Surgical treatment of craniofacial haemangioma in children

Background/purpose Infantile haemangiomas are the most common tumours of infancy, with an incidence of up to 12%. The craniofacial area is affected in 60% of cases, which represents a therapeutic challenge. The purpose of this study was to evaluate the indications, results and complications of early surgical management of craniofacial haemangiomas.Patients and methods Twenty-eight patients with craniofacial haemangiomas (18 females and 10 males) were subjected to surgical treatment between 2006 and 2010. They were presented within the first 2 years of life. For each patient, the age, sex, site, indication of surgery and postoperative complications were recorded.Results All patients in the study had a single lesion. Surgery consisted of complete, one-stage excision with primary closure (19 patients) or closure with local flaps (nine patients). Postoperative complications (25%) included partial disruption (two patients), partial recurrence (two patients) and one case each of haematoma, partial skin necrosis and infection.Conclusion Surgical treatment is the prime goal in cases of haemangioma obstructing vital functions and complicated haemangioma. Surgery offers a short-term period of treatment with good results.Keywords: craniofacial area, haemangioma, surgical treatmen

Fundoplication in neurologically impaired children: Nissen or Thal?

Background/purpose Gastroesophageal reflex disease (GERD) is a highly prevalent problem in infants and children with severe neurological impairment (33–75%). It occurs in 44–67% of children undergoing antireflux surgery. This study is conducted to compare the results of fundoplication, according to the Nissen and Thal procedure for management of GERD in neurologically impaired children.Materials and methods Between May 2007 and January 2011, 69 neurologically impaired children with severe GERD underwent fundoplication (Nissen= 32, Thal= 37) with construction of a Stamm gastrostomy tube in 58 patients. The male-to-female ratio was 1.6 : 1; the mean age was 1.8 years. Preoperative workup of the patients included upper gastrointestinal tract contrast series, upper gastrointestinal tract endoscopy, and a 24-h pH study.Results Perinatal asphyxia was the most common cause of neurological impairment (30.4%). Feeding dysfunction represented the most common indication for surgery (52.2%). Recurrence of symptoms was found in 14 patients (20.3%); 10 patients (14.5%) died because of respiratory failure. Acid pH-metry showed a statistically significant difference between preoperative and postoperative data; however, this difference was insignificant on comparing the postoperative parameters of the Nissen fundoplication group with the Thal fundoplication group.Conclusion GERD in neurologically impaired children is a very common problem associated with a high failure rate after properly performed fundoplication. In our series, the outcome of Thal fundoplication showed an insignificant difference when compared with that of Nissen fundoplication with less dissection and less dysphagia or gas bloat. Long-term evaluation is needed as incidence of recurrence increases with time secondary to the persistent comorbidities. Further refinement of management strategies is required to decrease incidence of recurrence and to improve the overall quality of life. Keywords: fundoplication, gastroesophageal reflux disease, neurological impairmen

Post-Bacillus Calmette-Gue´ rin lymphadenitis in Egyptian children: an outbreak

Background/purpose Intradermal vaccinations with Bacillus Calmette-Gue´ rin (BCG) give rise to a classic primary complex that consists of a cutaneous nodule at the site of injection and swelling of the regional lymph nodes. This study was performed to evaluate the clinical course of BCG lymphadenitis in relation to different management strategies and to assess the microbial resistance to an Indian BCG strain causing an Egyptian outbreak.Patients and methods Prospective analytical follow-up of 152 patients with BCG lymphadenitis attending the Mansoura University Children Hospital between March 2010 and May 2011; of these, eight patients who had lymph nodes that were B1 cm in size (group A =5.3%) were managed with regular follow-up, 86 patients who presented with lymph nodes larger than 1–3 cm in size (group B=56.6%) received isoniazid and rifampicin for 6 months, and 58 patients who presented with lymph nodes larger than 3 cm in size or with BCG abscess or sinus (group C=38.1%) were subjected to early surgical excision.Results Of the 152 patients, the male-to-female ratio was 1.7 : 1. The mean age was 5.97 months. The site of the lesions was the left axilla (132 patients, 86.84%), left supraclavicular (10 patients, 6.58%), cervical (four patients, 2.63%), and left axillary and supraclavicular (six patients, 3.95%). BCG lymphadenitis regressed spontaneously in four patients of group A (50%), 24 patients of group B showed an improvement in 6–9 months(27.9%), and progressive enlargement (44 cases, 51.2%) and development of BCG abscesses (18 cases, 20.9%) occurred in the rest of the patients who needed surgical treatment. For group C, surgical excision was performed from the start. Pathological examination was performed for all excised lymph nodes (124 patients, 81.6%) and revealed granulomas with extensive caseation necrosis. Microbiological examination was performed in all cases and revealed acid fast bacilli in 100 samples (80.6%) that were resistant to isoniazid, pyrazinamide, and streptomycin but sensitive to rifampicin only in 25 samples.Conclusion As antituberculous therapy was found to be ineffective in the management of BCG lymphadenitis, we recommend a careful choice of BCG vaccines to avoid multidrug-resistant strains, early surgical excision of lymph nodes larger than 3 cm and lymphadenopathy complicated with abscess or sinus formation, and regular follow-up of smaller lymph nodes.Keywords: Bacillus Calmette-Gue´ rinlymphadenitis, outbreak, tuberculosis, vaccinatio