Congenital lobar emphysema: peri-operative evaluation and management

Congenital lobar emphysema [CLE] is one of congenital lung malformations and is characterized by overdistension and airtrapping in the affected lobe. It is one of the causes of neonatal and infantile respiratory distress. This study was performed on 10 children with congenital lobar emphysema with a age range from 2 days to 7 months. The age of the first presentation was the neonatal period. It is frequently diagnosed in males. Tachypnea and dyspnea were present in all cases. The diagnosis was confirmed by Chest x-ray and computed tomography of the chest. All patients underwent total lobectomy or segmental resection. All cases survived after operation without early or late post operative complication

Risk factors of congenital pediatric surgical birth defects: a case control study

Birth defect is a global health problem. Serious birth defects are life threatening or have the potential to result in disability. In Egypt the prevalence of birth defects is increasing, it reached 3.2% of all births [1998]. The present study was earned out to identify different potential risk factors for birth defects and estimate the magnitude of risk for each factor Identified. A case control study was carried out in the Pediatric Surgical Department of El Shatby University Hospital in Alexandria. A structured interview schedule was used to collect data. Gastrointestinal tract [GIT] is the most commonly encountered system for birth defect [53.0%]. Only 11.0% of cases were diagnosed during pregnancy. Boys were more encountered than girls. The final model of multiple logistic regression analysis revealed that high maternal education, unplanned pregnancy, medical problems prior to pregnancy and eating contaminated raw food were significant contributing factors that increased risk of birth defects. No significant associations were found between cases and controls as regards consanguinity parental age, housing and working conditions, family and reproductive history. A pre- pregnancy visit was recommended to identify risk factors and allow for appropriate testing and guide for better changes to improve chances of having a healthy baby

Klippel-Trenaunay syndrome in children: Initial experience with the Nd-YAG Laser

Klippel-Trenaunay Syndrome [KTS] is a relatively uncommon disease. There is still no common consensus as to the management protocols, especially in children. The purpose of this study was to describe a series of patients with KTS and to report our initial experience in using the Nd-YAG laser as a new modality for treatment of the bleeding cutaneous capillary vascular lesions. We reviewed the clinical characteristics and outcomes in 8 patients [5 males and 3 females] with KTS who were managed during the period from January 1998 to August 2003 at the Pediatric Surgery Unit, Faculty of Medicine, Alexandria University. All patients presented with cutaneous bleeding to which single or repeated Nd-YAG laser photo coagulation sessions were conducted. Serial scanograms, arterial and, venous doppler studies were also performed. The male to female ratio was 5:3. All patients had visible varicosities, nevi and all the three characteristics of KTS. Bleeding was the main presenting symptom. Nd-YAG laser was used successfully for management of this complication. Nd-YAG laser as a new application in children suffering from KTS, with improvement of bleeding as an encountered complication.

Effect of benzalkonium chloride on urinary mucus concentration following augmentation ileocystoplasty in mice

Ileocystoplasty is a popular technique used for treatment of low-capacity urinary bladders. One of its major down sides is the ability of the intestinal mucosa to secrete mucous, with its related urinary complications. Benzalkonium chloride is an irreversible ganglion blocker. Its local application to the augmenting ileal patch could reduce the acetyl choline-mediated mucus secretion. The aim of this study was to evaluate the effect of benzalkonium chloride on urinary mucus concentration following augmentation ileocystoplasty in mice. Ileocystoplasty was performed experimentally in a group of albino mice, benzalkonium chloride was applied locally to the ileal patch in half of them. Twenty survivors from each group were evaluated by 24-hours urine collection and mucus concentration assessment. Histopathological evaluation of the urinary bladders was carried out three weeks later. In the benzalkonium group, the mean urinary mucous concentration was significantly lower than the control group [P<0.001]. In the former group, the histopathological examination revealed no reactions that might have resulted from benzalkonium application, together with a marked reduction in the mucus secretion activities in all specimens. Benzalkonium chloride might be used to reduce the incidence of mucus-related complications in ileocystoplasty. Its use in humans, as well as the adverse effects due to systemic absorption is still to be investigated

anterior sagittal anorectoplasty technique [ASARP] for treatment of recto-vestibular fistulae and vestibular anus in neonates and infants

Many surgical techniques have been described for functional treatment of vestibular anus, and recto-vestibular fistula in girls. Achievement of good results remains the main goal of treatment. Anterior sagittal anorectoplasty [ASARP] technique avoids dividing the pelvic floor, thus promises better postoperative continence. In this study, we evaluated the results of the ASARP technique in treatment of vestibular anus, and recto-vestibular fistula in neonates and children. In the period between May 2000, and May 2003, twenty female patients with anorectal anomalies [12 cases with vestibular anus, and eight cases with rectovestibular fistula] were treated by the ASARP technique in the pediatric surgery unit, Elshatby hospital, Alexandria University. Five cases were neonates. In all cases, the procedure was performed without protective colostomy. Median follow-up was 18 months [range 6- 28 months]. External appearance of the perineum and posterior fourchette was satisfactory in all patients, with no evidence of wound infection. No anterior anal migration, or retraction of the anal mucosa was detected. One case showed mild mucosal prolapse. Electrical stimulation revealed satisfactory contraction at the site of the new anus in all patients. Anal calibration revealed no anal stenosis. Continence score showed good score [3.5-5] in all assessed patients [nine]. No constipation or fecal impaction was recorded. The ASARP technique possesses many advantages in the treatment of vestibular anus and the rectovestibular fistula. Perineal dissection is more precise and yields excellent cosmetic results. It also obviates the need for pelvic colostomy and associated with minimal postoperative morbidity, with shortened postoperative hospital stay. In addition, it can be safely applied in the neonatal period. Excellent continence was achieved in all assessable cases

Ultrasound guided reduction of primary intussusception presented with simple intestinal obstruction using saline enema as a new hydrostatic-experienced technique

Ultrasound guided hydrostatic reduction is used as a routine in all cases of primary early non-complicated intussusception with a very high success rate. We observed from our experience some cases of primary intussusception presented by simple intestinal obstruction usually of long duration [3-5 days]. After diagnosis of these cases, exploration was indicated and easy simple reduction was done for all. A prospective study in 25 patients admitted to the Pediatric Surgery Department. Faculty of Medicine, Alexandria University, Egypt, between September 1996 and August 1997. Those patients were diagnosed and assessed clinically as primary intussusception presenting with simple intestinal obstruction [Abdominal distention, vomiting, no abdominal tenderness and no rigidity with multiple air fluid level], plain x-ray abdomen standing was done for all cases and the diagnosis may be confirmed by using ultrasonography and using warmed saline enema, ultrasound guided hydrostatic reduction for all patients. This study included 25 cases of primary intussusception presented by simple intestinal obstruction without abdominal rigidity and tenderness as appropriate candidates for a trial of hydrostatic pressure using saline enema under the ultrasonic scanning guidance. The intussusception was successfully reduced in 20 patients with a mean hospital stay of 12 hours. The; they received oral meals after a mean time of 14 hours. While children with operative intervention had a mean hospital stay of 4.5 days, and received oral feeds after a mean time of 3.1 days. Ultrasound guided reduction of primary intussusception presented by simple intestinal obstruction in clinically and radiologically selected patients. Using saline enema is a new technique and must be tried in every selected case