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Abstract

Neonatal sepsis, defi ned as sepsis occurring within the fi rst 28 days of life, is associated with signifi cant morbidity and mortality. It is undeniable that fi nding and appliance of biomarkers in clinical practice is of great importance, aiming at the early recognition of the impending clinical deterioration and the prompt and targeted therapeutic intervention. Aft er systematic and thorough research of the limited relevant literature, we attempt to present a documented point-of-view on the diagnostic value of TREM-1 and its soluble form both in early and late onset neonatal sepsis.

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Authors and Affiliations

Dimitrios Patoulias
Maria-Styliani Kalogirou
Ioannis Patoulias
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Abstract

Spigelian hernia (SH) is a rare ventral interstitial hernia occurring through a defect in the transversus abdominis aponeurosis (Spigelian fascia). Spigelian fascia is found between the lateral border of the rectus abdominis muscle and the semilunar line, which extends from the costal cartilage to the pubic tubercle. In other words, Spigelian line is where the transversus abdominis muscle ends in an aponeurosis characterized by a congenital or acquired defect in the Spigelian aponeurosis. Pediatric cases of SH are either congenital or acquired due to trauma, previous surgery or increased intra-abdominal pressure. SH in combination with ipsilateral cryptorchidism may constitute a new syndrome, as such cases are extremely rare in the literature Th is new syndrome is characterized by the following congenital, ipsilateral disturbances: SH, absence of inguinal canal and gubernaculum and the homolateral testis found within the Spigelian hernia sac (a hernia sac containing undescended testis). Th e aim of this study is to emphasize some typical fi ndings of this specifi c entity, and, hence, the necessity for a thorough investigation of the origin of the SH.

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Authors and Affiliations

Ioannis Patoulias
Evangelia Rahmani
Dimitrios Patoulias
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Abstract

We define as preterm any newborn born before 37 weeks of gestation. The incidence of inguinal hernia is 1–4.4% among full term neonates and older children. In preterm newborns it is significantly more often, with an incidence that raises up to 30%. In this comprehensive review of the literature we provide evidence-based answers in various questions concerning the optimal treatment of inguinal hernias in preterm neonates. Such questions include the proper time of intervention, the choice of optimal anesthesia, the necessity for contralateral investigation in case of an ipsilateral hernia, the prevention of post-operative apnea and the choice between classic and laparoscopic surgical techniques.
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Bibliography

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2. Lau S.T., Lee Y.H., Caty M.G.: Current management of hernias and hydroceles. Semin Pediatr Surg. 2007; 16: 50–57.
3. Vaos G., Gardikis S., Kambouri K., et al.: Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int. 2010; 26: 379–385.
4. Crankson S.J., Al Tawil K., Al Namshan M., et al.: Management of inguinal hernia in premature infants: 10-year experience. J Indian Assoc Pediatr Surg. 2015; 20: 21–24.
5. Uemera S., Woodward A., Amenera R., et al.: Early repair of inguinal hernia in premature babies. Pediatr Surg Int. 1999; 15: 36–39.
6. Steward D.J.: Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology. 1982; 56: 304–306.
7. Vogels H.D., Bruijnen C.J., Beasley S.W.: Predictors of recurrence after inguinal herniotomy in boys. Pediatr Surg Int. 2009; 25: 235–238.
8. Lautz T.B., Raval M.V., Reynolds M.: Does timing matter? A national perspective on the risk of incarceration in premature neonates with inguinal hernia. J Pediatr. 2011; 158: 573–577.
9. Antonoff M.B., Kreykes N.S., Saltsman D.A., et al.: American Academy of Pediatrics Section on Surgery hernia survey revisited. J Pediatr Surg. 2005; 40: 1009–1014.
10. Takahashi A., Toki F., Yamamoto H., et al.: Outcomes of herniotomy in premature infants: recent 10 year experience. Pediatr Int. 2012; 54: 491–495.
11. Lee S.L., Gleason J.M., Sydorak R.M.: A critical review of premature infants with inguinal hernias: optimal timing of repair, incarceration risk, and postoperative apnea. J Pediatr Surg. 2011; 46: 217–220.
12. Frumiento C., Abaijan J.: Spinal anesthesia for preterm infants undergoing inguinal hernia repair. Arch Surg. 2000; 135: 445–451.
13. Raveenthiran V.: Controversies Regarding Neonatal Inguinal Hernia. J Neonat Surg. 2014; 3: 31–34.
14. Esposito C., Turial S., Escolino M., et al.: Laparoscopic inguinal hernia repair in premature babies weighing 3 kg or less. Pediatr Surg Int. 2012; 28: 989–992.
15. Turial S., Enders J., Krause K., et al.: Laparoscopic inguinal herniorrhaphy in babies weighing 5 kg or less. Surg Endosc. 2011; 25: 72–78.
16. Chan I.H., Lau C.T., Chung P.H., et al.: Laparoscopic inguinal hernia repair in premature neonates: is it safe? Pediatr Surg Int. 2013; 29: 327–330.
17. Pastore V., Bartoli F.: Neonatal laparoscopic inguinal hernia repair a 3-year experience. Hernia. 2015; 19: 611–615.
18. Tackett L.D., Breur C.K., Luks F.I., et al.: Incidence of contralateral inguinal hernia: a prospective analysis. J Pediatr Surg. 1999; 34: 684–688.
19. Steven M., Greene O., Nelson A., et al.: Contralateral inguinal exploration in premature neonates: is it necessary? Pediatr Surg Int. 2010; 26: 703–706.
20. Marulaiah M., Atkinson J., Kukkady A., et al.: Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia? J Pediatr Surg. 2006; 41:2004–2007. 21. Steigman C., Sotelo-Avila C., Weber T.: The incidence of spermatic cord structures in inguinal hernia sacs from male children. Am J Surg Pathol. 1999; 23: 880–885. 22. Dehner L.P.: Inguinal hernia in the male child: where the latest skirmish line has formed. Am J Surg Pathol. 1999; 23: 869–887. 23. Walc L., Bass J., Rubin S., et al.: Testicular fate after inguinal hernia repair and orchidopexy in patients under 6 months of age. J Pediatr Surg. 1995; 30: 1195–1197. 24. Laituri C.A., Garey C.L., Pieters B.J., et al.: Overnight observation in former premature infants undergoing inguinal hernia repair. J Pediatr Surg. 2012; 47: 217–220. 25. Walther-Larsen S., Rasmussen L.S.: The former preterm infant and riskof post-operative apnoea: recommendations for management. Acta Anesthsiol Scand. 2006; 50: 888–893. 26. Murphy J.J., Swanson T., Ansermino M., et al.: The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit? J Pediatr Surg. 2008; 43: 865–868. 27. Özdemir T., Arıkan A.: Postoperative apnea after inguinal hernia repair in formerly premature infants: impacts of gestational age, postconceptional age and comorbidities. Pediatr Surg Int. 2013; 29: 801–804.
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Authors and Affiliations

Ioannis Patoulias
1
Ioanna Gkalonaki
1
ORCID: ORCID
Dimitrios Patoulias
2

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G Gennimatas”, Thessaloniki, Greece
  2. First Department of Internal Medicine, General Hospital “Hippokration”, Thessaloniki, Greece
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Abstract

The combination of the functional disorders of urination and defecation constitutes the Dys-functional Elimination Syndrome (DES). DES refers to an abnormal pattern of elimination of unknown etiology characterized by bowel and bladder incontinence and withholding, with no underlying anatomic or neurologic abnormalities. Essential precondition for a child to be subsumed under this entity is the exclusion of either anatomical or neurological causative factors. In the present review study the individual entities of dysfunctional filling, such as the unstable or lazy bladder, or dysfunctional urination, such as the detrusor sphincter dyssynergia and the functional constipation are being described comprehensively. Subsequently, the analysis of the pathophysiological effects of the dysfunctional elimination syndrome such as incontinence, urinary tract infections and the conservation or the deterioration of vesicoureteric reflux, is being accentuated. With the documentation of DES, the therapeutic strategy should aim at treating both the functional disorder of the vesicourethral unit and the functional constipation. The first part does not specify depending on the type of this disorder. Rarely, surgical treatment of functional urinary disorders may be required.
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Bibliography

1. Shaikh N., Hoberman A., Wise B., et al.: Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life? Pediatrics. 2003 Nov; 112 (5): 1134–1137.
2. Halachmi S., Farhat W.A.: Interactions of constipation, dysfunctional elimination syndrome, and vesicoureteral reflux. Adv Urol. 2008; 2008: 828275.
3. Aydoğdu O., Burgu B., Teber S., et al.: A challenging review of childhood incontinence: rare complications of dysfunctional elimination syndrome in an epileptic boy. Turk J Pediatr. 2011 Jan– Feb; 53 (1): 100–103.
4. Von Gontard A., Hollmann E.: Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations. J Urol. 2004 Jun; 171 (6 Pt 2): 2644–2647.
5. Curran M.J., Kaefer M., Peters C., Logigian E., Bauer S.B.: The overactive bladder in childhood: long- term results with conservative management. J Urol. 2000 Feb; 163 (2): 574–577.
6. Hadjizadeh N., Motamed F., Abdollahzade S., Rafiei S.: Association of voiding dysfunction with functional constipation. Indian Pediatr. 2009 Dec; 46 (12): 1093–1095. Epub 2009 Apr 1.
7. Klijn A.J., Asselman M., Vijverberg M.A., et al.: The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding. J Urol. 2004 Nov; 172 (5 Pt 1): 1986–1988.
8. Wein A.J., Kavoussi L.R., Campbell M.F.: Urology Cambell-Walsh, 10th ed. Saunders Elsevier: 2012; 3418–3420.
9. O’Regan S., Yazbeck S.: Constipation: a cause of enuresis, urinary tract infection and vesico-ureteral reflux in children. Med Hypotheses. 1985 Aug; 17 (4): 409–413.
10. O’Regan S., Yazbeck S., Schick E.: Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. 1985 Mar; 23 (3): 152–154.
11. Ab E., Schoemaker M., Van Empelen R.: Paradoxical movement of the pelvic floor in dysfunctional voiding and the results of biofeedback training. Br J Urol Int. 2002; 89: 48.
12. Patoulias I.: Voiding disturbance in childhood. 1st ed. Parisianos, Athens: 2011; 58– 59. ISBN 978- 960-394-723-3.
13. Loening-Baucke V.: Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997 Aug; 100 (2 Pt 1): 228–232.
14. Chase J., Austin P., Hoebeke P., McKenna P.: International Children's Continence Society. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2010 Apr; 183 (4): 1296–1302.
15. Hoebeke P., Van Laecke E., Van Camp C., Raes A., Van De Walle J.: One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int. 2001 Apr; 87 (6): 575–580.
16. Herndon C.D., Decambre M., McKenna P.H.: Interactive computer games for treatment of pelvic floor dysfunction. J Urol. 2001 Nov; 166 (5): 1893–1898.
17. Hansson S., Hjalmas K., Jodal U., Sixt R.: Lower urinary tract dysfunction in girls with untreated asymptomatic or cover bacteriuria. J Urol. 1990; 143: 333–336.
18. Issenman R.M., Filmer R.B., Gorski P.A.: A review of bowel and bladder control development in children: how gastrointestinal and urologic conditions relate to problems in toilet training. Pediatrics 1999; 103: 1346–1352.
19. Regan S.O., Schick E., Hamburger B., Yazbeck S.: Constipation associated with vesicoureteral reflux. Urol. 1986; 28: 394–396.
20. Chen J.J., Mao W., Homayoon K., Steinhardt G.F.: A multivariate analysis of dysfunction elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children. J Urol. 2004; 171: 1907–1910.
21. Naseer S.R., Steinhardt G.F.: New renal scars in children with urinary tract infections, vesicoureteral reflux and voiding dysfunction: a prospective evaluation. J Urol. 1997 Aug; 158 (2): 566–568.
22. Mulders M.M., Cobussen-Boekhorst H., de Gier R.P., Feitz W.F., Kortmann B.B.: Urotherapy in children: quantitative measurements of daytime urinary incontinence before and after treatment according to the new definitions of the International Children’s Continence Society. J Pediatr Urol. 2011 Apr; 7 (2): 213–218.
23. Nevéus T., Von Gontard A., Hoebeke P., et al.: The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006 Jul; 176 (1): 314–324.
24. Farhat W., Bägli D.J., Capolicchio G., et al.: The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 2000 Sep; 164 (3 Pt 2): 1011–1015.
25. Bower W.F., Yip S.K., Yeung C.K.: Dysfunctional elimination symptoms in childhood and adulthood. J Urol. 2005 Oct; 174 (4 Pt 2): 1623–1627; discussion 1627–1628.
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27. Dede O., Sakellaris G.: Daytime urinary incontinence. Essentials in Pediatr Urol. 2012; 57–68.
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29. Dyer L.L., Franco I.: Botulinum Toxin-A Therapy in pediatric Urology: Indications for the Neurogenic and Non-Neurogenic Neurogenic Bladder. Scientific World J. 2009; 9: 1300–1305.
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34. Lordêlo P., Soares P.V., Maciel I., Macedo A. Jr, Barroso U. Jr.: Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: long-term results. J Urol. 2009 Dec; 182 (6): 2900–2904.
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Authors and Affiliations

Ioanna Gkalonaki
1
ORCID: ORCID
Ioannis Patoulias
1

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki Greece, General Hospital “G.Gennimatas”, Thessaloniki, Greece
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Abstract

An 11-year old boy presented with a blunt trauma in the right inguinal area after a bicycle accident. Initial clinical picture was indicative of decreased arterial blood supply to the right lower extremity and the diagnostic confirmation was made with a colour flow Doppler ultrasonography. During operative investigation, a thrombosis of the common femoral artery, 3.5 cm in length, was found. The thrombotic part of the femoral artery was removed and replaced with a venous graft taken from the major saphenous vein, before the saphenofemoral junction. Postoperative course was uneventful. Traumatic thrombosis of the common femoral artery as a result of a blunt trauma is very rare, as only 4 relevant cases have been described previously.
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Bibliography

1. Corneille M.G., Gallup T.M., Villa C., et al.: Pediatric vascular injuries: acute management and early outcomes. J Trauma. 2011; 70: 823–828.
2. Allison N.D., Anderson C.M., Shah S.K., et al.: Outcomes of truncal vascular injuries in children. J Pediatr Surg. 2009; 44: 1958–1964.
3. Mommsen P., Zeckey C., Hildebrand F., et al.: Traumatic extremity arterial injury in children: epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score. J Orthop Surg Res. 2010; 5: 25.
4. Sarfati M.R., Galt S.W., Treiman G.S., Kraiss L.W.: Common femoral artery injury secondary to bicycle handlebar trauma. J Vasc Surg. 2002; 35: 589–591.
5. Conrad M.F., Patton J.H. Jr., Parikshak M., Kralovich K.A.: Evaluation of vascular injury in penetrating extremity trauma: angiographers stay home. Am Surg. 2002; 68: 269–274.
6. Harris L.M., Hordines J.: Major vascular injuries in the pediatric population. Ann Vasc Surg. 2003; 17: 266–269.
7. Hossny A.: Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg. 2004; 40: 61–66.
8. Milas Z.L., Dodson T.F., Ricketts R.R.: Pediatric blunt trauma resulting in major arterial injuries. Am Surg. 2004; 70: 443–447.
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Authors and Affiliations

Ioannis Patoulias
1
Ioannis Panopoulos
2
Georgios Pitoulias
3
Thomas Feidantsis
1
Dimitrios Patoulias
4

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki Greece, General Hospital “G. Gennimatas”, Greece
  2. Department of Pediatrics, General Hospital “G. Gennimatas”, Thessaloniki, Greece
  3. Department of Vascular Surgery, Aristotle University of Thessaloniki Greece, General Hospital “G. Gennimatas”, Greece
  4. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece
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Abstract

Chylolymphatic mesenteric cysts are extremely rare among children. Herein we report a case of a 3-month old infant that was admitted to the Emergency Department due to repeated vomiting. Preoperative ultrasonography demonstrated the presence of a thin-walled multiloculated cystic lesion in the right abdomen. Patient underwent then elective surgical excision. Histopathological examination documented the diagnosis of cystic lymphangioma type III, according to Lozanoff classification.

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Authors and Affiliations

Ioannis Patoulias
Theodora Plikaditi
Thomas Feidantsis
Despoina Ioannidou
Dimitrios Patoulias
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Abstract

Meckel’s diverticulum represents a remnant of the proximal end of the omphalomesenteric duct, which constitutes a connection between the middle intestine and the vitelline vesicle. It is the most common congenital anomaly of the gastrointestinal tract and is found in approximately 0.3–2% of the general population. Complications such as hemorrhage, bowel obstruction, infl ammation, perforation, intussusception, volvulus and malignant transformation develop in only 4–4.8% of all patients, with most cases presenting in childhood, while relative risk decreases during life. The aim of the present study is to present our experience in managing a 15-year old male patient with Meckel’s diverticulum covered perforation. It was a case of disguised perforation of the Meckel’s diverticulum, with development of adhesions to the anterior surface of the right third of the transverse colon, which was successfully treated on the basis of emergency. Diagnosis was made intraoperatively and was documented by histological examination of the excised diverticulum.

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Authors and Affiliations

Ioannis Patoulias
Maria Kalogirou
Evangelia Rachmani
Kyriakos Chatzopoulos
Thomas Feidantsis
Dimitrios Patoulias
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Abstract

The main target during management of a male pediatric patient with clinical signs of acute scrotum is the timely diagnosis, in order not to jeopardize the viability of the affected testicle. Thorough evaluation of the patient’s medical history, symptomatology, clinical and ultrasonographic findings, con-stitutes the basis of the diagnostic procedure. After comprehensive research of the relevant literature, we highlight the remaining difficulties in the evaluation of the clinical and ultrasonographic findings for the accurate diagnosis of the acute scrotum. In conclusion, it is worth emphasizing on the following: a. the most common diseases that come under the diagnosis of the acute scrotum may present with similar symptoms, b. in neglected cases the diagnostic approach becomes more difficult, constituting the evalua-tion of the pathognomonic clinical signs challenging, and c. inability to exclude the diagnosis of spermatic cord torsion should be an indication for the surgical exploration of the affected hemiscrotum.
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Authors and Affiliations

Ioanna Gkalonaki
1
ORCID: ORCID
Ioannis Patoulias
1
Michail Anastasakis
1
Christina Panteli
1
Dimitrios Patoulias
2

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece
  2. First Department of Internal Medicine, General Hospital “Hippokration”, Thessaloniki, Greece
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Abstract

The extremely rare localization of an intramuscular hemangioma (IMH) into the anterior scalene muscle was the motive for the present case report, aiming to highlight major, atypical characteristics. An 11-month-old boy with free medical history presented with a painless and progressively growing lesion 4.5 × 4 cm in diameter, located in the left supraclavicular region over the last 4 months. During physical examination, the presence of a painless, non-pulsating, non-adhesive to the overlying skin lesion was documented. Color Doppler flow ultrasonographic examination demonstrated the increased blood supply to the aforementioned lesion. Thus, we planned an elective surgical excision of the lesion in healthy limits. The postoperative course was uneventful, and the patient was discharged on the second postoperative day in good general condition. Histopathologic examination revealed the presence of hemangioma surrounded by connective tissue bundles and striated muscle fibers. IMHs do not follow the general rule of regression, beyond the age of 6–12 months, with no trend to increase over time. Accurate preoperative diagnosis is challenging. Color Doppler flow ultrasonographic examination is the imaging modality of choice during the preoperative assessment. Surgical excision of the IMH in healthy limits is the most appropriate treatment option.
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Authors and Affiliations

Ioannis Patoulias
1
Ioanna Gkalonaki
1
ORCID: ORCID
Magdalini Mitroudi
1
Thomas Feidantsis
1
Constantine Theocharidis
2
Dimitrios Patoulias
3

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Greece
  2. Department of Pathology, General Hospital “G. Gennimatas”, Thessaloniki, Greece
  3. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece
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Abstract

Scar development in the children’s renal cortex with vesicoureteral reflux (VUR) is one of the most important parameters of prognosis. It can develop regardless of the chosen treatment, even after the regression of VUR. The shape of the renal papillae, the ascending urinary tract infection, the greater than third-degree VUR, and finally the increased intra-calyceal pressure, induce the formation of renal scarring in the renal parenchyma. Renal scarring may complicate VUR independently of the therapeutic strategy (conservative or operative) and its regression. For restitution of this entity, many scientific terms have been used and the most common of them is intrarenal reflux (IRR). The effects of VUR on future renal function result from the limited ability of the affected kidney to grow (failure of renal growth) due to the existence of scars in the renal cortex, the worsening of these scars, or finally the creation of new scars. With the present study, we intend to clarify the etiology and the pathophysiology of IRR and the relation of VUR prognosis to newer biomarkers such as N-acetyl-beta-glycosaminidase, beta-2 microglobulin, Pen-traxin- 3 and Liver-type fatty-acid-binding protein.
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Authors and Affiliations

Ioanna Gkalonaki
1
ORCID: ORCID
Evangelia Schoina
1
Michail Anastasakis
1
Ioannis Patoulias
1

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece
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Abstract

Balanitis Xerotica Obliterans is a chronic, progressive, sclerosing inflammation of unclear etiology. It involves the external genitalia of males and more specifically the prepuce and its frenulum, the glans, and the external urethral meatus while it may extend to the peripheral part of the urethra. Recent studies have noted an increasing incidence in the paediatric population. It is the most common cause of secondary (pathologic) phimosis. Even more, in boys with physiologic phimosis that does not respond to conservative treatment, Balanitis Xerotica Obliterans should be considered as the underlying condition. In this study, we present all the latest data and attempt to create a diagnostic and curative algorithm regarding this condition.
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Authors and Affiliations

Ioanna Gkalonaki
1
ORCID: ORCID
Michalis Anastasakis
1
Ioanna Sofia Psarrakou
2
Ioannis Patoulias
1

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki Greece, General Hospital “G.Gennimatas”, Thessaloniki, Greece
  2. Department of Pediatrics, General Hospital “G. Gennimatas”, Thessaloniki, Greece
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Abstract

Incidence of colonic atresia in living infants ranges from 1:5,000 to 1:60,000 (average 1:20,000). It constitutes 1.8 to 15% of all cases of atresia of the gastrointestinal tract. In 58.56–75% of all cases is right-sided. We aim, through the presentation of two cases of colonic atresia which we encountered and after systematic research of the current literature, at addressing three major issues: diagnostic approach, operative strategy and management of the prognostic parameters of the colonic atresia. The common parameter in these two cases was the early diagnosis, which played a significant role in the uncomplicated postoperative course. The first case was a type I sigmoid atresia. Contrast’s escape during contrast enema examination due to accidental rupture of the distal part of the colon led to diagnosis. Side-to-side anastomosis, restoration of the rupture and a central loop sigmoidostomy were urgently performed. The second case was a type III atresia at the level of the ascending colon, which was early diagnosed via pregenital ultrasonography, in which colonic dilation was depicted. Restoration of the intestinal continuity early after birth was performed at a time. In conclusion, we believe that early diagnosis, selection of the appropriate operative strategy and prompt recognition of potential post-operative complications, especially rupture of the anastomosis, contribute to the optimization of the prognosis in patients with colonic atresia.

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Authors and Affiliations

Ioannis Patoulias
Thomas Feidantsis
Charalampos Doitsidis
Magdalini Mitroudi
Maria-Styliani Kalogirou
Dimitrios Patoulias
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Abstract

Hutch Diverticulum (HD) is defined as the protrusion of the mucosal and submucosal layer through the muscle bundles of the underlying detrusor muscle. HD is located at the vesicoureteral junction with a backward direction from the homolateral ureteral orifice. As far as its etiology is con-cerned, HD is caused either by a congenital muscle wall defect at the level where the Waldeyer’s fascia occupies the clefts between the vesical part of the homolateral ureter and the detrusor, or is associated with abortive ureteral duplication or defective incorporation of mesonephric duct into the bladder at the site of ureteral hiatus or finally is associated with the development of transient urethral obstruction. HD is usually unilateral and more common in male patients. It may be associated with the Ehlers-Danlos, Williams-Elfin and Menkes syndromes. HD usually occurs in childhood and rarely during adulthood. It is found in 0.2–13% of all children presenting with urinary tract infection. Through this short review article, we attempt to present in detail the most recent bibliographic data concerning this entity, focusing on pathophysiology, diagnostic approach, and treatment strategy.
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Authors and Affiliations

Ioanna Gkalonaki
1
ORCID: ORCID
Michail Anastasakis
1
Christina Panteli
1
Ioannis Patoulias
1

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Thessaloniki, Greece

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