Objective To investigate the clinical characteristics and choices of management of neonatal testicular torsion (NTF).Methods Between January 2013 and December 2015,the clinical data of 7 cases of neonatal testicular torsion who were confirmed by surgery and pathological examination in the department of pediatric surgery of our hospital was retrospectively reviewed.Of the 7 NTTs (4 in right,2 in left and 1 in both sides),the median age and onset time of NNTs was 3 d (1-21 d) and 1 d (1-21 d),respectively.The presentation of NTTs included swelling of scrotum,scrotal mass and discoloration of scrotum.Features of ultrasonography included enlargement of testicular volume,echo heterogenicity or enhancement of testis,and decreased or disappeared testicular blood flow.Results All NTTs were performed by surgery and confirmed by pathological examination.In the operation,5 patients with extravaginal torsion (1 bilateral) and 2 with intravaginal torsion were detected.The degree of twisted testis was from 270° to 720°(average 438.8°) and resection rate for necrosis testis was 87.5％ (7/8).The median time of follow-up was 12 months (3-36 months),and none of testis underwent re-torsion and the findings of testicular ultrasonography was not abnormal.Conclusions The presentation of neonatal testicular torsion is non-specific.Once the scrotum shows discoloration,swelling,or enlargement of testis,testicular torsion is suspected.Urgent surgical exploration is recommended in order to make an effort to save the testis.

Three cases of medallion-like dermal dendrocyte hamartoma are reported.The patients included two men and one woman,and were aged from 2 to 38 years.All the patients presented with medallion-shaped,welldefined,slightly atrophic and asymptomatic congenital patches with prominently dilated superficial veins that had grown proportionately with the body length.Histological examination revealed similar changes in all of these patients,including epidermal atrophy and dermal proliferation of spindle cells,which stained positive for CD34,factor ⅩⅢa and vimentin,but negative for S100,CD68,CDla,CD31 and smooth muscle actin (SMA).None of the patients received special therapy,and the lesions enlarged slightly with body growth within 3-4 years of follow-up after the diagnosis.

Objective Malrotation of intestine with midgut volvulus is a special disease in newbo-rns.It is important of early diagnosis to avoid the risk of intestinal infarct and necrosis.We intended to ex-plore the value of early ultrasonographic diagnosis in malrotation of intestine with midgut volvulus,comparing with upper gastrointestinal imaging.Methods Ultrasonographic features and upper gastrointestinal imaging of 48surgically confirmed malrotation of intestine with midgut volvulus between January 2011and December 2014were retrospectively analyzed.Results All patients were comfirmed by operaion.The rotational degree of midgut volvulus were 90to 720°.In 43of 48patients (89.58%)of malrotation of intestine with midgut volvulus were diagnosed by ultrasonography.The typical ultrasonographic features were called “whirlpool sign”,which was the superior mesenteric vein and the mesentery around the superior mesenteric artery.In 35 of 48(72.92%)patients with malrotation were confirmed by the upper gastrointestinal imaging.The typical sign of the upper gastrointestinal imaging was the helical form of the distal duodenum and proximal jejunum located at middle abdomen.Compared with upper gastrointestinal radiographic examination,ultrasonographic examination had more sensitivity in diagnosis of malrotation of intestine with midgut volvulus (P﹤0.05). Conclusion Ultrasonographic examination have more sensitivity in diagnosis.Noninvasiveness,absence of X-rays,and low costs could make ultrasonographic examination a useful screening test in patients with sus-pected malrotation of intestine with midgut volvulus.“Whirlpool sign”could be considered a specific ultra-sonographic sign in diagnosis of midgut volvulus,which could provide reference for the clinical treatment of malrotation of intestine with midgut volvulus.

Objective To investigate the prenatal diagnosis and postnatal management of fetal hydronephrosis.Methods One hundred and two cases (87 unilateral and 15 bilateral,with a total of 117 kidneys) of fetal hydronephrosis in singleton pregnancy were diagnosed by prenatal ultrasonography in Jinhua People's Hospital between January 2011 and December 2014.During pregnancy and postpartum,all cases were routinely examined by genitourinary ultrasound for the classification of severity of hydronephrosis.The age of gestation at diagnosis of fetal hydronephrosis,the classification of hydronephrosis and postnatal follow-up outcome were recorded and retrospectively analyzed by descriptive statistical analysis.Results Of the 102 pregnancies,the mean gravida age and gestational age at diagnosis of fetal hydronephrosis was (28.1 ± 3.7) years (20-39 years) and (30.44-4.9) gestational weeks (16-40 gestational weeks),respectively.One hundred and two cases (35 right,52 left and 15 bilateral) of fetal hydronephrosis were diagnosed by antenatal ultrasonography.In the second trimester,59 cases (11 bilateral) of fetal hydronephrosis were diagnosed,including 28 mild (five bilateral),24 moderate (three bilateral),four severe (one bilateral) and three terminated ones.In the third trimester,43 cases (four bilateral) were diagnosed,including 22 mild (two bilateral),17 moderate (one bilateral),two severe and two terminated ones.All these patients were re-examined by ultrasonography at 48 hourspostpartum,and hydronephrosis was still present in 41 cases (five bilateral),including 19 grade 1 (two bilateral),11 grade 2 (two bilateral),seven grade 3 and four grade 4 (one bilateral).From the second and third trimester to postnatal period,there were 18 (two bilateral) and 23 (three bilateral) cases of hydronephrosis,respectively.The regression rate of prenatal hydronephrosis was 53.8％ (63/117),including 64.3％ (45/70) in the second trimester and 38.3％ (18/47) in the third trimester.During postnatal follow-up period,two cases (6.7％,2/30,unilateral) of grade 2,four grade 3 (4/7,unilateral) and four grade 4 (one bilateral) underwent surgery.Eleven cases of grade 3-4 hydronephrosis (one bilateral) were followed up and nine kidneys were treated with surgery due to ureteropelvic junction obstruction (6/9),ureter stricture (1/9),vesicoureteral stricture (1/9) and posterior urethral valves (1/9).Conclusions Although the majority of cases of fetal hydronephrosis spontaneously regress,postnatal hydronephrosis should be monitored timely and continuously by ultrasound.In particular,grade 3-4 hydronephrosis should be followed up to evaluate renal functions.If hydronephrosis presents with symptoms,progressive aggravation,pathological obstruction,or differential renal function ＜ 40％,early surgical intervention should be provided to improve renal functions.

Objective To investigate the clinicopathological features and diagnosis of intestinal neu-ronal dysplasia type B.Methods Between January 2004 and August 2014 , 9 patients ( 5 males and 4 females) were treated for constipation and abdominal distention,and in all of them an intestinal neuronal dys-plasia type B was confirmed histopta holoig cally.The age of 9 patients ranged from 3 months to 1 year old ( mean 7.8 months) .The specimen of 9 patients was routinely takne by paraffin-embedded full-circumference sections of lesional bowel,hematoxylin and eosin and immunohits ochemical stainign were carried out on the specimen.The patholgo ical morphology and quantitative of inet stinal en urons and ganglia were retrospectively analyzed.Results Total of the 9 patients,the number and density of myenteric ganglia increased significant-ly increased in the lesional bowel,the pathological findings included giant nerve plexus,isolated and ectopic ganglia.In the proximal bowel,the number and density of myenteric ganglia were observed abnormal on giant nerev plexus, isoal ted and ectopci ganglia was osb erved.Combinated these pathological findings and symp-toms,intestinal neuronal dysplasia type B was diagnosed.Conclusion The diagnosis of ni testinal neuronal dysplasia type B relies on typical presentations of allied disorders of Hirschsprung′s disease,giant ganglia, isolated and ectopic ganglia,and increasing the density of giant submucosal ganglia of pathologic morpholo-gy,meanwhile,excludingo thers prima ry etiologies.

Esophageal cancer with eyeball metastasis is scarce,and the clinical diagnosis is based on ul-trasound.The treatment method is surgical removal at present.Our focus is through other local or systemic treat-ment to protect eyeball,protect the integrity intact and facial appearance.One patient's clinical data with esopha-geal eyeball metastasis from the People′s Liberation Army Cancer Center of No.105 Hospital was included.The patient was completed“enucleation of the right side of eyeball” by ultrasound diagnosis.The results of pathologi-cal suggested that poorly differentiated squamous cell carcinoma metastasis in the eye.Eyeball metastases′s opera-tion was received a good recovery after 2 months and there was no recurrence.In the present paper,we discuss e-sophageal eyeball metastases clinical characteristics and methods of diagnosis and treatment combined with the lit-erature.

Objective To evaluate the efficacy of single or double-antibiotic regimen for the treatment of complicated appendicitis in children,with the purpose to guide the rational use of antibiotics in clinic.Methods Six hundred and sixty-three patients with acute appendicitis admitted to the department of pediatric surgery in Jinhua Municipal Central Hospital between March 2011 and February 2015.One hundred and seventy-two of 663 patients with complicated appendicitis which confirmed by intra-operative macroscopic or post-operative pathological examination were eligible for the study.These patients were divided into two groups based on the regimen of their postoperative antibiotics:single or double-antibiotic regimen(treatment group,n=66);triple antibiotics regimen(control group,n=106).Demographic data,blood routine test and C-response protein(CRP),length of hospital stay,postoperative complications and duration of antibiotic treatment were recorded and statistically analyzed.Results There was no difference between the treatment group and control group with respect to age distribution,blood routine examination and CRP, length of hospital stay, duration of antibiotic treatment or postoperative complications.Although the number of patients changed of antibiotics on the basis of bacterial culture of pyogenic fluids in treatment group were more frequently than those in the control group(7/66 vs.1/106), the therapeutic effective rate of changed of antibiotics was 100% in both two groups.The culture positive rate of peritoneal fluids was 72.09% (124/172), the most common pathogens were escherichia coli(80.15%, 105/131),pseudomonas aeruginosa(5.34%,7/131)and klebsiella pneumonia (3.05%,4/131).The results of bacterial culture of peogenic fluids showed no difference in both two groups.Conclusion Children with complicated appendicitis can be managed effectively with single or double broad-spectrum antibiotics after appendectomy,and it may be beneficial to guide the rational use of antibiotics and decrease the irrational use of multi-antibiotics combination in clinic.

Objective To investigate the prenatal diagnosis and postnatal clinical outcomes of fetal congenital choledochal cyst (CCC) to improve the recognition and treatment of fetal CCC.Methods Clinical data of 23 cases of fetal CCC which were diagnosed during routine prenatal ultrasonic examination in Jinhua Municipal Central Hospital from June 2009 to May 2015 were retrospectively analyzzed. Maternal age, gestational age at diagnosis of CCC, location and size of cyst, postnatal examination, age at operation and follow-up outcomes were recorded and statistically analyzed by Wilcoxon rank-sum test.Results (1) Among the 23 cases, six (26%) were terminated and the rest 17 continued their pregnancies (74%). (2) Results of the prenatal ultrasonography of the 23 cases indicated that hepatic portal cysts were closely related to hepatic portal veins or arteries. Six of the cysts communicated with gall bladder and eight connected to intrahepatic bile duct. The maximum diameter of the cysts in the 23 cases was 16.0-31.0 mm, averagely (24.7±3.7) mm. The maximum diameter of cysts diagnosed in the third trimester was significantly larger than that in the second trimester [ 27.0 (22.0-31.0) vs 23.0 (21.0-25.0) mm,Z=-2.134,P<0.05]. (3) Among the 17 cases of continued pregnancy, one underwent cesarean section at 35+ weeks of gestation and 16 delivered at term with the average gestational age at delivery of (38.2±1.1) weeks. All neonates were re-examined by abdominal ultrasound at 1-2 postnatal weeks and confimed prenatal diagnosed of CCC. (4) The 17 neonates were re-examined by abdominal ultrasound during the second postnatal week and the results showed that cyst size remained the same in four, decreased in one and gradually increased with the gestational age in 12 neonates. Among the 16 cases of confirmed CCC, 12 received surgery, including 11 (Ⅰa, 6;Ⅰc, 3;Ⅳb, 2) within one year-old and one (Ⅰc) around 18 months old. The prognosis was uneventful. Four out of the 16 cases rejected surgical operation and were followed up in outpatient. One neonate was diagnosed with congenital biliary atresia and transferred to Children's Hospital for operation.Conclusions When fetal abdominal cyst presented with hepatic portal cyst which communicates with gallbladder or intra-hepatic duct in ultrasonography, a congenital choledochal cyst should be taken into consideration by excluding the possibility of biliary atresia in the first place. Surgery for CCC infants without symptoms or signs is suggested to be performed around three months after birth. The postoperative prognosis of CCC is favorable, so termination is not recommended for gravidas with fetal CCC in prenatal consultation.

Objective To evaluate the efficacy of mirror therapy for stroke patients with hemiplegia.Methods Eighty stroke patients with hemiplegia were randomly divided into study group and control group with 40 cases in each group.Conventional rehabilitation training was given to patients in both groups;patients in study group were given additional mirror therapy for 24 weeks.The Fugl-Meyer Assessment (FMA) scale was used to assess the motor function,Functional Independence Measurement (FIM) scale to assess the activity of daily living,Modified Barthel Index to assess the ability of daily living,Brunnstrom Stage Scale to evaluate the states of the upper extremities,and the modified Ashworth Scale to evaluate muscle spasticity before and after 24-week treatment.Results Mter 24 weeks of treatment,there were significant differences in FMA score [(44.08 + 2.44) vs.(40.53 +2.11),t =7.07,P＜0.05,FIM score [(71.08 + 5.37) vs.(64.18 + 4.47),t =7.20,P ＜ 0.05],modified Barthel index score [(59.75+7.84) vs.(54.25 +8.88),t =3.03,P＜0.05 and Brunnstrom stage (Z=-3.000,P＜ 0.05) between the study group and the control group.However,there was no significant difference in modified Ashworth score between the two groups of patients (Z =-1.732,P ＞ 0.05).Conclusion Mirror therapy can improve upper limb and hand function of the stroke patients with hemiplegia and enhance their ability of daily life activities;however,it has no significant effect to improve the limb spasm.

Necrotizing enterocolitis (NEC) is one of the most frequent and severe gastrointestinal diseases among neonates,especially preterm newborns.Its incidence is inversely associated with birth weight and gestational age.NEC is characterized by widespread or localized necrosis of the small intestine and colon,and intestinal perforation,septic shock and other complications can occur in severe cases.The overall survival rate of NEC has been improved in recent years.However,there is no uniform standards for early diagnosis and surgical intervention.Several biomarkers have been proposed for the early diagnosis of NEC and for the prediction of disease progression and severity.This review summarized the progress on early diagnosis and surgical indications of NEC.