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January-December 2019
Volume 16 | Issue 1-4
Page Nos. 1-48

Online since Wednesday, September 16, 2020

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ORIGINAL ARTICLES  

Accuracy of ultrasonography in the evaluation of abdominal masses in children in Nigeria Highly accessed article p. 1
Adebayo Ayokunle Adedayo, Joseph Bako Igashi, Philip Mari Mshelbwala, Abdulrashid A Nasir, Emmanuel A Ameh, James O Adeniran
DOI:10.4103/ajps.AJPS_74_16  PMID:32952131
Introduction: Abdominal masses in children constitute a spectrum of lesions of diverse origin, nature and significance. In a low-income setting with limited investigative facilities, accurate diagnosis of abdominal masses can be very challenging. However, ultrasound has been used preferentially as a diagnostic tool in evaluating abdominal masses in children. This study aimed to determine the accuracy of ultrasound evaluation of abdominal masses in children. Materials and Methods: This was a prospective descriptive study of 135 consecutive children presenting with palpable and/or suspected abdominal masses over a 1-year period at a tertiary hospital. Data analyses were done using SPSS version 17 software and level of significance was set at P < 0.05. Results: Abdominal mass was located in the kidney in 40 (32.3%) patients. Definitive diagnoses of abdominal masses were confirmed intraoperatively in 33 (24.4%) and by histopathological examination in 102 (75.6%) cases. Abdominal masses were detected in 124/135 (91.9%) of the participants. Ultrasound (US) correctly identified 109/124 (87.9%) of the pathologies. The sensitivity and specificity of USS were 87.9% and 81.8%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) were 97.2%–98.2% and 37.5%–45.7%, respectively. The overall US diagnostic accuracy was 87.4%. The predictive value of US for intussusceptions, Wilms' tumour and hydronephrosis was high (sensitivity was 92.0%, 95.8% and 81.1% and PPV was 90.0%, 83.0% and 93.8%, respectively). On the other hand, the sensitivity indices for appendiceal mass/abscess, lymphoma and neuroblastoma were low (28.6%, 66.7% and 57.1%, respectively), while their PPV was low too (66.7%, 42.9% and 77.7%, respectively). The PPV was especially poor for lymphoma. The specificity and NPV indices for these six disease conditions were good. Conclusion: Ultrasound is a reliable tool in the evaluation of abdominal masses in children in this setting.
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Laparoscopic treatment of varicocele within adolescents in two African countries Highly accessed article p. 6
Gbenou Antoine Seraphin, Fiogbe Michel Armand, Akakpo-Numado Gamedzi Komlatsè, Metchihoungbe Codjo Serge, Uroz Tristan Jos
DOI:10.4103/ajps.AJPS_28_16  PMID:32952132
Varicocele is often ignored by adolescents and their parents, in our context. The aim of the study is to present the indications and results of laparoscopic treatment in a population of adolescent students. Subjects and Methods: It is a descriptive and analytical prospective study over a period of 9 months (January to September 2013), focussed on cases of varicocele Grade 3 found in adolescents during a screening, and who underwent surgical treatment by laparoscopy. The laparoscopic treatment was done as part of a training mission to paediatrics surgeons, through a European Non-governmental organisation in two university hospitals in Africa. Of 2724 adolescent students examined, 149 (5.47%) had a varicocele. The average age was 16.39 ± 2.05 years (12 and 19). The side was unilateral (79.19%) with 76.51% left or bilateral (20.81%) (P = 0.00). According to the classification of Dubin and Amelar, there were 58 (38.92%) cases of Grade 1, 66 (44.30%) were Grade 2 and 25 (16.78%) were Grade 3. Results: The laparoscopic treatment was performed in 23 patients with varicocele Grade 3, by modified Palomo's technique, sectioning a segment of vessels between clips (15) between nodes (2) or after coagulation without clips and ligation (6). The hospital stay was 36 h. It has been observed one case of post-operative moderate vaginal hydrocele and 11 cases testicular hypertrophy. Conclusion: The laparoscopic treatment of varicocele in adolescents reduces post-operative morbidity related to conventional open surgery. This technique has been available in two poor African countries through partnership north-south.
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Preservation of glanular cleft in the configuration of a vertical slit neomeatus in modified mathieu hypospadias repair p. 10
Khizer Mansoor, Thomas Tsang, Philemon E Okoro
DOI:10.4103/ajps.AJPS_67_17  PMID:32952133
Background: The aim of this study is to review the results of modified Mathieu's repair in a single surgeon's series. The technique involved preserving the apical part of the glanular cleft including the lips, part of the un-formed glanular meatus in the reconstruction of a vertical slit neomeatus. The achievement of a vertical slit neomeatus was critically assessed. Materials and Methods: A retrospective analysis was carried out for all cases of Mathieu's repair done by a single surgeon over the past 22 years (1995–2017). Inclusion criteria included all cases of coronal, subcoronal and distal penile hypospadias. Cases done as redo secondary Mathieu's procedure were also included irrespective of the type of primary procedure. Results: A total of 97 cases fulfilled the inclusion criteria. 91 patients had a primary Mathieu's procedure. Six patients had a Mathieu's repair as a secondary operation. The complications included 4 fistulas (4.12%), 3 meatal retractions (3.09%) and 2 mild stenosis (2.06%). There were no breakdowns of the repair Ninety-four patients (96.90%) had a glanular vertical slit neomeatus. This included patients with a fistula and both patients with mild stenosis. All fistulas were successfully closed in a single attempt. Four patients (4.12%) had a slight splaying of the lower end of the meatus and three circular neomeatus (3.09%). Both cases of stenosis responded well to dilatation. Conclusion: Mathieu's repair is an old and time-tested technique used in surgery of distal hypospadias. With modification aiming to preserve the apical part of the glanular cleft adopted, a vertical slit neomeatus can be achieved readily as shown by our series and major complications appear rather uncommon.
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A new enema for treatment of intussusception with hydrostatic reduction: Olive oil p. 14
Burhan Beger, Ebuzer Duz, Baran Serdar Kizilyildiz, Huseyin Akdeniz, Mehmet Melek, Kemal Agengin, Veli Avci, Bulent Sonmez
DOI:10.4103/ajps.AJPS_83_17  PMID:32952134
Objectives: Intussusception is routinely treated using ultrasound-guided hydrostatic reduction (USGHR) with normal saline in our paediatric surgery department. With this study, olive oil was added to normal saline in ultrasound-guided reduction of intussusception. Materials and Methods: Forty patients who were diagnosed and treated for intussusception in Van Yuzuncu Yıl University Faculty of Medicine Pediatric Surgery Department from March 2017 to May 2017 were included in the study. During this retrospective study, randomly chosen 20 patients that treated with USGHR using normal saline were marked as Group 1. Moreover, 20 patients that treated with USGHR using a mixture of olive oil and saline (10% olive oil 90% normal saline) were marked as Group 2. Patients' age, gender, symptoms, treatment techniques, complications and hospitalisation periods were retrospectively noted. Results: Forty patients were included in the study. In Group 1, 14 patients were treated in the first session, 4 patients were treated in the second session and 2 patients required laparotomy. Mean reduction time in this group was 15 min mean fluid volume used in each reduction was 80 ml/kg and mean hospitalisation period was 38 h. In Group 2, 19 patients were treated in the first session, and only 1 patient required a second session. Mean reduction time was 12 min, used fluid volume was 58 ml/kg for each reduction and hospitalisation period was 24 h. Conclusion: The average volume of fluid used for reduction, average reduction time, numbers of recurrent reductions and hospitalisation were less when a mixture of olive oil and normal saline were used in comparison with when normal saline was used alone to reduction the intussusception under ultrasound guidance. Using olive oil mixed with normal saline as a new enema fluid is likely to increase the success rate of ultrasound-guided reduction of intussusception.
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Evaluation of topical corticosteroids in children with phimosis through morphological and immunohistochemical analyses of the foreskin p. 17
Luis Gustavo Sabino Borges, Maria Flávia Meirelles, Natália Bernardes, Felipe Lopes de Castro, Fernanda Rodrigues Helmo, Laura Penna Rocha, Vicente de Paula Antunes Teixeira, Rosana Rosa Miranda Correa
DOI:10.4103/ajps.AJPS_119_16  PMID:32952135
Introduction: Histopathological analysis of the foreskin has become more common in the last two decades. Objectives: This study aims to analyze the morphology of the foreskin and determine the effects of topical corticosteroid therapy on this tissue. Materials and Methods: We retrospectively evaluated forty foreskin samples from children aged from 2 years to 15 years with phimosis undergoing circumcision at our institution over a 2-year period. In the foreskin samples, we analyzed the elastic fibers (Verhoeff), epidermal thickness (hematoxylin and eosin), and Annexin 1 and Langerhans cells (LCs) (immunohistochemistry).Results: In the present study, 18 (45%) patients made use of topical corticosteroids, and 22 (55%) did not, while 4 (10%) had a history of balanoposthitis as previous complication. Forty patients were divided according to the parameter analyzed: with or without previous complication and with or without previous topical corticotherapy. Annexin 1 expression was significantly higher in group with a history of complications when compared with group without complications (P = 0.024) and lower in the group of those who used corticosteroids when compared with those who did not used corticosteroids (P = 0.364). In the analysis of all samples, the density of mature LCs was significantly higher when compared with immature LCs (P < 0.0001). The density of immature LCs was significantly higher in patients without previous complications when compared with group with complications (P = 0.028). Conclusions: These findings contribute to a better understanding of the histopathological aspects of previous complications and of treatment with corticosteroids in children with phimosis.
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A constellation of orthopaedic deformities in connection with cartilage oligomeric matrix protein mutation p. 23
Ali Al Kaissi, Maher Ben Ghachem, Vladimir Kenis, Eugene Melchenko, Franz Grill, Rudolf Ganger, Susanne Gerit Kircher
DOI:10.4103/ajps.AJPS_90_17  PMID:32952136
Background: Trendelenburg's gait can be observed in Legg-Calvé-Perthes disease, antalgic gait observed in osteoarthropathy and waddling gait is usually seen in genu varum and circumduction gait in patients with genu valgum. Disabling pain was a prime manifestation in slipped capital femoral epiphysis (SCFE). Limited joint range of motion with an inability to bear full weight on an affected extremity with swaying and wide-based gait is seen in patients with malalignment of the lower limbs. All the above-mentioned deformities have been labelled as idiopathic. The main objective of this article is to approach to the aetiology understanding. Patients and Methods: Ten children (3 girls and 7 boys with age average of 9 years) presented with variable deformities; Perthes-like deformity, genu varum/valgum and osteoarthropathy and one patient with SCFE. Clinical and radiological phenotypes were the baseline tool of diagnosis. Genotypic characterisations were performed. Results: Diverse clinical presentations of Perthes-like disease, osteoarthropathy, genu varum/valgum and SCFE were the most prominent skeletal abnormalities in patients manifested cartilage oligomeric matrix protein (COMP) gene mutation. Conclusion: The value of presenting this article is fourfold; first to signify that mutation study was essential for the increment of knowledge related to the genotype–phenotype relationships. Second, to indicate that professional awareness is needed to differentiate between the hidden pathologies in patients with Perthes-like deformity, genu varum, genu valgum and early osteoarthritis in correlation with COMP gene mutation. Third, it is mandatory to question the validity of the term idiopathic. Fourth, this article is an attempt to sensitise orthopaedic physicians and surgeons that deformities might be stemmed from diverse forms of intrinsic bone disorders.
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Transanastomotic tube in intestinal atresia: How beneficial are they? p. 29
Nitin Sharma, M Amin Memon, Shipra Sharma, Mini Sharma, Basant Chaurasia, Sewak Ram Verma
DOI:10.4103/ajps.AJPS_101_17  PMID:32952137
Introduction: Intestinal atresia requires multiple surgeries and long hospital stay. We tried managing these cases by primary anastomosis with transanastomotic tube (TAT) for early feeding. Aims: The aim of the study was to analyse the outcomes in patients of intestinal atresia who underwent primary anastomosis with a TAT. Materials and Methods: The records between June 2014 and November 2017 were analysed. Those with incomplete data or unclear final outcome were excluded. Patients managed by primary anastomosis with TAT (Group A) or without TAT (Group B) were included. The TAT was kept for 6 weeks. Oral feeds were started after 2 weeks in all the cases. P < 0.05 was considered as statistically significant. Results: Forty-eight cases were included. There were two duodenal atresia, 29 jejunal atresia and 17 ileal atresia. The mean age at surgery was 2 days (range: 1–16 days). There were 42 cases in Group A (with TAT) and six in Group B (without TAT). The average duration of start of feeds was 78 h (range: 72–96 h) in Group A and 402 h (range: 360–504 h) in Group B (P = 0.01). The mean duration of hospital stay was 7 days (range: 5–15 days) and 27 days (range: 19–48 days) in Group A and B, respectively (P = 0.02). The overall survival was 38 (91%) and 3 (50%) in Group A and B, respectively (P = 0.01). Reexploration was required in 2/42 and 2/6 cases in Group A and B, respectively (P = 0.4). Total parental nutrition was required in 2/42 and all cases in Group A and B, respectively. Conclusion: Primary repair in intestinal atresia with a TAT is a practical option. The overall outcome is better.
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CASE REPORTS Top

Pediatric fitz-hugh-curtis syndrome diagnosed by magnetic resonance imaging p. 33
Kazuaki Shibuya, Hisayuki Miyagi, Shohei Honda, Akinobu Taketomi
DOI:10.4103/ajps.AJPS_34_17  PMID:32952138
A 17-year-old girl, who had a sexual intercourse history, presented with fever and right upper quadrant pain. On physical examination, tenderness and percussion tender were identified at that quadrant point, but cervical motion tenderness was not identified. Plane X-ray, abdominal ultrasonography, and nonenhanced abdominal computed tomography, because of contrast agent allergy, showed no specific findings. Nonenhanced magnetic resonance imaging (MRI) demonstrated the high-intensity area in the surface and subcapsule of the liver. From vaginal discharge, polymerase chain reaction for Chlamydia trachomatis was positive. Considered physical and MRI findings, Fitz-Hugh-Curtis syndrome was diagnosed. After Azithromycin administering (1000 mg/day), she got better and discharged.
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Injury of the external genitalia in 10-year-old boy p. 35
Kleanthis Anastasiadis, Chrysostomos Kepertis, Dimitrios Sfoungaris, Ioannis Spyridakis
DOI:10.4103/ajps.AJPS_98_17  PMID:32952139
Degloving injury of penis and scrotum is very rare in child population and requires early reconstructive surgery for good outcomes. We report a 10-year-old boy with complete avulsion of the scrotum and partial of the penis caused by a bicycle chain due to off-road bicycling. The patient has been treated successfully with a single-staged surgery.
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How replace the gastrostomy tube in children with extremely compromised general conditions p. 38
Carmine Noviello, Marcedes Romano, Lorenzo Rossi, Giovanni Cobellis, Ascanio Martino
DOI:10.4103/ajps.AJPS_100_17  PMID:32952140
The percutaneous endoscopic gastrostomy is the best technique to use in case of children requiring long-time enteral nutrition. The first replacement of the tube is easy in most of the patient, but this step can be extremely problematic in patients with compromised general conditions. The authors report their experience in some cases. Two boys with endoscopic gastrostomy had a deterioration in the general conditions, when replacing the probe, these conditions contraindicated anaesthesia for which the “cut-and-push” technique was adopted in a patient with heart malformation and a local anaesthetic in a neuropathic patient. Both the boys died a few days after this procedure. In our opinion, in children who are not using anaesthesia to reposition the gastrostomy probe, it is best to continue feeding through the nasogastric probe.
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Scrotal hematoma of the newborn in the tropics: What attitude? p. 40
Ello Nicolas Moh, Yapi Landry Ake, Kokoe Gonebo Midekor, Sohie Dria A.K. Kouassi, Leopold Azakpa, Rebecca Bonny
DOI:10.4103/ajps.AJPS_17_17  PMID:32952141
Scrotal hematoma (SH) in newborn is a rare condition. It can occur secondary to adrenal hemorrhage which often is associated with birth trauma. Scrotal hematoma often raises the suspicion of testicular torsion leading to unnecessary surgery. We report two cases which improved our management approach.
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Spontaneous gallbladder perforation occurring at neck in an 8-year old boy p. 43
Ashesh Kumar Jha, Abhishek Singh Rathore, Kamal Raikuni, Renu Gupta
DOI:10.4103/ajps.AJPS_4_17  PMID:32952142
Spontaneous gallbladder perforation (GBP) is a rare condition. Most of these perforations occur at the fundal region of the gallbladder. Perforation occurring at the neck of the gallbladder seems to be the rarest phenomenon. We herein describe a case of spontaneous GBP occurring at the neck of gallbladder in an 8-year-old boy, which was managed satisfactorily by surgical exploration and cholecystectomy.
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Asymptomatic perforated gastric duplication clogged by omentum, anorectal malformation and agenesis of the corpus callosum: A rare combination p. 46
Samia Belhassen, Salwa Ammar, Arije Zouaoui, Nouri Abdellatif
DOI:10.4103/ajps.AJPS_4_18  PMID:32952143
Gastric duplication cysts are uncommon congenital anomaly and its association with other malformations is rarely reported. Many theories exist for the development of these lesions. This case report describes coincidental detection of perforated gastric duplication clogged by the omentum associated with anorectal malformation and agenesis of the corpus callosum.
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