Acute appendicitis (AA) is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. The aim of this study was to compare diagnostic value of different serum inflammatory markers in detection of phlegmonous or perforated appendicitis in children. Data were collected prospectively on 211 consecutive children. Laparotomy was performed for suspected AA for 189 patients. Patients were subdivided into groups: nonsurgical abdominal pain, early appendicitis, phlegmonous or gangrenous appendicitis, perforated appendicitis. White blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), acid α₁-glycoprotein (α₁GP), endotoxin, and erythrocyte sedimentation reaction (ESR) were estimated ad the time of admission. The diagnostic performance was analyzed using receiver operating characteristic (ROC) curves. WBC count, CRP and IL-6 correlated significantly with the severity of appendiceal inflammation. Identification of children with severe appendicitis was supported by IL-6 or CRP but not WBC. Between IL-6 and CRP, there were no significant differences in diagnostic use. Laboratory results should be considered to be integrated within the clinical assessment. If used critically, CRP and IL-6 equally provide surgeons with complementary information in discerning the necessity for urgent operation.

Testicular and even more paratesticular tumours in children are rare. The aim of the study is to characterise the spectrum of these lesions with focus on the feasibility and effectiveness of testis sparing surgery. Twenty-four boys treated between 1980 and 2004 at the University Leipzig Medical Centre were evaluated. At presentation patients were between 5 months and 18 years old (median 23 months). Generally a high rate of malignant or potentially malignant tumours was observed. The majority of these tumours occurred in the first three years of age. The spectrum of testicular tumours comprised 13 germ cell tumours (6 yolk sac tumours, 6 teratomas, 1 embryonal carcinoma) and 4 sex cord stromal tumours (2 Leydig's cell, Sertoli's cell, granulosa cell). Both Leydig's cell tumours were endocrine active. Further on, we observed 3 boys with paratesticular rhabdomyosarcoma (RMS), and three with testicular and paratesticular metastases (Wilms’ tumour, neuroblastoma, leukaemia). Serum alpha1-fetoprotein (AFP) was clearly elevated in 5 of 6 yolk sac tumours but remained within normal limits concerning the other entities. Human chorionic gonadotrophin was normal in all cases tested. During the observation period high inguinal orchidectomy was the surgical standard method. Dependent on tumour histology, stage and the recommended treatment schedule postoperative chemotherapy was added. Testis sparing surgery was performed in 3 boys with primary testicular tumours (2 Leydig's cell, mature cystic teratoma). Local relapses were not observed. Systemic relapses occurred in 3 cases (2 RMS, leukaemia). During a median follow up of 5 years all patients with primary testicular tumours survived event free. Meta-analysis of the recent literature revealed that testis sparing surgery is feasible and save in praepubertal boys after exclusion of a malignant tumour. If a testis sparing approach is planned, the following criteria are essential: 1. The presence of a well defined circumscribed nodule confirmed by imaging. 2. Normal levels of serum AFP and hCG. 3. The presence of sufficient healthy testicular parenchyma. However, the high rate of malignant or potentially malignant tumours suggests that high inguinal orchidectomy should remain the surgical standard of therapy. Testikuläre und paratestikuläre Tumoren sind im Kindesalter sehr selten. Ziel der Untersuchung ist es, das Spektrum dieser Neubildungen, insbesondere auch unter dem Blickwinkel des hodenerhaltenden Vorgehens, zu charakterisieren. Wir identifizierten 24 Knaben, die zwischen 1980 und 2004 im Kinderzentrum am Universitätsklinikum Leipzig behandelt wurden. Ihr Alter betrug zwischen 5 Monaten und 18 Jahren (Median 23 Monate). Charakteristisch ist ein hoher Anteil maligner bzw. potentiell maligner Tumoren, die überwiegend in den ersten drei Lebensjahren auftraten. Das Spektrum testikulärer Tumoren umfasste 13 Keimzelltumoren (6 Dottersacktumoren, 6 Teratome, 1 embryonales Karzinom) sowie 4, teilweise endokrin aktive, Stromatumoren (2 Leydigzell-, Sertolizell-, Granulosazelltumor). Daneben beobachteten wir 3 paratestikuläre Rhabdomyosarkome sowie eine noduläre Periorchitis. Weiterhin lagen in 3 Fällen Metastasen (Wilms-Tumor, Neuroblastom, Leukämie) vor. Das Alpha-1-Fetoprotein (AFP) erwies sich bei 5 von 6 Dottersacktumoren, nicht jedoch bei den anderen Entitäten als erhöht. Das beta-Human-Choriongonadotropin (hCG) war in allen untersuchten Fällen normal. Die chirurgische Therapie bestand in der Regel in der hohen inguinalen Orchidektomie. In Abhängigkeit von Tumorhistologie, Stadium und jeweils gültiger Behandlungsempfehlung erfolgten eine sorgfältige Nachbeobachtung oder eine post-operative Chemotherapie. Eine hodenerhaltende Operation erfolgte bei 3 Patienten mit primären Hodentumoren (2 Leydigzelltumoren, zystisches Teratom). Lokalrezidive wurden über eine Nachbeobachtungszeit von 5 Jahren im Median nicht beobachtet. Systemische Rezidive traten bei zwei Patienten mit paratestikulärem RMS bzw. einem Patienten mit Leukämie in Erscheinung. Eine Metaanalyse von Literaturangaben zeigt, dass eine hodenerhaltende Chirurgie unter sorgfältiger Beachtung der notwendigen Vorsichtsmaßnahmen bei präpubertären Knaben nach Ausschluss eines malignen Tumors machbar und sicher sein kann. Wesentliche Voraussetzungen dafür sind: 1. Nachweis eines umschriebenen Tumors mittels exakter präoperativer Bildgebung; 2. Serum-Tumormarker (AFP, hCG) innerhalb der altersphysiologischen Streubereiche, sowie 3. Verbleiben von ausreichend gesundem Hodenparenchym. Aufgrund eines hohen Anteiles maligner oder potentiell maligner Tumoren bleibt die hohe inguinale Orchidektomie chirurgisches Standardverfahren. 1 This work was partially supported by grants of the University of Turin (ex-60 % funds).