Surgical treatment for congenital duodenal obstruction.

Thirty-four congenital duodenal obstructions (19 duodenal atresia, 7 duodenal web, 7 annular pancreas and one duodenal stenosis) were surgically treated in Siriraj Hospital between 1990 and 1999. Eleven per cent of duodenal atresia had no bile-stained vomiting. Duodenal web which received web excision and duodenoplasty in 43 per cent of cases, also presented with bile-stained vomiting. Duodeno-duodenostomy, duodeno-jejunostomy and web excision with duodenoplasty were performed in 29, 2 and 3 patients respectively. Duodeno-duodenostomy and web excision with duodenoplasty had no difference in the feeding capability. There was no statistically significant difference in duration of TPN, ability to be early fed, post-operative onset of full feeding and hospital stay between diamond-shaped (n = 18) and side-to-side (n = 11) duodeno-duodenostomy. Although transanastomotic feeding tube (n = 4) decreased a percentage of TPN requirement and made early feeding possible, the onset of full feeding, duration of TPN and hospital stay were not different from those who had no transanastomotic tube (n = 30).

Necrotizing enterocolitis: a comparison between full-term and pre-term neonates.

A retrospective study comparing 16 full-term and 18 pre-term neonates with NEC operated on at Siriraj Hospital between 1987 and 1999 is presented. Major risk factors leading to NEC in full-term neonates included sepsis, SGA, birth asphyxia, severe jaundice requiring exchange transfusion and chorioamnionitis. Although full-term neonates developed NEC earlier than pre-term neonates (8.56 days vs 12.78 days), the average ages of operation in both groups were the same. There was no difference in CBC and bacteriological culture's results between term and pre-term patients. The decision to conduct operative treatments for full-term neonates with NEC was mostly based on only clinical signs of peritonitis (56.25%) before the pneumoperitoneum developed (31.25%). Ileo-caecal region was the most common site of bowel necrosis in both premature and full-term infants. Although term infants had a better 3-month survival rate than pre-term neonates (75% and 61% respectively), both groups had the same surgical complication rates.

Sacrococcygeal teratoma: 25 year experience.

We retrospectively studied all thirty-five children (M 6, F 29) with sacrococcygeal teratomas admitted to Siriraj Hospital between 1974 and 1999. Although an abdominal delivery is recommended for lesions greater than 5 cm to avoid dystocia, the average diameter of masses which required interventions from dystocia (n = 3) was not different from vaginal delivery (n = 27). All except two first presented with sacral masses recognized at birth. One patient presented with an abdominal mass and the last one was diagnosed after suffering from difficulty in urination. Ninety-seven per cent of cases were completely excised initially (32 sacral, 2 abdomino-sacral approaches), however, six patients required other treatment for recurrent diseases. One mature teratoma recurrence was resected. Two patients who had malignant recurrences following complete benign excisions, died from advanced malignancy. Four presented with malignancy initially. Wound infection, bladder atony and UTI were the most common complications postoperatively. Advanced malignancy was the major cause of death. No patient died directly from the procedure.

Treatment of tetanus in children.

Analysis of 678 cases of tetanus in children for a period of 28 years has been performed with particular stress paid to the conservative, uncomplicated treatment. The combination of diazepam, chlorpromazine, methocarbamol, antitetanus serum, heavy dose of penicillin and intensive nursing care are simple, uncomplicated and give quite a good result. The mortality rate decreased from 30% to 4.4%. Paralysis was cared and there was a need for artificial respiration. This method can be used everywhere with case.