Ureteropelvic junction obstruction: an objective approach to diagnosis and treatment

Favorable outcome of the management of ure-teropelvic junction [UPJ] obstruction depends upon early recognition of the disease and the proper selection of patients for operative or non operative treatment. Over the last 4 years, eighteen patients with confirmed or suspicious diagnosis of UPJ obstruction were referred for management at the pediatric Surgical Units in Ain Shams University, Cairo and the Arabian Oil Hospital Saudi Arabia. The first group [Group A] included twelve neonates with confirmed antenatal diagnosis of UPJ obstruction in 8 and suspected in 4, while the second group [Group B] included six children [aged 4 months to 6 years], 5 of whom were referred for evaluation of their urinary act infection and the sixth had pelvicalyceal dilatation on US done for his blunt abdominal trauma. According to the results of confirmatory US and diuretic renogram, obstructed kidneys were found in 15 patients, for whom Anderson-Hynes dismembered pyeloplasty was performed. The other 3 patients showed equivocal results, and were managed conservatively. All patients were followed up for 6 months to 4 years. Following surgery, neonates had better improvement of their renal functions than children. Conservative treatment yielded good results in 2 patients, while the third [a neonate] had pyeloplasty 6 months later.Our data emphasize the importance of antenatal diagnosis of UPJ obstruction to initiate prompt postnatal diagnosis of UPJ obstruction to initiate prompt postnatal work up and the significance of diagnosing the obstruction objectively, so as to select the patients for operative or non operative treatment

Cholelithiasis in infancy and child hood: spectrum and current management

The advances of imaging studies have led to the recognition of cholelithiasis in infancy ad childhood with increasing frequency. This study includes twenty eight children with cholelithiasis managed at the surgical departments of Ains Shams University Hospital, cairo and Arabian Oil Company Hospital, Saudi Arabia over the past 4 years. Their ages ranged from 1 to 12 years. Twelve children suffered from predisposing disorders: eight had gall stones in association with hearditary spherocytosis and underwent cholecystetomy during the course of splenectomy while four premature babies were treated with total parenteral nutrition [TPN] prior to the diagnosis of cholelithiasis and showed spontaneous stone resolution within 1 year. sixteen children had idiopathic gall stones: twelve of them underwent open cholecystectomy [in addition to cystogastrostomy for pancreatic pseudocyst in one of them], while four had laparoscopic cholecystectomy [LC]. Follow up period ranged from 3 months to 4 years. We highlight the importance of nonoperative treatment of childhood cholelithiasis in elected patients aiming at spontaneous stone resolution and the advantages of applying laparoscopic cholecystectomy [LC] in children

Neonatal intestinal obstruction: antenatal diagnosis and postnatal management

The increased use of ultrasonography in the evaluation of pregnancy has provided a unique opportunity to diagnose fetal abnormalities in utero. This study includes 24 neonates referred over the past 3 years for management of their antenatally diagnosed intestinal obstruction. The postnatal work up included immediate resuscitation, confirmation of the diagnosis and timely intervention. One infant died soon after birth due to associated malformations. In the remaining 23 patients, surgical interventions yielded favorable results. The value of antenatal diagnosis of intestinal obstruction is emphasized for alerting the obstetrician, the pediatrician and the pediatric surgeon to avoid delayed diagnosis and management and decreasing the neonatal morbidity and mortality rates