Management of esophageal atresia and tracheoesophageal fistula - review of 05 years

To analyze the morbidity and mortality in 38 patients with variants of esophageal atresia and trachea-esophageal fistula who were treated between January 2007 and January 2012. This is a retrospective study. Data were collected from hospital records. The study was conducted at the Children Hospital Quetta from January 2007 to January 2012. The records of 38 patients of esophageal atresia and trachea-esophageal fistula were reviewed. The mean birth weight was 2.5 kg and mean gestational age was 38 weeks [range 30 to 38 weeks]. The risk classification was based on Waterston's classification and included 18 case of type[A] 12 cases of type [B] and 8 cases of type [C.] There were associated anomalies in many patients that included, cardiac, skeletal neurological and renal and anorectal defects. There was an anastomotic leak in 8 patients [21.05%], sepsis in 12 [13.5%], pneumothorax was recorded in 3 patients [7.8%].The results of this congenital malformation requiring surgical treatment, is less than optimal in our setup. The likely reasons are late presentation, and less than ideal neonatal services

Esophageal atresia with or without tracheoesophageal fistula: success and failure in 94 cases

The management of newborns with esophageal atresia [EA] with or without tracheoesophageal fistula [TEF] has evolved considerably over the years. Currently an overall survival of 85% to 90% has been reported from developed countries. In developing Countries, several factors contribute to higher mortality rates. We describe our experience with 94 consecutive cases of EA with or without TEF. We retrospectively studied 94 patients with EA with or without TEF treated at our hospital over a period of 15 years. Medical records were reviewed for age at diagnosis, sex, birth weight, associated anomalies, aspiration pneumonia, method of diagnosis, treatment, postoperative complications and outcome. Ninety-four newborns [55 males and 39 females] with EA/TEF were treated at our hospital. Their mean birth weight was 22 kg [700 g to 3800 g]. Age at diagnosis ranged from birth to 7 day. At the time of admission 37 [39.4%] had aspiration pneumonia. Associated anomalies were seen in 46[49%] patients. Thirteen patients had major associated anomalies that contributed to mortality Postoperative complications were similar to those from developed countries but overall operative mortality [30.8%] was high. The overall mortality was high but excluding major congenital malformations, sepsis was the most frequent cause of death. Factors contributing to mortality included prematurity, delay in diagnosis with an increased incidence of aspiration pneumonia and a shortage of qualified nurses. To improve overall outcome, factors contributing to sepsis should be evaluated and efforts should be made to overcome them

Lung function abdominalities follwing repaired esophageal atresia and tracheoesophageal fistula

Esophageal atresia and tracheo-esophageal fistula [EA/TEF] is common in the neonatal period and survival depends on the severity of the associated anomalies, prematurity and pre-morbid factors. This study represents the experience of a tertiary care center in Saudi Arabia of pulmonary function test abnormalities [PFT] after repair of [EA/TEF] including long-term effect on the lungs. A retrospective review of all patients referred to pulmonary clinic with EA/TEF and or Pre-operative evaluations from the period 1993-2004. A total of 41 patients. Twenty-six [63%] males and 15 [37%] females. EA/TEF was diagnosed at birth in 34 [83%]. EA and distal TEF were found in 37 [90%] of the patients. Congenital anomalies were associated in 28 [68%]. More than 1/3 of the patients had postoperative complications including pneumothorax, recurrent TEF, leakage at operation site and empyema. More than two-third of the patients required prolonged ventilation. Pulmonary complications developed in > 70% of the patients including persistent atelectasis, chronic aspiration pneumonia, tracheomalacia in 12 [29%] and bronchiectasis in 7 [17%]. Eighty-eight percent of patients who were able to do PFT showed abnormal values of moderate obstructive and restrictive lung disease. [EA/TEF] form significant PFT abnormalities and cause significant morbidities that may last for a long period of time

Oesophageal atresia and tracheosophageal fistula

Forty-six neonates with esophageal atresia and tracheoesophageal fistula were admitted in Mayo Hospital Lahore over a three and half years period from Jane 1995 to December 1998. Of these 76.08 percent were male. Delayed referral of 24 hours or more was noted in 78.20 percent. Among the neonates admitted 88 percent had moderate to severe chest infection and 70 percent weighed three or more than three kilograms. Associated congenital anomalies were noted in 41.3 percent, of which high imperforate anus accounted for more than 50 percent. Ligation of fistula and primary oesophageal end to end anastormosis was performed in 28 patients and in 4 neonates oesophagostomy and gastrostomy were performed. Survival rate of category A was 80 percent and overall survival was 40.63 percent

Accidente paralítico posvacunal (rabia) (APPV): informe de un caso / Neuroparalytic accident following immunization with antirabies vaccine: a report case

Introducción: los accidentes neuroparalíticos secundarios a la vacunación contra la rabia, se observan a menudo en los países en vías de desarrollo. Objetivo: presentar un caso poco común de polineuropatía debido a la administración de la vacuna antirrábica de cerebro de embrión de ratón (CER). Reporte del caso: una mujer de 48 años de edad fue mordida por un perro desconocido y recibió 14 dosis de vacuna antirrábica (CER). Trece días después desarrolló polineuropatía e insuficiencia ventilatoria. Se le asistió con ventilación mecánicas y pocas semanas después se le practicó una traqueostomía. El día 156 de estancia en la UCI falleció por mediastinitis (secundaria a fístula traqueo-esofágica). En octubre de 1995 la Secretaría de Salud de México anunció que se suspendío la producción de la vacuna antirrábica preparada con cerebro de embrión de ratón, y que la misma dejaría de utilizarse. Por lo tanto, éste podría ser el último caso de complicaciones neurológicas debido a este tipo de vacuna en México

Cirugía neonatal: experiencia de 10 años / Neonatal surgery: 10 years experience

Se presentan 504 recién nacidos, operados dentro de los primeros 28 días de vida, en el Departamento de Cirugía Pediátrica del Hospital "San Bartolomé", por ser portadores de alguna anomalía congénita quirúrgica, desde Enero de 1982 hasta Diciembre de 1991 (10 años). Evaluamos la incidencia, anomalías asociadas, procedimientos quirúrgicos y mortalidad de todas las malformaciones congénitas quirúrgicas operadas comparándolas con otras series. La patología más frecuente fue la malformación anorectal con 182 casos (33,33 por ciento); seguida de las atresias y estenosis intestinales, 138 casos (25,27 por ciento) y la atresia de esófago con FTE distal, 70 casos (12,82 por ciento). Entre estos tres diagnósticos se reúne al 71,42 por ciento de toda la casuística revisada. De los 504 recién nacidos operados sobrevivió el 56 por ciento (282); falleció el 39 por ciento (196) y en 5 por ciento (26) no fue posible obtener este dato. Resaltamos el hecho de que la mortalidad es absoluta. No discriminamos a los neonatosexpresando nuestra mortalidad global en forma no selectiva