ABSTRACT
Infantile hemangioma is a common disease. Steroids have been used for its treatment; however, intralesional steroids cause pain and other problems. A treatment modality that can avoid these problems is desirable. The authors evaluated the role of topical steroids as an alternative to intralesional steroids in the treatment of superficial hemangioma. Inclusion criteria were <2 superficial type ofhemangiomas <5 cm. The topical steroid mometasone furoate was applied twice daily. Intralesional triamcinolone acetonide was injected at monthly intervals using a 24-gauge needle at doses of 1 to 2 mg/kg. Forty-five (86.5%) patients responded to treatment with the topical steroids, of which 50% had excellent and 36.5% had good response. In the intralesional group, the response rate was 95.7%, of which 63.8% had excellent and 31.9% had good response. Complications in the topical steroid group were mild itching and irritation (19.2%) and hypopigmentation (7.6%). Complications in the intralesional group were pain (100%), bleeding (17%), infection (17%), cutaneous atrophy (8.5%), cushingoid facies (2.1%), and growth retardation (2.1%). Topical steroids are a reasonably good alternative to intralesional steroids as an initial choice for treating superficial hemangioma.
Subject(s)
Glucocorticoids/administration & dosage , Hemangioma/drug therapy , Pregnadienediols/administration & dosage , Triamcinolone Acetonide/administration & dosage , Administration, Topical , Glucocorticoids/adverse effects , Humans , Infant , Mometasone Furoate , Treatment OutcomeABSTRACT
To compare the results of the staged procedure (Group A) with the primary single stage posterior sagittal anorectoplasty (PSARP) procedure (Group B) for high and intermediate anorectal anomalies. Four hundred ninety cases of primary single stage procedure done over a period of seven years (1996-2003) were compared with 458 out of 763 cases of staged procedure (Historical control) that underwent all three stages done from 1989 to 1996. Two hundred cases that had been in regular follow up in Group A and 254 cases in Group B who had attained three years of age were evaluated for continence by Kelly's method. The approximate cost of treatment was also calculated. Continence was good in 90 cases (45%), fair in 66 cases (33%) and poor in 44 cases (22%) in Group A while it was good in 204 cases (80% ), fair in 38 cases (15%) and poor in 12 cases (5%) in Group B. In Group A, the mortality was high as only 40% cases completed all the three stages of operation. The mortality was 4.5% in Group B. Primary PSARP is recommended as the better treatment option for intermediate and high-anorectal anomalies with superior results in terms of morbidity, mortality, continence and cost.
Subject(s)
Anal Canal/abnormalities , Anal Canal/surgery , Intestinal Obstruction/surgery , Rectum/abnormalities , Rectum/surgery , Colostomy , Fecal Incontinence/etiology , Health Care Costs , Humans , India , Infant, Newborn , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/economics , Plastic Surgery Procedures/methods , Survival AnalysisABSTRACT
BACKGROUND/PURPOSE: The standard procedure in the management of pouch colon is the staged procedure (SP), which has well-known disadvantages. We believe that staging is unnecessary and primary single-stage procedure (PSSP) can be done. METHODS: Patients with pouch colon who underwent PSSP (102 cases from 1997 to 2003) and SP (98 cases from 1991 to 1997), 63 and 42 of whom, respectively, were in regular follow-up for more than 3 years, were evaluated. RESULTS: In PSSP, male/female ratio was 94:8; in SP, 89:9. Mean age in PSSP was 4.6 days and in SP 26 months. The distribution of cases into types I, II, III, and IV was 10, 24, 14, and 15 in PSSP, and 8, 20, 10, and 4 in SP, respectively. The ratio of PSSP/SP for total pouch colon (I and II) was 34:28 and for partial pouch colon (III and IV) was 29:14. The ratio of PSSP/SP in terms of continence, mortality, and cost was 75:48, 11:47, and 1:4, respectively. CONCLUSIONS: Primary single-stage procedure gives better continence and cosmesis, with low morbidity and mortality at a low cost, and hence is recommended.
Subject(s)
Anal Canal/abnormalities , Anal Canal/surgery , Rectum/abnormalities , Rectum/surgery , Child, Preschool , Digestive System Surgical Procedures/methods , Fecal Incontinence , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/surgery , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Male , Treatment OutcomeABSTRACT
Gastric volvulus in children is a rare surgical emergency. We describe 2 cases of gastric volvulus with gastric perforation in association with congenital diaphragmatic hernia. One case presented in infancy after recurrent chest infections with intestinal obstruction. The other case presented in the early neonatal period. Both cases underwent laparotomy with repair of the stomach and diaphragm defect. The first case developed pyoperitoneum postoperatively, was reexplored but succumbed to septicaemia. The second baby had a favourable postoperative outcome.
