Minimal Access Surgery in Children: A 5 Year Study.

Over a period of 5 years, we analyzed our data on outcome, feasibility, and safety of Minimal Access Surgery (MAS) in 211 children. The outcome was compared objectively with age matched controls with similar diagnosis undergoing open surgery over the same period. There was no significant difference between mortality, morbidity, re-exploration rates and analgesic requirement between MAS and open surgery. There was a significant difference in the length of stay in hospital, in favour of laparoscopic cholecystectomy, appendectomy, nephrectomy, splenectomy, surgery for intra-abdominal testis compared to open surgery but not for children undergoing surgery for appendicular perforation and intestinal pathology. All parents preferred the cosmetic outcome of minimal access surgery.

Nutritional assessment of patients under hemodialysis in nepal medical college teaching hospital.

Malnutrition is very common in hemodialysis patients and is predisposed by many factors. Malnutrition is associated with increased morbidity and mortality. Total of 26 patients (16 males and 10 females) who were under hemodialysis in our center were included in the study. With the help of Malnutrition Score (MS) developed by Kalanter-Zadeh, nutritional status of the patients was assessed. Patients also underwent different anthropometric measurements such as Body Mass Index (BMI), Triceps skin fold thickness (TSF), Mid Arm Circumlference (MAC) and Mid Arm Muscle Circumference (MAMC) and laboratory investigations. Mean age of the study population was 42.58 +/- 16.32 years (range 19 to 74 years). Females were older than males. MS of the study population was 15.82 +/- 3.76 (range 9-24). Female patients were having higher MS than males (16.5 +/- 4.11 vs. 15.06 +/- 3.55). Based on MS, 22 patients (84.6%) had mild to moderate malnutrition, 2 (7.7%) patients were having severe malnutrition and remaining 2 (7.7%) had normal nutrition score. Females were having lower BMI, MAC and MAMC but higher value of TSF. Significant negative correlation was present between MS and weight, BMI, MAC and MAMC. Calculated Urea Reduction Ratio (URR) of study population was 57.27 +/- 10.89. URR was higher in females than in males (61.77 +/- 12.74 vs. 54.45 +/- 8.85). Only 23.0% of the study population had URR of >65.0%. Protein Catabolic Rate (nPCR) in our study was 0.77 +/- 0.28 g/kg/day. Malnutrition is very common in our center which is >90% when MS was considered. In our study it negatively correlated with weight, BMI, MAC and MAMC. Dialysis inadequacy was present in around 75.0% of our study population.

Urinary tract infection: the urological perspective.

Urinary tract infection in babies often presents with non specific symptoms and signs. It must be considered in the differential diagnosis of a febrile sick baby or any baby with failure to thrive. In a significant proportion of babies with recurrent urinary tract infection, urological abnormality is demonstrable. The diagnosis of urinary tract infection is confirmed by the presence of pus cells and growth of microorganism in a fresh urine specimen. The voidoing history and detailed ultrasound examination in the baby including a post void evaluation of the upper and lower urinary tract can lead to the possible diagnosis in the majority. Antibiotic therapy for urinary tract infection should be followed by consideration about the need for urinary drainage at the appropriate level, particularly in cases where resolution is delayed despite antibiotics. There is a role for prophylactic antibiotics after the resolution of acute infection, at least until detailed evaluation several weeks after the acute episode, has excluded any abnormality. Micturating cytourethrogram is usually done under antibiotic cover and better done in centres with facility for fluoroscopic examination. Isotope studies have to be evaluated in the light of inherent limitations. Transient urodynamic abnormality of the urinary bladder in infancy is being increasingly recognized and should be the subject of evaluation in specific circumstances. A multidisciplinary team improves the quality of investigations, subsequent interpretation and long term care of these children. A large majority of urological abnormality in infancy and early childhood can be effectively managed by endocopic procedures. Temporary urinary diversion may be required in a small proportion. Urological reconstruction should be approached with caution, after a detailed analysis of the evolving urological tract in a baby. An aggressive approach to early diagnosis and appropriate treatment of urinary tract infection and any underlying abnormality, has been shown to significantly reduce the incidence of chronic renal failure in long term longitudinal studies in children.

Crohn's disease: disastrous consequences of late diagnosis.

Chronic and recurrent perianal abscess is an uncommon condition in children. Tuberculosis is thought to be the common etiology for such a presentation in India. We report a case of a child with colonic and perianal disease due to Crohn's disease and emphasize the disastrous complication due to delayed diagnosis.

Shah Waardenberg syndrome.

Intermittent or partial small bowel obstruction in a neonate may be a rare presentation of total aganglionosis. The presence of partial albinism and white forelock should alert the clinician to the possibility of associated Hirschsprung disease as a cause of bowel symptoms. Such a rare association has been called Shah Waardenberg syndrome and is being reported.

Delivery systems for pediatric parenteral nutrition.

Delivery systems for parenteral nutrition have to be based on fundamental principles regarding venous access, choice of intravenous line, need for inline filters, infusion rate control and mode of packaging into "all in one" bags/two line/or the older three line system and, above all, the aseptic maintenance of this delivery system. Delivery systems need to be modified as per the available resources and hospital where they are to be used. Central venous access and handling of lines demand a high level of dedication and discipline, ideally left to a dedicated team of nurses and doctors. Staff training is the key factor in developing an efficient delivery system.

Management of anorectal malformation in neonates.

Anorectal malformations are one of the commonest anomalies in the new born. Major advances have been made in the last decade in operative techniques to reconstruct this abnormality. The final outcome in these babies is dependent on careful planning and operative intervention in the neonatal period. The purpose of this paper is to discuss the varied presentations of this anomaly, initial assessment and operative management with reference to our own experience.

Helicobacter pylori infection in patients with perforated duodenal ulcer.

AIM: Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia. PATIENTS AND METHODS: The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori. RESULTS: While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis. CONCLUSION: Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.