Tag Archives: paediatric surgery

Snoring children

For Emergency Departments, For General Practitioners,

Amutha reviewed a paper from Brazil in February’s Paediatric Pearls on children who snore.  I thought it was the kind of problem that would go to GPs but she tells me that a lot of the ED juniors ask her about it as well so presumably parents are seeking information on the cause of their sleepless nights from a number of different sources.

 The paper which talks about obstructive sleep apnoea and the need for ENT referral is downloadable in full from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942010000500003&lng=en&nrm=iso&tlng=en.  Braz J Otorhinolaryngol. 2010 Oct;76(5):552-6. 

The effects of sleep disturbed breathing during middle- to late-childhood is related to important aspects of behavioral functioning, especially inattention and learning difficulties, that may result in significant functional impairment at school.  Sleep. 2010 Nov 1;33(11):1447-56.  (http://www.ncbi.nlm.nih.gov/pubmed/21102986)

January GP edition here!

For General Practitioners, PDF digests: for General Practitioners, , , ,

January reminds us all of the NICE guideline on head injury and specifically when a child is supposed to be referred for a CT.  We continue our 6-8 week baby check series with information on undescended testes.  There are also links to agreed blood test reference ranges and resources to help with the identification of asthma inhalers.  Download January 2011 GP PDF here.

Undescended testes

For Emergency Departments, For General Practitioners,

Undescended testes (cryptorchidism) with thanks to Dr Sara Waise

 Occasionally when you are examining a male infant, you may think that one or both of his testes has not yet descended into the scrotal sac.    Infant testes are actually quite retractile; ask parents if they are visible in the scrotum when the baby has a warm bath.  At 6 weeks some babies’ testes may still be palpable within the inguinal canal, especially if they were born a bit early.  Infants with a true undescended testis need to be referred to a paediatric surgeon any time from 6 months of age and definitely by 1 year of age.  Our local paediatric surgery service is at the Royal London Hospital, Whitechapel.

One of the junior doctors, Dr Sara Waise, has put together the following notes on undescended testes for Paediatric Pearls: 

Check whether testes are:

  • Present or absent
  • In the inguinal canal
  • High in the scrotum
  • Able to be brought down into the scrotum

 Identify any other congenital defects 

  • May be isolated
  • Can occur as part of genetic or endocrine disorders and for this reason, my colleague with an interest in endocrinology asked me to remind you that bilateral undescended testes need immediate referral.

 If the testis remains undescended at 1 year of age, referral to a urologist is needed.

 Early correction maximises future fertility potential

  • Outcome is poorer for bilateral undescended testes
  • Unclear whether surgical correction fully normalises this

 Surgical correction reduces malignancy risk

  • Facilitates self-examination
  • Risk remains 5-10 times greater than normal following orchidopexy

 

References

Kurpisz,. M., Havryluk, A., Nakonechnyj, A., Chopyak, V. & Kamieniczna, M. (2010). Cryptorchidism and its long-term consequences. Reproductive Biology 10 19-35

Hutson, J.M., Balic, A., Nation, T. & Southwell, B. (2010). Cryptorchidism. Seminars in Pediatric Surgery 19 215-234

http://www.patient.co.uk/health/Undescended-Testis.htm provides a useful, printable overview for parents of boys in whom you have found an undescended testis. 

http://www.patient.co.uk/doctor/Undescended-and-Maldescended-Testes.htm has information for medical professionals and includes information about the ascending testis syndrome in the older child (around 8 to 10 years old).