The versatility of the transumbilical approach for laparotomy in infants

Background/purpose Although the transumbilical approach became very popular for pyloromyotomy, it has not been widely used in other procedures in children. The aim of this work was to evaluate the safety and the versatility of this approach for laparotomy in infants.Patients and methods All hemodynamically stable neonates and infants with gastrointestinal surgical problems or pelvic or abdominal cystic masses were considered candidates for this approach. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline in a cephalic or caudal direction depending on the site of the lesion. The bowel or the mass was delivered outside the peritoneal cavity, and the procedure was completed in the standard open manner. Patients were evaluated with regard to the feasibility of the surgery and or any difficulty to complete the surgery, any complications related to the approach, and the cosmetic outcome.Results A total of 141 infants underwent transumbilicallaparotomy during the period from June 2008 to December  2013. The  primary pathology was hypertrophic pyloric stenosis (n= 65), duodenal, small-intestinal atresia/stricture (n =22), colonic atresia (n= 2), malrotation with/without volvulus (n= 10), ovarian cysts (n= 12), intussusception (n= 9), spontaneous intestinal   perforation (n =7), remnants of vitellointestinal duct (n =4), mesenteric cysts (n= 3), patent urachus (n= 3), postoperative  complications of strangulated inguinal hernia (n= 3), and complications in ventriculoperitoneal shunts (n= 1). Their age ranged  from 1 day to 22 months. The operating time ranged from 30 to 120 min. Three patients required transverse extension of the  wound. Two (1.4%) patients developed dehiscence of the wound that required wound closure. Five (3.5%) patients had superficial periumbilical cellulitis and wound infections, and one patient had suture reaction treated conservatively. Late complications  (adhesive intestinal obstruction) occurred in three (2%) patients. Parents were very satisfied with the final cosmetic outcome.Conclusion The transumbilical approach is both afeasible and a safe approach for a broad spectrum of  surgical procedures in neonates and infants. The cosmetic results are excellent.Keywords: abdominal masses, infants, laparotomy, transumbilical approac

Y-to-V umbilicoplasty for proboscoid umbilical hernia

Background/purpose Several techniques are proposed for reconstruction of proboscoid umbilical hernia in the pediatric patients. In this work, we reported our experience with Y-to-V umbilicoplasty in the surgical repair of proboscoid umbilical hernia in infants and children.Patients and methods A 3-year prospective study included 15 children presented with proboscoid umbilical hernia. A skin marker was used to draw the lines of skin incisions. ‘Y’ incision was done starting with the vertical limb. The facial defect was repaired. Lateral twin isosceles triangular flaps were excised. A new umbilical valley was reconstructed by one or two subcutaneous stitches of the residual umbilical flap fixing the flap’s summit to the aponeurosis plane. We appreciated the results as excellent, fair or bad according to criteria of the peripheral rim (raised, flattened or depressed) and the central depression (deep, shallow or absent).Results This study included 10 boys and 5 girls. Their ages ranged from 1 to 7 years at the time of surgery. The mean duration of the operation was 45 min and the mean hospitalization stay was 1 day. The early results were excellent in all cases. Follow-up period continued for 6 months and revealed a natural-looking umbilicus with excellent peripheral rim and central depression.Conclusion Y-to-V umbilicoplasty in the surgical repair of proboscoid umbilical hernia in infants and children is simple and easy to design and carried out with excellent aesthetic results

Urethral advancement procedure in the treatment of primary distal hypospadias: a series of 20 cases

Introduction: Distal hypospadias is the most common genital anomaly, occurring in almost 65% of all hypospadias cases. Although there are several surgical techniques for the treatment of distal hypospadias, it is clear that none can be used to correct all forms of hypospadias. The aim of the study was to evaluate urethral advancement in the repair of primary distal penile hypospadias with regard to feasibility, complication rates and the final cosmetic outcome.Patients and methods: Between October 2014 and June 2015, the urethral mobilization technique was used in 20 patients who presented at the Pediatric Surgery Unit, Tanta University Hospital, with primary distal hypospadias. A submeatal crescent-like incision was performed a few millimeters proximal to the meatus with two vertical incisions from the lateral ends of the submeatal incisions. The urethra within the corpus spongiosum was dissected from the skin of the ventral surface and from the glans and corpora cavernosa for a distance of ~ 4 : 1. The urethra was advanced till the urethral meatus reached its normal position without any tension. Spongioplsty can be performed, and covering Buck’s or Dartos’ layers can be used. The follow-up was conducted on a weekly basis in the outpatient clinic in the first month, and then every month for 6 months.Results: The age of the patient at the time of operation ranged from 6 to 24 months, with a mean age of 10.5 months. The operative time ranged from 60 to 90 min, with a mean time of 73.5 min. Intraoperative urethral injury occurred only in one patient. In all patients, the catheter was removed immediately postoperatively except for one patient who had operative urethral injury. Deep wound infection was noticed in only one patient, followed by partial glanular disruption. Only one patient had urethrocutaneous fistula and two patients had meatal retraction.Conclusion: Urethral advancement can be used safely in the mobilization of the distal urethra with wide glanular dissection and wide lateral mobilization of glanular wings. However, it should be stressed that in the presence of hypoplastic distal urethra and/or persistent ventral curvature, another technique should be adopted. The majority of our patients had very good cosmetic results and minimal complication. However, the technique requires further studies with a larger number of patients and longer follow-up periods to draw more precise and final conclusions.Keywords: distal hypospidaus, primary, urethral advancemen

Ultrasonic Guided Insertion of Central Venous Catheter in Infants and Children

Background/Purpose: ultrasound is licensed for application of regional blocks and insertion of vascular access. We aimed to compare ultrasonic guided (USG) and anatomical landmark technique (ALT) for insertion of central venous catheter (CVC) as regard success rate and rate of complications in infants and children. Materials & Methods: eighty childen (age ranged from 1-5 y) were classified into 2 groups, anatomical landmark technique was used to insert CVC in group I and ultrasonic guided technique was used in group II. Number of trials, duration of the procedure, and rate of complications were recorded. Results: There was a significant increase in success rate of insertion in group II as compared to group I (p = 0.001). Number of trials showed significant decrease in group II as compared to group I (p<0.0001). Incidence of arterial puncture was significantly decreased in group II (p = 0.028). Duration of the procedure was 21.3 ± 0.05 min in group I, and 12.5 ± 0.3 min in group II, ( p<0.0001). Conclusion: Insertion of central venous catheter in children should be guided with ultrasonography to avoid complications and failure of the procedure.Index Word: CV line insertion, ultrasonography

Mineral and heavy metals content in tilapia fish (Oreochromis niloticus) collected from the River Nile in Damietta governorate, Egypt and evaluation of health risk from tilapia consumption

This study was conducted to determine heavy metals and trace elements content in tilapia fish collected from three sources in Damietta governorate, Egypt and to evaluate the human health risk due to tilapia consumption. Tilapia samples were collected from two locations in the River Nile stream, tow fish farms and two sluiceways. Health risk assessment was evaluated based on the consumption habits of adult human. The results revealed that all samples vary in elements concentrations. The calculation of human health risk revealed that the consumption of tilapia in the three tested area does not pose any health risk except for Selenium. It could be concluded that consumption of such fish may be a risk for consumers who eat fish more than one time per week. Consequently, precautions should be taken and warning against eating tilapia fish caught from these regions should be announced.This study was conducted to determine heavy metals and trace elements content in tilapia fish collected from three sources in Damietta governorate, Egypt and to evaluate the human health risk due to tilapia consumption. Tilapia samples were collected from two locations in the River Nile stream, tow fish farms and two sluiceways. Health risk assessment was evaluated based on the consumption habits of adult human. The results revealed that all samples vary in elements concentrations. The calculation of human health risk revealed that the consumption of tilapia in the three tested area does not pose any health risk except for Selenium. It could be concluded that consumption of such fish may be a risk for consumers who eat fish more than one time per week. Consequently, precautions should be taken and warning against eating tilapia fish caught from these regions should be announced

Evaluation of plasma neurotransmitters in children living with Attention-Deficit Hyperactivity Disorder (ADHD)

This study aimed to ascertain the underlying neuro-biochemical imbalances that exist in children with ADHD by assessing the plasma levels of dopamine, serotonin, norepinephrine, γ aminobutyric acid (GABA) and glutamate. Moreover, it investigated the potential effects of PUFA and vitamins supplementation as an alternative therapy to modulate the levels of these neurotransmitters and the overall clinical status of ADHD patients. The study included 40 ADHD patients, aged 4-6 years. The diagnostic and statistical manual of mental disorders (DSM-5) test has been employed to diagnose patients with ADHD and the severity of symptoms was assessed using the Arabic version of Conners' Parent Rating Scale. Additionally, patients were assessed using the Arabic versions of Mini International Neuropsychiatric Interview for Children (M.I.N.I. Kid) and Stanford-Binet Intelligence Scale, 5th Edition (SB5). Recruited patient received nutritional supplement of semi-solid diet containing 1000 mg PUFA with selected vitamins once daily for six months. The evaluation of ADHD symptoms and levels of neurotransmitters has been carried out at pre-/post-intervention stage. Post-nutrition intervention assessment, there was a significant increase in dopamine, norepinephrine, GABA levels (p-value < 0.0001) with significant decrease in glutamate level (p-value < 0.0001) when compared to their correspondent pre-intervention levels. Symptoms of inattention and/or hyperactivity-impulsivity were significantly improved after 6 months nutrition intervention program (p-value<0.001). Therefore, supplementation with omega-3 fatty acids and vitamins could be considered more extensively in therapy of ADHD patients particularly those who are less than 6 years old

An investigation of the mechanical properties of ternary blend cement pasts containing a large amount of cement kiln dust

Cement kiln dust is a by-product of the cement industry composed of particles of feedstock and condensed volatilized inorganic salts. The effect of Cement kiln dust (CKD) on the mechanical properties of ternary blend cement pastes was studied by preparing different mixes using 40%CKD, 10% OPC and 50% of three different pozzolanic material (ground granulated blast furnace slag (GGBFS), metakaolin (MK), and ground clay brick (GCB)). The mechanical properties were tested via the determination of compressive strength, bulk density, total porosity, and chemically combined water content at 3, 7, 28, 90, and 180 days. The hydration products were evaluated using x-ray diffraction analysis. The result indicated that 40%CKD greatly enhances the activation of GGBFS, MK, and GCB. The paste that contains (10% OPC, 40% CKD, and 50% GGBFS) gives the highest compressive strength, while (10% OPC, 40% CKD, and 50% GCB) gives the lowest compressive strength