Plastibell circumcision; evaluation of a technique in 800 cases

Purpose: evaluation of plastibell device as an option for circumcision in neonates and infants

Material and Methods: between August 2002 and July 2004,800 cases had been circumcised by the authors using the plastibell device. Eighty five percent [680 boys] were circumcised before their mothers were discharged from the hospital after delivery. This was performed as an office procedure under local anesthesia. The babies were reviewed one to two weeks later by the same surgeon

Results: the mean time for executing the procedure was 5 minutes. In 584 cases [73%] the bell fell off spontaneously between the fifth and the 7th days. Complications occurred in 48 cases [6%]. Twelve cases [1.5%] had minor bleeding during the procedure. In five cases, the bell had to be taken off and circumcision proceeded in the conventional suturing technique to control bleeding. Twenty-seven cases [3.4%] had minor infection in the form of yellowish slough that responded to simple in ensures at home. The results were satisfactory for the parents in [792] cases [99%]. Eight cases developed phimosis [1%], only four cases required re-circumcision

Conclusion: plastibell device is a simple, safe and convenient option for circumcision. It is easily learned, less time consuming and having satisfactory outcome

Simple technique for stent fixation in hypospadias repair

Purpose: many pediatric surgeons do not leave urethral-stents after hypospadias repair. However, many others still do. We present a simple technique for stent- fixation

Patients and methods: between April12002 and Apri1/2004, 36 hypospadias cases were treated by the author. For hypospadias proximal to mid-glans [29 cases, 80. 5%], a stent was left behind as a routine. Fifteen boys [51.7%] and their stents draining in urinary-bags and 14 t [48.2%] in their diapers. The stent was fixed by wrapping a small adhesive-plaster piece [2x1 tin] around the stent, just distal to the rneatus, leaving a small mesentery of 10 mm. A stitch of non-absorbable suture ZURS passed through this mesentery, without transfixing the stent, their fasten the two suture ends together lightly around the plaster. The two suture ends were tied to the glanular tension-stitch applied at the start of the procedure. Then normal dressing was done

Results: the cases came to the follow-zip with no problems related to stent fixation. No accidental stent- migration was observed. Two cases [6.8%] had partial stent-blockage at the bladder-end

Conclusion: this simple technique for stent- fixation is easy, cheap and suitable for arty type of dressing

Blunt abdominal trauma in children with solid organs injuries; experience in 24 cases

Aim: although operative-management was the standard for blunt abdominal trauma [BAT] in children, recently a non-surgical approach was recommended for pediatric solid-organs-injuries

Methods: to determine the role of conservative approach in BAT children, we retrospectively analyze the data of children with [BAT] and solid-organs-injuries managed by the authors over 4 years

Results : from December /2000 through December /2004, 24 children with [BAT] and solid- organs-injuries were managed. Injury mechanisms were road-traffic-accidents [RTA] in 19 [79%], sport-related in 4 [17%] and falling-from-height in 1[4%]. The spleen was injured in 13 [54%]; the liver in 12 [50%], the kidneys in 3 [13%], and the adrenal-glands in 2 [8%]. Thirteen cases were managed conservatively [53%], and I 1 operatively [47%]. Operations for the spleen [6] included, splenectomy in 3 [50%], partial splenectomy in 2 [33%] and splenorraphy in 1[17%], for the liver [6], suturing tears in 4 [67%] and per hepatic packing in 2 [33%]. Four children [17%] died from their injuries; [2] severe chest-injuries, [1] spinal-fracture and [1] severe liver-injury

Conclusions: children with BAT and solid-organs injuries-can be treated without surgery if the decision is based-on their hemodynamic status and response and resuscitation. Management in pediatric-trauma-centers, with the involvement of pediatric surgeons gives the best outcome

Dramatic vascular course of Behcet's disease

Vascular involvement in Behcet's disease is rare approximately 14% venous and 1.6% arterial, serious and recurrent. We report a case of Behcet's disease with deep venous thrombosis and right iliac pseudoaneurysm which was repaired with polytetrafluoroethylene PTFE graft. The patient received warfarin, aspirin, clopidogrel, immunosuppressive and corticosteroids. Two months later the patient developed manifestations of superior vena cava thrombosis and the graft was blocked. Three months later, ischemia of the right foot deteriorated and left femoral artery to right femoral artery crossover PTFE graft was performed