Evaluation of early and late complications in patients with congenital lobar emphysema: a 12 year experience.

BACKGROUND: Congenital lobar emphysema (CLE) is characterised by over distension of one lobe and pressure on the adjacent lobe and mediastinum. In this study, we review the pathological results of our paediatric patients with CLE, highlighting the early and late complications that occurred in these patients. PATIENTS AND METHODS: In a prospective study from 1996 to 2008, we evaluated 30 patients with CLE diagnosis. Variables collected included sex, age at the time of diagnosis, radiological diagnostic method, type of treatment, pathological analysis, surgical findings and early postoperative complications. Parents were asked to refer to our clinic for follow-up and evaluation of late complications. RESULTS: Thirty patients and males accounted for majority of the study population (n = 20, 67%). The mean age of male and female patients (at admission) was 7.2 ± 2.3 and 4.7 ± 1.2 months respectively (P = not significant). The main diagnostic method was chest x-ray (CXR) in all patients. Abnormal bronchial cartilage was found in 71% of patients. The most affected lobe was left upper lobe (50%). Associated anomalies were seen in four patients. Early postoperative periodhadtwo cases of pneumothoraces. At six month follow up, five (25%) males and four females (40%) had delayed weight gain. Permanent oxygen dependency was seen in two patients. Twenty- six patients underwent thoracotomy. Mortality rate was 13%. Base deficit at the time of admission was greater in those patients who eventually died, (-8.6 ± 1.2 versus -3.1 ± 0.4) (P = 0.0003). There were two deaths in the bilobar involvement group and two in the unilobar involvement group (P = 0.07, near significant). CONCLUSION: This study confirms that the number of affected lobes and base deficit at the time of admission were associated with significantly increased mortality.

Non iatrogenic paediatric vascular trauma of the extremities and neck.

AIM: Vascular trauma in children is uncommon. Considering the complexity of these injuries, we have tried to determine their demographic data, the different factors changing their outcome, the different modalities of management, and their outcomes. PATIENTS AND METHODS: We reviewed the medical records of 52 pediatric patients of less than 15 years f age for about ten years (1996 to 2006) .The review was followed by physical examination done by two surgeons. Vascular injuries included blunt and penetrating injuries to the neck and extremities. Their management included conservative management, primary closure, end-to-end anastomosis, graft interpositioning, and fasciotomy. RESULTS: The patients included 41 males and 11 females and their mean age was 9.7 years (ranging from 3 to 14 years). Males were significantly more (78%) involved. Penetrating upper extremity injuries were the most common cause of vascular injury in the paediatric population (65% on the right side). The most common mechanism was cutting the hand by glass (most of them on the ulnar side). These vascular injuries per se did not cause any disability in the upper extremities. The outcome of these injuries depended more on simultaneous nervous injury and to a lesser extent, on tendon injury. There was no significant long-term difference between ligation and anastomosis of the radial and ulnar arteries. Lower extremity vascular injuries had significantly higher mortality and morbidity. CONCLUSION: As the reconstructive procedures to manage vascular injuries are technically difficult, we suggest conservative managements to be applied first. Prompt surgical intervention is necessary if there are any critical signs of ischaemia or unsuccessful conservative management.