Miscellaneous

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Hydrometrocolpos presents at the two extremes of childhood: initially during the neonatal period, when there is a high level of maternal hormones, and then at early puberty, when the patient herself begins to have production of estrogenic hormones. The distal vaginal obstruction is mostly due to imperforate hymen (in two thirds of cases), followed by a transverse vaginal septum and less commonly, vaginal atresia (with or without persistence of a urogenital sinus or cloaca)." "Associated anomalies are common and quite often severe. These include anorectal malformations and unilate…

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February 25Feb 25

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The confluence is not always readily apparent, especially in very masculinized patients who have a UGS resembling a male urethra. In these patients, one must actively look for a verumontanum-like structure with a small “utricular” opening in the proximal urethra. This is the confluence. A guidewire or ureteral catheter should be inserted into this communication through the cystoscope, and then the scope can be passed over the guide into the vagina. In almost all cases, we find it helpful to place a Fogarty catheter into the vagina and inflate the balloon (Fig. 68.1). Even in the …

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February 19Feb 19

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Rink et al. described the “PVE” classification, in which the length and width of the phallus (P) is measured in centimeters, the location of the vaginal confluence (V) is recorded in centimeters from the bladder neck and from the UGS opening, and the degree of masculinization of the external genitalia (E) is estimated with a Prader number of 1–5."

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February 19Feb 19

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "If, based on the AFP level, a tumour is felt to be malignant, then an inguinal orchiectomy is performed. Tumours that are likely to be benign based on AFP level should be managed initially with an excisional biopsy and frozen section analysis. Even tumors that appear on ultrasound to replace the testis may be enucleated, leaving significant residual testicular tissue. If a benign histology is confirmed, then the testis is closed with absorbable suture and returned to the scrotum. If the biopsy reveals a malignant tumour (usually yolk sac) or potentially malignant tumour (such as …

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February 6Feb 6

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Most testicular tumours present as a painless, hard mass, though rarely they may present with pain related to an acute bleed. On physical examination, a mass that cannot be separated from the testis is assumed to be a testis tumour until proven otherwise. Ultrasound is very helpful in making this distinction when the physical examination is unclear. Rarely, testis tumours may present with a reactive hydrocele. If a hydrocele is large and firm enough to preclude palpation of the testis, an ultrasound should be obtained."

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February 6Feb 6

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "These lesions are best resected within the first 24 h after birth, because the gut is usually not colonized in the first 24 h, reducing the risk of infection if the field is contaminated by stool during the resection. Perioperative antibiotics are given immediately before surgery commences and continued for 24–48 h postoperatively."

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January 29Jan 29

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "An abdominal ultrasound will determine the size and consistency of any pelvic or abdominal component. It may be necessary to fill the bladder with water to allow it to be used as a sonic window. MRI should clearly distinguish between sacrococcygeal teratoma and anterior meningocele, and may be able to detect the occasional extension of the tumour through the sacral hiatus into the spinal canal."

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January 29Jan 29

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Dermal sinuses must be differentiated from benign coccygeal pits, which end blindly and never extend intraspinally, and therefore do not require further imaging evaluation or treatment. Dermal sinus tracts are found above the natal cleft and are usually directed superiorly. By comparison, coccygeal pits are found within the natal cleft, below the top of the intergluteal crease, with a tract extending either straight down or inferiorly. Coccygeal pits occur over the lower sacrum and coccyx and are anatomically located below the level of the subarachnoid space. They are encountered…

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January 26Jan 26

video 1

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October 16, 2025Oct 16

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "A technique to prevent distal obstructions where the distal catheter is passed through the falciform and positioned above the liver with the tip pointed at the hepatic flexure has been described in adults [45]."

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August 1, 20251 yr