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   2014| October-December  | Volume 11 | Issue 4  
    Online since October 17, 2014

 
 
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ORIGINAL ARTICLES
Surgical treatment of chronic osteomyelitis in children admitted from developing countries
Reiner Wirbel, Karl Hermans
October-December 2014, 11(4):297-303
DOI:10.4103/0189-6725.143133  PMID:25323177
Background: The surgical management of chronic osteomyelitis in children is still challenging in developing countries. This study analysed the extent of the disease and the therapeutic regime. Subjects and Methods: This was a retrospective study in two primary health care hospitals from January 2009 to December 2013, 27 children (20 males and 7 females, mean age 7 years) admitted from developing countries who were treated for chronic osteomyelitis. Localization, duration of the disease, extent of the osseous involvement, spectrum of germs, number of previous and required surgical procedures and duration of hospital stay are reported. Results: A total of 16 cases had haematogenous and 11 cases post-traumatic aetiology. The mean duration of the disease was 18 months. On average, three (range, 1-12) previous surgical procedures were performed. The affected bones were: Tibia in 11, femur in 8, forearm in 6 cases, spine and humerus each in 1 case. Staphylococcus aureus was the responsible germ in 75%. On average, four (range, 2-8) surgical procedures were required. Osseous stabilizations were necessary in 17, plastic soft tissue reconstructions in 8 cases. In three cases with metaphyseal/diaphyseal defect, bone transfers had to be performed (2 × fibula-pro-tibia, 1 × rib for radius). The mean hospital stay took 8 (range, 4-20) weeks. Three local recurrences occurred within 3 months, all could be cured surgically. Conclusions: The surgical treatment of chronic osteomyelitis in children requires a radical osseous debridement. The knowledge of different plastic-surgical procedures is necessary to reconstruct osseous and/or soft tissue defects.
  2 6,473 315
A retrospective review of the adnexal outcome after detorsion in premenarchal girls
Abdullah Yildiz, Başak Erginel, Melih Akin, Cetin Ali Karadağ, Nihat Sever, Canan Tanik, Arzu Canmemiş, Ali Ihsan Dokucu
October-December 2014, 11(4):304-307
DOI:10.4103/0189-6725.143134  PMID:25323178
Background: The aim of this study was to report our results on premenarchal girls with adnexal torsion who were treated with different approaches. Materials and Methods: Twenty-six adnexal torsions in children were analysed retrospectively. Group 1 included cases of oophorectomy for the twisted adnexa. Group 2 contained the patients with adnexal torsion who untwisted either with a laparoscopic or open approach. Postoperative restoration of ovarian function was evaluated by Doppler ultrasound at the 6 th month. All oophorectomy and biopsy specimens were also evaluated. Results: Group 1 consisted of eleven cases that underwent oophorectomy due to gangrenous change and haemorrhagic infarction. Histology was of a mature teratoma in two cases and haemorrhagic necrosis due to torsion in seven. Group 2 consisted of 15 patients. In 10 out of 15 patients, preoperative biopsy is performed in which their histology revealed haemorrhagic necrosis in eight cases, and simple cyst with a benign nature in two cases. In all of the 10 untwisted adnexas, postoperative radiological imaging showed complete recovery with normal follicular development. No malignancy or increased tumour markers were noted in both groups. Conclusion: Adnexas can be left in place regardless of the preoperative degree of necrosis. Biopsy can be added to the procedure to rule out malignancy.
  2 6,531 311
CASE REPORTS
Complex bladder-exstrophy-epispadias management: Causes of failure of initial bladder closure
Kouame Dibi Bertin, Kouame Yapo Guy Serge, Sounkere Moufidath, Koffi Maxime, Odehouri Koudou Thierry Hervé, Yaokreh Jean Baptiste, Tembely Samba, Dieth Atafi Gaudens, Ouattara Ossenou, Dick Ruffin
October-December 2014, 11(4):334-340
DOI:10.4103/0189-6725.143149  PMID:25323185
The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0), concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0). The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin) used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation.
  1 4,340 208
HOW I DO IT
Reverse gastric tube oesophageal substitution for staged repair of oesophageal atresia and tracheo-oesophageal fistula
Christopher Olusanjo Bode, Adesoji Oludotun Ademuyiwa
October-December 2014, 11(4):366-370
DOI:10.4103/0189-6725.143180  PMID:25323192
The management of oesophageal atresia and tracheo-oesophageal atresia (OATOF) is very challenging. While in developed countries survival of patients with this condition has improved, the outcome in many developing countries has been poor. Primary repair through a thoracotomy (or video-assisted thoracoscopic surgery where available) is the gold standard treatment of OATOF. However, in our setting where patients typically present late and with minimum support resources such as Neonatal Intensive Care Unit and total parenteral nutrition; staged repair may be the only hope of survival of these patients and this communication highlights the essential steps of this mode of treatment.
  1 2,588 135
ORIGINAL ARTICLES
Challenges in managing paediatric osteomyelitis in the developing world: Analysis of cases presenting to a tertiary referral centre in Tanzania
Adam M Ali, Elisfuraha Maya, Kokila Lakhoo
October-December 2014, 11(4):308-311
DOI:10.4103/0189-6725.143136  PMID:25323179
Background: The literature on paediatric osteomyelitis in the developing world is scarce, and there have been calls for further characterisation of its epidemiology and the identification of factors that limit effective management in order to guide local service delivery. Our centre is a hospital serving a population of 11 million people in Tanzania. Materials and Methods: We identified patients <18 years admitted between 1 st January 2008 and 31 st December 2010 with a diagnosis of osteomyelitis through a search of admission logbooks. Patient notes were reviewed for information regarding the nature of the presentation, treatment given and outcome, with the primary outcome measure being recurrence of infection at follow-up. Results: A total of 63 patients were identified, notes available for 55: 40 males and 15 females, mean age of 11 years. The most common sites were the tibia and femur with other sites including the skull, humerus and foot. At presentation, 8 cases were categorised as acute, 5 as acute with X-ray changes, 40 as chronic localised and 2 as chronic systemic.A total of 11 patients were treated with antibiotics only, 11 with incision and drainage and 30 with surgical debridement. Bacterial cultures were available in 11 cases. all Staphylococcus aureus tested were gentamicin-sensitive, but at least one patient had S. aureus resistant to cloxacillin, erythromycin, co-trimoxazole, tetracycline or a combination of these. Of 29 patients attending follow-up, 20 made a full recovery and 9 developed recurrence of infection. Eight out of nine with recurrence had time from symptom onset to presentation of >3 months. Twelve out of 13 with a time from symptom onset to presentation of <2 months did not develop recurrence. Conclusions: This is, to the best of our knowledge, the second largest study of paediatric osteomyelitis in the developing world. Major challenges facing this centre include a lack of availability of bacterial cultures and failure to attend follow-up. Delayed presentation of osteomyelitis to our centre is associated with recurrence of infection.
  1 2,966 153
Burden of congenital inguinal hernia and hydrocele in northern and southern Nigeria: An opportunity for awareness creation
Musa Ibrahim, Kabiru Ibrahim Getso, Mohammad Aminu Mohammad
October-December 2014, 11(4):312-316
DOI:10.4103/0189-6725.143139  PMID:25323180
Background: Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward. Materials and Methods: Data obtained from organised free hernia missions to the rural populace from northern and southern Nigeria by the West African Collage of Surgeons in 2010 and Kano State Government in 2013 was analysed. Results: A total of 811 patients aged from 3 months (0.25 years) to 35 years was screened and found to have congenital hernia and/or hydrocele from the two centres. 171 (21.1%) were successfully operated, while the remaining 640 (78.9%) could not benefit from a surgical procedure during the missions. There were n = 46 (26.9%) patients with various forms of genital mutilations/and or surgical mismanagements among the operated patients. Conclusion: The burden of congenital anterior abdominal wall defects among Nigerian children is high. A little effort could bring succor and create awareness among this group of people.
  1 2,847 151
Burns injury in children: Is antibiotic prophylaxis recommended?
Jamila Chahed, Amine Ksia, Wieme Selmi, Saida Hidouri, Lassaad Sahnoun, Imed Krichene, Mongi Mekki, Abdellatif Nouri
October-December 2014, 11(4):323-325
DOI:10.4103/0189-6725.143141  PMID:25323182
Background: Wound infection is the most frequent complication in burn patients. There is a lack of guidelines on the use of systemic antibiotics in children to prevent this complication. Patients and Methods: A prospective study is carried out on 80 patients to evaluate the role of antibiotic prophylaxis in the control of infections. Results: The mean age was 34 months (9 months to 8 years). There was a male predominance with sex ratio of 1.66. The mean burn surface size burn was 26.5% with total burn surface area ranging from 5% to 33%, respectively. According to American Burn Association 37% (30/80) were severe burns with second and third degree burns >10% of the total surface body area in children aged <10 years old. Scalds represented 76.2% (61/80) of the burns. Burns by hot oil were 11 cases (13.7%), while 8 cases (10%) were flame burns. The random distribution of the groups was as follow: Group A (amoxicilline + clavulanic acid) = 25 cases, Group B (oxacilline) = 20 cases and Group C (no antibiotics) = 35 cases. Total infection rate was 20% (16/80), distributed as follow: 8 cases (50%) in Group C, 5 cases (31.2%) in Group A and 3 cases in Group B (18.7%). Infection rate in each individual group was: 22.9% (8 cases/35) in Group C, 20% (5 cases/25) in Group A and 15% (3 cases/20) in Group B (P = 0.7). They were distributed as follow: Septicaemia 12 cases/16 (75%), wound infection 4 cases/16 (25%). Bacteria isolated were with a decreasing order: Staphylococcus aureus (36.3%), Pseudomonas (27.2%), Escherichia coli (18.1%), Klebsiella (9%) and Enterobacteria (9%). There is a tendency to a delayed cicatrisation (P = 0.07) in case of hot oil burns (65.18 ± 120 days) than by flame (54.33 ± 19.8 days) than by hot water (29.55 ± 26.2 days). Otherwise no toxic shock syndrome was recorded in this study. Conclusion: It is concluded that adequate and careful nursing of burn wounds seems to be sufficient to prevent complications and to obtain cicatrisation. Antibiotics are indicated only to treat confirmed infections.
  1 4,324 284
Limits and advantages of abdominal ultrasonography in children with acute appendicitis syndrome
Valentina Pastore, Raffaella Cocomazzi, Angela Basile, Marlena Pastore, Fabio Bartoli
October-December 2014, 11(4):293-296
DOI:10.4103/0189-6725.143130  PMID:25323176
Background: Graded compression ultrasonography (US) has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013. Materials and Methods: Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients) and non-operated (260 patients) the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients. Results: Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis. Conclusion: Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis.
  1 3,312 451
Alimentary tract duplications in children: Report of 16 years' experience
Mohamed Zouari, Habib Bouthour, Rabia Ben Abdallah, Youssef Hlel, Riath Ben Malek, Youssef Gharbi, Kaabar Nejib
October-December 2014, 11(4):330-333
DOI:10.4103/0189-6725.143146  PMID:25323184
Background: Alimentary tract duplications (ATDs) are a rare condition in children, characterised by a large pathogenic, clinical, and histological polymorphism. Surgical observation and pathologic evaluation of the resected specimens are the only way to confirm the diagnosis. In this study, we want to analyse the anatomical, clinical and therapeutic aspects of this entity. Patients and Methods: A total of 12 cases of ATD were diagnosed over a 16-year period at paediatric surgery department. The diagnosis was evoked on clinical and radiological data. Histological study of the resected specimens confirmed the diagnosis in all cases. Results: The mean age of patients at diagnosis was 41 months with a peak of incidence at the 1 st year of life (42%). Out of a total 12 cases, 10 were girls and 2 were boys. Abdominal pain and vomiting were the most frequent presenting features. Ultrasonography, tomodensitometry and magnetic resonance imaging were useful for diagnosis. ATDs were localised on the oesophagus in one case, the stomach in one case, the duodenum in four cases, the ileum in five cases, and the colon in one case. All these duplications were cystic, with three communicating duplications. All patients underwent surgery, and resection procedure was chosen according to duplication type and site. Histological study confirmed the diagnosis in all cases. Conclusion: ATDs are a rare condition in children. Diagnosis relies on histology, and treatment can only be by means of surgery. The outcome after surgery is generally favourable. Diagnosis and precocious surgery of ATDs can warn serious complications.
  1 2,334 206
CASE REPORTS
Spinal and pelvic corrections in a patient with spondylocostal dysplasia syndrome and hemimyelomeningocele
Ali Al Kaissi, Ralf Stuecker, Rudolf Ganger, Klaus Klaushofer, Franz Grill
October-December 2014, 11(4):341-346
DOI:10.4103/0189-6725.143163  PMID:25323186
Congenital malformation complex of the spine and the spinal cord can be a syndromic entity rather than a symptom complex. The spinal cord lesion is usually bilaterally symmetrical, but, there are occasional cases with one or more hemivertebrae, often associated with a central bony spur splitting the cord (diastematomyelia), in which one leg is virtually normal while the other is severely paralysed. Hemimyelomeningocele over the lumbar area may be associated with extensive spine malsegmentation compatible with the diagnosis of spondylocostal dysplasia syndrome. In this report, we present a 3-year-old girl who underwent neurological evaluation and spinal imaging studies for extensive spine malsegmentation compatible with spondylocostal dysostosis syndrome associated with hemimyelomeningocele. She had a series of corrective orthopaedic interventions to reconstruct her pelvic girdle and spine deformities, with a satisfactory outcome.
  - 2,873 108
Mesenteric inflammatory pseudo-tumour of the small intestine presenting with intestinal obstruction in a child: Case report and literature review
Toshiaki Takahashi, Tadaharu Okazaki, Geoffrey J Lane, Takuo Hayashi, Atsushi Arakawa, Atsuyuki Yamataka
October-December 2014, 11(4):347-350
DOI:10.4103/0189-6725.143165  PMID:25323187
We report a case of mesenteric inflammatory pseudo-tumour of the small intestine in a 4-year-old boy admitted with intestinal obstruction diagnosed from histopathology of 8 cm × 7 cm × 5 cm mass resected at laparotomy. We reviewed the literature and recommended complete resection with thorough histopathologic evaluation and long-term follow-up.
  - 2,007 134
Littre's hernia in a paediatric patient
Daorui Qin, Guochang Liu, Zhe Wang
October-December 2014, 11(4):351-353
DOI:10.4103/0189-6725.143168  PMID:25323188
Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is generally asymptomatic and manifests only in a specific way when complications exist. Littre's hernia is a rare complication of MD . The definition of Littre's hernia is based upon the protrusion of a MD through a potential abdominal opening accompanied in some cases by incarceration, inflammation, or necrosis. The most common site of Littre's hernia is the inguinal canal, usually on the right. It is difficult to diagnose before surgery. We report a 4-month-old boy with Littre's hernia, including join with incarcerated hernia in the left side.
  - 2,349 117
Heterotopic pancreas in Meckel's diverticulum in a 7-year-old child with intussusception and recurrent gastrointestinal bleeding: Case report and literature review focusing on diagnostic controversies
Guanà Riccardo, Bucci Valeria, Carbonaro Giulia, Cerrina Alessia, Ferrero Luisa, Teruzzi Elisabetta, Mussa Alessandro, Morra Isabella, Schleef Jürgen
October-December 2014, 11(4):354-358
DOI:10.4103/0189-6725.143172  PMID:25323189
Meckel's diverticulum, the most common congenital abnormality of the small intestine, may be associated to heterotopic pancreas, often diagnosed incidentally on histopathological examination. Intussusception affects infants between the ages of 5 and 9 months, but it may also occur in older children, teenagers and adults, and in some cases can be derived by a Meckel's diverticulum resulting in acute abdomen. We analyse the management and the recent literature on similar cases, describing diagnostic options. In May 2013, a 7-year-old girl admitted to our hospital with recurrent gastrointestinal bleeding, was discovered to have an ileoileal intussusception with a leading Meckel's diverticulum with heterotopic pancreatic tissue. This association is rare evidence in children and its proper management can be controversial, in particular from a diagnostic point of view. In such cases, preoperative radiological diagnosis can be only suspected in the presence of suggestive signs, more often depicted by ultrasound or computed tomography scan. During laparotomy an accurate exploration of all ileum is recommended, for the possibility to find others heterotopic segments.
  - 2,574 151
Duodenal obstruction due to a preduodenal portal vein
MNC Vilakazi, F Ismail, HM Swanepoel, EW Muller, ZI Lockhat
October-December 2014, 11(4):359-361
DOI:10.4103/0189-6725.143176  PMID:25323190
An infant presented with clinical signs and symptoms suggestive of a pyloric stenosis. On abdominal ultrasound, pyloric stenosis was excluded, and other causes for proximal duodenal obstruction, such as a duodenal web or annular pancreas, were suspected. At surgery, the cause was found to be due to an anterior portal vein or preduodenal portal vein, compressing the duodenum. There were no associated findings such as midgut malrotation, duodenal web and congenital anomalies. The treatment was a diamond-shaped duodeno-duodenostomy anterior to the portal vein. The patient improved after surgery.
  - 2,732 150
Pyloric atresia-Three cases and review of literature
Sandesh V Parelkar, Satish P Kapadnis, Beejal V Sanghvi, Prashant B Joshi, Dinesh Mundada, Shishira Shetty, Sanjay N Oak
October-December 2014, 11(4):362-365
DOI:10.4103/0189-6725.143178  PMID:25323191
Pyloric atresia (PA) is a rare congenital anomaly that constitutes approximately 1% of all intestinal atresias, and its incidence is approximately 1 in 100,000 live births. PA may occur as an isolated condition or associated with other abnormalities, the most common being Junctional epidermolysis bullosa (JEB). Evidence suggests that PA-EB (Pyloric Atresia - Epidermolysis Bullosa) Syndrome is a distinct entity. In this report, we present three cases of pyloric atresia, one of which was associated with Junctional epidermolysis bullosa. The literature on the subject is also reviewed.
  - 3,657 170
LETTERS TO THE EDITOR
Dog bite injuries of genitalia and rabies immunisation
Mirko Bertozzi, Antonino Appignani
October-December 2014, 11(4):371-371
DOI:10.4103/0189-6725.143183  PMID:25323193
  - 1,475 115
Is it a Palomo's operation?
Nitinkumar Borkar, Nitin K Kashyap, Debajyoti Mohanty
October-December 2014, 11(4):371-372
DOI:10.4103/0189-6725.143188  PMID:25323194
  - 1,513 106
Transanal protrusion of intussusceptions
Beuy Joob, Viroj Wiwanitkit
October-December 2014, 11(4):372-373
DOI:10.4103/0189-6725.143190  PMID:25323195
  - 1,313 114
Topical feracrylum citrate versus adrenaline as haemostatic agent in hypospadias surgery
Sora Yasri, Viroj Wiwanitkit
October-December 2014, 11(4):373-373
DOI:10.4103/0189-6725.143191  PMID:25323196
  - 1,455 104
Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele
Sim Sai Tin, Viroj Wiwantikit
October-December 2014, 11(4):373-374
DOI:10.4103/0189-6725.143192  PMID:25323197
  - 1,408 119
Manual versus hydrostatic reduction for intussusception
Sora Yasri, Viroj Wiwanitkit
October-December 2014, 11(4):374-374
DOI:10.4103/0189-6725.143193  PMID:25323198
  - 1,484 120
ORIGINAL ARTICLES
Our experience with unusual gastrointestinal tract duplications in infants
Bilal Mirza, Sarfraz Ahmad, Arsalan Raza Wasti, Muhammad Afzal Mirza, Nabila Talat, Muhammad Saleem
October-December 2014, 11(4):326-329
DOI:10.4103/0189-6725.143143  PMID:25323183
Background: Classical duplications may present along any part of gastrointestinal tract (GIT) from mouth to anus. Atypical or unusual rare varieties of GIT duplications may also occur, but with different anatomical features. Materials and Methods: We reviewed our 5-year record (February 2008-January 2013) to describe clinical profile of unusual GIT duplications in neonates and small infants. Results: Three patients with atypical variety of GIT duplications were managed in our department during this tenure. Two were females and one male. Age was ranged between 11 days and 2 months. All patients presented with massive abdominal distension causing respiratory embarrassment in two of them. In all patients, the pre-operative differential diagnoses also included GIT duplication cysts. Computerized tomography (CT) scan showed single huge cyst in one and multiple cysts in two patients. In one patient the CT scan also depicted a thoracic cyst in relation to posterior mediastinum. At operation, one patient had colonic tubular duplication cyst along with another isolated duplication cyst, the second case had a tubular duplication cyst of ileum with its segmental dilatation, and in the third case two isolated duplications were found. Duplication cysts were excised along with mucosal stripping in one patient, cyst excision and intestinal resection and anastomosis in one patient, and only cysts excision in one. All patients did well post-operatively. Conclusion: We presented unusual GIT duplications. These duplications are managed on similar lines as classical duplications with good prognosis when dealt early.
  - 2,576 158
An audit of morbidity and mortality associated with foreign body aspiration in children from a tertiary level hospital in Northern India
Aparna Williams, Christina George, Philips S Atul, Sherene Sam, Sharmishtha Shukla
October-December 2014, 11(4):287-292
DOI:10.4103/0189-6725.143129  PMID:25323175
Background: There is paucity of data regarding the morbidity and mortality of rigid bronchoscopy in children for foreign body (FB) retrieval from India. The aim was to audit data regarding anaesthetic management of rigid bronchoscopy in children and associated morbidity and mortality. Materials and Methods: Hospital records of all patients below 18 years of age undergoing rigid bronchoscopy for suspected FB aspiration (FBA) between January 1, 2002 and December 31, 2011 were audited to assess their demographic profile, anaesthetic management, complications, and postoperative outcomes. The children were divided into early and late diagnosis groups depending on whether they presented to the hospital within 24 hours of FBA, or later. Results: One hundred and forty children, predominantly male (75%), with an average age of 1-year and 8 months, presented to our hospital for rigid bronchoscopy during the study period. Majority of children presented in the late diagnosis group (59.29% vs. 40.71%). The penetration syndrome was observed in 22% of patients. Majority of patients aspirated an organic FB (organic: Inorganic FB = 3:1), with peanuts being the most common (49.28%). A significantly higher number of children presented with cough (P = 0.0001) and history of choking (P = 0.0022) in the early diagnosis group and crepitations (P = 0.0011) in the late diagnosis group. Major complications included cardiac arrest (2.1%), pneumothorax (0.7%), and laryngeal oedema (9.3%). The average duration of hospitalization in our series was 3.08 ± 0.7 days. Conclusions: Foreign body aspiration causes considerable morbidity, especially when diagnosis is delayed.
  - 2,898 223
Perioperative blood glucose in a paediatric daycase facility: Effects of fasting and maintenance fluid
Anthony Taiwo Adenekan
October-December 2014, 11(4):317-322
DOI:10.4103/0189-6725.143140  PMID:25323181
Background: Many Children are daily exposed to prolonged preoperative fasting time. The choice of intraoperative maintenance fluid continues to be an issue of controversy. This study assesses the duration of preoperative fast among children undergoing ambulatory surgery and the appropriateness of the maintenance solutions used. Patients and Methods: Seventy-eight children undergoing ambulatory surgery were prospectively randomised to receive lactated Ringer's (LR) solution or 4.3% dextrose in 0.18% saline (DS) as maintenance fluid. The duration of preoperative fast was noted and the blood glucose measured at induction, but before infusion of any intravenous fluid, and subsequently every 30 min. Data were analysed with Statistical Packages for the Social Sciences 16.0 (SPSS incorporated, Chicago Ill, USA). P < 0.05 was considered as significant. Results: The age range was 3 months to 15 years (mean = 4.9 ± 3.6 years); mean weight was 16.3 ± 7.8 kg. The mean duration of fasting was 13.4 ± 3.5 h (range = 4-18.5 h), but no child was hypoglycaemic throughout the study. The mean blood glucose in the LR group rose steadily from 5.18 ± 0.98 mmol/L post-induction to a peak value of 7.40 mmol/L at 120 min. In the DS group, the mean blood glucose level increased from the post-induction value of 5.56 ± 0.86 mmol/L to 12.7 ± 3.98 mmol/L at 120 min. Conclusion: Most children undergoing ambulatory surgery at our facility are still exposed to prolonged fasting time. Glucose containing fluid often administered as maintenance fluid to treat the presumed hypoglycaemia causes worsening hyperglycaemia, which may be harmful.
  - 3,557 190
REVIEW ARTICLE
Management of associated anomalies of oesophageal atresia and tracheo-oesophageal fistula
Kamalesh Pal
October-December 2014, 11(4):280-286
DOI:10.4103/0189-6725.143127  PMID:25323174
Tracheo-oesophageal fistula (TEF)/oesophageal atresia is one of the most common and serious congenital malformation. Despite progresses made in the field of early diagnosis, surgical techniques, ventilatory support and control of chest infections; morbidity and mortality still remains quite high and differs a lot from one to another centre particularly in the developing countries; as the availability and the level of neonatal care facilities are different. Associated anomalies play a significant role in dictating the outcome, timing of intervention and even the approach to management. The objectives of this review article is to outline the spectrum of associated anomalies, emphasise need of standardised system of documentation of anomalies, prognosis and management issues that would influence timing and approach of TEF repair.
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