Laparoscopic versus open appendicectomy in children: a UK District General Hospital experience.

AIMS: The aim of this study was to evaluate the potential role of laparoscopic appendicectomy in reducing morbidity and length of stay in children compared to open procedures in a UK District General Hospital setting. METHODS: A three-year retrospective review of children ≤ 15 years with histologically confirmed appendicitis who underwent laparoscopic (LA) and/or open (OA) appendicectomy was performed. Choice of operation was based on individual surgeon's preference and on patient's body size. Data collected included rate of histologically complicated appendicitis, post-operative length of stay (LOS), and collective and differential morbidity rates, i.e., wound infection, intra-abdominal collection, and ileus. Chi-square and Mann-Whitney tests were used for statistical analysis. P<0.05 was regarded as significant. RESULTS: Eighty children (70% male) were identified at median age 11 (3-15) years. They could be divided into complicated (n=18, 22%) and simple appendicitis (n=62, 78%). Appendicectomy was performed in all as an OPEN (n=53, 66%) or LAPAROSCOPIC (n=27, 34%) procedure. Both groups were comparable in gender distribution (P=0.11) and rate of complicated appendicitis (30% vs. 19%, respectively; P=0.27). Median age was significantly lower in the OPEN group [10 (3-15) vs. 12 (7-15) years; P<0.004]. Laparoscopic appendicectomy had a significantly lower rate of collective morbidity (3.8% vs. 25.9%; P<0.003), including lower rate of intra-abdominal collection (1.9% vs. 14.8%; P<0.01). Median LOS was not significantly different (1 day vs. 2 days; P=0.14). CONCLUSION: Laparoscopic appendicectomy in children in a UK District General Hospital is safe and was associated with significantly less post-operative morbidity than the open technique.

Modifying three-dimensional scaffolds from novel nanocomposite materials using dissolvable porogen particles for use in liver tissue engineering.

BACKGROUND: Although hepatocytes have a remarkable regenerative power, the rapidity of acute liver failure makes liver transplantation the only definitive treatment. Attempts to incorporate engineered three-dimensional liver tissue in bioartificial liver devices or in implantable tissue constructs, to treat or bridge patients to self-recovery, were met with many challenges, amongst which is to find suitable polymeric matrices. We studied the feasibility of utilising nanocomposite polymers in three-dimensional scaffolds for hepatocytes. MATERIALS AND METHODS: Hepatocytes (HepG2) were seeded on a flat sheet and in three-dimensional scaffolds made of a nanocomposite polymer (Polyhedral Oligomeric Silsesquioxane [POSS]-modified polycaprolactone urea urethane) alone as well as with porogen particles, i.e. glucose, sodium bicarbonate and sodium chloride. The scaffold architecture, cell attachment and morphology were studied with scanning electron microscopy, and we assessed cell viability and functionality. RESULTS: Cell attachment to the scaffolds was demonstrated. The scaffold made with glucose particles as porogen showed a narrower range of pore size with higher porosity and better inter-pore communications and seemed to encourage near normal cell morphology. There was a steady increase of albumin secretion throughout the experiment while the control (monolayer cell culture) showed a steep decrease after day 7. At the end of the experiment, there was no significant difference in viability and functionality between the scaffolds and the control. CONCLUSION: In this initial study, porogen particles were used to modify the scaffolds produced from the novel polymer. Although there was no significance against the control in functionality and viability, the demonstrable attachment on scanning electron microscopy suggest potential roles for this polymer and in particular for scaffolds made with glucose particles in liver tissue engineering.

Interventional bronchoscopy for benign tracheobronchial diseases under cardiopulmonary bypass support: case reports and literature review.

The use of cardiopulmonary bypass as an adjunct to airway surgery for non-malignant diseases in adults is not well established in the UK. We are reporting two cases which demonstrate the additional benefits of using cardiopulmonary bypass during difficult bronchoscopy and complex airway stenting. The first case presents an emergency indication for cardiopulmonary bypass in a life-threatening but benign condition. The second case presented, utilises cardiopulmonary bypass standby as adjunct to a potentially life threatening procedure. A review of the literature is also provided.

Are routine chest radiographs needed after fluoroscopically guided percutaneous insertion of central venous catheters in children?

UNLABELLED: Current guidelines for children still mandate routine postprocedural chest x-ray to confirm placement and detect complications. This is in spite of the risk of unnecessary exposure to radiation, the additional stress to children and their parents, and the cost of this practice. We studied the impact and cost-effectiveness of this practice on the management of children after percutaneous fluoroscopically guided central venous catheter (CVC) insertions. METHODS: A retrospective review of children who underwent percutaneous fluoroscopically guided CVC insertions between January 2000 and December 2005. Only patients with reported postprocedural radiographs in the electronic database were included, and we referred to the medical notes when the report indicated a complication. RESULTS: Two hundred eighty consecutive patients aged between 4 and 16 years were identified. Two hundred seventy-eight (99.3%) of the reports indicated absence of complications, whereas only 2 reports (0.7%) indicated any form of complications. Of the 2 complications detected, 1 was an asymptomatic pneumothorax, and the other was a slight kink in the line; on review of the medical notes, both lines were fully functional and neither required treatment. CONCLUSION: After percutaneous fluoroscopically guided CVC insertions and in the absence of clinical indications, the use of routine postprocedural radiographs in children cannot be justified and is not cost-effective.

A solitary encapsulated pelvic aggressive angiomyxoma.

Aggressive angiomyxoma (AAM) was first reported in 1983 as a distinct, slow growing, benign but locally infiltrative, soft tissue tumour. It usually arises in the pelvic and perineal organs, mostly in women. A 47-year-old woman was found to have a large encapsulated retroperitoneal aggressive angiomyxoma. The mass was completely excised via abdomino-perineal approach, and no recurrence noted on MRI at 19 months' follow-up. The encapsulation of this tumour together with other reported rare presentations, suggest an isolated mesenchymal cell origin. A review of the literature is provided.