Positive and Negative Rates in Children with Acute Appendicitis

Background: Acute appendicitis remains the most misdiagnosed condition worldwide. Children tend to present with a variety of clinical symptoms, may have difficult communication and could be difficult to examine

Design: A Retrospective Study

Setting: King Hamad University Hospital, Bahrain

Method: One hundred thirty-six patients who had appendectomy were reviewed between 1 May 2012 and 31 March 2016. The final diagnosis of acute appendicitis was the histological analysis of the excised specimen

Result; One hundred thirty-six underwent appendectomy and were included in this study between 1 May 2012 nd 31 March 2016. One hundred sixteen [85%] patients had uncomplicated appendicitis and 16 [12%] patients had complicated appendicitis. Four patients were histologically negative; Negative Appendectomy Rate [NAR] was 2.9%. Twelve patients had perforation; therefore, the Perforation Rate [PR] was 8.8%. Sixty-six [49%] laparoscopk appendectomies and 70 [51%] open appendectomies were performed. There was no significant difference between hospital stay and surgical technique; the average stay was 4.3 days

Conclusion: Our study has demonstrated NAR of 2.9% for a histologically normal appendix; a perforation rate of 8.8%. This study revealed the need for a prospective study for the pediatric acute abdomen and a dedicated radiological resource focused on pediatric radiology. The diagnosis of appendicitis in children remains largely clinical with appropriate use of US

national oncology center at king hamad university hospital

The modern treatment of a patient with cancer requires great expertise, adequate resources and a multi-disciplinary approach. Much of this approach is derived from the experience of multicenter controlled trials and the focused experience of specialist cancer centers. The experience of institutions such as Memorial Sloan Kettering Cancer Center in New York, Institute Gustave Roussy in Paris and many more has been to the forefront in clinical trials of newer approaches and the introduction of better care. This has developed pari-pasu with significant strides in research and these centers of excellence have improved our understanding of the genetics of cancer and targeted therapy. The degree of specialization within these and other modern cancer centers is such that entire teams are devoted to the management of the patient with specific diseases such as a breast service or a hepatobiliary service etc. This level of specialization is now accepted as the norm and allows the development of unique skills and expertise

Percutaneous endoscopic gastrostomy: a review of practice and complications

Background: Percutaneous Endoscopic Gastrostomy [PEG] is the standard option for long-term nutritional support in infants and children with nutritional deficit due to feeding difficulties

Objective: To assess the indications, complications and long-term efficacy of PEG

Design: A Retrospective Study

Setting: Our Lady's Children's Hospital, Crumlin, Dublin, Ireland

Method: One hundred forty-eight patients underwent PEG insertion from October 2004 to December 2007. Data were reviewed from the Hospital Inpatient Enquiry [HIPE] and patients' charts

Result: One hundred forty-eight patients underwent PEG insertion; 91 [61.5%] males and 57 [38.5%] females with a median age of 15 months [range 1-190 months]. The procedure was abandoned in one patient due to unfavorable anatomy [failure rate 0.7%], and this patient is excluded from this report. PEG was indicated for feeding difficulties in 102 [68.9%] patients, recur rent aspiration pneumonia in 15 [10.1%] and failure to thrive in 31 [11.6%V No mortality was recorded; however, 15 [10.1%] patients developed stomal leakage and 3 [2%] of these required change of PEG. Nine [6%] patients developed a wound infection, 2 [1.4%] developed a gastrocolic fistula, 1 [0.7%] patient developed adhesive intestinal obstruction requiring laparotomy and adhesiolysis. Two [1.4%] patients had aspiration pneumonia, 3 [2%] had inadvertent tube removal, 4 [2.7%] had tube blockage, 3 [2%] had tube breakdown, 2 [1.4%] had tube migration, 5 [3.4%] had vomiting and 6 [4%] patients had excess granulation tissue

Conclusion: PEG tube feeding is an efficient, well-tolerated method for medium and long-termenteral feeding with excellent results and minimal overall morbidity

Tracheoesophageal atresia and fistula: a case of mistaken identity?

Tracheoesophageal atresia with or without fistula presents shortly after birth with difficulty in swallowing saliva, history of polyhydramnios and failure to pass a nasogastric tube which coils in the proximal blind ending esophagus. Early thoracotomy and primary anastomosis within a few hours of birth have produced a significant survival result; mortality is associated with coexisting serious cardiac disease, late diagnosis and presentation. The majority of patients have a fistula which could result in significant pulmonary contamination with saliva [or food] if the abnormal connection is not urgently ligated

We report a case of a neonate referred at three days of age where the nasogastric tube [NGT] had not coiled proximally as expected; the tube initially extended vertically to the level of the diaphragm, giving the impression of an intact esophagus. The neonate subsequently underwent primary repair of the atresia with fistula ligation. At five-months post-discharge follow-up, the patient was thriving and well

uncommon diagnosis of Windsock deformity for a common presentation

We report a two-year-old Indonesian female who presented with vomiting and weight loss for more than one month and was ultimately diagnosed with duodenal obstruction due to a windsock deformity. This is a rare and intrinsic congenital anomaly of the duodenum. The diagnosis as well as immediate and conclusive surgical management is discussed

Surgical management of Necrotizing Enterocolitis following Congenital Diaphragmatic Hernia Repair

Necrotizing Enterocolitis [NEC] is a significant cause of in-hospital mortality. The pathogenesis remains unclear, but may be associated with Staphylococcus epidermidis related sepsis, hypertonic feeds or other stress. It is also associated with Abdominal Compartment Syndrome [ACS] as documented after complete closure of gastroschisis. While the incidence of NEC is rare, the associated mortality is significant. We report a case of NEC following the repair of a congenital diaphragmatic hernia [CDH]; an unusual yet serious complication. A literature search revealed only one similar case which resulted in mortality. The possibility of serious postoperative complications following the repair of CDH must be considered in any neonate who exhibits deterioration in their general condition

Is it time for a virtual autopsy service in Bahrain?

Post-mortem examination, or autopsy, is known to have been first performed by the ancient Egyptians to prepare the deceased by embalming and other means for their journey into the after-life. In the second century AD, Galen established the concept of autopsy in Rome, albeit mainly in monkeys; this was the first attempt to correlate the physical findings on post-mortem with the symptoms and signs experienced by the patient before death. Autopsy appears to have then become unfashionable or undesirable until the time of the Renaissance and afterwards. In the mid-sixteenth century, Vesalius practiced autopsy and taught it to his students. In about 1543 or 1544, he published De humani corporis fabrica on the composition of the human body based on his post-mortem studies, which is probably the most important anatomy textbook ever published1. Of interest to intensivists, he was the first to describe artificial ventilation by attaching a pair of bellows to a post-mortem trachea-lung preparation. In the nineteenth century, the study of the body post-mortem became more widespread. Doctors such as Rudolph Virchow [Virchow's node] in Germany described an organized technique of carrying out a post-mortem; and much of the progress in western medicine during that time can be attributed to the postmortem study of Virchow and others. The practice of teaching anatomy using cadavers also became widespread during the nineteenth century. Since then, post-mortem science has progressed greatly. It is now possible to extract a healthy infant from the womb of a pregnant woman immediately after death, and it is even possible to harvest the spermatozoa of a dead man, either by the transrectal electro-ejaculation method or by collecting the contents of the epididymis immediately post-mortem. It is important to remember that the harvesting of entire organs for use in transplantation takes place during post-mortem dissection, either with or without a beating heart. The benefits of performing a post-mortem today include: 1. Discovery of the cause of death when the cause is unexplained. 2. As a quality marker, to assess whether the diagnosis and treatment were correct. 3. To assess the effect of treatment given. 4. To look for genetic conditions and give genetic counselling as a result. 5. Teaching medical students and trainee doctors. 6. Forensic purposes. There are particular areas in a hospital where the availability of a post-mortem service is important. Clearly, a patient dying of multiple long-standing illnesses in a hospital medical ward would not usually merit a post-mortem, but a patient dying of a sudden unexplained illness in an emergency department or an adult Intensive Care Unit would need post-mortem investigation to determine the cause of death and to rule out foul play. In addition, neonates and older children dying of unexplained conditions need to have their cause of death investigated to satisfy the parents' unanswered questions and to establish the presence or otherwise an inherited cause of death. It has been a source of considerable frustration to the first author that no post-mortem study has been possible in patients where the cause of death has not been fully explained. Different religions have different views on post-mortem study. No religion encourages it. Christianity tolerates it as a necessary aspect of science. However, Muslims, Hindus and Jews have similar views; all three religions object to post-mortem dissection on three grounds: first, the body should be moved as little as possible, second, the integrity of the body as a whole must not be compromised, and third, post-mortem delays burial [or cremation in the case of Hindus] as burial should take place quickly, preferably on the same day. It is probably reasonable to assume that all religions in olden times viewed corpses as a potent source of infection, and were anxious for burial or cremation to take place as soon as possible after death