Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children

Background/Aims@#This study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite. @*Methods@#This a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy. @*Results@#Among the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children. @*Conclusions@#Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.

Timing of cholecystectomy after acute severe pancreatitis in pregnancy

Acute pancreatitis is one of the most common diseases of the gastrointestinal tract and is usually caused by gallstones; its occurrence in pregnancy is rare. Cholecystectomy for biliary pancreatitis during pregnancy is unavoidable, but its timing is controversial. We herein present the case of a patient who underwent termination of pregnancy due to deteriorated acute severe pancreatitis during the 27th week of gestation. Cholecystectomy was performed because of the relapse of acute biliary pancreatitis 10 days after being discharged. The interval from pancreatitis to cholecystectomy varies with its severity; in mild pancreatitis the interval may be one week, but in severe cases it maybe up to three weeks. Because pancreatitis may relapse during this interval, as occurred in the present case, a better solution for the timing of cholecystectomy must be sought.

Symptomatic lymphocele after kidney transplantation a single-center experience

In a retrospective study, we evaluated the frequency, clinical presentation, and management of lymphocele in kidney transplant recipients operated on in a single center. Between September 1984 and June 2005, we had 2147 kidney transplantations from living donors. During the follow-up period, ultrasonography was performed in symptomatic patients and those with elevated serum creatinine level postoperatively. Other radiological procedures were done in complicated cases. Patients with lymphocele were treated by percutaneous drainage with or without injection of sclerotizing agent [povidone iodine]. If recurrence occurred, surgical intraperitoneal drainage was performed. In cases with multiloculated collection or inappropriate access for percutaneous drainage, the primary approach was surgical intraperitoneal drainage. Symptomatic lymphocele collection was seen in 17 kidney recipients of our series [0.8%; 95% confidence interval, 0.4% to 1.2%]. It presented with elevation of serum creatinine concentrations [47.1%], pain and abdominopelvic swelling [29.4%], and lower extremity edema [23.5%]. Percutaneous drainage was used for the treatment of lymphocele in 11 patients, but recurrence occurred in 7 [63.6%]. These cases were treated with open surgical drainage. In 6 patients, the primary approach was surgical intraperitoneal drainage, because of multiloculated collection or inappropriate access for percutaneous drainage. All of the patients were treated successfully and no graft loss occurred during the follow-up period. Symptomatic lymphocele is an uncommon complication after kidney transplantation. Surgical intraperitoneal drainage is the most effective approach for the management of symptomatic lymphocele

Radiofrequency-induced thermotherapy in benign prostatic hyperplasia

We evaluated the efficacy and safety of radiofrequency-induced thermotherapy of the prostate in patients with benign prostatic hyperplasia [BPH]. Radiofrequency-induced thermotherapy of the prostate was performed under local anesthesia in 24 patients [median age, 67 years] with BPH. The International Prostate Symptom Score [IPSS] score, maximum flow rate, postvoid residual urine volume, and prostate volume were measured preoperatively and 4 months postoperatively. Nine patients [37.5%] had urinary retention preoperatively. One patient [4.2%] required transurethral resection of the prostate due to retention despite improved symptoms, and 2 [8.3%] needed an alpha-blocker, postoperatively. The success rate was 87.5% after 4 months follow-up. All patients were catheter-free after the procedure. The mean IPSS score decreased from 26.08 +/- 3.9 to 13.33 +/- 4.69 [P <.001], and the mean maximum flow rate increased from 4.63 +/- 4.4 mL/s to 13.21 +/- 4.28 mL/s [P <.001]. The mean prostate volume and mean residual urine volume were 46.38 +/- 16.8 mL and 160 +/- 57 mL, which decreased to 39.6 +/- 16 mL [P =.009] and 61.46 +/- 17.45 mL [P =.003], respectively. Fever, dysuria, and perineal pain [in 9 patients; 37.5%] were improved with conservative therapy. Retrograde ejaculation, erectile dysfunction, and urinary incontinence were not reported. Radiofrequency-induced thermotherapy of the prostate is a new, safe, and effective treatment for BPH. This technique is carried out under local anesthesia and mild sedation with little bleeding. It is especially appropriate for patients who present as high risk for general anesthesia

Ethylenedicysteine versus diethylenetriamine pentaacetic acid as the carrier of technetium Tc 99m in diuretic renography for patients with upper urinary tract obstruction

L,L-ethylenedicysteine [EC] is a new carrier of technetium Tc 99m [99mTc] with a lower affinity to plasma albumin in comparison with diethylenetriamine pentaacetic acid [DTPA]. We compared 99mTc-EC scan with 99mTc-DTPA scan in diuretic renography for patients with obstructive uropathy. Thirty-three patients with upper urinary tract obstruction were randomly selected and underwent diuretic renographies by 99mTc-EC and 99mTc-DTPA. The counts of radioisotope per pixel in the target [the kidney] and background tissues as well as the clearance half-life of these two radiopharmaceuticals were measured and compared. Mean counts of radioisotope per pixel in the target tissue was not different between 99mTc-EC and 99mTc-DTPA scans, but in the background tissue, it was less for 99mTc-EC [P =.003]. Target-background ratio was higher for 99mTc-EC scan [3.80 +/- 2.11 versus 2.48 +/- 1.39; P <.001]. Renal clearance half-life of radioisotope was shorter for 99mTc-EC scan than 99mTc-DTPA scan [58.15 +/- 15.17 minutes versus 78.65 +/- 19.99 minutes; P =.033]. The results were similar for uremic patients [with a serum creatinine level > 2mg/dL]. Target-background ratio of radiopharmaceutical uptake rates in diuretic renography was a good indicator of the higher resolution of 99mTc-EC than 99mTc-DTPA scan. We also demonstrated the faster clearance of 99mTc-EC than 99mTc-DTPA. This results in less radiation that is especially useful in children. To our opinion, 99mTc-EC can better depict the kidneys in comparison with 99mTc-DTPA

Comparative evaluation of urinary bladder cancer antigen and urine cytology in the diagnosis of bladder cancer

The diagnostic value of the urinary bladder cancer [UBC] antigen as a tumor marker is not clear yet. We designed this study to compare the accuracy of the UBC antigen and voided urine cytology in patients with bladder cancer. Fifty-four consecutive patients admitted for a diagnostic workup for bladder cancer were enrolled. Two voided urine samples were taken for urinalysis, both before performing cystoscopy. The samples were examined for urinary urine cytology and UBC antigen. Cystoscopy was done. Resection of pathologic lesion, if any, or random biopsies of multiple foci of the bladder was performed. The results of the diagnostic tests were compared with the pathology examination results. Of 54 patients, 31 had histologically confirmed transitional cell carcinoma. Results were positive for UBC antigen in 28 and for urine cytology in 16 patients. Sensitivities and specificities were 74.2% and 78.3% for UBC antigen, 48.4% and 95.7% for urine cytology, and 87.1% and 73.9% for combined UBC antigen and cytology, respectively. Positive and negative likelihood ratios were 3.42 and 3.03 for UBC antigen, 11.3 and 1.85 for urine cytology, and 3.34 and 5.73 for combined UBC antigen and cytology, respectively. The UBC antigen test had acceptable sensitivity and specificity in our study. However, results of voided urine cytology are significantly more reliable. A combination of tumor markers may help diagnose new tumors and lower the requirements for cystoscopy during follow-up. Further studies are warranted to find a more accurate noninvasive test or a complex of tests comparable with cystoscopy for diagnosis of bladder cancer

Epidemiology of hepatitis B in the Islamic Republic of Iran

Hepatitis B virus, a common cause of viral hepatitis, consumes a large portion of health resources in developing countries. Data obtained from the Survey of Health and Disease in the Islamic Republic of Iran were analysed with respect to hepatitis B-carrier epidemiology. Since the precise mode of transmission of hepatitis B is not well known, the study was designed to evaluate its transmission as a community-acquired disease. HBsAg tests were performed on the sera of 39 841 persons and the impact of several factors on the prevalence rate of HBV carriers was determined. The rate of hepatitis B carriers varied between zero and 3.9% with an average of 1.7%. Older males living in a village with low socioeconomic status, poor sanitation and intrafamily contact are the most important contributors to the rise of hepatitis B infection in the country