Résumé
Surgery and anesthesia can cause a considerable distress with psychological consequences for children. This preoperative anxiety can lead to post operative emergence delirium, maladaptive behavioral changes such as night time crying, enuresis, feeding difficulties, apathy, and withdrawal. The aim of this study is to investigate the effect of nasal midazolam as a routine intervention to reduce pre-operative anxiety and inducing anxiolysis in children undergoing day case procedure. Method: One hundred children were randomly allocated into two groups. The study group [N=50] were premedicated with nasal midazolam 0.2mg/kg and the control group [N=50] who received 0.04ml of normal saline. The children response to nasal administration was noticed and after 15 minutes children were taken to operating room. Anxiety at parental separation and at induction of anesthesia was measured using modified-Yale Preoperative Anxiety Scale. Children who received nasal midazolam had a significantly better parental separation and induction of anesthesia. 88% of children who received nasal midazolam scored below 30-indicating absence of anxiety-on modified-Yale Preoperative Anxiety Scale compared to 32% in the control group. More than half of patients in both groups found nasal route to be unpleasant and stressful. For children undergoing elective brief surgical procedure, nasal midazolam is effective in reducing preoperative anxiety. Nasal midazolam was associated in more than half of patients with nasal irritation and crying, a route can not be recommended in children
Résumé
Cryptorchidism is encountered in 21% of preterm infants, 2-4% of all full term boys and 1% of one year old boys. To present our experience in the utilization of diagnostic laparoscopy for the management of children with impalpable testes. This is a retrospective study conducted between March 2010 and December 2011. The medical records of boys with impalpable testis were reviewed. Diagnostic laparoscopic findings regarding presence, morphological state, and location of testis were analyzed. Special attention to how initial laparoscopy influenced subsequent surgical procedures and management. Fifty four boys underwent laparoscopy with 76 impalpable testes. Forty testes were unilateral impalpable testes, two third of them were left sided. Thirty seven testes were intraabdominal, eight of them were atrophied and excised laparoscopically. Twenty nine of them were viable, 90% of them underwent first stage Fowler-Stephens procedure, while the rest underwent primary laparoscopic orchidopexy. Vas and spermatic vessels were seen entering inguinal canal in 25 testes. This group had immediate inguinal exploration, 22 of testes underwent orchidopexy and three orchidectomy. Fourteen boys found to blind end vas and vessels with no further treatment needed. Laparoscopic exploration should be performed because it accurately identifies and localizes the missing testis. In addition, it facilitates the planning of definitive surgical management of orchidopexy, staged orchidopexy or orchidectomy. So we recommend that initial laparoscopic exploration should be performed for patient with impalpable testis
Résumé
during recent years different procedures have been used to assist in the diagnosis of questionable cases of acute appendicitis. Among these methods, there are few scoring systems. The aim of this study is to evaluate Alvarado scoring system feasibility, value and accuracy as an aid in surgical decision making in cases of possible appendicitis. a prospective study involving 106 adults and 20 pediatric patients who were referred from emergency department to our surgical unit at princess haya hospital in Aqaba, Jordan with provisional diagnosis of acute appendicitis during the period August, 2001 and January, 2002. scores were determined based on the system described by alvarado. After initial evaluation, the patient either had surgery or observed in the ward. The diagnosis of appendicitis was confirmed histologically in resected specimen. the overall accuracy of Alvarado scoring system for diagnosis of appendicitis in adult male, adult female and children was 93%, 78% and 60% respectively. All patients who had an alvarado score of 9 or higher had appendicitis irrespective of age or gender. For adult male patients who scored 6 to 8, had a probability of having appendicitis equal to 93%. this probability dropped to 47% and 34% in women and children respectively Alvarado scoring system is a simple, safe and effective diagnostic aid in the management of adult male patients with suspected appendicitis while in children and adult female patients other diagnostic aids are needed