Factors affecting survival in surgically treated neonates with necrotizing enterocolitis

Necrotizing enterocolitis [NEC] is a life threatening disease of stressed neonates that is more common in low-birth weight [LBW] and preterm infants. It is considered as the most devastating gastrointestinal emergency in newborn infants. As more premature infants with NEC survive, the morbidity, mortality, functional outcome and prognosis in neonates with NEC have become a subject of great interest. The aim of this study is to identify mortality predictive factors in neonates with NEC who required surgical intervention. The study was conducted at Cairo University Children Hospital [CUCH] during the period from May 2001 to June 2003. Forty one patients with NEC requiring exploratory laparotomy were studied. Patients underwent follow-up for 90 days after the procedure. Certain variables have been taken into consideration as predictive factors for mortality. These variables were: Weight at birth, Gestational age, Sex, Presence of sepsis, Type of feeding, Gas in the peritoneal cavity at abdominal x-ray, Extent of disease, operative strategy [Resection and anastomosis or resection and enterostomy], and extent of bowel resection [ileocecal valve retained or removed]. Database configuration and analysis was performed with Microsoft access and statistical analysis was performed with the use of X2-analysis and the student t-test for paired groups using two tailed comparisons with P-value less than 0.05 considered statistically significant. Statistical analysis revealed that mortality was significantly higher with pan intestinal disease, weight less than 1.8 kg and gestational age less than 30 weeks

Factors affecting survival in surgically treated necrotizing enterocolitis in neonates

Necrotizing enterocolitis [NEC] is a life threatening disease of stressed neonates that is more common in low-birth weight [LBW] and preterm infants. It is considered as the most devastating gastrointestinal emergency in newborn infants. As more premature infants with NEC survive, the morbidity, mortality, functional outcome and prognosis in neonates with NEC have become a subject of great interest. The aim of this study: Is to identify mortality predictive factors in neonates with NEC who required surgical intervention. It was conducted at Cairo University Children Hospital [CUCH] during the period from May 2001 to June 2003. Patients and methods: Forty one patients with NEC requiring exploratory laparotomy were studied. Patients underwent follow-up for 90 days after the procedure. Certain independent variables have been taken into consideration as predictive factors for mortality. These variables were:1] Weight at birth, 2] Gestational age, 3] Sex, 4] Gas in the peritoneal cavity at abdominal X-ray, 5] Extent of disease, 6] operative strategy[Resection and anastomosis or resection and enterostomy], and 7] extent of bowel resection[ileocecal valve retained or removed]. Database configuration and analysis was performed with Microsoft access and statistical analysis was performed with the use of X 2 -analysis and the student t-test for paired groups using two tailed comparisons with P-value less than 05 considered statistically significant. Statistical analysis revealed that mortality was significantly higher with pan intestinal disease, weight less than 1.8 kg and gestational age less than 30 weeks

Laparoscopic varicocelectomy in children and adolescents, advantages and surgical outcomes

Varicocele occurs in approximately 16.2% of school boys aged 10-19 yrs old, an incidence that is similar to that in the adult male population. There is general acceptance for surgical treatment of varicocele in children and adolescents. However, specific indications for varicocelectomy in children and adolescents are controversial. Open surgery using different techniques has been the usual procedure. However, with the general trend towards less-invasive operating techniques, laparoscopic varicocelectomy has had an increasing acceptance in the last years and is sometimes even demanded by the parents. Seventeen children under went laparoscopic treatment of varicocele in the pediatric surgical department of Cairo University Children Hospital. The diagnosis of varicocele was based on physical examination, scrotal ultrasonography and color Doppler evaluation. The spermatic artery was separated from the venous plexus in all patients. On follow-up, symptoms of patients, clinical examination including testis size and the presence of varicocele were evaluated. Color Doppler ultrasonography studies were performed by an experienced radiologist. The children ages ranged between 9.3 and 14.5 years [median age, 13.1 yrs]. One patient had a relapse [slight reflux on Valsalva's maneuver after surgery]. One patient developed reactionary hydrocele postoperatively which resolved spontaneously. The general incidence of complications in this series was 2 out of 17 patients [11.8%]. This preliminary study confirms that laparoscopic internal spermatic veins clipping and division is a simple, safe, effective, procedure for varicocele repair

Laparoscopic diagnosis of contralateral patent processus vaginalis through the surgically opened sac in children with unilateral inguinal hernia

For more than two decades, the controversy has persisted as to what is to be done to the opposite side of an infant or child who has evidence of a unilateral inguinal hernia. Various methods have been advised for identifying the contralateral patent processus. Discussions on the subject intensified in recent years because of the use of laparoscopy to show the presence of a clinically undetectable contralateral hernia. Chu et al in 1993 and Groner et al in 1995 used a modified procedure in which the Laparoscope was introduced into the peritoneal cavity via the hernial sac to avoid a puncture wound. A random group of 53 patients with unilateral inguinal hernia in infants and children were studied to detect the presence of a patent processus vaginalis on the opposite side. The hernial sac was opened, and diagnostic laparoscopy was performed through the known hernia sac with C02 insufflation to 10 mm Hg. A 5 mm 30° telescope was used to inspect the contralateral inguinal region. A patent processus was diagnosed when an obvious opening through the internal ring was identified or if bubbles were seen on external manipulation of the scrotum and internal ring. Contralateral conventional exploration was then done in all cases of this series to confirm or disprove the findings of the laparoscope. Positive CPPV was diagnosed by laparoscopic exploration in 16 cases constituting 30.2%. On surgical exploration, 17 cases of CPPV were detected with an incidence of 32.1% CPPV. One patient with positive test proved to be negative on surgical exploration. Also two patients with negative tests proved to have CPPV on surgical exploration. It is worth mentioning that these three cases were early in the series. This constitutes a good degree of agreement between the two procedures with reasonable sensitivity [88.2%] and high specificity [97.2%] and total accuracy of laparoscopic diagnosis 94.3%. Laparoscopic evaluation of a contralateral patent processus vaginalis through the surgically opened sac in children with unilateral inguinal hernia is a safe and accurate procedure. This method helps avoid any unnecessary contralateral inguinal exploration. It can be performed without any complications

Laparoscopy in the management of impalpable undescended testis

Impalpable undescended testes offer a greater diagnostic and therapeutic challenge for the radiologist and the surgeon. Evaluation of the impalpable testis using diagnostic laparoscopy has received appreciable support in the last years. Laparoscopy to evaluate the impalpable testis has also a great impact on treatment. In this study 36 children with impalpable testes underwent diagnostic and therapeutic laparoscopy for evaluation of impalpable testis. 9 patients had bilateral and 27 patients had unilateral impalpable undescended testis. The left testis was affected in 16 boys and the right in 11. Laparoscopy localized 29 [64.4%] testes out of 45 impalpable testes and 16 [35.6%] blind ended vas deferens. Two-stage Fowler-Stephens orchidopexy was performed in 6 testes [4unilateral and 1 bilateral cases]. The remainder, or 23 intra-abdominal testes [79.3%], were mobilized sufficiently to allow scrotal placement without dividing the testicular vessels. The overall success rate for all Fowler-Stephens procedures was 83.3% [5 out of 6], for all single stage laparoscopic orchidopexies was 91.3% [21 out of 23] and for all laparoscopic procedures was 89.66% [26 out of 29] where 26 out of 29 testes were placed successfully in the scrotum with no atrophy. Laparoscopy for the impalpable undescended testis offers a simultaneous diagnostic and therapeutic tool. It obviates the need for invasive and/or expensive diagnostic imaging and saves the patient an extensive surgical procedure. This study recommends laparoscopic orchidopexy as the treatment of choice for the impalpable undescended testis

Comparative study between superiorly based pharyngeal flap and sphincteroplasty in treatment of velopharyngeal insufficiency after cleft palate repair

Despite technical advances in cleft palate repairs, the post-surgical development of palatal fistulas and velopharyngeal insufficiency [VPI] is not uncommon. Approximately 20-38% of children who undergo cleft palate repair develop VPI. Surgical alteration of the VP sphincter is directed at decreasing the horizontal cross-sectional surface area of the sphincter's tissue boundaries. This can be achieved by the interposition of pedicled pharyngeal flaps [splitting one large port into two smaller one] or repositioning the posterior and lateral borders of the sphincter by the introduction of musculomucosal tissue flaps [Sphincteroplasty]. is to compare results of pharyngoplasty and superiorly based pharyngeal flap in the treatment of velopharyngeal insufficiency after cleft palate repair. A random group of twenty - two patients with VPI after cleft palate repair was studied. Patients were prone to three diagnostic procedures at phoniatric clinic, preoperatively: 1- Flexible fiber optic nasopharyngoscopy. 2-Nasometric evaluation 3-Tape recording. Patients were classified into two random groups; For 11 patients pharyngoplasty was done. Superiorly based pharyngeal flap was done for the rest of the patients. Nasometric evaluation and tape recording were repeated after phonotherapy [3-4 months postoperatively] and percentage drop in nasometer for nasal and oral sentences were calculated.Flexible fiber optic nasopharyngoscopy was repeated after 3 - 6 months postoperatively. In group I, three patients had persistence of nasal tone postoperatively [two patients had marked improvement and one patient had minimal improvement], giving incidence of complications 27.3%. According to results of postoperative tape recording of this group, 8 patients were categorized as good results, two as moderate and one as poor result. In group II, one patient had partial dehiscence and persistence of nasal tone postoperatively. Two patients had hypo nasality, one of them developed sleep apnea. Incidence of complications in this group was 27.3%. According to results of postoperative tape recording in this group, 9 patients were categorized as good results, one as moderate and one as poor result. Percentage drop in nasometer in nasal sentence in group I and II was 35.55% and 42.61% respectively. Percentage drop in nasometer in oral sentence in group I and II was 51.95% and 49.11% respectively. Both sphincter pharyngoplasty and superiorly based pharyngeal flap proved to be effective in treatment of velopharyngeal insufficiency with accepted incidence of complications. Sphincter pharyngoplasty had better results in patients with good palatal and lateral pharyngeal wall movements on preoperative videoendoscopy. Superiorly based pharyngeal flap had better results in patients with poor palatal and lateral pharyngeal wall movements on preoperative videoendoscopy

Evaluation of percutaneous intratumoral injection of p53 gene in the treatment of inoperable hepatocellular carcinoma as compared to alcohol injection

P53 is a tumour suppressor gene on chromosome 17 P. Alterations [deletion or mutation] within the coding sequences of the gene are among the most frequent genetic changes detected in human neoplasm. The use of gene therapy in some tumours is a new trend nowadays which carries many hopes for the future treatment of these tumors. This modality of treatment utilizes transfer vectors [plasmid, virus,] for delivering certain genes into malignant cells to induce tumour suppression. Injection of P53 intratumoral [I.T] in Hepatocellular Carcinoma [H.C.C.] is an example of this therapy. The aim of this study is to compare the effect of intratumoral injection of P 53 to that achieved with alcohol injection in cases of H.C.C. In a prospective study, eleven consecutive patients, diagnosed as H.C.C., were subjected to I.T injection of alcohol [Group I] and another eleven patients were subjected to I.T P 53 injection [Group II]. The results show that alcohol injection has superior results in treating H.C.C. over P 53 injection