Parasitic infestation in pediatric and adolescent appendicitis: a local experience

The relationship between parasites and pediatric appendicitis is a highly debatable issue. This study aims to investigate the role of parasitic infestation in the etiology of acute pediatric appendicitis. A retrospective study including 1600 pediatric and adolescent patients who had undergone surgical therapy for a diagnosis of acute appendicitis over a period of ten years from Jan 2001 to Dec 2010. Demographic data were retrieved including the patient's age, sex, clinical data, clinical presentations, laboratory investigations, operative data and pathological findings to identify the presence and type of parasites. Patients were divided into two groups according to the presence or absence of parasites in the appendix lumen. In group I [n: 88], parasitic infestation was observed, whereas in group II [n: 1502], no parasitic infestation was present. Parasites were present in 5.5% [88 patients], and of those 88 parasitic infestations, 45 [51.1%] were Enterobaisis, 8 [9.1%] were Schistosomiasis, 23 [26.1%] were Ascariasis, 7 [8%] Trichuriasis, and 5 [5.7%] were Teania Saginata. The percentage of patients with suppurative, gangrenous or perforated appendicitis was similar in both groups with no statistical significance, irrespective of the presence or absence of parasitic infestation. The low prevalence of parasites among the appendectomy specimens did not support the notion that parasites were a major cause of appendicitis in pediatric patients

Recurrent laryngeal nerve injury in thyroid surgery

Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve [RLNI] is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 [3.2%] cases, and in 1 [0.3%] case, it became permanent [post Rt. Hemithyroidectomy]. Bilateral vocal cord problems occurred in 2 cases [0.58%], but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation [21.7% in secondary vs. 2.8% in primary, p=0.001], total/near total thyroidectomy [7.2% in total vs. 1.9% in subtotal, p=0.024], non-identification of RLN during surgery [7.6% in non-identification vs. 2.6% in identification, p=0.039] and in malignant disease [12.8% in malignant vs. 2.9% in benign, p=0.004]. However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender [4.1% in male vs 3.8% in female, p=0.849]. The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury

Laparoscopic management of malfunctioning peritoneal dialysis catheters

Continuous ambulatory peritoneal dialysis [CAPD] is an established alternative method to hemodialysis for treating endstage renal disease patients. Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis [PD]. Laparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. The purpose of this study is to present our experiences with laparoscopic repair of peritoneal catheter dysfunction Between April 2006 and March 2010, 21 cases of laparoscopic interventions were performed for the salvage of malfunctioning CAPD catheter. Two trocars [5 mm] were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed and complications. The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in fifteen cases, malpositioning in four cases, and tunnel infection in the remaining two cases. Adhesiolysis was performed in cases with adhesions. In the cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn and exchanged because of infection. There were no mechanical or infection problems. The overall success rate of catheter function [>30 days after laparoscopy] was 100%, except for two cases in which the catheters had to be removed. Laparoscopy is a safe, highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction