importance of portal venous gas in neonatal necrotizing enterocolitis; review of 15 cases

To find out if the presence of portal venous gas [PVG] in the abdominal radiography of neonates with necrotizing enterocolitis [NEC] indicates surgical intervention. Retrospective study of cases of NEC managed by the authors over a period of 5 years. Cases with and without PVG were compared Records of 63 neonates with the diagnosis of NEC were obtained. The overall mortality was 20 cases [31.7%]. In both the medically [48 cases] and the surgically [15 cases] treated group. The mortality rates of cases with PVG were not statistically different from those without PVG [33.3% versus 15% ; P value=0.3, for the medical, and 83% versus 66.6% ; P value=0.6, for the surgical]. At surgery, intestinal pan-necrosis was found in 3 cases with PVG [50%] and non in cases without PVG [P=0.04]. Many cases of NEC with PVG could be treated successfully without surgery, with no difference in mortality. However, the presence of this radiological sign in cases requiring surgery, based on other indications, is associated with poor prognosis

Tunica vaginalis flap; a feasible second-layer for proximal hypospadias Re-Do

Interposing vascularized flaps between the urethra and the skin sutures is recommended in hypospadias surgery. This decreases the rate of complications; mainly urethrocutaneous fistula. Although this is more needed in redo complicated cases, yet this is not always possible. The aim of this study was to evaluate our experience with the tunica vaginalis flap [TVF] and compare it with the use of the adjacent local para-urethral tissue as a second layer cover in complicated redo cases of proximal hypospadias. This is a retrospective study of the redo correction of proximal hypospadias cases with failed previous repairs, comparing the use TVF [group I] and the adjacent local para-urethral tissue [group II], as a second layer cover. The study included only the cases corrected by the modified Theirsch-Duplay technique. The age of the patients, types of hypospadias, the complications after the 1ry repair, the follow-up results were reported. Between 1999 and 2006, 26 children with failed previous repairs of proximal hypospadias were corrected using the modified Theirsch-Duplay technique. Eleven cases had scrotal and 15 had proximal penile hypospadias as their original pathology. Nine cases presented with complete disruption and 17 with partial disruption of the primary repairs. During the follow-up period [6-24; mean 9 months], in group I; [n=12 cases] 3 cases [25%] developed urethrocutaneous fistula and 1 case developed partial disruption, whereas in group II; [n=14 cases] 4 cases [29%] developed fistula, 2 partial disruption [14%] and 1 complete disruption [7%]. In group I, the appearance of the scrotum was almost normal in all cases. TVF is a good option that should always be kept in mind in redo complicated cases of hypospadias. When the local tissues seem to be scarred, it offers a second-layer cover that is properly vascularized, virgin and with mostly any length that might be needed