The European Board of Paediatric Surgery (EBPS) includes a written Part 1 and an oral/practical Part 2 component. The goal of this study was to describe the EBPS examination candidate pool, and to determine factors associated with successfully passing the examination.

Background: Chronic pericardial effusions may present with a spectrum of symptoms. When the volume of fluid in the pericardium increases briskly, it may compromise cardiac function. In such cases, urgent pericardiocentesis for short-term management is indicated. A more permanent solution is the creation of a pericardial window. In children, this is mostly performed through a subxiphoid open approach. Objective: We describe a thoracoscopic technique for creation of a pericardial window in a toddler. Case: A 2-year-old girl with Down syndrome with acute myeloid leukemia treated with bone marrow transplant developed a large, chronic pericardial effusion as a result of graft-versus-host disease. Several attempts of ultrasound-guided pericardiocentesis were performed, with reaccumulation of the fluid and signs of cardiac tamponade within a few days. After stabilization, she was taken to the operating room where a pericardial window anterior to the right phrenic nerve was created thoracoscopically using ultrasound shears. An 8F Jackson–Pratt drain was placed as a chest tube. Results: The procedure was well tolerated by the patient, and hemodynamics improved immediately. The operative time was 36 minutes and the blood loss was minimal. The chest tube was removed on postoperative day 8, at which time the cardiac silhouette had normalized. A chest CT performed 1 month later for worsening pulmonary status showed no recurrent pericardial or pleural effusion. Conclusions: Pericardial windows can be performed safely via a thoracoscopic approach in children with symptomatic chronic pericardial effusions. The procedure is simple and quick and normalizes cardiac function immediately. The surface area of the pleura seems to be adequate for resorption of the pericardial fluid in this case. No competing financial interests exist. Runtime of video: 3 mins

PurposeOvarian torsion (OT) is a true surgical emergency that requires prompt diagnosis and therapy. There are conflicting reports on the accuracy of different imaging modalities for OT. In this study, we performed a meta-analysis of all the published studies on B-mode ultrasound (US, morphological criteria), Doppler US (DUS, flow criteria), and computed tomography (CT) for the diagnosis of OT.MethodsThe medical literature from 1987 to 2013 was searched for studies that evaluated US, DUS, CT, or combination of these techniques to diagnose OT in children using PubMed/MEDLINE database. The studies were screened and included if the quality criteria were met. Data were extracted using a standardized form. Reported sensitivities and specificities were pooled with 95% confidence intervals using a RevMan version 5.1 software (The Cochrane Collaboration, Oxford, United Kingdom).ResultsA total of 18 US studies with 716 combined patients were included, along with 15 DUS studies comprising of 1,021 patients, and 5 CT studies with a total of 107 patients. All studies reported sensitivities, while only few selected studies also reported specificities. Using morphological criteria on B-mode US (including absolute or relative ovarian size, echotexture, location, and configuration) yielded high sensitivity and specificity (average 92 and 96%, respectively); DUS was highly specific, but lacked sensitivity, while CT was the least sensitive test. CT specificities could not be calculated from the available data.ConclusionThis study found considerable variability of the reported sensitivities and specificities for the diagnosis of OT across all evaluated imaging modalities. Interestingly, B-mode US was the most sensitive and specific examination to detect OT. Some authors reported high diagnostic accuracy of DUS as well, but these findings have not been universally reproduced. CT had low overall sensitivity and is not recommended for the workup of suspected OT.