Ultrasound Findings to Predict Risk of Recurrence in Pediatric Intussusception After Air Enema Reduction.

OBJECTIVES: Intussusception is one of the most common abdominal emergencies in early children. Intussusception recurs in 8-20% of children after successful nonoperative reduction. The aim of this study was to explore the ultrasound findings to predict risk of recurrence in pediatric intussusception after air enema reduction. METHODS: A total of 336 intussusception children were followed up for 1 year after received successful air enema reduction. They were divided into the recurrent group and the non-recurrent group. The differences of clinical characteristics, ultrasonic features, and laboratory tests were analyzed by univariate analyses and the Cox proportional hazard model. RESULTS: Sixty-five children with recurrent intussusception were identified. There were statistically significances in the diameter of the mass, in the presence or absence of enlarged lymph nodes out of the sleeve, and in the sleeve between recurrent and non-recurrent groups (P < .05). Other ultrasonic features, clinical characteristics, and blood parameters had no differences (P > .05). Multivariate Cox proportional hazard model showed that the diameter of the mass and abdominal lymph nodes may be the risk factors of intussusception recurrence (HR = 1.395, 95% CI: 1.045~1.863 and HR = 2.078, 95% CI: 1.118~3.865, P < .05). The cut-off value of mass diameter was 2.55 cm, above which recurrence is more likely. CONCLUSIONS: Intussusception recurrence was prone with greater mass diameter (>2.55 cm) and enlarged abdominal lymph nodes. Although these ultrasound findings for recurrence do not necessarily reduce the rate of recurrence, it can predict the recurrent possibility, and help the emergency physicians to be more vigilant in these children and better counsel parents upon discharge.

Surgical outcomes of bladder augmentation: A comparison of three different augmentation procedures.

BACKGROUND: Augmentation cystoplasty is indispensable in many pediatric diseases, especially neurogenic bladder. Various methods and materials are used to augment the bladder, and these methods are associated with different shortcomings and complications. AIM: The present study reported the mid-term outcomes of patients undergoing various bladder augmentation procedures in a single institution, and assessed whether seromuscular cystoplasty lined with urothelium (SCLU) provided better urodynamic results than auto-augmentation (AA). METHODS: A retrospective review of 96 patients undergoing various augmentation methods between 2003 and 2018 was performed. The patients were divided into three groups according to the type of augmentation, and their outcomes were compared. All patients developed neurogenic bladder due to myelomeningocele or sacrococcygeal teratoma. The clinical data of all patients were collected. RESULTS: The mean ages at surgery in the three groups (standard cystoplasty [SC], SCLU, AA) were 10.8, 7.5, and 4.8 years, respectively, with mean follow-ups of 36, 61, and 36 mo, respectively. The mean preoperative and postoperative bladder capacities of the SC, SCLU, and AA groups were 174 ± 11.7 vs. 387 ± 13.7 (P < 0.0001), 165 ± 12.2 vs. 240 ± 14.7 (P = 0.0002), and 138 ± 16.7 vs. 181 ± 9.9 (P = 0.0360), respectively. Compared with the AA group, the SCLU procedure did not have better postoperative urodynamic parameters. Incontinence was reduced in most patients. The mean times of clean intermittent catheterization per day in the SC, SCLU, and AA groups were 5.6, 7.8, and 8.2, respectively. The main complications of the SC group were recurrent urinary tract infections (8%) and bladder calculi (6%). Re-augmentation was done in patients in the SCLU (8) and AA (3) groups. CONCLUSION: SC provided sufficient bladder capacity and improved compliance with acceptable complications. After AA and SCLU, the patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation. Compared with AA, SCLU did not yield better postoperative urodynamic parameters.

[Magnetic resonance imaging of children with fecal incontinence after anoplasty for anorectal malformation and its clinical significance].

OBJECTIVE: To study the development of pelvic floor muscle, morphology and location of rectum and anal canal as well as morphology of spinal cord and sacrum based on pelvic magnetic resonance imaging(MRI) of children with fecal incontinence after anoplasty for anorectal malformation and to provide information on management of fecal incontinence. METHODS: Clinical and MRI data of 34 children with fecal incontinence after anoplasty for anorectal malformation in the Second Hospital of Shangdong University from September 2009 to December 2011 were analyzed retrospectively. There were 21 males and 13 females with the age of 3 to 14 years old. All the children underwent MRI detection. The morphology of external anal sphincter, puborectalis, ani levator, rectum and anal canal as well as the development of spinal cord and sacrum were observed using 1.5T MR scanner, including routine axial view, coronal view and sagittal view. RESULTS: MRI revealed that dysplasia of external anal sphincter, puborectalis and anilavatory were found in 18, 23 and 27 children, respectively. MRI also showed ectopia of rectum(n=6), dilation of rectum(n=12), increased anorectal angle(n=11), fat tissue around the anal canal(n=5), tethered cord syndrome(n=2), Currarino syndrome(n=2), sacrum dysplasia(n=11); and rectourethral fistula(n=2). The above MRI findings were confirmed by operation and clinical practice. CONCLUSIONS: MRI can provide clear morphology of external anal sphincter, puborectalis and ani lavatory, and location of rectum and anal canal as well as the development of spinal cord and sacrum. MRI is a valuable method to evaluate the children with fecal incontinence after anoplasty.

Changes of lipid peroxidation in carbon disulfide-treated rat nerve tissues and serum.

To further elucidate the mechanism and determine the biomarker of neuropathy induced by carbon disulfide (CS(2)), we performed a longitudinal observational study of reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GSH-Px), catalase (CAT), superoxide dismutase (SOD) and total antioxidative capacity (T-AOC) in rat cerebral cortex, hippocampus, spinal cord and serum after 0, 2, 4, 8 and 12 weeks of CS(2) administration. CS(2) exposure was found to markedly increase ROS and MDA levels in cerebral cortex, hippocampus, spinal cord and serum of rats in both time and symptom-dependent manners. Although SOD activities slightly increased, there was a decrease in the GSH contents and GSH-Px, CAT activities in cerebral cortex, hippocampus, spinal cord and serum after 2, 4, 8 or 12 weeks' CS(2) intoxication and at gait score of 2, 3, or 4. The activities of T-AOC also decreased in all three nerve tissues and serum as time went on and symptom developed. Furthermore, significant correlations between LPO and gait abnormality were observed as symptom developed. Oxidation stress also resulted in Ca(2+) concentrations and calmodulin (CaM) levels increases in cerebral cortex, hippocampus and spinal cord. Thus, CS(2) intoxication was associated with elevation of lipid peroxidation (LPO) and reduction of antioxidant status, and the time and symptom-dependent changes of these indexes in rats' nerve tissues and serum suggested that ROS and concomitant LPO, at least in part, were involved in CS(2)-induced neuropathy.