ABSTRACT
AIM OF THE STUDY: We present our experience with the Malone antegrade continence enema technique in children suffering from severe anal incontinence. METHODS: The Malone antegrade continence enema technique was performed using the appendix, caecum or ileum in 20 children with faecal incontinence. The stoma was kept catheterised for three weeks after the operation in all patients and irrigation with saline was initiated after that period. Tap water was used for irrigations after discharge from hospital. The functional success was evaluated according to the classification defined by Curry et al. RESULTS: The mean age and the mean follow-up period was 11 years and 5 years, respectively. Strictures developed in five of the 20 cases (25 %) in this series. Four of these patients underwent revisional surgery, but in one case with appendiceal tube the stricture and catheterisation difficulty resolved spontaneously. Full continence was achieved in 13 of the children (65 %). CONCLUSIONS: The Malone procedure is an effective procedure in children with faecal incontinence. It should be performed after confirming that the patient is completely clean using Peña's programme and aften ensuring that both the child and the parents will properly follow the recommendations.
Subject(s)
Enema , Fecal Incontinence/therapy , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , MaleABSTRACT
AIM: A modified Barcat operation, when carried out properly, provides an anatomically and cosmetically successful result in distal hypospadias repair in each glans configuration. We retrospectively evaluated our experience with this technique in the last five years. PATIENTS AND METHODS: 78 children with primary distal type hypospadias were operated between 1998 - 2003, using a modified Barcat technique. RESULTS: The mean age of the patients was 3 years (6 months - 14 years). The mean follow-up period was 2 years (1 month - 60 months). Nesbit plication was performed in four cases with chordee. Fistula developed in five (6.5 %) cases and required reoperation. Stenosis which did not require surgical intervention occurred in 5 children and resolved with self-dilatations. CONCLUSION: The Barcat technique is an appropriate operation for distal type hypospadias cases but should be modified by creating second tissue layers over the neourethra and a wide meatus.
Subject(s)
Hypospadias/surgery , Penis/surgery , Urethra/surgery , Urologic Surgical Procedures, Male/methods , Adolescent , Child , Child, Preschool , Humans , Infant , MaleABSTRACT
Between 1990 and 1999, 741 bronchoscopic procedures were performed in 698 children, 594 of whom were evaluated for foreign-body aspiration (FBA) (mean age 3.9 years, male:female 287/307). Based on the presenting symptoms, clinical outcome, and complications, two major groups were identified. Group 1 consisted of 438 patients with a definitive history of FBA. Most were admitted soon after the aspiration with sudden onset of symptoms such as coughing, choking, wheezing, and respiratory distress. Group 2 comprised 156 patients with chronic pulmonary infections and/or atelectasis without a definitive history of FBA. The most common radiographic finding was emphysema of one lung in group 1 (61.1%) and pneumonia in group 2 (70%). Among the patients in whom a FB was removed, the percentage of normal radiography was 17%. The FB was identified and removed in 83% of cases in group 1. The complication rate in this group was 9.8%, and all the complications were treated medically. Only 2 patients required intercostal drainage. In group 2, a FB was identified in 25% of bronchoscopic examinations and 17% of the patients developed complications. One of these patients underwent an urgent thoracotomy due to bilateral tension pneumothoraces and 2 required tracheostomies. Patients with a definitive history of FBA, even with a normal physical examination and radiographic findings, must undergo bronchoscopic investigation. Cases with late presentation and chronic pulmonary infection are at high risk. In this group care should be take in determining the indication and timing of bronchoscopy in order to prevent life-threatening complications.
Subject(s)
Bronchi , Bronchoscopy , Foreign Bodies/therapy , Trachea , Bronchography , Child , Child, Preschool , Female , Foreign Bodies/diagnosis , Foreign Bodies/etiology , Humans , Infant , Male , Medical History Taking , Suction , Time FactorsABSTRACT
A case of gastroschisis complicated by vanishing bowel and presenting as jejunal atresia is reported that is uniquely different from previously reported cases. Following delivery, complete closure of the abdominal wall with a small fascial defect was observed. Complete healing of this fascial defect was observed at 1 month of age.
