Pediatric retroperitoneal neuroblastoma in the Upper Egypt

Neuroblastoma is the most common intra-abdominal malignancy of infancy and the most common extra cranial solid tumor of childhood. Compared to any other tumour, this, tumour has varied clinical presentation and has great differences in distribution and respond to therapy. Although there have undoubtedly been major advances in therapy over recent decades, there is still room for significant improvements in outcome to be made. To review the clinical behaviors, management options and outcome of pediatric retroperitoneal neuroblastoma, treated at Sohag university hospital and to highlight on some prognostic factors affecting the outcome. Thirteen children with abdominal neuroblastoma were diagnosed and treated between April 1997 and April 2004 at surgery department of Sohag university Hospital. The data included the age, sex, clinical presentation, duration of symptoms, primary anatomic site, size, stage of the tumour, metastatic site if present, histopathology, modalities of treatment and prognostic factors. Patients were stratified as stage 1, 2A, 2B, 3, 4, 4S according to the post surgical International Neuroblastoma Staging System [INSS]. Thirteen patients were encountered. There were seven males and six females. Their ages ranged from 9 months to 5 years. The mean age was 1.8 years. Clinical presentation included painless abdominal swelling in7patients [54%], abdominal pain in 5 [38%], vomiting in 5 [38%], fever in 4 [30%], diarrhea in 2 [15%] and loss of weight in 2 [15%]. Duration of symptoms was from 2 weeks to 8 months, the mean duration was 1 1.5 weeks. Primary sites of involvement included: general retroperitoneal space in 8 patients [62%], the pelvis in 3[23%] and adrenal in 2 patients [15%], site of metastasis was the liver in 3, bone marrow in 4, cortical bone in 2 and distant lymph nodes in 3 patients. According to [INSS], stage 2B in 3, stage 3in 3, stage 4in 3 and stage 4s in 4 patients. Pathological features showed: neuroblastoma in 9 patients [70%], gangiloneuroblastoma in 3 [23%] and Ganglloneuroma in one patient [7%]. All cases were subjected to surgery, where complete excision was done in 7, total nephrectomy in 2. partial exision in 2 and only biopsy in 2 patients. All patients were subjected to postoperative chemotherapy. 6 patients to postoperative radiotherapy. Overall survival rates at 3 years at different stages were as followed: Stage 2: 100%; Stage 3: 33.3%; Stage 4: 0%: and Stage 4S: 100%. The overall survival rate during 3years follow up was 61.5% [5 out of 13 patients] died. Mortality rate is 38.5%. The tumour growth rates of neuroblastoma in age < two years are quicker than in age > two years. Wide local excision with retroperitoneal lymphadenectomy is the treatment of choice in operable cases. Neuroblastoma in pediatrics age group patients is more sensitive to chemotherapy than in older children. Factors of favorable prognosis are infants and children less than two years, stage 1, 2, and .48, the tumour site at the pelvis or retroperitoneal, low level of N.S.E and favorable histology

Different surgical techniques in management of high fistula in Ano

The major objectives in the management of fistulae are to drain sepsis, to define and eradicate the fistulous tract, and to preserve sphincter integrity and function. For these reasons many surgical techniques are described in medical literature, but their outcomes with respect to recurrence and incontinence rates are still under debate. This study was conducted on 75 patients with high anal fistulae who were admitted to Sohag University Hospital in the period from October 2003 to July 2005.All patients were subjected to the following preoperative evaluation including: full history taking, anorectal examination and preoperative special investigations as fistulogram to all patients, magnetic resonance imaging [MRI] in recurrent cases and preoperative biopsy whenever indicated. Patients were divided into 3 equal groups; each group included 25 patients and treated randomly by certain surgical modality as follows: group A treated by cutting seton, group B treated by core fistulectomy and advancement flap and group C treated by autologous fibrin glue injection after curettage of the fistulous tract and drainage of the external opening. Comparative Evaluation of postoperative outcome was performed as regards recurrence, incontinence and other complications. The mean age was 37.45 years [range from 10-74 years]. There were 65 males [86.67%] and 10 females [13.33%]. Purulent discharge was the most common symptom [69%]. Analysis of the history of our series showed that 23 patients [30.7%] were previously operated upon for anal fistula. Intra-operative assessment of the fistulous tract was accurate in detection of type of fistula in 72 patients [96%], site of internal opening in 71 [94%] and detection of side tracts in 69 [92%]. Our patients were categorized into: high transsphincteric fistulae in 58 [77.3%], supra-sphincteric fistulae in 7 [9.3%], extra-sphincteric fistulae in 2 [2.7%] and high transsphincteric fistula with horse shoe extension in 8 [10.7%]. Our results recorded that; all patients in group [B] and group [C] were satisfied with the degree of continence, while in group [A], 3 patients had minor disturbances of continence. As regards the recurrence rate, the least recurrence was recorded in group B [8%] in comparison with group A and C [16% and 24% respectively, P value < 0.02]. Surgical procedures in treatment of high perianal fistulae such as seton placement, core fistulectomy with advancement flap and injection of fibrin glue, are different in characters and results. The most successful one is the advancement flap technique, but it is difficult and has prolonged postoperative hospital stay. Fibrin glue injection has the highest rate of recurrence but it is easy, least painful and not associated with division of the sphincter muscles. Seton technique carries the highest risk of incontinence rate, and the most painful one, but its results in curing fistulae are considered to be reasonable

Management outcomes in blunt abdominal trauma in children: [a prospective study]

Clinical pathways now highlight both observation and operation as acceptable initial therapeutic options for management of blunt abdominal trauma in children. The purpose of this study was to evaluate treatment trends and end results of blunt abdominal trauma in children. Sixity child were admitted to trauma and emergency department of Sohag university hospital in the period from October 1998 To March 2000. The age ranged from 1 To 14 years old [42 male, 18 female]. According to clinical examination and radiological investigations, patients were classified into two groups the first group [40 cases] was subjected to abdominal exploration and the second group [20 cases] was subjected to non-operative treatment. The first group: splenectomy was done for 21 cases [15 cases of grade 5, 6 cases of grade 4 splenic injury]. Hepatic tear was found in 4 cases, where suturing was done in 2 cases while homeostatic agents were applied in 2 cases. Biliary injury was found in 2 cases and intestinal injury was found in 13 cases. The second group: the non-operative management was successful in 9 out of 12 cases with grade 1, 2 and 3 of splenic trauma [75% success rate] while it was successful in 6 out of 8 cases of hepatic trauma [75% success rate]. The operative management was mandatory in blunt abdominal trauma in children if there was haemodynamic unstability or positive diagnosis of haemoperitoneum by one of different methods of investigation. The conservative management was successful in splenic injuries using the criteria of AAST [American Association for the Surgery of Trauma] if there was haemodynamic stability plus absence of other associated abdominal injury. It was also successful in hepatic injuries in specific conditions