Phoenix dactylifera L. sap enhances wound healing in Wistar rats : Phytochemical and histological assessment

Acknowledgment Financial support of the Tunisian Ministry of Higher Education and Scientific Research is gratefully acknowledged.Peer reviewedPostprin

Small bowel perforation secondary to accidental magnetic objects ingestion: (Two pediatric cases report)

Foreign bodies ingestion is considered as a common pediatric problem, it is mostly encountred in infants between 6months and 2 years. Ingestion of magnets was documented in only few reports. We report two uncommon cases of bowel perforations owing to magnets ingestion. Patients were respectively aged of 10 months and 20 months .they were successfully managed. Once ingested, magnetic objects would attach each other through intestinal wall leading subsequently to intestinal necrosis. Thus their surgical removal is unavoidable.

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Metanephric stromal tumor: An unusual presentation of a rare paediatric renal neoplasm

A 2-year-old boy with prenatal diagnosis of a malformation uropathy was referred to paediatric surgery department. On systemic examination, there were no palpable masses. An ultrasonography of abdomen with color Doppler, a renal artery angiographic and scintigraphy revealed a preostial aneurysm at the left renal artery. The patient had a left nephrectomy. Grossly, the specimen measured 75 mm × mm 50 × 20 mm with renal artery aneurysm measuring 30 mm × 35 mm. On cut section, the renal parenchyma contained a whitish tumor that measured 35 mm × 10 mm. Histopathologically, this tumor was diagnosed as metanephric stromal tumor

A new operative approach for long-gap esophageal atresia

Surgical management of long-gap esophageal atresia (LGEA) remains challenging. Yet, there is a consensus among pediatric surgeons to preserve native esophagus. We used a new surgical technique to successfully manage three children diagnosed with LGEA. This technique consists of a combined thoracic and cervical approach to the EA repair using the patient's native esophagus. All patients initially had had gastrostomy and continuous upper pouch suction while awaiting surgery. This new technique has the potential to become the choice method in LGEA management

Congenital Band Compression: A Rare Cause of Small Bowel Obstruction in Newborns: Congenital Band Compression

Anomalous congenital band is a very rare cause of intestinal obstructions in newborns. It should be consideredas one of the etiologies of acute small bowel obstruction in neonatal period. We report here a retrospective study of three newborns with anomalous congenital bands who underwent surgical intervention between 2015 and 2018. There were 2 girls and 1 boy, aged respectively 1, 27 and 30 days. All the newborns were admitted with clinical diagnosis of acute small bowel obstruction. While band excision was done in all, one case received resection and anastomosis for intestinal necrosis. There are no specific signs that can help make the diagnosis of anomalous congenital band before surgical exploration

Burns injury in children: Is antibiotic prophylaxis recommended?

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

Neonatal Solitary Intestinal Myofibromatosis

Solitary intestinal myofibromatosis (SIF) is a very rare condition affecting the pediatric population and carries good prognosis following adequate management based on segmental resection. We describe a rare case who presented with features of neonatal intestinal obstruction due to a solitary stenosing fibrotic lesion originating from the ileum and compatible with SIF

Lipoblastoma in childhood: About 10 cases

Background: Lipoblastoma is a rare benign mesenchymal tumour of embryonal fat that occurs almost exclusively in infants and children. This determined the epidemiological, clinical and therapeutic aspect of this disease. Materials and Methods: A total of 10 cases of pathologically proven lipoblastoma from 2003 to 2012 were reviewed. Results: There were six boys and four girls ranging in age from 7 months to 9 years. A soft-tissue mass was the main complain in nine patients. The various locations of the mass were mediastinal, thigh, buttock, inguino-scrotal, the greater omentum and the Latissimus dorsi. Lesions measured 5-15 cm. complete excision was done. The median time of follow-up was 42 months (ranges between 18 and 84 months). There were no recurrences. Conclusion: It is important to consider lipoblastoma in the diagnosis of a rapidly enlarging fatty mass in children. Complete resection is the only definitive treatment and should not be delayed when impingement on surrounding structures is imminent. There is a tendency for these lesions to recur despite presumed complete excision. Therefore, follow-up for a minimum of 5 years is recommended

Management of double aortic arch in children

Introduction: Double aortic arch (DAA) is a rare congenital malformation. Strategies for diagnosis and treatment are different. Reports of thoracoscopic treatment of DAA are rare. We report a description of our diagnostic and therapeutic approach and evaluate outcomes.Material &amp; Methods: We reviewed charts of infants with double aortic arch who were hospitalized in our department from 2008 to 2014. Age at symptom onset, clinical presentation, diagnostic modality, operative details and post operative outcomes were retrieved. Results: We identified 7 patients presenting at a median age of 11,8 months (range: 2 months-27 months) and median weight of 10kg. Respiratory symptoms were present in all cases. Difficulties in feedings were present in 3 cases. Chest radiography, oesophagogram and Computed Tomography (CT) with three-dimentional (3D) reconstructions were performed for all patients. One patient had laryngo tracheoscopy and 3 patients echocardiography. The dominant branch was the right one in all cases. Associated cardiac anomaly was found in 1 case. Operative approach was thoracotomy in 3 cases and thoracoscopic video assisted surgery (VATS) in 4 cases. Median operative time was 132 min. Only one patient required conversion. Median hospital stay was 4,1 days.Conclusion: Double aortic arch is a rare malformation which can cause persistent non specific respiratory symptoms in infants. The use of 3D-CT scan reconstruction facilitates diagnosis and the operative approach. Thoracoscopy and thoracotomy are effective procedures even for patients with low body weight. The operative time seems similar for both approaches. Thoracoscopy offers less post-operative analgesia requirement, shorter hospital stay and good cosmetic results