Pneumatic reduction of intussusception: factors affecting outcome in Thailand.

Background: Pneumatic reduction has become a therapeutic method for intussusception instead of surgery. It is more successful than barium reduction, but it depends on how much the operator is familiar with the method and equipment. Objective: Determine success rate and recurrent rate of intussusception and factors affecting outcome of pneumatic reduction in Thailand. Materials and methods: Fifty-eight children with 73 numbers of intussusception who underwent pneumatic reduction at Songklanagarind Hospital, Thailand between January 2002 and March 2007 were retrospectively reviewed. Age, sex, clinical parameters, physical examination, imaging findings, and reduction technique were evaluated. Results: Overall success rate was 54 out of the 73 episodes and recurrent rate was 10 out of 58 patients with intussusception. Long duration of symptom, rectal bleeding, dehydration, and leukocytosis significantly affected poor outcome. Radiographic findings of gut obstruction and ascites as well as sonographic findings of thickened colonic wall, trapped fluid between intussusceptum and intussuscipien, and small bowel obstruction could also predict the poor outcome. Conclusion: Many factors from clinical presentation, plain radiographic, and sonographic findings affect poor outcome of pneumatic reduction. However, it can be performed unless peritonitis and sepsis/shock are present.

Primary pigmented nodular adrenocortical disease with synaptophysin immunoreactivity in two thai children.

This paper reports the cases of two Thai children diagnosed with primary pigmented nodular adrenocortical disease (PPNAD). The first was a thirteen and a half year old male who presented with Cushing syndrome for three years and severe osteoporosis. He had hypercortisolemia, a non-suppressible dexamethasone suppression test, and low serum ACTH. A CT scan showed slight enlargement of both adrenal glands. A bilateral adrenalectomy was performed. The second case was a thirteen-year old female who presented with mild Cushing syndrome for one year with paradoxical response to high-dose dexamethasone suppression test. An MRI revealed suspected microadenoma of the left adrenal gland. Blood sampling showed a higher cortisol level from the left adrenal vein than from the right. A left adrenalectomy was performed, followed by a right adrenalectomy four months later. The pathologies were compatible with PPNAD. Immunostaining for synaptophysin was done in both patients. The cells in the adrenocortical micronodules of both cases were stained intensely with antiserum for synaptophysin, whereas the surrounding adrenal cortex did not.