Value of fine needle aspiration in diagnosing abdominal and retroperitoneal masses of children

The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retropertioneal massess within a 4 year period [1998-2001] preoperative finer needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases. This study showed that the sensitivity and specificity of fine needle aspiration cytology for the diagnosis of malignancy and benignity [positive or negative for malignancy] is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm's tumor, 77% accurate for lymphoma and 57% for germ cell tumors. There was no complication in any of the cases after fine needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases

Modified duhamel operation using a newly designed crushing clamp

Using a newly-designed crushing clamp, modified Duhamel Operation [MDO] was performed in 15 children aged between 2 to 8 years with Hirschsprung's disease. Post-operative recovery was uneventful in all patients. No clamp-related complication was observed. Complete bed rest was not necessary for more than 3-4 days. The clamp was passed spontaneously 8-11 days after operation. Endoscopy 3-4 weeks later did not reveal any colo-rectal septum in the neo-rectum in any patient. Performing MDO using this instrument is convenient to the patient. More importantly, with equal efficacy, it is more cost-effective as compared to the currently used GIA stapler

Correlation between anorectal manometric findings and clincal outcome in patients operated for hirschsprung's disease

In order to identify a possible correlation between anorectal manometry [ARM] findings and clinical outcome in patients operated for Hirschsprung's disease [HD], ARM was performed on 58 patients 4-9 years after operation. In relation to bowel habits, three different clinical categories were defined. Normal bowel movement was present in 39 [67%] patients [Group I]. Fourteen [24%] patients had frequent soiling and were considered incontinent [Group II]. The remaining five [8.6%] cases had constipation [Group III]. ARM in group I revealed normal tone [10-40 mm Hg] in 21 [53.8%] and increased tone [>40 mm Hg] in the remaining 18 patients. Seven out of 14 [50%] of group II patients had markedly decreased anal tone [<10 mm Hg], while all five patients with constipation had increased tone. The mean anal sphincter tone in group II was significantly lower than that of groups I and III [p < 0.05]. Furthermore, while rectoanal reflex [RAR] was present in about one third of patients in group I, it was absent in patients of group III. This reflex, however, could not be evaluated because of the very low tone in the soiling group. In conclusion, the majority of patients with HD had normal bowel movement after surgery along with normal or increased internal sphincter tone. Although most of these patients showed lack of relaxation, which has no diagnostic value, the presence of RAR may have a predictive value, since it is frequently associated with fecal continence. Moreover, although high tonicity was not correlated with clinical status, markedly decreased anal tone was almost always associated with incontinence. Therefore, to make a proper decision for further management, the clinical status of the patient's bowel habit should be interpreted in the light of ARM findings