Saturday, November 21, 2020

5 Best looking and best Pediatric Hospitals in the US (update 2020)

         Wondering where you can go in case your child suffers from a disease that needs surgery? Let's dive right in the 5 best Hospitals for Pediatric Surgery in the US in 2020.


     #1 – Cincinnati Children's Hospital

        Cincinnati, Ohio USA


        Cincinnati Children's Hospital is a 628-bed, nonprofit facility established in 1883. It admits over 30,000 patients per year, and its emergency department has been called one of the best in in the country, treating nearly 100,000 patients annually. The hospital includes a strong academic and research component. It comprises the Department of Pediatrics at the University of Cincinnati College of Medicine and is the third highest recipient of grants from the National Institutes of Health (NIH) for the funding of pediatric research. In addition to its certified Magnet status by the American Nurses Credentialing Center, Cincinnati Children's Hospital was ranked in the top three for nephrology, pulmonology, cancer, gastroenterology, and neonatology by U.S. News & World Report. The hospital attracts patients from around the world suffering from rare or complex disorders.


        #2 – Children's Hospital Los Angeles

        Los Angeles, California USA


        Children's Hospital Los Angeles is a non-profit teaching hospital that cares for over 100,000 patients each year. Physicians in over 100 different pediatric specialties work to make the facility one of the finest of its kind in the country and in the world. The hospital specializes in pediatric trauma care and is the top referral hospital in the region for patients in critical condition. As such, it houses a Level I Pediatric Trauma Center as well as 35 critical care beds, more than any other medical facility in the Western United States. Its research arm, The Saban Research Institute, ranks ninth in the nation for pediatric research funding from organizations such as the National Institutes of Health and the Centers for Disease Control and Prevention. Children's Hospital of Los Angeles is an affiliate of the University of Southern California.


        #3 – Rady Children's Hospital

        San Diego, California USA

        With 520 registered beds, Rady's Children's Hospital is the largest children's hospital in California and the sixth largest in the nation. One of the hospital's missions is to never turn a sick child away for lack of a bed. The facility was recently ranked in all ten pediatric specialties in U.S. News & World Report's list of America's top children's hospitals. In the same publication, Rady Children's Hospital was designated #2 in the nation in the specialty of orthopedics. The hospital's dedication to children is unparalleled. In addition to typical child and family support services such as a canine care program and family advisory council, Rady's has some truly unique programs. For instance, its on-site Chadwick Center for Children & Families provides therapy and treatment for abused, neglected, and traumatized kids. In addition, the hospital is home to the Helen Barnardy Center, the only pediatric nursing home in California.


        #4 – Boston Children's Hospital

        Boston, Massachusetts USA

        With a 395-bed capacity, Boston Children's hospital is one of the largest pediatric healthcare institutions in the United States. Although most of the hospital's 25,000 admissions and 557,000 visits per year are from children birth through 21 years old, the hospital also treats unborn children beginning at 15 weeks gestation. As a comprehensive care facility, the hospital treats patients suffering from a variety of illnesses and conditions including heart conditions, cancer, diabetes, and more. In addition to being recognized by many organizations for its exemplary care, Boston Children's Hospital also hosts one of the largest pediatric research enterprises in the world, the John F. Enders Pediatric Research Laboratories. Of the 1,100 scientists that make up its research community, nine are members of the National Academy of Sciences and eleven are members of the Institute of Medicine.


        #5 – Children's Hospital Colorado

        Aurora, Colorado USA

The 284-bed facility known as Children's Hospital Colorado is home to several regionally and nationally acclaimed programs. For instance, it features a Level IIIC Neonatal Intensive Care Unit. This is the highest distinction granted by the American Academy of Pediatrics. As such, it treats 750 infants annually, who come from a 10-state radius. The hospital's pediatric cardiology arm, known as Children's Hospital Colorado Heart Institute, has been internationally recognized for its successful heart transplants. An academically-minded institution, the hospital has close affiliations with the University of Colorado School of Medicine. Its Research Foundation, established in 1953, is responsible for several medical breakthroughs including the development of new pediatric heart surgery techniques as well as the discovery of toxic shock syndrome. The hospital maintains an ongoing commitment to patient health and safety and reports an 11 percent reduction in preventable harm in 2020.


Friday, November 20, 2020

3 Ways to check if your child has Acute Scrotum Sydrome (update 2020)


        Testicular pain or swelling, often referred to as the acute scrotum, can have a number of causes. Testicular torsion represents a surgical emergency because the likelihood of testicular salvage diminishes with the duration of torsion. Therefore, the family physician must act quickly to identify or exclude this condition in any patient who presents with an acute scrotum. This article reviews an approach to the diagnosis and treatment of the acute scrotum.


        The history and physical examination can significantly narrow the differential diagnosis of an acute scrotum, if not establish the exact cause. None of the conditions responsible for acute scrotal pain or swelling has a single pathognomonic finding, but the combined background information and physical findings frequently suggest the correct diagnosis.

        The age of the patient is important. Testicular torsion is most common in neonates and postpubertal boys, although it can occur in males of any age. Schönlein-Henoch purpura and torsion of a testicular appendage typically occur in prepubertal boys, whereas epididymitis most often develops in postpubertal boys.

            The onset and duration of pain must be carefully determined. Testicular torsion usually begins abruptly, as if a switch has been flipped. The pain is severe, and the patient often appears uncomfortable. Moderate pain developing gradually over a few days is more suggestive of epididymitis or appendiceal torsion. With either of these conditions, the patient may appear relatively comfortable except when examined.


      Physical Examination

         A general abdominal examination should be performed, with particular attention given to flank tenderness and bladder distention. Next the inguinal regions should be examined for obvious hernias and any swelling or erythema. The spermatic cord in the groin may be tender in a patient with epididymitis but typically is not tender in a patient with testicular torsion.

            The genital examination begins with inspection of the scrotum. The two sides should be assessed for discrepancies in size, degree of swelling, presence and location of erythema, thickening of the skin and position of the testis. Unilateral swelling without skin changes suggests the presence of a hernia or hydrocele.

            The duration of symptoms is also relevant. A high-riding testis with an abnormal (transverse) lie may suggest torsion, but this diagnosis is unlikely if pain has been present for over 12 hours and the scrotum has a normal appearance. In both epididymitis and testicular torsion, the affected hemiscrotum typically displays significant erythema and swelling after 24 hours.

        Diagnostic Studies

          Urinalysis should be performed to rule out urinary tract infection in any patient with an acute scrotum. Pyuria with or without bacteria suggests infection and is consistent with epididymitis. Based on our experience, a white blood cell count is not helpful and should not be routinely obtained.

          Until recently, no imaging studies were useful in confirming the cause of an acute scrotum. Immediate surgical exploration was thus the standard approach when torsion was suspected. However, studies conducted in the past few years have shown that only 16 to 42 percent of boys with an acute scrotum have testicular torsion.

        In an effort to improve diagnostic accuracy and avoid needless surgery, both nuclear medicine imaging and sonography have been performed in patients with an acute scrotum. Unfortunately, Doppler stethoscopes and conventional gray-scale ultrasonography have not been useful and therefore should not be used. Nuclear testicular flow studies can be helpful; however, they often require too much time and thus have fallen into disfavor.


Wednesday, November 18, 2020

Basic understanding of the Phymosis and Paraphymosis (2020 update)

         Phymosis is a condition where the foreskin is too tight to be pulled back over the head of the penis. Phymosis is normal in babies and toddlers, but in older children it may be the result of a skin condition that has caused scarring. It is usually not a problem unless it causes symptoms.

         Most uncircumcised baby boys have a foreskin that will not retract because it is attached to the glans.This is perfectly normal for about the first 2 to 6 years. By around the age of 2, the foreskin should start to separate naturally from the glans.The foreskin of some boys can take longer to separate, but this does not mean that this is a problem, it will just detach at a later stage.

Children with phymosis


        Phymosis  is not usually a problem unless it causes symptoms  such as redness, soreness and swelling.If your child's glans is sore and inflamed, they may have balanitis (inflammationvof the head of the penis).There may also be a thick discharge underneath the foreskin. If both the glans and foreskin are inflamed, it is known as balanoposthitis. 

        Most cases of balanitis can be easily managed using a combination of good hygiene, creams or ointments , and avoiding substances that irritate the penis. Balanoposthitis can also sometimes be treated by following simple hygiene measures, such as keeping the penis clean by regularly washing it with water and a mild soap or moisturiser.



        May be needed if a child  has severe or persistent balanitis or balanoposthitis that causes the foreskin to be painfully tight. There are 2 procedures that are usually performed:

       1.Duhammel's dorsal debridation - in which after anaesthesia the surgeon retracts the foreskin and make an incision on the dorsal part of the forskin in order to remove the strangulation ring that the foreskin is making around the glans.

       2.Circumcision - in which after anaesthesia the surgeon removes all the foreskin . These procedure is performed if usually the Duhammel's dorsald debridation has failed or in ritual cases.



        Paraphymosis is where the foreskin cannot be returned to its original position after being retracted. It causes the gland  to become painful and swollen . 


        It may be possible to reduce pain and inflammation by applying a local anaesthetic gel to the penis and pressing on the glans while pushing the foreskin forward. In difficult cases , it may be necessary to make a small slit in the foreskin to help relieve the pressure. In severe cases of paraphymosis , circumcision may be recomended. In very severe cases of paraphymosis, a lack of blood flow to the penis can cause tissue death (gangrene) and surgical removal of the penis may be necessary. 

History of Pediatric Surgery

 It all started in the middle of the 19th century as the surgical care of birth defects required novel techniques and methods and became more commonly based at children's hospitals. One of the sites of this innovation was Children's Hospital of Philadelphia. Beginning in the 1940s under the surgical leadership of C. Everett Koop, newer techniques of endotracheal anesthesia of infants allowed surgical repair of previously untreatable birth defects. By the late 1970s, the infant death rate from several major congenital malformation syndromes had been reduced to near zero.

  Nearly 100 years ago, William Ladd, MD, of Boston Children’s Hospital, helped establish pediatric surgery as a medical subspecialty. The recognition that children require unique surgical management hasn’t changed, but the instruments and procedures we use to operate on children have evolved dramatically. Here’s a glimpse of the surgical state of the art then and now.




The 1920s marked the earliest use of scrub attire. White gowns, white masks and white linens emphasized the importance of cleanliness — and perhaps compensated for the dim lighting. Chloroform and ether, dating back before the Civil War, were the anesthetics of the day. Though penicillin was discovered in 1928, antibiotics were still two decades away from actual use. Imaging was limited to X-rays. It was in this setting that pediatric surgery began to evolve.




In the XXI century we find Pediatric Surgery at another level. Keeping it at the same level and performance as Adults General Surgery nowdays pediatric surgeons perform surgeries using most advanced techniques. Stepping over the boundaries, we find pediatric surgeons using surgical robots and state of the art technologies in their surgical techniques.

5 Best looking and best Pediatric Hospitals in the US (update 2020)

            Wondering where you can go in case your child suffers from a disease that needs surgery? Let's dive right in the 5 best Hosp...