Household teaspoon and oral liquid medication: the present scenario

To determine the parental dosing errors in administering oral liquid medication to pediatric population. Cross sectional study. Department of Pediatric Surgery Civil Hospital and Pediatric Medicine Lyari General Hospital Karachi, from February 2009 to September 2009. Parents of children admitted were enrolled in the study. They were asked to measure one teaspoonful [5 ml] of paracetamol syrup from the tray containing household spoons of different sizes. The amount filled by the parents was measured by 5 ml syringe. Accurate dose was defined as 5.0 ml while an acceptable dose was 5.0 +/- 0.5 ml [4.5 ml - 5.5 ml] according to National Formulary and USP Standards of a + or - of 10% of error dosage range for oral devices. A total of 530 parents participated in the study. The age of the participants ranged from 16 year to 55 year [mean= 28.93 +/- 6.6 year]. Only 118 [22.3%] participants measured accurate dose while 164 [30.9%] measured the acceptable dose and 366 [69.1%] participants measured inaccurate dose. Accuracy in measuring household teaspoon quantity was not associated wirh parents' age [p >.05], education [p >.05], cooking experience [p >.05] and previous drug administering experience [p>.05]. Household teaspoons were unreliable when measuring and administering liquid medication to pediatric population. Oral syringe is recommended as the best device for both measuring and delivering liquid medication

Spontaneous per urethral expulsion of gossipibyoma - a rarity

Foreign bodies left accidentally during a surgical procedure are rare. In spite of careful intra-operative precautions and gauze counts mistake still occurs. Many of these cases present with sepsis, the foreign body may erode hollow viscera with and without signs of peritonitis and discovered on laparatomy. These foreign bodies may remain silent for years. We are reporting an interesting case of an 11 years old girl who presents with gauze piece coming out of her urethra 4 years after cystolithotomy and right ureterolithotomy. Such cases of intraluminal migration and spontaneous expulsion of foreign body are rarely reported

Knotting of urethral catheters: a preventable complication

A number of complications are associated with Urethral catheterization. Feeding tube is usually used for this purpose in children. Spontaneous intravesical knotting of such urethral catheters is a known but rare complication. We are reporting two cases of intravesical knotting of feeding tube used to drain bladder in patients who underwent urethroplasty

Congenital segmental dilatation of sigmoid colon, penile agenesis and umblical cord hernia: a new association

Congenital segmental dilatation of the colon, penile agenesis and umbilical cord hernia are individually rare congenital malformations. An association between all three malformations has not been previously reported. We report a neonate with congenital segmental dilatation of the colon, penile agenesis and umbilical cord hernia all coexistent in a new born

Preliminary results of laparoscopic assisted orchidopexy for intra-abdominal testis

To analyze the outcome Laparoscopic assisted Orchidopexy for Intra-abdominal Testis. A prospective, descriptive study from July 1997 to January 2007. The study was conducted in the Departments of Pediatric Surgery at Dow Medical College / Civil Hospital Karachi and National Institute of Child Health, besides some private hospitals of Karachi. All patients with impalpable testis. Patients with intra-abdominal testis were subjected to Laparoscopic assisted single stage or 2-stage Fowler-Stephens orchidopexy. All patients were reviewed two and six months after the procedure to assess the outcome of surgery. A total of 28 patients with 35 impalpable testes were seen during the study period. Of these 13 had impalpable testes on the right and eight on the left side, whereas seven were bilateral. Laparoscopic examination revealed 29 intra-abdominal testes. Amongst these, Laparoscopic assisted Single stage Orchidopexy was performed in four testes and the first stage of Fowler-Stephen Orchidopexy in 29 testes. Second stage of the Fowler-Stephens Orchidopexy was completed in 18 testes successfully, as we did not encounter testicular atrophy in any case so far. Postoperative complications were seen in two patients. One case developed port site haematoma which was drained and the other subcutaneous emphysema which was managed conservatively. Laparoscopic assisted single and 2-stage orchidopexy is a safe and successful treatment procedure for intra-abdominal testes

To determine the efficacy and safety of caudal bupivacaine in combination with rectal diclofenac for postoperative analgesia in paediatric patients

To assess the efficacy and safety of combination of caudal bupivacaine anesthesia and diclofenac sodium suppository for postoperative analgesia in pediatric patients. Interventional study. Imam Clinic [a private hospital] North Nazimabad Karachi. from May 2004 to March 2007. All pediatric patient ASA physical one and two between the ages 6 months to 12years of either sex undergoing infra umbilical surgery received caudal block with bupivacaine 0.25% in a dose of 0.5ml/Kg and diclofenac sodium suppository 1mg/Kg rectally. Patients in whom caudal analgesia was contra indicated or failed were excluded from the study. Postoperative pain was assessed using observers' pain scale and self report of pain by child when he was greater than 2 years age. Postoperative complications were also recorded. During the study period, 99 patients undergoing different infra umbilical procedures [hernia, hypospadias repair, PPV ligation, circumcision, orchidopexy etc] received combination of caudal bupivacaine analgesia and rectally administered diclofenac sodium for post- operative analgesia. There were 94 male patients. In all patients caudal block remained successful. All patients were pain free and none of them required additional/rescue analgesia. Postoperative nausea and vomiting were reported in 3 patients. No other side effects like retention of urine, respiratory depression etc was observed postoperatively. Combination of single shot caudal block with bupivacine 0.25% in a dose of 0.5 ml/Kg and rectal diclofenac sodium for postoperative analgesia in pediatric patient is a simple, safe and effective procedure

Laparoscopic surgery in children

To assess the efficacy and safety of various laparoscopic procedures in paediatric population. An analytical case series. Various public and private sectors hospitals of Karachi, from January 2001 to December 2006. Case records of all paediatric patients who underwent laparoscopy for diagnostic or therapeutic purposes were reviewed. Age, sex, investigations, preoperative diagnosis, per operative diagnosis, procedure, duration of operation, hospital stay and intra-operative and post-operative complications where recorded. Patients with impalpable testes were excluded from the study as they are reported in another study. During the study period, 19 paediatric patients underwent laparoscopy for different surgical conditions. Age ranged from 5 to 12 years. Eight patients were males and 11 females. Six patients underwent cholecystectomy for cholelithiasis. Investigations did not reveal any cause for cholelithiasis. Appendicectomy was performed in 7 cases. Two of them had interval appendicectomy, while five were operated for acute appendicitis. Out of 5, three had acute appendicitis while two had mesenteric lymphadenitis. Adhesiolysis was performed in five patients. Adhesions in four of them were due to tuberculosis, band, recurrent appendicitis and post-operative adhesions, while in fifth patient no cause could be ascertained. One patient underwent left varicocelecotmy. None of the patients required conversion to open surgery. There was no intra-operative complication while post-operative complications were minimal. We conclude that laparoscopic surgery is feasible, effective and safe in the management of a wide range of surgical conditions in children

Modification of mathieu procedure to repair anterior hypospadias

To assess the results of one-stage repair of anterior hypospadias using modified Mathieu procedure. An interventional study. Department of Paediatric Surgery, Dow Medical College and Civil Hospital Karachi, from September 1997 to December 2003. Patients and All the patients with anterior hypospadias without or with minimal chordee were included. Patients with hypoplastic urethra or re-do surgery were excluded. Modified Mathieu repair was performed in all cases. The modifications used were interrupted inverting sutures of 5/0 polyglycolic acid for urethroplasty; neourethra covering with subcutaneous [dartos] pedicle flap, developed from the preputial or penile shaft skin and dorsal / anterior meatotomy for meatal stenosis. A total of 69 patients with anterior hypospadias were operated using modified Mathieu's repair. Only two patients [2.89%] developed urethrocutaneous fistula. Five patients developed partial devitalisation of the covering skin while one patient had complete breakdown. Modified Mathieu's procedure is an effective method, to repair the anterior hypospadias without or with minimal chordee

Abdominal masses in children: a diagnostic challenge

We report a 6 year old female child who presented with mass in right upper quadrant of abdomen. She was intensively investigated and with the suspicion of hydatid cyst liver received albendazole for many months. As mass increased further laparotomy was planned. At exploration it turned out to be a large retroperitoneal mass and dissected out easily. Biopsy report was that of benign teratoma

role of sclerotherapy in rectal prolapse and it's combination with Thiersch's ligature in refractory cases

This prospective study was conducted in the Department of Paediatric Surgery, Civil Hospital, Karachi on all patients with rectal prolapse who underwent sclerotherapy [ST] alone or in combination with Thiersch ligature from April 1994 to December 2003, to assess the efficacy of sclerotherapy in rectal prolapse [RP] and the role of combination of ST with Thiersch ligature[TL] in refractory cases. Out of the 104 patients that underwent sclerotherapy, 69 were males and 35 females, with an age range between 13 months to 12 years. After one session of sclerotherapy the cure rate was 86% [89 patients] and after second session 91% [95 patients], the remaining nine patients responded to Thiersch ligature with 3rd session of sclerotherapy. Postoperative complications were minimal. It is therefore concluded that sclerotherapy is a cheap, safe and effective method of treatment for paediatric rectal prolapse not responding to conservative treatment

Onlay island flap in the repair of mid and distal penile hpospadias without chordee

A prospective study was conducted on 13 patients with mid and distal penile hypospadias [without chordee] to study the out come of Onlay Island Flap repair in the Department of Paediatric Surgery of Dow Medical College and Civil Hospital Karachi from July 1997 to August 2003. Excellent cosmetic results were obtained in 12 patients. Only one patient developed urethrocutaneous fistula, which was successfully repaired. It is, therefore, concluded that the onlay island flap technique is a very good procedure for midpenile hypospadias without chordee and in patients with distal penile hypospadias with deficient ventral skin

Laparoscopy in the evaluation of impalpable testes

To examine the role of laparoscopy in the evaluation of the non-palpable testes. Design: A descriptive study. Setting: The study was conducted in the Department of Pediatric Surgery, Dow Medical College and Civil Hospital Karachi, some of the private hospitals from July 1997 to July 2003 and Pediatric Surgical unit B, National Institute of Child Health, Karachi, from January 2001 to July 2003. Patients And All the patients with impalpable testes had ultrasound examination and were evaluated laparoscopically. Twenty patients with 25 impalpable testes were seen during the study period. Ultrasound examination was inconclusive in all cases. Laparoscopic examination was helpful in the diagnosis of presence or absence of impalpable testes in all cases. Laparoscopy is a safe reliable and effective method for the evaluation of impalpable testes

Epididymal abnormalities associated with undescended testis

To identify and record the number and type of epididymal abnormalities [EA] associated with undescended testis and its correlation with the location of the testis. Design: Descriptive study. Place and Duration: Department of Pediatric Surgery, Dow Medical College and Civil Hospital, Karachi Patients And All patients with undescended testis operated in this unit from September. 1997 to October 2003 were included. Clinical data and surgical findings were recorded. A new method of classification for the anomalies was employed to make comparison between various studies easy and meaningful. A total of 107 testes in 97 patients were operated. Epididymal anomalies were found with 37 testes. Obstructive anomalies were found with 19 testes and non obstructive anomalies were found with 18 testes. Obstructive anomalies were more frequent with the testes located high up in the inguinal canal or intra-abdominally. Undescended testes that are non-palpable and located high up are more likely to have associated epididymal anomalies causing obstruction to the sperm conducting pathway

Trichobezoar and gastric polyps: a rare association

A 10 year old female child presented with upper abdominal pain and huge abdominal mass in epigastrium extending to both hypochondria and umbilical regions. Investigations revealed a trichobezoar with gastric polyps. At operation, a large trichobezoar occupying almost whole of the stomach was removed along with gastric polyps. Biopsy suggested hyperplastic polyps