Penetrating abdominal injuries in children: a study of 33 cases

Background: Trauma is gradually becoming a major cause of disability and it can be of any form, physical or emotional. For the surgeon the physical form is of major interest, especially its causes and incidence, which can be influenced by environmental or social factors.Aim: The aim of this work was to study the incidence, etiology, principles of management and outcome of children with penetrating abdominal injuries.Materials and methods: This was a 2-year prospective study of 33 children aged 0–15 years with penetrating abdominal injuries at the University of Maiduguri Teaching Hospital in northeast Nigeria. Information obtained included the following: the patient’s biodata, mechanism of injury, time of presentation to the Accident and Emergency Department after the injury, haemodynamic status at presentation, presence or absence of abdominal organ evisceration, presence or absence of associated injuries, the timing of surgery, intraoperative findings, the type of surgical procedure and outcome.Results: Thirty-three (31.4%) children [of whom 24 (i.e. 72.7%) were from the rural areas] of 105 children with trauma-related injuries had penetrating abdominal injuries. The male : female ratio was 3 : 1, and the mean age ± SD was 2.30± 0.81 years. There were 15 (45.4%) children with gunshot wounds, 11 (33.3%) with bomb blast wounds, three (9.1%) with impalement injuries and two (6.1%) with arrow injuries. Fourteen (42.4%) patients had abdominal organ evisceration; of them, nine were as a result of gunshot injuries. Routine exploratory laparotomy was carried out in all 33 patients. Seven (21.2%) were operated on with simultaneous resuscitation in the immediate laparotomy group, and 26 (78.8%) underwent delayed laparotomy. There was a negative laparotomy in four (12.1%) patients, two of whom had only omental evisceration with no other accompanying visceral injuries, and two without evisceration. Three (9.1%) patients died after developing enterocutaneous fistula, compartment syndrome and sepsis.Conclusion: There were more cases of penetrating abdominal injuries among boys and children from the rural areas than in those from urban areas.Keywords: evisceration, exploratory laparotomy, penetrating abdominal injur

Intermittent left cervical vagal nerve stimulation damages the stellate ganglia and reduces the ventricular rate during sustained atrial fibrillation in ambulatory dogs

BACKGROUND: The effects of intermittent open-loop vagal nerve stimulation (VNS) on the ventricular rate (VR) during atrial fibrillation (AF) remain unclear. OBJECTIVE: The purpose of this study was to test the hypothesis that VNS damages the stellate ganglion (SG) and improves VR control during persistent AF. METHODS: We performed left cervical VNS in ambulatory dogs while recording the left SG nerve activity (SGNA) and vagal nerve activity. Tyrosine hydroxylase (TH) staining and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining were used to assess neuronal cell death in the SG. RESULTS: We induced persistent AF by atrial pacing in 6 dogs, followed by intermittent VNS with short ON-time (14 seconds) and long OFF-time (66 seconds). The integrated SGNA and VR during AF were 4.84 mV·s (95% confidence interval [CI] 3.08-6.60 mV·s) and 142 beats/min (95% CI 116-168 beats/min), respectively. During AF, VNS reduced the integrated SGNA and VR, respectively, to 3.74 mV·s (95% CI 2.27-5.20 mV·s; P = .021) and 115 beats/min (95% CI 96-134 beats/min; P = .016) during 66-second OFF-time and to 4.07 mV·s (95% CI 2.42-5.72 mV·s; P = .037) and 114 beats/min (95% CI 83-146 beats/min; P = .039) during 3-minute OFF-time. VNS increased the frequencies of prolonged (>3 seconds) pauses during AF. TH staining showed large confluent areas of damage in the left SG, characterized by pyknotic nuclei, reduced TH staining, increased percentage of TH-negative ganglion cells, and positive TUNEL staining. Occasional TUNEL-positive ganglion cells were also observed in the right SG. CONCLUSION: VNS damaged the SG, leading to reduced SGNA and better rate control during persistent AF

Severe Exercise and Exercise Training Exert Opposite Effects on Human Neutrophil Apoptosis via Altering the Redox Status

Neutrophil spontaneous apoptosis, a process crucial for immune regulation, is mainly controlled by alterations in reactive oxygen species (ROS) and mitochondria integrity. Exercise has been proposed to be a physiological way to modulate immunity; while acute severe exercise (ASE) usually impedes immunity, chronic moderate exercise (CME) improves it. This study aimed to investigate whether and how ASE and CME oppositely regulate human neutrophil apoptosis. Thirteen sedentary young males underwent an initial ASE and were subsequently divided into exercise and control groups. The exercise group (n = 8) underwent 2 months of CME followed by 2 months of detraining. Additional ASE paradigms were performed at the end of each month. Neutrophils were isolated from blood specimens drawn at rest and immediately after each ASE for assaying neutrophil spontaneous apoptosis (annexin-V binding on the outer surface) along with redox-related parameters and mitochondria-related parameters. Our results showed that i) the initial ASE immediately increased the oxidative stress (cytosolic ROS and glutathione oxidation), and sequentially accelerated the reduction of mitochondrial membrane potential, the surface binding of annexin-V, and the generation of mitochondrial ROS; ii) CME upregulated glutathione level, retarded spontaneous apoptosis and delayed mitochondria deterioration; iii) most effects of CME were unchanged after detraining; and iv) CME blocked ASE effects and this capability remained intact even after detraining. Furthermore, the ASE effects on neutrophil spontaneous apoptosis were mimicked by adding exogenous H2O2, but not by suppressing mitochondrial membrane potential. In conclusion, while ASE induced an oxidative state and resulted in acceleration of human neutrophil apoptosis, CME delayed neutrophil apoptosis by maintaining a reduced state for long periods of time even after detraining

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Challenges of Management of Childhood Cervical teratomas in a Developing Country

Background: Cervical teratomas are uncommon tumours in paediatric age groups. These are mostly benign and of favourable outcome when promptly diagnosed and surgically extirpated. The objective of this study is to report our experience with the challenges of management of 5 cases of cervical teratoma. Patients and Methods: This is a retrospective study of all cases of cervical teratoma managed at the University of Maiduguri Teaching Hospital and the Federal Medical Centre Gombe, Gombe ,Nigeria. Results: Five cases, comprising 3 neonates and 2 infants. There were 4 females and 1 male. Four of them had predominantly left sided tumour while 1 was right sided. Four had mild to moderate respiratory compromise, which necessitated emergency operation and all the tumours were completely extirpated. Four of the tumours were benign and 1 malignant. Surgical complications encountered were tracheal perforation, and wound infection in 1 patient, wound haematoma in another, and post-extubation tracheal collapse in one other child which resulted in the only mortality recorded. Conclusion: Cervical site remains a rare site of teratoma occurrence and respiratory compromise is an ever-present danger peri-operatively because of the presenting large cervical masses, anatomical distortions and attenuation of tissues. Postoperative ventilation is advisable for at least 72 hours to forestall preventable mortality. Keywords: Cervical Teratoma, Children, antenatal diagnosis, Nigeria African Journal of Paediatric Surgery Vol. 3 (1) 2006: pp. 9-1

Meconium Peritonitis in Nigerian Children

Background: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter. Methods: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria. Results: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X- rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%). Conclusion: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung’s disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.Contexte: La péritonite à méconium est une maladie rare d&apos;issue fatale. Au Nigéria et en Afrique, seuls quelques cas cliniques se rapportent au sujet. Méthode: Il s&apos;agit d’une étude rétrospective de 10 ans portants sur tous les patients traités pour péritonite à méconium dans les CHU de Maiduguri, de l&apos;Université de Lagos, de Obafemi Awolowo et du Centre Médical Federal Gombe. Résultats: Il s&apos;agissait de 10 nouveau-nés dont 6 filles et 4 garçons. L&apos;âge médian était de 4 jours (étendue 2 à 4 jours). Six des mères avaient eues une surveillance prénatale et 4 avaient eues une échographie prénatale mais le diagnostic de péritonite à méconium n&apos;avait pas été posé. La manifestation clinique la plus fréquente était une distinction abdominale à la naissance chez 9 des 10 patients. La radiographie sans préparation de l&apos;abdomen montrait une calcification et une opacité homogène chez 4 patients et un pneumopéritoine chez 2 patients. A la laparotomie, tous les patients avaient des adhérences inflammatoires et des anses intestinales emmêlées. La forme généralisée était la forme la plus fréquente (7 patients) et on notait un pseudokyste géant chez 2 patients. Le site de perforation le plus fréquent était l&apos;iléon chez 4 patients et le jéjunum chez 3 patients. Chez un patient la perforation s&apos;était bouchée à la laparotomie. L&apos;obstruction intestinale était la cause la plus fréquente de péritonite à méconium chez 7 des 10 patients. Chez les 3 patients restants, la cause est restée inconnue. La plus fréquente procédure exécutée fût la résection anastomose (4 patients). Le taux de mortalité était élevé (50% Conclusion: Nos données révèlent la rareté de la péritonite méconiale et l&apos;occlusion intestinale comme la cause la plus fréquente. Il est recommandé chez les patients avec une cause non identifiée, qu&apos;une biopsie rectale soit faite pour identifier une éventuelle maladie de Hirschsprung. Le diagnostic précoce, une prise en charge chirurgicale correcte et des soins post-opératoires méticuleux devraient améliorer leur survie