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   2016| January-March  | Volume 13 | Issue 1  
    Online since May 3, 2016

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Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy
Taiwo Olugbemiga Adedeji, Yemisi B Amusa, Ademola A Aremu
January-March 2016, 13(1):14-19
DOI:10.4103/0189-6725.181701  PMID:27251518
Background: Adenoid hypertrophy is one of the most common health problems affecting the paediatric population. This study aims to correlate adenoidal nasopharyngeal ratio (ANR) with symptoms of enlarged adenoids in children with enlarged adenoids. Materials and Methods: It was a year, cross-sectional, hospital-based study conducted at Lautech Teaching Hospital, Osogbo. ANR was determined by dividing adenoidal depth with nasopharyngeal depth on the plain lateral radiographs. Results: A total of 90 consecutive children consisting of 61 males and 29 females were included in the study with M:F ratio of 2.1:1. Their ages ranged from 8 months to 11 years. All the patients presented with nasal obstruction, mouth breathing and noisy breathing. Majority (64.5%) had severe obstructions with preponderance among children of 3-5 years (39.9%). Linear regression analysis showed significant association between age and ANR (t = 10.447, P < 0.001). There was high significant association (P < 0.05) between presenting symptoms and degree of nasopharyngeal airway obstruction; for snoring (r = 0.251, P = 0.000), sleep apnoea (r = 0.594, P = 0.000), nasal discharge (r = 0.314, P = 0.001), excessive daytime sleepiness (r = 0.219, P = 0.019) and failure to thrive (r = 0.240, P = 0.011). Conclusion: Lateral X-ray of the nasopharynx is an effective tool to evaluate children with suspected adenoid hypertrophy. It correlates well with patients' symptoms and provides objective measures of adenoid hypertrophy.
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Forgotten/retained double J ureteric stents: A source of severe morbidity in children
Rajendra B Nerli, Prasad V Magdum, Vikas Sharma, Ajay Kumar Guntaka, Murigendra B Hiremath, Shridhar Ghagane
January-March 2016, 13(1):32-35
DOI:10.4103/0189-6725.181704  PMID:27251521
Background: The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. Materials and Methods: Hospital records of all patients' <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. Results: During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. Conclusions: Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain.
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One-stage vs. three-stage repair in anorectal malformation with rectovestibular fistula
Omid Amanollahi, Saman Ketabchian
January-March 2016, 13(1):20-25
DOI:10.4103/0189-6725.181702  PMID:27251519
Background: Anorectal malformations (ARMs) disease is one of the congenital anomalies with an incidence of about 1 in 5000 neonate births, and treatment requires surgical intervention. Selecting the one- or three-step surgical procedure to treat the disease, especially in female neonates with rectovestibular fistula, is a subject of debate. This study aims to compare the advantages and disadvantages of these two methods. Materials and Methods: Forty female neonates with ARM and rectovestibular fistula between March 2011 and March 2013 were included in the study, and they were divided into two equal groups. Allocation of the first case was random, and all cases were then allocated alternatively (every other subject was assigned to a treatment group) until each group received 20 cases equally patients of study group underwent a one-stage posterior sagittal anorectoplasty (PSARP) and in control group patients underwent a three-stage operation (colostomy, PSARP, and closure of colostomy). The complications during and after the surgery were recorded in both groups, and the results were compared. Results: In the control group, only one case (5%) of wound infection and dehiscence was seen, whereas in the one-stage study group, six cases (30%) of wound infection and dehiscence were seen (P value = 0.046). However, regarding the incidence of other complications, such as iatrogenic vaginal injury as well as final recovery, no considerable differences were seen between the two groups. Conclusions: Despite more surgical site infections and dehiscence in the one-stage repair, but due to the numerous advantages compared to the three-stage method, which is more time-consuming, more costly, and causes more adverse effect on parents and children, performing the one-stage repair is recommended for this anomaly.
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Surgical treatment options for septic arthritis of the hip in children
Gang Xu, Muriel Spoerri, Erich Rutz
January-March 2016, 13(1):1-5
DOI:10.4103/0189-6725.181621  PMID:27251515
Septic arthritis is the result of bacterial infection of the hip joint and is often found in infants and toddlers. It is the most common septic joint condition during growth and may cause the most devastating complications without prompt and proper treatment. Early diagnosis and intervention are required to avoid irreversible complications. This review documents the systematic approach to diagnosis and management of septic arthritis in children.
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Early diagnosis of post-varicella necrotising fasciitis: A medical and surgical emergency
Rose Xavier, Bobby Abraham, Vinod Jacob Cherian, Jobin I Joseph
January-March 2016, 13(1):44-46
DOI:10.4103/0189-6725.181707  PMID:27251524
Necrotising fasciitis (NF) is an extremely rare complication of a rather common paediatric viral exanthem varicella. Delayed diagnosis and treatment can lead to significant morbidity and mortality. Laboratory risk indicator of NF score aids in early clinical diagnosis in suspected cases of post-varicella NF thus enabling timely intervention. Surgery delayed for more than 24 hours, is an independent risk factor for death. Surgical debridement with good antibiotic coverage is the definitive treatment for NF.
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Topical tranexamic acid as a novel treatment for bleeding peptic ulcer: A randomised controlled trial
Mandana Rafeey, Maryam Shoaran, Robabeh Ghergherechi
January-March 2016, 13(1):9-13
DOI:10.4103/0189-6725.181700  PMID:27251517
Background: Peptic ulcers are among the most common causes of upper gastrointestinal (GI) bleeding in children. The standard care for GI bleeding is endoscopy for diagnostic and therapeutic purposes. We aimed to assess the effect of topical tranexamic acid (TXA) via endoscopic procedures in children with GI bleeding caused by bleeding ulcers. Procedure: In this randomised controlled trial, 120 children were evaluated by diagnostic procedures for GI bleeding, of which 63 (30 girls, 33 boys) aged 1-month to 15 years were recruited. The patients were randomly divided into case and control groups. In the case group, TXA was administered directly under endoscopic therapy. In the control group, epinephrine (1/10,000) was submucosally injected to the four quadrants of ulcer margins as the routine endoscopic therapy. In both groups, the patients received supportive medical therapy with intravenous fluids and proton pump inhibitor drugs. Results: The mean ± standard deviation age of the children was 5 ± 2.03 years. Rebleeding occurred in 15 (11.4%) and 21 (9.8%) patients in the case and control groups, respectively (P = 0.50). The frequency of blood transfusion episodes (P = 0.06) and duration of hospital stay (P = 0.07) were not statistically different between the groups. Conclusion: Using topical TXA via endoscopic procedures may be effective in cases of GI bleedings caused by active bleeding ulcers. In order to establish this therapeutic effect, a large number of clinical studies are needed.
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Labial adhesion in children at the Jos University Teaching Hospital
Ephraim Samuels, Amaka Ngozi Ocheke, Nathaniel E. O. Samuels
January-March 2016, 13(1):6-8
DOI:10.4103/0189-6725.181622  PMID:27251516
Background: Labial adhesion is one of the most common reasons for gynaecologic consultations in children. We sought to determine the prevalence of labial adhesions, mode of presentation and treatment in children at the Jos University Teaching Hospital. Materials and Methods: A retrospective study of labial adhesions in children from January 2004 to December 2013. Data on paediatric gynaecological consultations, and labial adhesions were retrieved from the gynaecological clinic and the theatre records. The case notes of those with labial adhesions were retrieved and the relevant data extracted. Results: The total number of paediatric patients seen at the gynaecology clinic over the study period was 379 and 25 had labial adhesion (6.6%). The majority (88%) presented in the first 2 years of life, all the patients were asymptomatic, and 2 (8%) had surgical separation of the adhesions while the rest were managed conservatively. A total of 5 (20%) came for follow-up. While 2 (8%) came a week later following surgical management, 3 (12%) came back more than 6 months later due to recurrence following conservative management. Conclusion: Labial adhesions account for significant proportion of paediatric gynaecologic consultations. They are usually asymptomatic, occur in the first 2 years of life and frequently managed conservatively.
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Endoscopic removal of impacted oesophageal foreign body: A case report and a review of literature
Olusegun A Obateru, Matthew O Durowaye, Abdulfatai B Olokoba, Olufemi K Olaniyi
January-March 2016, 13(1):41-43
DOI:10.4103/0189-6725.181706  PMID:27251523
Foreign body (FB) impaction in the oesophagus is fairly common in paediatric Gastroenterology practice. This study aims to describe a case of an unusually impacted button lithium battery, in the mid-oesophagus of a 7-year-old child that was confirmed, and removed during oesophagogastroduodenoscopy. A 7-year-old male child, presented at the Emergency Paediatric Unit of our hospital with a history of ingestion of a button-like metallic object. A plain soft tissue X-ray of the neck and chest, however, revealed a dense round object located at the sternal angle of Louis. The object was dislodged and identified as a flat lithium battery after an oesophagogastroduodenoscopy, carried out under general anaesthesia using a flexible forward-viewing video gastroscope. The button battery was subsequently passed in faeces. Endoscopic removal of impacted oesophageal FBs under general anaesthesia is an effective and safe procedure in children in experienced hands.
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Congenital diaphragmatic hernia, Meckel's diverticulum and malrotation in a 3-month-old infant
Laxman Basani, Roja Aepala, B Madhu Mohan Reddy
January-March 2016, 13(1):47-49
DOI:10.4103/0189-6725.181708  PMID:27251525
Congenital diaphragmatic hernia (CDH) is a common developmental anomaly that usually presents in the neonatal period. It is known to be associated with cardiac, renal, genital and chromosomal anomalies. Late presentation of CDH (beyond 1-month of age) is seen in 13% of the cases. Malrotation is reported in 42% of CDH cases. We report a case of a 3-month-old infant with concurrent CDH, Meckel's diverticulum and malrotation. This is the first case report of such an association in an infant.
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Comparison of trans-perineal ultrasound-guided pressure augmented saline colostomy distension study and conventional contrast radiographic colostography in children with anorectal malformation
Okechukwu Hyginus Ekwunife, Eric Okechukwu Umeh, Jideofor Okechukwu Ugwu, Uzoamaka Rufina Ebubedike, Chinedu Christian Okoli, Victor Ifeanyichukwu Modekwe, Kelechi Collins Elendu
January-March 2016, 13(1):26-31
DOI:10.4103/0189-6725.181703  PMID:27251520
Background: In children with high and intermediate anorectal malformation, distal colostography is an important investigation done to determine the relationship between the position of the rectal pouch and the probable site of the neo-anus as well as the presence or absence of a fistula. Conventionally, this is done using contrast with fluoroscopy or still X-ray imaging. This, however, has the challenges of irradiation, availability and affordability, especially in developing countries. This study compared the accuracy of trans-perineal ultrasound-guided pressure augmented saline colostomy distension study (SCDS) with conventional contrast distal colostography (CCDC) in the determination of the precise location of the distal rectal pouch and in detecting the presence and site of fistulous communication between the rectum and the urogenital tract was studied. Materials and Methods: Trans-perineal ultrasound-guided pressure augmented SCDS, CCDC and intra-operative measurements were done sequentially for qualified infants with anorectal malformation and colostomy. Pouch skin distance and presence or absence of recto urinary or genital fistula was measured prospectively in each case. Statistical significance was inferred at P-value of <0.01. Results: There were thirteen infants, 9 males and 4 females. The age at onset of investigation ranged from 2 to 12 months with a median value of 9 months. Using paired t-test at a confidence interval of 95%, the P value when SCDS values are compared with CCDC is 0.19; and 0.06 when SCDS was compared with intra-operative measurements. Hence, there is no statistical difference as P > 0.01. On its ability to detect presence or absence of a fistula: SCDS had a sensitivity of 50.0%, specificity of 100.0%, accuracy of 69.2%, negative predictive value of fistulas of 55.6% and a positive predictive value of fistulas of 100.0%. Conclusion: Ultrasound-guided pressure augmented SCDS can safely and reliably be used to assess the distal colonic anatomy and the presence of fistula in infants with Anorectal malformation who are on colostomy.
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Oesophageal pseudodiverticulum after foregut duplication cyst excision: Case report and literature review
Iuliana D Bobanga, Raymond W Redline, Anthony L DeRoss
January-March 2016, 13(1):50-53
DOI:10.4103/0189-6725.181709  PMID:27251526
Oesophageal pseudodiverticula rarely occur after excision of benign oesophageal neoplasms. While management and outcomes have been reported in the adult leiomyoma literature, sparse data exist on the occurrence and management of pseudodiverticula after foregut duplication cyst excision. We discuss our experience with a paediatric patient and review relevant literature regarding operative techniques and surgical outcomes.
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Umbilical only access laparoscopic pyeloplasty in children: Preliminary report
Rajendra B Nerli, Prasad V Magdum, Shridhar C Ghagane, Murigendra B Hiremath, Mallikarjuna Reddy
January-March 2016, 13(1):36-40
DOI:10.4103/0189-6725.181705  PMID:27251522
Background: Over the past three decades, laparoscopic surgery has become a well-established alternative to open surgery in the management of ureteropelvic junction (UPJ) obstruction. Currently, several efforts are being made, aimed at further reducing the morbidity associated with conventional laparoscopy. We report our experience with modified umbilical port laparoscopic pyeloplasty in children. Materials and Methods: Children presenting with hydronephrosis secondary to UPJ obstruction formed the study group. A 5 mm endoscopic port was placed on the inferior umbilical crease. The two 3 mm instruments were introduced through puncture sites created a few mm superior and lateral to the endoscopic port, under vision. Total operating time, the time taken for insertion of double pigtail catheter, time taken for pyeloplasty anastomosis and complications were noted. Results: During the study period, 16 children underwent modified umbilical only access laparoscopic pyeloplasty. The total operating time and the time for insertion of double pigtail catheter were significantly more in our earlier half of cases. Conclusions: Modified umbilical port laparoscopic pyeloplasty reduces the morbidity associated with conventional multiport laparoscopy without the need of expensive multichannel cannulas, curved laparoscopic instruments and longer laparoscopic endoscopes. Though crossing instruments are a factor which prolongs the duration of surgery, it does not hinder complex suturing needed during pyeloplasty.
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Congenital hernias and hydrocele: Importance of age
Musa Ibrahim
January-March 2016, 13(1):54-55
DOI:10.4103/0189-6725.181710  PMID:27251527
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