ABSTRACT
Purpose: The purpose of our study was to review outcome of circumcision among children with bleeding disorders at our institution and also to determine the impact of optimization leading to safe circumcision
Methods: Data representing boys [age 0-16 years] who underwent routine circumcision at the Aga Khan University Hospital [AKUH] between1988-2014 was retrospectively reviewed. Children with bleeding disorder were identified using International Classification of Diseases [ICD] Code 64.0. Data was retrieved and confidentially was maintained. SPSS version 19 was used for statistical analysis
Results: During 26 years 13,200 circumcisions were performed at AKUH. Amongst these 8,463 [64.11%] were done by using Plastibell, while 4,737 [35.88%] by open slit method. Only 23 [0.17%] children were identified with bleeding disorder. Two groups were made, Group-A [n:15] children with known bleeding disorders having circumcision and GroupB, [n:8] those in whom bleeding disorder was diagnosed after circumcision. Median age of children in Group-A was 9 years. All children in Group-A underwent open circumcision. 10 patients had Factor VIII deficiency, 2 had Glanzmann's thrombasthenia, 1 had Factor IX deficiency, 1 had Quebec platelet disorder, and 1 had Von Willebrand disorder. Median age of children in Group-B was 3 months. 7 out of 8 underwent plastibell while one had circumcision by open technique. 7 were diagnosed as Factor VIII deficiency and 1 diagnosed later to have Glanzmann's thrombasthenia. Statistical analysis showed significant difference among these two groups' p-value with respect to age [p-value 0.00] and family history [p-value 0.04- Fisher's exact test]. Both groups had similar postoperative length of stay. Overall bleeding complication rate after optimization was 13.33%
Conclusion: With the help of hematologist and adequate Factor replacement, these children can be managed as daycare. We suggest risks and benefit should be discussed with parents before procedure
ABSTRACT
Objective: To determine the outcome of wilms tumors among children in our center and compare the results of treatment on the basis of management proposed by the National Wilms tumor study board [NWTS] and the Societe international D'oncologie pediatrique [SIOP]
Patients and methods:- This study includes 49 children who presented to the Aga Khan University Hospital[AKUH] with wilms tumors from January 1988 to December 2015 [aged 0-16 years]. Patients were further divided according to the treatment strategies they received i.e NWTS and SIOP. Data was analyzed using SPSS 10
Results:-.A total of 49 patients [57%male and 43% female] were included in the study. Majority of the cases [56%] were between 1-5 years. The tumors mostly presented on the right side [65%].The diagnostic work up of the patients mainly involved CT imaging [69%].35% of children in the SIOP group presented with stage 3 diseases whereas in the NWTS group 42% presented with stage 1 disease. In the SIOP group 4 [14%] patients had disease reoccurrence and 2 [7%] patients died. In the NWTS group 2[10%] patients had disease reoccurrence and 1 [5%] patient expired. A 5 year survival rate of both groups was calculated to be more than 80%. Mean follow up in SIOP group was 119 months and In NWTS group was 114 months
Conclusions:- Wilms tumors are curable in the majority of the patients even with limited resource as in our country. The NWTS and SIOP treatment approaches are almost equally effective at our center however adherence to a single treatment is mandatory for effective treatments