Comparison of Two Different Method of Surgery in Ileus Meconium

Introduction: meconium ileus occurs when the terminal ileum is obstructed by unusually tenacious meconium; it is more prevalent in neonates with cystic fibrosis. Up to 33% of neonatal small-bowel obstructions are due to meconium ileus. Symptoms such as: vomiting which may be bilious, distention of the abdomen and inability to pass meconium in the first days of life are some of the most common symptoms. Clinical presentation and x-rays are the basis of diagnosis. First step of treatment is contrast enemas under fluoroscopy and if it fails surgery should be carried out. Different surgical methods are used for operative management of uncomplicated meconium ileus. In our series, we have compared two different methods of surgery: Primary resection and anastomosis; and enterostomy using the Bishop-Koop method. We compared their effectiveness and complications.Materials and Methods: Forty neonates with ileus meconium were included in the study, 20 patients in each group. Alternating allocation that is allocating every other subject to each treatment group: for the Bishop-Koop enterostomy and anastomosis (study group) or primary resection and anastomosis (control group) was carried out .Results of treatment and complications during and after the surgery were recorded in both groups and compared together.Results: There was 3 case of mortality in the study group (%15) and 8 case of mortality in control group (%40). There was a meaningful statistical difference between mortality in the two groups (p=0/002).Conclusion: Despite the advantages of one stage repair with primary resection and anastomosis in neonates it results in a higher rate of mortality compared to the Bishop-Koop method. Thus performing the two-stage Bishop-Koop repair seems to be a more safe approach for this anomaly

Diagnostic value of inflammatory markers (complete blood count, erythrocyte sedimentation rate, and C-reactive protein) in children with acute appendicitis

Objective The aim of the study was to evaluate the diagnostic value of inflammatory markers [complete blood cell count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation of acute appendicitis from nonspecific abdominal pain in children.Patients and methods In this prospective study, 150 children admitted for referral to Mohammad Kermanshahi Hospital (Kermanshah, Iran) (from June 2011 to May 2012), and suspected to have acute appendicitis were enrolled. Careful assessment of history and observation of physical signs were performed and evaluated during the hospitalization period; decisions to operate or to observe were made on the basis of clinical characteristics. Patients who had acute appendicitis, according to the pathologic report, were included in the study group and patients who had nonspecific abdominal pain were included in the control group. Venous blood samples were taken from all patients on admission and sent to the laboratory and CBC, ESR, and CRP levels were measured. Serum CRP level more than 8 lg/ml, ESR more than 20 mm/h, and white blood cell (WBC) count more than 10 000/mm3 were considered abnormal. Sensitivity, specificity, positive predictive, and negative predictive values were calculated for each test and in combination.Results In total, 150 patients were studied in two groups; 54% were females and 46% were males. The mean age of the patients was 7.7± 1.3 years in the study group and 8.7 ± 1.3 years in the control group. In the study group, 80% had leukocytosis (WBC> 10 000), 64% had elevated ESR, and 70.6% had elevated CRP. However, in the control group (nonspecific abdominal pain), 17.3% had leukocytosis, 25.3% had elevated ESR, and 26.6% had elevated CRP.Conclusion The results of our studies showed that inflammatory markers in patients with acute appendicitis are significantly higher than those in children who have nonspecific abdominal pain. Measurement of these markers is valuable in the diagnosis of appendicitis in children. The diagnostic value of CBC is higher than that of ESR and CRP.Keywords: acute appendicitis, childrens, inflammatory markers (complete blood count, erythrocyte sedimentation rate, and C-reactive protein), leukocytosi

Comparison of two method of hydrocele repair in children

Introduction: Hydroceles is accumulation of fluid in the processus vaginalis(PV) resulting in swelling of the inguinal region or scrotum. Its treatment depends on age, symptoms and conection with abdomen. Preferred method of treatment is subject of debate. In this study we assessed two different method of hydrocele repair in children's hydrocelotomy and hydrocelectomy and compared their complications and recurrences rate.Materials and Methods: 70 children with noncomunicating hydrocele included in study, allocating every other subject to each treatment group (alternating allocation) for the hydrocelotomy group(incision and evacuation of hydrocele sac)and hydrocelectomygroup(excision and removing of heydrocele sac. The complications and recurrence rate were recorded in both groups and compared together.Results: From 70 children 25 patient had right side hydrocele(%35/7) and in 45 children hydrocele found in left side.(%64/3). No statistical difference was found for complications like bleeding, wound infection, spermatic cord damage, and recurrent hydrocele between two groups in post operation Period.Conclusion: although there not found very different result in rate of complications and recurrency between two groups but it seems that hydrocelotomy is enough treatment with less probability of spermatic cord damage and other complication.

Traumatic injuries in pregnant women: a case of motor vehicle accident for “Ground Round” discussion

The main objective for introducing this case study is to create a platform from which the importance of road traffic related injuries and traumas can be emphasized and discussed within and across various fields of investigation. The long term goal is to entice public campaign around unmet needs for higher road safety measures to reduce primary, secondary, and tertiary risks of injuries and traumas

One-stage vs. three-stage repair in anorectal malformation with rectovestibular fistula

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

The Study Of Diagnostic Value of Elevation of Serum Amylase as a Predictive Factor for Appendiceal Perforation in Children with Acute Appendicitis

Background Recent studies indicate increased serum amylase in children with acute appendicitis. The objective of the current study was to determine the diagnostic accuracy of raised serum amylase level in prediction of perforated appendicitis in children with acute appendicitis. Materials and Methods In this cross-sectional study, 61 children (aged 3 to 15 years) who underwent appendectomy surgery due to acute appendicitis at two university hospitals in Kermanshah, Iran, from 2015 to 2016 were included. The diagnosis of appendicitis was confirmed with histopathologic examination. Before surgery, venous samples were obtained and serum amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase were assayed. The patients were divided into two groups: perforated appendicitis (18 cases) and non-perforated appendicitis (43 cases). The laboratory tests were compared between the two groups. Results The mean (±standard deviation) serum amylase level was 69.2 (±28.9) mg/dL in perforated group and 29.9 (±11) mg/dL in non-perforated group (P< 0.001). At serum level of 46 mg/dL, serum amylase had a sensitivity of 89% and its specificity was 100% in prediction of acute perforated appendicitis.  Conclusion The serum amylase level in perforated appendicitis was significantly higher compared to patients with non-perforated appendicitis. Serum amylase has good diagnostic value in prediction of perforated appendicitis