Outcome of Tenckhoff catheter in children with end stage renal disease

Continuous ambulatory peritoneal dialysis by using Tenckhoff catheter for the treatment of children with end stage renal disease has become firmly established during the last 3 decades as a widely used safe technique. To highlight the technique that may improve the outcome of Tenckhoff catheter for peritoneal dialysis in children. Over the last 2 years, thirty children presented to Saudi hospital in Yemen republic, suffering from end stage renal disease had been subjected to insertion of pediatric Tenckhoff catheter, through midline infra-umbilical incision. Peritonitis had been recorded in 4 patients [13.33%], 3 patients [10%] experienced exit site infection, 3 patients [10%] had outflow obstruction of the catheter, dialysate fluid leakage occurred in 2 patients [6.6%], inguinal hernia was detected in 1 patient [3.3%], and 1 patient [3.3%] died [non-catheter related death]. Routine subtotal omentectomy is better to be done to decrease the outflow obstruction and double cuff catheter is more durable than single cuff catheter with lesser incidence of fewer complications

Conservative management of penetrating abdominal injuries

Non-operative management of penetrating abdominal trauma is not widely practiced modality of management in third world countries. Some retrospective studies showed that major surgical intervention was needed during operation in considerable percentage of patients and routine exploration laparotomy led to unacceptable negative explorations. The aim of this prospective study was evaluation of non-operative management in selected group of patients presented with gunshot and stab abdominal injuries. The study included 192 admitted cases, classified into two groups: group A, 135 cases presented with abdominal gunshot injuries and group B, 57 cases presented with abdominal stab injuries. Both groups had no clear indication for laparotomy on admission. All patients received resuscitative measures, with repeated physical examination by the same senior surgeon and ultrasonography to detect any developing indication for laparotomy. Conservative management was abandoned in 27 patients [conversion rate 14%] and they were explored. The remaining 165 cases got benefit from conservative treatment [86%] and had satisfactory outcome without missed injuries. Mortality in gunshot group, included; four deaths in non-operated group and one postoperative death in an explored patient. While in the stab wounds group, included; two deaths in the non-operative group and three postoperative deaths in the explored patients. This form of management has a role in properly selected cases of penetrating abdominal trauma guided by strict protocol, monitoring of patient in surgical intensive care and preparedness to undertake an operation immediately when required. Conversion rate in our study is 14% and expected to be less in the next few years if we continue application of the same protocol

Predictive value of leucocyte count, c-reactive protein, ultrasonography and laparoscopy in the diagnosis of acute appendicitis in children

In a prospective study, the mean preoperative leucocyte count, C- reactive protein [CRP] value, ultrasonographic outer appendiceal diameter and diagnostic laparoscopy [when needed] in 120 children suspected of having acute appendicitis were studied. The patients were divided into three groups. Diagnostic laparoscopy allowed the correction of the preoperative suspected diagnosis of acute appendicitis in seven patients in group I, thus preventing an unnecessary appendectomy. The study also revealed a significant increase in the leucocytic count and appendiceal diameter in groups II and III compared with group I. Moreover, there was a significant increase in CRP in group III compared with groups I and II

Randomized clinical trial of local ropivocaine perfusion versus bupivacaine for pain relief after laparotomy in children

Opioids are often used to decrease pain following laparotomy but are associated with unwanted side-effects. The effectiveness of local perfusion of bupivacaine 0.5 percent versus ropivacaine 0.5 percent following laparotomy was studied. A prospective randomized study involving patients undergoing laparotomy using midline incision was undertaken. Patients were randomized to receive continuous wound perfusion of either bupivacine 0.5 percent or ropivacaine 0.5 percent. Forty patients were recruited, 20 in each group, patient age, height, weight, surgical procedure duration, and complications were comparable in the two groups. The wound lengths were similar [median 14 cm in both groups]. There was statistically significant difference in the postoperative pain scores at rest and with movement between the two groups. One patient in bupivacaine group developed CNS toxicity and two patients in the same group developed transient hypotension and one patient developed transient hypotension in ropivacaine group. Three patients in bupivacaine group experienced repeated vomiting and one patient in ropivacaine group experienced vomiting. Mild wound redness occurred in one patient in each group and staphylococcus epidermidis was cultured from the catheter tip in 3 patients of each group. Direct continuous local wound perfusion of bipivacaine 0.5 percent and ropivacaine 0.5 percent is effective for postoperative pain relief after laparotomy in children. Ropivacaine because of lower cardiovascular and central nervous system toxicity in comparison to bupivacaine is better to be used in children safely

efficacy of martin's procedure in total colonic aganglionosis with short small intestinal involvement

The objective of this study was to discuss the efficacy of Martin's procedure in total colonic aganglionosis [TCA]. Eleven patients had TCA with variable small intestinal involvement have been subjected to Martine's procedure. Three mortalities occurred, two deaths happened prior to Martin's procedure, four patients got repeated attacks of enterocolitis, one patient got diarrhea, one patient got fecal soiling and one patient got constipation. The results have shown that the length of the affected small intestine bears a direct relation to the success of therapy; the longer the affected segment, the higher the mortality rate and the complication rate and the Martin modification of Duhamel procedure can be successfully performed with an acceptable mortality rate. The high incidence of post-Martin pull-through complications with the studied patients warrants the examination of alternative procedures that have similar long term results

Outcome of temporary hemodialysis permcatheter in children

In this study, 42 intra-atrial permanent catheters were used in 35 children with a mean age of 3.9 years and a mean weight of 11.6 kg. A total of 20 complications were seen. There were ten cases of blood born bacteremia, three cases of exit site infections, three cases of poor blood flow, two cases of cuff extrusion and two cases, each of catheter perforation and cracked Luer-Lok. Seven catheters had to be replaced due to complications, the commonest of which was infection. It has been concluded that intra-atrial permanent catheter provides a safe and reliable temporary vascular access for small children who are unsuitable for conventional vascular access. Infection is the major disadvantage with this type of access

Adolescent varicocele: the role of laparoscopic ligation and colour doppler ultrasonography

The objective of this study was to report the results of laparoscopic varicocelectomy and the role of color Doppler ultrasonography [CDU] in adolescent varicocele. Twenty-two laparoscopic varicocelectomies and CDU were performed for 18 patients. In the postoperative follow up period, symptoms disappeared in 17 patients, three patients had pneumoscrotum, one patient had vaginal hydrocele and one patient had recurrent varicocele. Ultrasonography showed the testicular growth in 15 patients within 12 months of surgery. CDU was an easy, effective and noninvasive modality for the pre and postoperative assessment of these patients

Non-operative treatment for blunt liver trauma in children: a successful, safe, cost effective protocol

In this study, a protocol for managing hepatic trauma in hemodynamically stable children was proposed where specific criteria for pediatric ICU admission were applied and ultrasonography replaced CT scan for following up the process of hepatic healing. The study was carried out on 51 children with blunt hepatic trauma. Initial CT scan was done to 49 patients and identified the hepatic injuries and their grade in all patients. Intraperitoneal fluid was found in 26 of these patients. CT scan at discharge confined the ultrasound findings in 47 discharge patients. Four patients died, one due to grade VI liver injuries and the other three due to severe associated head injuries. Although the pediatric ICU was the standard location for initial nonoperative management of children with blunt hepatic injuries, yet a successful, safe and cost effective treatment could be achieved for properly selected hemodynamically stable patients. Ultrasonography was an effective alternative to CT for following up the healing process of these liver injuries