The Use of T‑tube Cholangiocatheter Stents in the Treatment of Pediatric Tracheomalacia

Tracheomalacia is a common disorder in neonate and infants, which can lead to life‑threatening airway occlusion, because of external pressure or intrinsic defect of tracheobroncial cartilage. Aortopexy and Stents are effective in relieving tracheomalacia in the latter patients. In this case we are to show how t‑tube cholangiocatheter is effective and easy available in sever tracheomalacia neonates with intrinsic defect. It can be easily replaced and causes no infection, erosion, or sever complication in 9 months period.Key words: Stent, tracheomalacia, t‑tube cholangiocathete

Our experience with caustic oesophageal burn in South of Iran

Context: The alkaline oesophageal burn (EB) is a very debilitating injury  and common in the southern rural area of Iran, where the air conditioning systems are cleaned with an alkaline liquid, which is accidentally ingested by children.Aims: The aim is to share our experiences with caustic injury in children. Settings and Design: A ‘before’ and ‘after’ clinical trial.Materials and Methods: From November 2006-2009, 35 cases of alkaline burns were referred to our center. All underwent flexible endoscopy and thereafter received steroid, antibiotic and H2 blocker. They subsequentlyunderwent rigid oesophagoscopy, with grade IIb or higher burns, for  inserting the two different kinds of stents.Results: Four out of 10 (GIIa <) underwent dilatation occasionally. Fifteen (GIIb) with early large stent (eight weeks) developed complications (three antral contractures, one oesophagotracheal fistula, one tracheobronchial fistula, three perforations, three deaths, and the remaining cases had not undergone dilatation yet. Four out of 10 with (GIIb), who had small stents (Six months) and early gastrostomy needed dilatation every four to six weeks and all recovered, with no significant complications. Conclusions:Early use of gastrostomy prevents malnutrition in patients. Small size stents are much more tolerable for a prolonged time are not obstructed by saliva that washes the wall of the damaged oesophagus continuously and promotes healing

Transvesical direct visualization of Fogarty balloon catheter ablation of posterior urethral valves in the newborn

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Botulinium toxin, as bridge to transanal pullthrough in neonate with Hirschsprungs disease

Aims and Objectives: The aim of this study is to find easier way of home care while obviating the colostomy before single stage pull through operation. Materials and Methods: From August 2005 to December 2006, eight cases of neonatal Hirschsprung disease were treated. Mean age 4.5 (2-6) day/old with absent anorectal inhibitory reflex, rectosigmiod disease in Barium enema, positive Acetylcholine esterase (Ache) staining, good response to rectal washout. They underwent botulinium toxin injection (5 unit /kg/quadrant) in four quadrant intrasphincteric. They were followed until pull through operation in 8-10 weeks post injection. Results: Four of 8 (50%) cases only needed rectal washout for three to five days post injection until pull through operation, two had decrease in number of rectal washouts /day and the remaining two underwent colostomy five days post injection because of no response. Conclusion: Botulinium toxin injection can help in palliative care in patients with Hirschsprung disease who are waiting for colostomy or definitive pullthrough. It gives an option of eaiser home care for these patients

Role of bulking agents in bladder exstrophyepispadias complexes

Background: Role of pelvic osteotomy in surgical management of bladder exstrophy is controversial But pelvic rim closure importantly. Bulking  agents have been used for perineal and pelvic dysfunction in adults. In this study, bladder extrophy repair was performed without pubic closure And bulking agent injections were used as the strut of anterior pelvis for prevention of Organ prolapse and other functions in this series.Patients and Methods: During the period 2008-2012, twenty-five exstrophy-epispadias complex patients with a mean age of 14 months underwent surgical reconstruction. Rectus abdominis Muscle was detached from the superior pubis and sutured to each other in the midline and Re-anchored at the pubis and 8-9 month later urethra was constructed and placed between prineal muscles. Bladder neck repair and intersyphyseal  reconstruction was done With bulking agents one year after primary bladder closure when in our series bladder Prolapse mainly occurred. One to 4 mL of bulking agents polyacrylate (vantris/promedon) was injected at the level of the intersymphyseal area and opening on either sides of the urethra. Results: Mean urinary continence score, before, 3 and 6months after injection Were (2.65 ± 074),(1.95 ± 082),(1.75 ± 0.78), respectively.(p < 0.001). The correlation factor Between before injection, 3 and 6 months were % 82, % 74 spectively. Mean capacity of bladder before, 3, 6 months after injection were (31 ± 14.01), (41 ± 12.81), (56 ± 11.98) mml,respectively. The correlation factor before and after injection were 59%. Comparing the CS and CB between male and female before and after Injection were signifi cant. (p < 0.001) but correlation factor in male 99%and Female 74%. Three out of five girls had improved bladder prolapse. There was no Complication, infection or migration of bulking agents. Patients had increased in soft tissue according to MRI. Conclusion: Using bulking agents is a good alternative to sling pelvic floor not only cosmetically but also for ease of patients and operation.Key words: Bulking agent, continence, exstrophy, pubic closur