Epidemiologic and clinical specifications of patients with Hirschsprung's disease in Khouzestan Province Iran

To find out epidemiological and clinical profile of patients with Hirschsprung's disease. Descriptive study. In pediatric surgery department of Imam Khomaini and Abouzar hospitals Ahwaz Khouzestan Iran, from 1994 to 2004. We checked all the files of admitted patients with Hirschsprung's disease during the study period for personal qualification, clinical examination findings and the involved portion of intestine. The data was analyzed using software SPSS 11.5. There were 71 boys [63.2%] and 41 girls[36.6%].Sixty one patients [57.1%] presented with meconium impaction, vomiting and abdominal distension. Constipation and chronic abdominal distension were the chief complaints in 37 patients [33%].The most common form of involvement was in rectosigmoid region which was seen in 81 patients [72.3%]. Herein we observed just one[0.9%] patient with Down syndrome. In this study the ratio of males to females was 2:1. In our study 61.6% patients were diagnosed in neonatal period

Evaluation of lab tests and correlation with hospital stay, transfusion and ICU care in paediatric trauma patients

The aim of this study was evaluation of lab tests and their correlation with hospital stay, transfusion and ICU care in pediatric trauma patients. Analytical study. Department of pediatric surgery at Imam Khomeini Hospital, Ahwaz, Iran from 2002 to 2006. All pediatric trauma patients, under 15 years of age admitted to the department during the study period were included. Their file record was put on a specially designed proforma noting age, gender, lab tests like complete blood count, serum electrolytes, urea, blood sugar, urine analysis etc. The data collected was analyzed by X[2] test via SPSS. A total of 86 patients were admitted during the study period. Among these 53 were boys. Abnormal tests were white blood cell / hemoglobin [68.6%, 23%] Na[+]/ K[+]/BS [7%, 15.1%, 60.5] and U/A 31.4%. Most of patients did not require blood transfusion, ICU care and surgery. The results for lab tests in trauma were similar to the results of studies in other countries. Leucocytes and hyperglycemia are important findings. Other laboratory results like anemia, hematuria and change of Na[+] and K[+] levels are of little value in the management of injured children

Effect of oral glucose and the response to pain in the term neonate

If neonates are exposed to severe pain or long duration pain stimulus, it may increase morbidity. Infants who experienced pain during neonatal period, will response intermittently to pain during next painful events. In the newborn and young infants who have undergone painful minor surgery, oral sucrose will provide safe way to analgesia. The aim of this study was to evaluate effect of oral glucose on the reduction of pain in neonates. All of the neonates aged 2-10 days and weighted>2500gm who were admitted for phototherapy and bilirubin and were not in the range of exchange, were included in this study. This study was carried out in department of neonatology of Abuzar Children Hospital and Imam Khomeini hospital. One hundred eight neonates were included. Each neonate was fed through a syringe every 30 minutes with 2ml of distilled water, D/W10%, D/W20%, D/W50% on the anterior portion of the tongue. Immediately, a lancet was injected into the heel of neonate and changes in the face and crying was recorded for three minutes after injection. Wong criteria was used for assessment of changes in the face and crying. The type of this study was Quasi-experimental and Fischer-exact test was used for data analysis. From 108 neonates who were fed with distilled water, D/W 10%, D/W20% and D/W50%; 1[0.9%], 41[28%],101[93.5%], and 106[98.1%] showed decreased pain sensation respectively. The results of this study revealed that oral glucose is the safe analgesic agent and is recommended for use in the neonatology ward before painful procedure

Association of urinary tract abnormalities in children with first urinary tract infection

Urinary Tract Infections [UTI] may be a variety of presentation of underlying urinary tract abnormalities including vesicoureteral reflex [VUR], obstructive uropathy, urolithiasis, and ureteral duplication. The long-term complications of UTI with these conditions are renal scarring, hypertension, and chronic renal failure. The aim of this study was to determine the incidence of urinary tract anomalies associated with first UTI. We reviewed 158 patients [aged one month to 15 years] who were hospitalized with symptomatic UTI during a 2-year period [2001-2003]. Patients with incomplete investigations were excluded from the study. One hundred twenty six patients [100 girls and 26 boys] were included in the study. Ninety-seven [77%] were under 5 years. Confirmed cases of UTI underwent renal and urinary tract ultrasonography [US], voiding cystourethrography [VCUG],and 99mTc-dimercaptosuccinc acid [DMSA] scan. The most common presentation were fever [83%] and dysuria [48%]. The commonest causative agent was E coli [88%]. VUR was found in 50 [39.6%], 39 girls, and 11 boys. Other urinary tract abnormalities were renal stone in 10 [8%] patients, pelvic ureteric junction obstruction in 8 [6.3%], neurogenic bladder in two boys and one girl, double collecting system in 2 girls, posterior urethral valves in two boys and ureterocele in one girl, respectively. Forty percent of patients had VUR and 20% had other associated abnormalities in urinary tract. We recommend that US, VCUG and DMSA scan should be routinely performed on all patients after the first UTI

study of esophageal strictures after surgical repair of esophageal atresia

The aim of this study was to find out the prevalence of esophageal stricture [ES] following surgical repair of esophageal atresia. This retrospective study was carried out in two referral hospital [Bahrami and Children Medical Centre] from April 1999 till March 2000. Data was collected from patient's file and follow up clinics. Seventy four patients with esophageal atresia were operated during this period. Twenty one patients who died and two patients with long gap esophageal atresia were excluded from the study. Hence fifty one patients were included in this study. End to end anastomosis was done in 45 and end to side anastomosis in 6 patients. Forty five patients had extrapleural thoracotomy while 6 patients had intrapleural thoracotomy. Single layer and double layer anastomosis were done in 36 and 25 patients respectively. Vicryl was used for repair in 47 babies and silk in 4 patients. Standard post operative care was provided to all patients. Of 51 patients who survived 28 [54.8%] were male 23 [45.2%] female. Anastomotic leak was seen in 10 [19.6%] babies. 26 patients [M=16, F=10] developed ES. 22 [43.1%] patients had radiologically proven gastro-esophageal reflux. Incidence of stricture formation was significantly higher in babies who developed anastomosis leak after repair [p<0.05]. GER and leakage from the anastomosis site were significantly higher in the group A. The risk of stricture formation is a potential threat for up to a year in patients without G.E.R and up to 18 months in patients with GE Reflux. Leakage of anastomosis and GE Reflux play a major role in post operative strictures after esophageal atresia repair so treatment and prevention of these complications are very important

Diagnostic value of quantitative CRP measurement in patients with acute appendicitis

Acute appendicitis is one of the most common surgical emergencies. Main stay of diagnosis of acute appendicitis is accurate history, clinical evaluation and physical examination. It is further reinforced by laboratory investigation like raised leukocytes count. To avoid unnecessary removal of normal appendices more laboratory tests like C-Reactive Proteins [CRP] have been evolved. This is a prospective and cognitive study from January to June 2004 of all those patients who had appendectomies at the Golestan and Imam Khomeini Hospital of Medical University, Jundi-Shapour, Ahwaz. Out of a total of 98 patients, on histological examination 88 [89.7%] had acute appendicitis whereas 15 [10.3%] were normal with no sign of inflammation. Range of CRP varied between 3.8 to 19.5 mg/1 [mean 6.34 mg/1], in patients with normal appendix and between 3.8 to 468.5 mg/1 [mean 49 mg/1], in patients with simple appendicitis and 30.1-408 mg/1 mean [113/2] in patients with complicated appendicitis. Normal CRP range of CRP was noted in 9 patients with acute appendicitis, and in 8 cases with normal appendectomy. Positive predictive value of CRP was 97.5%, specificity 89.7% sensitivity 80% and accuracy 88.7% Raised value of CRP was directly related to the severity of inflammation [p-value<0.05]. Taken in conjunction with leukocyte count the diagnostic accuracy became more reliable. CRP monitoring enhances the diagnostic accuracy of acute appendicitis thus unnecessary removal of normal appendices may be reduced to about half

Factors responsible for fistula failure in hemodialysis patients

There are multiple factors in failure of Arterio Venous Fistula [AVF] in patients with Chronic Renal Failure [CRF] that require periodic hemodialysis. Out of technical errors, hypotension, site of insertion, size of vessels, diabetes and atherosclerosis are the common causes of failure in AVFs. In this study failure of 100 AVFs in 70 patients was evaluated during four years. Seventy five cases of CRF patients who were referred for AVF during January 1996 to December 2000 [1375-1379] were selected and operated upon AVF by a given surgeon with the same technique [end-to-side] and followed for two years regularly, In addition to underlying disease such as diabetes mellitus, atherosclerosis and inappropriate vessels another factors such as hypotension and bleeding of aneurismal vessels were recorded when AVF failed. Five out of 75 patients were excluded from this study because of impossible insertion of AVF due to severe damage and thrombosis of peripheral vessels, One hundred AVFs were inserted in 70 patients, 53 in snuff box of left hand, 26 in distal of left forearm, 17 cases in left arm and 4 ones in snuff box of right hand. Thirty percent failed primarily [before dialysis] commonly due to drop in blood pressure and among the remaining 70%, 47 patients had functional AVF for at least 20 months and 23 of them 7.5 months functioned for then failed monthly due to hypotension during hemodialysis [p=0.006]. Hypotension was the cardinal cause of failure of AVFs in CRF patients. We can reduce failure rate of AVFs by monitoring and controlling the blood pressure during hemodialysis and prevent hypotension by salted regimen intake