4 research outputs found
Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children
No full textIntroduction. The incidence of corrosive esophagitis, also known as caustic esophagitis in children, is still increasing in developing countries, according to different clinical reports. Acids and alkalis are, in the same manner, involved in the pathogenesis of corrosive esophagitis in children. The aim of our study was to determine the incidence and endoscopic grading of corrosive esophagitis in a cohort of children from a developing country. Materials and methods. We performed a retrospective analysis of all pediatric patients who were admitted for corrosive ingestion at Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca, over 10 years. Results. A total of 22 patients consisting of 13 (59.09%) girls and 9 boys (40.91%) were found in the present research. The majority of children lived in rural areas (69.2%). The results of laboratory tests were not well correlated with the degree of the injury. White blood cell counts over 20,000 cells/mm3, an increase in the C-reactive protein level and hypoalbuminemia were noticed only in three patients with strictures. The lesions were associated with increased levels of the pro-inflammatory cytokines, including interleukin (IL)-2, IL-5 and Interferon-gamma. Severe late complications such as strictures have been noticed in children with grade 3A injuries. The endoscopic dilation was done after the six months endoscopy. None of the patients treated with endoscopic dilation required surgical intervention for esophageal or pyloric perforation or dilation failure. The majority of complications (such as malnutrition) were noticed in children with grade 3A injuries. In consequence, prolonged hospitalization has been required. The second endoscopy (done six months after ingestion) revealed stricture as the most common late complication (n = 13, 60.60%: eight patients with grade 2B and five with grade 3A). Conclusion. There is a low incidence of corrosive esophagitis in children in our geographic area. Endoscopic grading is a predictor of late complications such as strictures. Grade 2B and 3A corrosive esophagitis are likely to develop strictures. It is crucial to avoid strictures and to prevent malnutrition
IgA Tissue Transglutaminase Antibodies at Different cut-offs in the Evaluation of Possible Celiac Patients
No full textAbstract The celiac disease screening with IgA tissue transglutaminase antibodies depends on the cut-off reaction, therefore many patients with values less but close to the cut-off may be undiagnosed. Material and Method. We conducted the CD screening with IgA tissue transglutaminase antibodies in a group of 1616 children during 2014 at a cut-off of 25 U/ml and at a cut-off of 10 U/ml. We also wanted to compare our results with IgA tissue transglutaminase antibodies prevalence from other countries. Results. We found a IgA tissue transglutaminase antibodies prevalence rate of 3% for values higher 25 U/ml and a IgA tissue transglutaminase antibodies prevalence rate of 1.6% for values between 10-25 U/ml. A prevalence of 13.6% for IgA tissue transglutaminase antibodies was observed in Germany, Finland and Sweden. Conclusions. We observed a 4.6% IgA tissue transglutaminase antibodies prevalence at a cut-off of 10 U/ml. Prevalence of IgA tissue transglutaminase antibodies from Romania is lowered compared with other European countries
Are We Going to Give Up Imaging in Cryptorchidism Management?
No full textBackground and Purpose: Undescended testes (UDT) is recognized as the most prevalent anomaly of the male genitalia and presents a significant risk factor for long-term complications, including infertility and testicular cancer. Currently, there is no consensus on the necessity of imaging in the management of UDT, nor is there agreement on which imaging modality is preferred or to what extent these tests offer real added value in the clinical setting. This review aims to evaluate the various imaging options available in the management of cryptorchidism, discussing their utility, advantages, and disadvantages compared to exploratory laparoscopy. Methods: We conducted a PubMed search using the following search terms: [“undescended testis”] OR [(“cryptorchidism”) OR (“diagnostic imaging”)] OR [(“Ultrasound”), OR (“CT scan”) OR (“MRI”)] AND [“laparoscopy”]. We analyzed 90 full articles, excluding irrelevant ones, and, in total, 18 publications were included in this review. Results: Ultrasound (US) is the most commonly used technique due to its non-invasive nature and absence of ionizing radiation. It is particularly beneficial in cases of non-palpable UDT. However, its main limitation lies in the difficulty in accurately locating UDT, especially when they are situated outside the inguinal region. Computed tomography (CT) scans serve as a crucial diagnostic tool, particularly for testes located below the internal inguinal ring. While CT exhibits comparable accuracy in detecting UDT, the need for sedation or general anesthesia, along with the costs and potential risks of secondary malignancy due to radiation exposure, does not favor its routine use. Magnetic resonance imaging (MRI) offers higher sensitivity than US and does not utilize ionizing radiation or intravascular contrast agents. It allows for the generation of multiplanar images, thereby providing improved tissue characterization. However, limitations include prolonged scan durations, the potential for motion artifacts during imaging, the need for sedation, and higher costs. Laparoscopy has been shown to provide better accuracy, offering both diagnostic and therapeutic benefits, particularly in cases of non-palpable UDT. It is widely regarded as the gold standard in achieving clear diagnostic and definitive therapeutic procedures and has demonstrated its utility in determining the anatomical position of intra-abdominal testes, owing to its magnification capabilities and minimally invasive approach. Conclusions: Achieving a correct and comprehensive diagnosis of cryptorchidism requires the medical team to decide on the appropriate imaging studies, as these will not significantly influence or alter the therapeutic decision-making process. It is unlikely that medical practice will eliminate imaging studies before a surgical decision is made in the near future. Therefore, a multidisciplinary approach that includes clinical examination, imaging, and diagnostic laparoscopy remains essential for the accurate management of UDT
