Spontaneous closure of the large idiopathic full-thickness macular hole

Dear Editor, Idiopathic full-thickness macular hole (FTMH) represents an interruption in all retina layers from the internal limiting membrane to the photoreceptors, is unrelated to any other ocular or systemic conditions, and usually affects older women. Disruption of the macula and fovea causes poor vision, metamorphopsia, and central scotoma. Optical coherence tomography (OCT) is used in the diagnosis, classification, management results, and follow-up. While spontaneous closure of traumatic MH in a few weeks following the trauma is a frequent event in the literature, the spontaneous closure of stage III and IV idiopathic MH is only sporadically reported. Standard procedures to close the MH and enhance visual function include sutureless, small incision vitrectomy, and internal limiting membrane peeling. Herein we report a case of a 76-year-old woman who presented with spontaneous closure of stage II idiopathic FTMH documented by OCT after the patient refused surgery and missed the advised regular follow-up due to the COVID-19 pandemic.The authors acknowledge the patient's written consent to report this peculiar case.Scopu

Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country.

To evaluate the clinical outcome and complications in the pediatric population who had splenectomy at our institution, emphasizing the incidence of postplenectomy reactive thrombocytosis (RT) and its clinical significance in children without underlying hematological malignancies. The medical records of pediatric patients undergoing splenectomy were retrospectively reviewed for the period 1999-2018. The following variables were analyzed: Demographic parameters (age, sex), indications for surgery, operative procedures, preoperative and postoperative platelet count (postplenectomy RT), the use of anticoagulant therapy, and postoperative complications. The patients were divided into two groups according to indications for splenectomy: The non-neoplastic hematology group and the non-hematology group (splenectomy for trauma or other spleen non-hematological pathology). Fifty-two pediatric (37 male and 15 female) patients who underwent splenectomy at our institution were reviewed. Thirty-four patients (65%) were in the non-hematological group (splenic rupture, cysts, and abscess) and 18 patients (35%) in the non-neoplastic hematological group (hereditary spherocytosis and immune thrombocytopenia). The two groups did not differ significantly in regards to the patients' age, sex, and preoperative platelet count (P>0.05 for all variables). Forty-nine patients (94.2%) developed postplenectomy RT. The percentages of mild, moderate and extreme thrombocytosis were 48.9%, 30.7%, and 20.4%, respectively. The comparisons of RT patients between the non-neoplastic hematology and the non-hematology group revealed no significant differences in regards to the patients' age, sex, preoperative and postoperative platelet counts, preoperative and postoperative leukocyte counts, and the average length of hospital stay (P>0.05 for all variables). None of the patients from the cohort was affected by any thrombotic or hemorrhagic complications. We confirm that RT is a very common event following splenectomy, but in this study it was not associated with clinically evident thrombotic or hemorrhagic complications in children undergoing splenectomy for trauma, structural lesions or non-neoplastic hematological disorders

Large Bartholin's gland cyst in a premenarchal girl: a rare clinical finding

Disorders related to Bartholin’s duct and glands affect approximately 2% of young women, and are very rare in premenarchal girls. Bartholin’s gland cysts are usualy small, do not cause any symptoms and resolve spontaneously. However, symptomatic larger cysts require medical treatment. Although many treatment modalities have been applyed, the best approach has not yet been found. Treatment modalities of Bartholin’s cyst include application of silver nitrate to the abscess cavity, incision and drainage of the cyst, curettage of the abscess cavity, placement of “Word catheter”, marsupialization, needle aspiration and alcohol sclerotheraphy, carbon dioxide laser excision and surgical gland excision. Here, we report a case of a large, soft, regular contoured painless Bartholin’s cyst located in the left labia minora with a diameter of 8 x 5 cm in an 11-year-old premenarchal girl, treated by surgical gland excision after previous unsuccessful incision and aspiration of the cyst

Giant paratubal serous cystadenoma in an adolescent female: Case report and literature review.

Paraovarian/paratubal cysts constitute 5-20% of all adnexal lesions and typically originate from the paramesonephric or Müllerian duct. The primary epithelial tumors arising from paraovarian cysts account for 25% of the cases, but giant cystadenomas of paraovarian origin are extremely uncommon during childhood and adolescence with very few cases reported in the literature. We present the case of a 15-year-old female that presented with a bulky mass in the abdomen and pelvis. An initial clinical and radiological examination indicated an ovarian cyst measuring ∼25x20 cm. However, explorative laparotomy revealed a giant paratubal cyst that was successfully treated with complete excision using fertility-sparing surgery. Histopathological examination was consistent with a serous cystadenoma. The postoperative course was uneventful and the girl was discharged on the seventh postoperative day. At the follow-up of six months, the patient was doing well. Due to their rarity and enormous size, the proper diagnosis and adequate management of giant paratubal cystadenomas are challenging. A complete excision of cystadenoma with preservation of adnexa represents a desirable treatment modality in adolescent females and should be attempted whenever possible

How to deal with rare pediatric surgical diseases in the small developing country with limited resources: Insights from Bosnia and Herzegovina

The European Union Regulation on Orphan Medicinal Products defines a disease/condition as rare if it affects < 1 in 2.000 in the European population, making the prevalence data a key tool in creating health care policies for patients with rare diseases (RD). There is approximately 7.000 RD, mainly genetic, affecting approximately 30 million people in Europe and between 25 and 30 million in the United States. Due to increased public awareness, improved understanding and treatment of the relatively more common disorders, elimination of nutritional deficiencies, and the development of laws related to the treatment of RD, pediatric rare diseases (PRD) have recently received increased attention. The numerous challenges clinicians face in treating patients with PRD are due to the lack of standardized diagnostic criteria, referral pathways, and treatment guidelines

A free terminal ileal perforation as the presenting sign of crohn’s disease in an adolescent female

The authors present a rare case of Aa free terminal ileal perforation as the presenting sign of Crohn's disease in an adolescent female

Decreased number of acute appendicitis cases in pediatric population during the COVID-19 pandemic: Any link?

The reasons behind the decrease in AA frequency during the COVID-19 pandemic remain unclear. Some authors have proposed that milder forms can be treated conservatively at home [15] or using antibiotics. Snapiri et al. also reported delays in diagnosing AA in seven pediatric patients having complicated forms of AA. We believe that other factors may contribute to the decrease including various infectious agents (viruses, bacteria, fungi and parasites) whose exposure in the pediatric population and a potential link to AA have been proposed. It is also well-known that some of these pathogens may give specific histomorphological forms of AA. During the lockdown period, it is likely that the exposure to various microbes has been substantially reduced and consequently affected the frequency of AA in pediatric population. Regardless the causes and numbers, all pediatric emergencies, including AA, during the COVID-19 pandemic should be promptly treated as any delay in their diagnosis and treatment may be as big of a threat as the COVID-19 virus itself

Effect of Preoperative Hormonal Therapy in Hypospadias Surgery: Evaluation of the current practice at the Pediatric surgery Clinic, Clinical Center University of Sarajevo

Introduction:The most common congenital abnormality of the penis is hypospadias. Although the main treatment is surgical; hormone therapy with dihydrotestosterone is also used.Materials and Methods: This randomized clinical trial was carried out between January 2012 and December 2017 on 79 children with hypospadias (in the Clinic of Pediatric Surgery, Clinical Centre University of Sarajevo). Their mean age was 38.2±2.8 months. GroupI included 36 children whom were treated with 2.5% dihydrotestosterone gel which was applied twice a day to the penile shaft and glans for one month prior to surgery. GroupII included 43 children whom did not receive any treatment preoperatively.Results: Mean age of patients in group I was 37.3±6.3 months and in groupII it was 39.1±5.9 months which were comparable. Complications occurring postoperatively were: urethrocutaneous fistula in 6 patients (13.9%) in group II, versus 1 patient (2.7%) in group I. There were 2 patients with meatalstenosis in group II (4.7%), and 3 (8.3%) in group I. Finally, there was a significant difference (p&lt;0.05) between the overall reoperation rates between groups (p&lt;0.05).Conclusion: Pretreatment with 2.5% dihydrotestosterone transdermal gel before hypospadias repair is beneficial in decreasing complication rates

The predictors of perforated appendicitis in the pediatric emergency department: A retrospective observational cohort study

Objective Appendiceal perforation has significant effects on perioperative morbidity and postoperative outcome. The present study aimed to identify possible predictive factors associated with perforated appendicitis (PA) in children at admission in the emergency department (ED). Methods In this retrospective observational cohort study, consecutive medical records of children <18 years old with surgically and histopathologically confirmed acute appendicitis (AA) over three years (2013–2015) were analyzed. Patients were divided into two groups: PA and non-perforated appendicitis (NPA). The differences between the two groups and potential predictors of PA were explored using univariate and multivariate analyses. Results During the study period, 295 patients underwent an appendectomy and had confirmatory AA diagnoses. Ninety-two patients had a PA (31.2%). In the univariate analysis, male gender, vomiting, diarrhea, fever, elevated white blood cell count (WBC) levels, and high C-reactive protein (CRP) were identified as predictors of PA. In the multivariate analysis, male gender (odds ratio [OR]: 3.133; 95% confidence interval [CI]: 1.610–6.096); vomiting (OR: 2.346; 95% CI: 1.141–4.822); diarrhea (OR: 4.549; 95% CI: 1.850–11.181); fever (OR: 3.429; 95% CI: 1.765–6.663); elevated WBC (OR: 2.962; 95% CI: 1.491–5.884) and elevated CRP (OR: 3.061; 95% CI: 1.267–7.396) were variables that predicted the PA in children. Conclusion Our data indicate that several clinical and biochemical parameters can reliably distinguish between pediatric PA and NPA at admission in the emergency department.Qatar National Library funded the open access publication of this article

Intestinal obstruction caused by a clamped persistent omphalomesenteric duct in congenital hernia into the umbilical cord.

A congenital hernia into the umbilical cord (CHUM) is often misinterpreted as a mild form of omphalocele. Herniated content in CHUM can be either the solitary intestinal loop or persistent omphalomesenteric duct (POMD) with the potential for traumatic injury in a case of inadequate examination of the umbilical cord and its clamping in the delivery room. Herein, we report a case of a male newborn with a functional bowel obstruction due to peritonitis caused by necrosis of iatrogenically clamped POMD in the CHUM.Qatar National Librar