In-situ emergency pediatric surgery in the intensive care unit.

BACKGROUND: The role of surgery in the intensive care unit (ICU) remains unclear. Although previous studies have not shown any increase in morbidity when operating on patients in the ICU for surgical procedures; there remains a reluctance to operate on sick patients in the ICU. AIM: We did a retrospective study of critically ill children and neonates who underwent in-situ surgery (ISS) to further evaluate its safety and potential. Surgery was aided with the use of operative loupes and high-intensity headlight. METHODS: The medical records of all patients who had undergone surgical procedures in the pediatric ICU over an 11-year period from January 1998 till December 2008 were retrospectively reviewed. We reviewed our experience looking specifically at wound infection rates along with other morbidities in 543 patients. RESULTS: Our morbidities were comparable with that of operations performed in the operating theater, with low wound infection rates (1%) for all surgeries undertaken in the pediatric ICU. CONCLUSION: ISS avoids the risks of transfer to the operative theater and the potential delays in theater access. Our results suggest that ISS in a tertiary-level pediatric surgical hospital is safe and does not impact adversely on clinical outcome.

Three-dimensional analysis of the islet vasculature.

The pancreatic islets of Langerhans are highly vascularized structures scattered throughout the pancreas that contain a capillary network 5-10 times denser than that of the exocrine pancreas. A simple method for three-dimensional (3D) analysis of this intricate intraislet vasculature has been difficult because of the intrinsic opacity of the pancreas. We developed a whole-mount imaging technique that allows relatively easy visualization of the islet vasculature. In combination with confocal microscopy and the use of 3D imaging software, we were able to readily reconstruct the 3D architecture of an islet, allowing delineation of the islet volume, length of the intraislet vessels, and the number of vessel branch-points. This technique allows for straightforward 3D image analysis that may help toward understanding islet function.

Pancreaticoduodenectomy in children: optimising outcome of uncommon paediatric procedures.

Contemporary surgical practice is increasingly dominated by subspecialisation in response to improved outcome from high volume centres, though uncertainties persist for uncommon paediatric procedures. Three paediatric pancreaticoduodenectomies performed at Our Lady's Children's Hospital, Dublin, over a period of 9 years were evaluated to substantiate their continuing performance by paediatric rather than adult pancreatic surgeons. With ages ranging from 18 months to 8 years old, the mean operating time was 263 minutes, while the average hospital stay was 12 days. There was no perioperative mortality, although complication rate was 100%. Re-operation was required in 33%. The long term outcome of this small paediatric cohort was comparable to adult series despite the low patient accrual, underscoring the advantages of a multidisciplinary approach afforded by tertiary paediatric institutions for intricate yet infrequent operations in children.

A 9-year single center experience with circumumbilical Ramstedt's pyloromyotomy.

INTRODUCTION: Pyloric stenosis is a common cause of vomiting in infancy and is usually treated with a Ramstedt's pyloromyotomy. In this study we retrospectively reviewed our experience with the circumumbilical incision for the treatment of pyloric stenosis with a particular emphasis on the relation between postoperative emesis and postoperative time to feeds. MATERIAL AND METHOD: The medical records of all patients undergoing pyloromyotomy for IHPS from January 2000 to December 2008 were reviewed retrospectively. Patient details were recorded and statistically analyzed using SPSS version 13. We reviewed our experience looking specifically at the postoperative time to initial feeds as a way of minimizing hospital stay. RESULTS: 513 patients' notes were available for the study. There were 440 males and 73 females (M:F ratio 6:1). Median age at operation was 40 days (2-194 days) and a positive family history was obtained in 11.9%. Median duration of symptoms was 10 days (range 1-60 days). There were 31 (6%) complications related to surgery. The average number of postoperative emesis episodes was 1.9. The median postoperative hospital stay was 2 days (1-60). The average time to feeding was 20 h (1-69). CONCLUSION: This is a large single-center retrospective study where, in the era of minimally invasive surgery, Ramstedt's pyloromyotomy via the circumumbilical approach has a low rate of complications and is a safe and feasible method to treat pyloric stenosis. The establishment of feeds soon after surgery minimizes the postoperative in-hospital stay.

Sport injuries in Donegal Gaelic footballers.

We aimed to identify any pattern of injuries that impacted on the long-term physical wellbeing o f players, sustained by Senior County Gaelic-football players during their playing career and the impact of those injuries on their quality of life. A questionnaire was sent to different Donegal-Panels looking for injuries and surgical procedures undergone in playing and post-playing career including chronic joint and musculoskeletal problems.

Clinical trial: randomized, double-blind, placebo-controlled study of nitazoxanide monotherapy for the treatment of patients with chronic hepatitis C genotype 4.

BACKGROUND: Nitazoxanide, licensed in the US for treatment of Cryptosporidium parvum and Giardia lamblia, inhibits hepatitis C virus replication in replicon systems. AIM: To evaluate the safety and efficacy of nitazoxanide monotherapy for the treatment of chronic hepatitis C. METHODS: This multicentre, randomized, double-blind, placebo-controlled study randomized 50 adult patients with chronic hepatitis C genotype 4 at three centres in Egypt to nitazoxanide 500 mg tablet or placebo twice daily for 24 weeks. Patients were followed up every 4 weeks during treatment and for 24 weeks after therapy. RESULTS: Seven of 23 patients (30.4%) in the nitazoxanide group achieved undetectable serum HCV RNA compared to 0 of 24 in the placebo group during therapy (P = 0.004). Each of the seven responders had baseline HCV RNA levels < or =400 000 IU/mL. Six of the seven virological responders were followed up for 24 weeks after the end of treatment, and four patients (17.4% of 23 treated) had a sustained virological response. Adverse events were similar in the nitazoxanide and placebo groups. CONCLUSION: Nitazoxanide monotherapy is safe and effective in achieving sustained virological response in a modest number of patients with chronic hepatitis C genotype 4, particularly in patients with low baseline serum HCV RNA levels.

Nitazoxanide in the treatment of viral gastroenteritis: a randomized double-blind placebo-controlled clinical trial.

BACKGROUND: Enteric viruses including noroviruses and rotavirus are leading causes of diarrhoeal disease and gastroenteritis worldwide, and there is no effective treatment. AIM: To evaluate nitazoxanide, a thiazolide anti-infective agent, in treating viral gastroenteritis in adults and adolescents. METHODS: 50 out-patients at least 12 years of age (mean 33.5 years) presenting with diarrhoea and stool-positive by enzyme-linked immunosorbent assay for norovirus, rotavirus or adenovirus were enrolled in a double-blind, placebo-controlled clinical trial. Patients were randomly assigned either nitazoxanide 500 mg or placebo twice daily for 3 days. The primary end point was time from first dose to resolution of symptoms. Analysis was modified intent-to-treat for 45 patients, excluding five patients with other identified enteropathogens at baseline. RESULTS: The median time from first dose to resolution of symptoms was 1.5 days (IQR: 0.5-2.5) for nitazoxanide-treated patients and 2.5 days (IQR: 1.5-4.5) for the placebo group. Significant reductions in time to resolution of symptoms were observed for all patients analysed (P < 0.0001) and for subsets of patients with rotavirus (P = 0.0052) and norovirus (P = 0.0295). The number of patients with adenovirus (n = 5) was too small to draw any conclusion. No significant adverse events were reported. CONCLUSIONS: Nitazoxanide may play an important role in managing viral gastroenteritis in adults.

Diagnosis of bilharziasis (S. haematobium and S. mansoni) by the ELISA using the homologous antigen.

Sera of subjects with S. haematobium, S. mansoni and mixed infection were studied by the ELISA by means of homologous antigens. The extinction values for S. haematobium and S. mansoni cases were higher with the homologous antigen. Generally, S. haematobium cases were less reactive than S. mansoni or mixed infection.