Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries.

BACKGROUND: The survival rate of infants with gastroschisis has improved significantly. It is over 90% in developed countries, but 50% in developing countries. This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries. METHODS: Neonates meeting the inclusion criteria, who presented to our center since the establishment of delivery room surgery, were enrolled into this retrospective study. Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants. RESULTS: A total of 64 infants were identified. The overall survival rate of the infants was 60.9%. The survival rate of infants in inborns was 76.5%, and the survival rate of infants in outborns was 43.3%. Infants of the outborn group took more time to reach full enteral feeding, and were more likely to require a prolonged stay in hospital when compared with those of the inborn group. Logistic analysis identified that the surgical technique, the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis. CONCLUSIONS: The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants.

Feasibility of orthotopic fetal liver transplantation: an experimental study.

BACKGROUND: The use of livers from nonviable fetuses is particularly attractive for its potential to solve the current limitations of organ availability for the pediatric recipient. Therefore, it is essential to study the feasibility of orthotopic fetal liver transplantation. METHOD: We measured the hepatic and extra-hepatic anatomical structures of fetal and neonatal lambs and established an orthotopic liver transplantation model of the fetal lamb. RESULTS: Mean weight of the liver of fetal lambs at 142 to 145 days gestation was 34.75 g and the mean diameter of the portal vein was 3.03 mm, the supra-hepatic vena cava was 5.88 mm, and the infra-hepatic vena cava was 4.00 mm, which matched the corresponding sizes in neonatal lambs aged up to 2 weeks. Using standard surgical procedures we completed the vascular inosculation of fetal liver. However, all the newborn lamb recipients survived less than 24 hours. CONCLUSIONS: Orthotopic transplantation of the fetal liver is anatomically and technically feasible. However, perioperative issues need to be resolved prior to clinical application.

Laparoscopic radical excision of urachal remnants with recurrent infection in infants.

PURPOSE: To evaluate the usefulness of laparoscopic surgery in the management of urachal remnants with recurrent infection in infants. PATIENTS AND METHODS: Eight infants (mean age 9.6 months, range 2-16 months) underwent laparoscopic excision of urachal remnants with recurrent infection between June 2006 and December 2008. During the same period, 10 infants (mean age 13.2, range 4-17 months) underwent open surgery for the same condition. The laparoscopic surgery was performed transperitoneally by using three ports. The urachal remnant was dissected from the umbilicus to the bladder dome and then removed completely. RESULTS: Immediate complications did not develop in any patient. Blood loss, hospital stay, and operative time with laparoscopic surgery were less than those with open surgery. Recurrence did not develop in any patient who underwent laparoscopic surgery, while it did develop in one patient who underwent open surgery. CONCLUSION: The laparoscopic approach appears to be a safe and effective alternative to open surgery in the management of urachal remnants with recurrent infection in infants.

Detection of intestinal bifidobacteria and lactobacilli in patients with Hirschsprung's disease associated enterocolitis.

BACKGROUND: The etiology of Hirschsprung's disease associated enterocolitis (HAEC) is unknown. Previous investigations have suggested that several factors such as dilation of proximal bowel, changes in colonic mucosal defence, and overgrowth of toxigenic bacteria may be related with it. This study was to quantify bifidobacteria and lactobacilli in the feces of Hirschsprung's disease (HD) patients with or without enterocolitis and those of normal children. METHODS: Fresh stool specimens were collected at the first three days of the admission from 30 HD patients (aged 2 weeks to 2 years) and 15 healthy age-matched non-HD patients in the morning once a day for at least three days. All of them have not been given probiotics or antibiotics at least 7 days before stool collection. Hematoxylin-eosin and acetylcholinesterase histochemical staining on rectal biopsies of patients with HD confirmed the diagnosis of HD in all 30 patients. The 30 HD patients were divided into two groups based on the clinical history of enterocolitis: the HAEC group (n=10) and HD group (n=20). Fecal bifidobacteria and lactobacilli were consecutively quantified by SYBR Green I-based real-time PCR assay. Data were analyzed using SAS v. 12.6 for Windows. All tests were two-tailed, and P values <0.05 were considered statistically significant. RESULTS: The mean levels of bifidobacteria were 7.35+/-0.59, 8.16+/-1.17, and 8.35+/-0.74 in the HAEC, HD and control groups, respectively. The bifidobacteria colonization levels were lower in the HAEC group than in the HD and control groups (P<0.05, P<0.001 respectively). The mean level of lactobacilli in the HAEC (5.51+/-0.65) and HD groups (5.87+/-0.78) was significantly lower than that in the control group (6.39+/-0.56) (P<0.05). But there was no difference in log numbers of lactobacilli between HAEC and HD groups (P>0.05). CONCLUSIONS: The scarcity of bifidobacteria and lactobacilli in HAEC patients may result in a decrease in epithelial barrier function and be a predisposing factor in the development of HAEC. This decline suggests that treatment with probiotics or prebiotics may be beneficial in these individuals. Further research will focus on whether probiotics can decrease the incidence of HAEC.

Leydig cell transplantation restores androgen production in surgically castrated prepubertal rats.

Prepubertal testicular dysfunction and the subsequent development of hypogonadism affects an estimated one in 200 children worldwide. As the testosterone levels are dynamic during development and puberty, traditional hormone treatment regimens are often inadequate, thereby leaving associated physiological conditions unresolved. Therefore, we have investigated the potential therapeutic effect of mature Leydig cell transplantation for the treatment of prepubertal primary hypogonadism through the use of a surgically induced hypogonadistic rat model system. In the experiment, Leydig cells were surgically isolated from mature Sprague-Dawley rats and transplanted into prepubertal recipients. Serum testosterone levels and microscopic analysis of the stained testicular interstitium were compared with sham-treated controls, as well as with castrated and intact rats during sexual development. At 4 weeks post-implantation, serum testosterone was detectable in Leydig cell recipients, but not in surgical controls, and progressively increased as a function of time until reaching levels comparable with sexually mature males at 12 weeks post-implantation. Histological analysis revealed a high rate of Leydig cell survival as well as steroidogenic secretory activity. Therefore, we conclude that mature Leydig cell transplantation in prepubertal hypogonadism recipients has therapeutic potential in rats and merits further investigation for clinical application.

[Allotransplantation of Leydig cells increases serum testosterone in rats].

OBJECTIVE: To observe the changes of serum testosterone after allotransplantation of Leydig cells in rats. METHODS: Leydig cells were isolated from the testes of SD rats with the Percoll technique and serum testosterone of the receptors was determined once a month for 3 successive times. RESULTS: After allotransplantation of Leydig cells, the serum testosterone level of the receptors increased gradually, significantly higher at 3 months than that of the normal rats younger than 2 months old. CONCLUSION: Allotransplantation of Leydig cells has a promising application value in the treatment of male primary hypogonadism.

Tight filum terminale syndrome in children: analysis based on positioning of the conus and absence or presence of lumbosacral lipoma.

BACKGROUND: Tight filum terminale syndrome (TFTS) characterized by findings consistent with a tethered cord but with the conus ending in a normal position has only recently been observed in children. In this situation, diagnosis may prove difficult and sectioning of the filum terminale is questionable. MATERIALS AND METHODS: Sixty cases of pediatric TFTS were analyzed by methods including spinal X-ray and magnetic resonance imaging (MRI). Twenty-one patients exhibited a normally positioned conus, 18 a low-lying conus, and 21 a low-lying conus with accompanying lumbosacral lipoma. These three groups were compared preoperatively and postoperatively for lumbosacral cutaneous stigmata, vertebral anomalies, concomitant congenital spinal dysraphisms, lower limb deformities, and sphincter dysfunction. RESULTS: Rates of occurrence of lumbosacral cutaneous stigmata and other concomitant congenital spinal dysraphisms differed significantly among the groups. Differences in other parameters were not observed. All groups responded positively to surgery. CONCLUSIONS: Pediatric TFTS may involve a normally positioned conus. Diagnosis of pediatric TFTS should be based on clinical presentation, physical and radiological examinations, MRI, and pathologic changes in the filum. When neurological signs accompany such changes, early severing of the filum is indicated regardless of conus position.

[Advances in testicular allotransplantation].

Testicular allotransplantation is one of the effective options for the treatment of male infertility and hypogonadism. Since the first experimental testis transplantation, nearly 3 centuries have passed and great strides have been made in this field. Nevertheless there remain some problems that call for the attention of the medical world. Based on varieties of related literature, this paper gives a general review of the history, the status quo and the prospects of testicular allotransplantation.

Long-term influence of prepubertal testicular torsion on spermatogenesis.

PURPOSE: To study the influence of prepubertal unilateral testicular torsion on spermatogenesis postpubertally. METHODS: Sixty prepubertal SD male rats were divided into 6 groups. In each group, animal suffered different courses of unilateral testicular torsion including sham operation, 2- and 6-hour-long torsion, and permanent torsion. Salvia miltiorrhiza was injected as a remedy to release the I/R injury in the 2- and 6-hour-long torted groups. Postpubertally, the percentage of DNA content of haploid cells in the testes was determined individually. RESULTS: The percentage of haploid cells in the sham operation group was 76.5+/-1.9%. The number decreased in every other group (p<0.01). Comparing with the same course of torsion, Salvia miltiorrhiza injection could improve the percentage of haploid cells (p<0.01). In the permanent unilateral testicular torted group, the percentage was nearly zero (0.4+/-0.2%). CONCLUSIONS: Prepubertal unilateral testicular torsion induces decreased spermatogenesis postpubertally. The result takes place in the bilateral testes. Salvia miltiorrhiza, as an antioxidant remedy, could relieve the injury which manifests improved spermatogenesis.

Surgical management to conjoined twins in Shanghai area.

Conjoined twins are very rare congenital malformation. The aim of this study was to summarize our experiences of surgical separation on seven sets of conjoined twins, and improve the treatment of conjoined twins in the future. A retrospective review of surgical separation included data of prenatal diagnosis, associated malformation, timing of separation, intra- and postoperative management, and follow-up of six sets of conjoined twins at Shanghai Xin-Hua Hospital from 1980 to 2005 and one set at Shanghai Children's Hospital in 2002. Surgical separation was performed on seven sets of conjoined twins; six sets of thoracopagus-omphalapagus (including four sets of xipho-omphalopagus) and one set of ischiopagus. All sets presented varying degrees of severity of congenital cardiac malformations. Four sets were diagnosed prenatally by ultrasonography. Two sets of conjoined twins (case 2 and case 3) required emergent separation within 7 days after birth; both members of case 2 died within 2 days post operation, one member of case 3 died during operation while the other member survived. Five sets had scheduled separation undertaken more than 30 days after birth. One member of a set (case 6B) died 13 days after operation due to severe congenital cardiovascular anomalies. All other members of conjoined twins survived. Case 6A had a severe defect of the anterior thoracic cage and prosthesis of titanium alloy scaffold filled with silicone rubber was used to repair the defects successfully. Following up from 1980 to 2005, one member of a set (case 1A) died 4 years after operation due to pneumonia. Contact was lost to the surviving member of case 3 (ischiopagus). Other survivors of the separations had normal development. (1) Timing of operation and separation plan should be given according to the circumstances and the nature of the organ shared in each individual set of twins. (2) Prosthesis of titanium alloy scaffolds filled with silicone rubber may become one of viable methods for repairing severe defects of the thoracic cage.

Bilateral intrarenal pelvis Wilms' tumor with fibroepithelial polyp.

Intrarenal pelvis Wilms' tumor is rare in children. A case of a 28-month-old boy with bilateral intrarenal pelvis Wilms' tumor associated with a fibroepithelial polyp is reported in this article. The tumor was evaluated by ultrasonography, computed tomography, and intravenous pyelography. The boy underwent bilateral renal pelviotomies. Now he is being treated and followed up by pediatric oncologists.

The use of a retrievable self-expanding stent in treating childhood benign esophageal strictures.

BACKGROUND/PURPOSE: Esophageal stenting is a popular form of treatment of esophageal strictures in adults but is not widely used in children. The aim of the current study was to investigate whether esophageal stents could be used safely and effectively in the treatment of esophageal stenosis in children. METHODS: Covered retrievable expandable nitinol stents were placed in 8 children with corrosive esophageal stenosis. The stents were removed 1 to 4 weeks after insertion. RESULTS: The stents were placed in all patients without complications and were later removed successfully. After stent placement, all patients could take solid food without dysphagia. Stent migration occurred in one patient and so the insertion procedure was repeated to reposition the stent. During the 3-month follow-up period after stent removal, all children could eat satisfactorily. After 6 months, 2 children required balloon dilation (3 times in one and 5 times in the other). The dysphagia score improved in all patients. CONCLUSIONS: The use of the covered retrievable expandable stent is an effective and safe method in treating childhood corrosive esophageal stenosis.