A longitudinal follow-up using the high trans-scrotal approach for inguinal and scrotal abnormalities in boys.

The popular incision for surgical approach to pediatric inguinal pathologies has been the suprapubic transverse inguinal incision. Yet alternative incisions may be considered. A prospectively randomized study of a consecutive series of 256 male infants and children with various inguinal pathologies (mainly indirect inguinal hernias) were treated surgically using the "high trans-scrotal skin-crease incision," over a period of 84 months (7 years) and were compared and found to be clinically better than age- and sex-matched 278 controls with suprapubic transverse inguinal incisions for wound healing/infection, edema, seroma, hematoma, malpositioning or atrophy of testes and recurrence of the primary pathology. The results in the study group were cosmetically and clinically more favorable, and better than the control group. Nosocomial infections, complications of incarceration, and emergency surgery have resulted in an acceptable morbidity rate of approximately 5%. Popularized use of the high trans-scrotal incision and further clinical experience is recommended to facilitate even better results.

A novel incision for groin pathologies in children: the low inguinal groove approach.

BACKGROUND: The traditional approach to pediatric inguinal pathologies has been the suprapubic transverse inguinal incision. Alternative incisions for better cosmetic results may be considered. MATERIALS AND METHODS: The recently defined "low inguinal groove incision" was used in a consecutive series of 483 children having indirect groin hernias, hydroceles, and palpable undescended testes, etc. The neonates, infants, and children were operated on as elective day surgery cases. RESULTS: All children ended with excellent cosmetic and functional results. There were no complications or morbidity apart from a recurrence of an inguinal hernia in a 7 year-old boy. In addition to the series of girls reported earlier, this novel surgical incision has further been employed in boys with excellent results.

Reduction of surgery-induced peritoneal adhesions by continuous release of streptokinase from a drug delivery system.

Postoperative abdominal adhesions may lead to intestinal obstruction and infertility. The effect of continuous release of streptokinase to the peritoneal cavity on postoperative adhesions was examined under experimental conditions. Peritoneal adhesions were induced in rats and the animals were further treated by intraperitoneal administration of streptokinase solution, polyhydroxybutyrate-co-hydroxyvalerate (PHBV) membrane alone and streptokinase loaded PHBV membrane and compared to sham operated and untreated groups. Formation of adhesions was evaluated by quantitative macroscopic grading, histopathologically with light microscopy, on the following week. Streptokinase loaded PHBV prevented postoperative adhesion formation in 90% of the cases. PHBV membrane alone also reduced the severity of adhesions due to its anti-adhesive properties. Histopathological examination revealed limited foreign body reaction due to PHBV. Continuous streptokinase activity in the peritoneal cavity during early post-surgical period prevents postoperative adhesion.

Low inguinal groove incision for indirect inguinal hernias in girls: a preliminary report on an incisional proposal.

BACKGROUND: Work on an innovative transscrotal incision to the palpable undescended testes has recently been applied in the management of inguinal hernias and hydroceles. This route is considered less traumatic and a more cosmetically acceptable technique. STUDY DESIGN: Near-perfect cosmesis was achieved using a new incisional approach for inguinolabial abnormalities in female infants and children in a series comprised of 25 girls with indirect inguinal hernias operated on consecutively as day cases through an incision placed at the lower portion of the inguinal groove. RESULTS: The low inguinal groove incision has enabled almost scar-free healing at the incision site. The results have been excellent. There has been no serious morbidity and no mortality. CONCLUSIONS: Although initially cumbersome to master, this new technique is hoped to become an ad hoc method once the pediatric surgeon has passed through the learning curve.

Augmentation of mucosal adaptation following small-bowel resection by electromagnetic field stimulation in rats.

Survival following massive resection of the small intestine is often possible due to substantial hyperplasia of the mucosal surface in the remaining small intestine. While nutrients provide the major stimulus for hyperplasia in the clinical setting, the availability of drugs to augment this process would have obvious therapeutic implications. Electromagnetic field stimulation (EMF) of connective tissue and skin increased the DNA and messenger RNA and protein synthesis in experimental studies. We evaluated the ability of electromagnetic field stimulation to augment mucosal hyperplasia following massive small bowel resection in the rat. Two groups of 10 Wistar rats, 250 gr body weight, were subjected to 70% jejunoileal resection. The first group received EMF stimulation for ten days at a dosage of 43.20 gauss, the second group did not receive any stimulation. After fourteen days, segmental evaluation of mucosal mass in the remaining small intestine was determined by measuring mucosal protein, and disaccharidase levels, as well as intestinal length and circumference. EMF stimulation appears to augment mucosal adaptation following massive small bowel resection in rat, in the proximal and distal small intestine.

The effect of electromagnetic field stimulation on corticosteroids-inhibited intestinal wound healing.

Electromagnetic field (EMF) stimulation has been used successfully in the clinical setting to promote healing of ununited fractures. In a few studies, EMF stimulation enhanced soft tissue healing. To investigate the effect of EMF stimulation on intestinal wound healing in normal rats and in those treated with corticosteroids, 80 Wistar rats received twice-daily injections of either saline dexamethasone (0.1 mg/kg/day for 2 weeks. Animals then underwent creation of single-layer, inverting small intestine anastomoses. All injections were continued postoperatively. Animals were grouped as intestinal anastomoses; intestinal anastomoses plus EMF stimulation; intestinal anastomoses plus dexamethasone; and intestinal anastomoses plus dexamethasone plus EMF. On postoperative days 7 and 14, the anastomosed intestines were removed and the tensile strength (TS) and hydroxyproline (OH-P) contents measured. EMF stimulation significantly increased intestinal wound healing in normal animals by the 7th and 14th day. Corticosteroids significantly impaired the healing of the small intestine anastomoses, with decreased TS and OH-P contents after the first and second weeks. However, EMF stimulation significantly reversed this inhibitory effect.

Hepatic fascioliasis and biliary surgery.

This series represents seven cases of hepatic fascioliasis (HF), two diagnosed as the sequelae of the disease and five showing the parasite itself at the time of the primary surgical intervention. The mean history of the symptoms was 42.6 mths. All of the patients were initially misdiagnosed as having cholecysto- and/or coledocho-lithiasis or hepatitis. Definite diagnosis was established intraoperatively in each instant. At surgery cholecystectomy, choledochotomy with extirpation of the flukes from the biliary tree and T-tube biliary drainage was performed without any complications in five patients. The remaining two patients were suffering from recurrent cholangitic episodes and were regarded as sequelae and therefore treated with hepatic peri-arterial neurectomy with favourable results. Six patients received medical treatment involving emetine hydrochloride. Two patients failed to return for follow-up while others were seen to be well 6, 12, 24 mths and 13 and 24 yrs postoperatively, implying promising long-term results both in the active and chronic stages of HF.

Primary colonic non-Hodgkin lymphomas: a retrospective clinicopathologic study of 14 cases.

Fourteen cases of primary colonic non-Hodgkin lymphomas (NHL) with a mean age of 51.5 yrs and 64.3% of them female, are reported. While diagnoses were only obtained by cytologic or histopathologic means, 35.5% of the cases were in Stage 1e (S1e) and a further 42.6% in Stage 2e (S2e) and 7.1% in Stage 3e (S3e) according to the modified Manchester classification. 63.9% were of immunoblastic and 21.3% lymphoblastic type according to the Kiel classification. 85.2% of the tumours were located at the caecum. While acute abdomen required surgery in two patients, 85.2% of the series underwent radical interventions. 14.2% were able to receive chemotherapy with a subsequent total morbidity and mortality figures of 21.3% each. It is the authors' argument that prognosis is not solely dependent on the age, sex or the malignancy state of the tumour but more on its infiltrative stage and on the advent of treatment, whether by radical surgery and/or medical means.

A contemporary evaluation of enteric perforations in typhoid fever: analysis of 257 cases.

Of the 257 typhoid enteric perforations analysed at the Departments of General and Paediatric Surgery, Ankara University Hospital, through the years 1979-1986, 74.9% were males, while the patients mean age was 35.8 years. The early signs and symptoms averaged 5.9 days. The corresponding percentages for the occurrence of abdominal pain, fever, nausea and vomiting and central nervous system disorders which constituted the clinical findings were 97.27, 51, 61.2 and 18 respectively. While the mean value for the white blood count ranged around 6600, only 61.9% of the cases had diagnostic findings in their erect abdominal roentgenograms. The standard method for the treatment of typhoid enteric perforations is still presently primary suturing of the perforated viscus and peritoneal drainage. Despite the use and misuse of a large variety of antibiotics, typhoid perforations still have a high morbidity of 74.1% and a mortality of 31.4%. Generalized peritonitis (78.4%), is considered to be to the most important cause in both situations.

Bilateral transverse iliac osteotomy in the correction of neonatal bladder extrophies.

In a clinical and radiological study of seven neonates with bladder extrophy (BX), separation of pubic bones from the midline, lateral and caudal tilting of the iliac alae and external rotation of the acetabula, with consequent early predisposition to bilateral congenital hip dislocation (CHD), who were treated by a combined bilateral innominate osteotomy and reconstruction of the urinary bladder, there were only two failures due to CHD and three due to BX, which were dealt with at a later session. Although the bilateral transverse iliac osteotomy procedure is very rarely, if ever, employed in the neonatal period, it may well be combined with the reconstructive surgical procedures that involve pelvic skeletal structures while dealing with soft tissue procedures. Bilateral transverse iliac osteotomy was preferred to the conventional two-stage posterior iliac vertical osteotomies because of its easiness and the simple approach provided by the supine positioning of the patient.

Treatment of biliary fistulas and cholelithiasis: is endoscopic sphincterotomy acceptable in the paediatric age group?

Two children, both girls, aged 11 and 16 with a postoperative biliary fistula and cholelithiasis, choledochal cyst and common bile duct stones have undergone endoscopic sphincterotomy (EST), leading to a rapid recovery from their pathologies, thanks to cooperative work. In reviewing the literature we have not come across any cases of EST in our patients' age group. There were no complications during or immediately after endoscopic sphincterotomies. We believe that it has become an important and valuable rival to conventional surgical means with correct indications and in experienced hands.