypoid hemangioma. This case, to our knowledge, is a rare case of protruding polypoid hemangioma of the external urethra reported in the literature. The lesion presented as a reddish-pink formation protruding through external urethra on physical examination. Doppler ultrasound described a high vessel density hemangioma.Physical examination is usually sufficient for diagnosis. Biopsy should be performed in any vascular lesion in which malignancy is suspected. Although approximately 20% of hemangiomas cause destructive, obstructive or endangering complications, less than 1% are truly life-threatening

Advanced Ovarian Dysgerminoma Infiltrating Both Ovaries and Uterus in a 7-Year-Old Girl

Introduction. Ovarian dysgerminoma is a rare malignant ovarian germ cell tumor with its peak incidence in young women. Abdominal pain, abdominal distention, and the presence of a palpable mass are common symptoms at presentation. Depending on the FIGO stage at presentation the prognosis of dysgerminomas after surgical treatment, adjuvant chemotherapy, and radiotherapy is promising. Case Presentation. A 7-year-old girl was presented at our clinic with abdominal pain in all abdominal quadrants. Later the pain localized in the region of her right ovary. CT scan revealed a massive formation which was connected to her right ovary. Conclusion. Although malignant ovarian germ cell tumours are rare in children, physicians must always consider the possibility of MOGT-occurrences. The clinical symptoms might not be specific: abdominal pain, abdominal distention, nausea, and vomiting. In order to make a correct diagnosis the patients should undergo a complete clinical examination including radiological scans. Initial management is frequently surgery, followed by adjuvant chemotherapy and radiotherapy. Although disgerminoma is malignant tumor, the prognosis is promising