Fistulectomy and anoplasty for low imperforate anus with anoperineal fistula in boys

Purpose To present our operative technique for the treatment of anoperineal fistula, discussing its advantages in comparison with other methods of treatment. Patients and methods This study included 35 neonate boys, 34 were full term and one was preterm. Their age ranged from 1 to 4 days, and they were diagnosed to have low imperforate anus with anoperineal fistula, without associated major anomalies. They were treated by fistulectomy and anoplasty. Results The operative time ranged from 25 to 40 min. The operation was completed successfully in all patients. All patients started gradual oral feeding 2 h postoperatively and were discharged after 24–48 h on oral feeding. Postoperative stricture occurred in two patients, one responded to dilation and the other needed redo surgery by a simple cutback technique. Continence could be assessed in 23 patients whose follow-up periods were longer than 3 years. Twenty-one patients had a good score and two had a fair score. No patients had a poor score. Conclusion Our approach has the following advantages: (i) the operation is simple and easy to perform. (ii) It has a minimal complication rate, with a good cosmetic and functional outcome. (iii) Anorectal function was not adversely affected in patients with anterior position of the anal orifice.Keywords: anorectal anomalies, anoperineal fistula, low imperforate anu

Prolapsed ileocolic intussusception

Purpose This study aimed at presentingour experience with cases of prolapsed intussusception and discussing the line of treatment and the morbidity and mortality.Patients and methods Nine infants aged from 5 to 10 months were diagnosed as prolapsed intussusceptions by clinical examination. All of them were treated by abdominal exploration through a right transverse supraumbilical incision.Results The mean operative time was 65 min. The intussusceptum was viable in five cases and was gangrenous in four cases. There was ischemic perforation in the colon in two cases. Resection and anastomosis were performed in six cases, sigmoid colostomy was performed in one case, and reduction by milking without resection was performed in three cases. All the patients recovered well.Conclusion Prolapsed intussusception is a rare presentation of intussusceptions; its diagnosis is easy but may be misdiagnosed as rectal prolapse. Its only treatment is surgery and it carries a good prognosis.Keywords: intussusception, prolapsed intussusception, ileocolic intussusceptio

Sacrococcygeal teratoma: 10-year experience in upper Egypt

Purpose To evaluate our experience with 45 patients with sacrococcygeal teratoma (SCT) in our community (upper Egypt) over a period of 10 years between 2001 and 2011 and determine the outcome of the management and recommendations for treatment strategies.Patients and methods A retrospective study was conducted at our Pediatric Surgical Unit, Assiut University Hospital. The medical records were reviewed for age at presentation, clinical manifestations and investigations, time of surgical approach, histopathology, recurrences, bladder and anorectal function, and cosmetic outcome.Results Forty-five patients with SCT were referred to the Pediatric Surgical Unit. The time of referral was as follows: immediately after birth in the case of five patients; during the first week for 17 patients (four of them died before surgery because of hemodynamic instability and other associated congenital anomalies and were excluded from the study); later in infancy for 22 patients; and at one and half years of age for one child. The lesion was excised in the case of 41 patients. Teratomas were of type I (n =9), type II (n = 20), type III (n= 11), and type IV (n =1) (Altman’s classification). The age of patients at surgery ranged from 2 days to 1.5 years. Histological analysis of results revealed mature teratoma (n =27), immature teratoma (n =9), and malignant teratoma (n= 5). The coccyx was not removed in two cases during the early period of the study. The follow-up period ranged from 3 months to 10 years. Recurrence occurred in five (12%) cases, wound infection in four (9.7%), and diarrhea in two (4.8%) cases. The a-fetoprotein level was high in 35 cases and was normal in two patients; it decreased after excision. Fetal diagnosis was made in five cases by means of a prenatal sonographic scan.Conclusion Prenatal diagnosis of SCT is very important and it is recommended to save the baby from obstructed labor. Early diagnosis allows early surgical intervention and avoids malignant transformation. The coccyx should be excised to decrease the risk of recurrence. Skin flap modification is feasible for large teratomas with healthy skin. Keywords: infants, neonates, sacrococcygeal teratom

Transcolostomy-site endorectal pullthrough for Hirschsprung’s disease

Purpose To present our results for an endorectal pullthrough operation as the second stage for the treatment of Hirschsprung’s disease through the colostomy site.Materials and methods This study included 13 patients, four girls and nine boys. Their ages ranged from 9 months to 7 years. They presented with a leveling colostomy with a diagnosis of Hirschsprung’s disease. The colostomy was carried out in the neonatal period because of neonatal intestinal obstruction in three patients (one female and two males), in two patients because of recurrent attacks of enterocolitis, and three patients because of the inability of the patient to withstand major surgery. Four patients presented without a clear history of the cause for the colostomy. One patient aged 7 years presented with sigmoid volvulus. All the patients were subjected to a transcolostomy endorectal pullthrough.Results The operation was completed as described in all patients. The time from colostomy to pullthrough ranged from 3 to 7 months (median 4.7 months). The operation time ranged from 95 to 140 min (median 113 min). All the patients passed stool within 24–48 h. Stool output ranged from two to six stools per day. Optimal wound healing occurred in all patients without wound complications. Postoperative perineal excoriation occurred in four patients. A urinary tract infection developed in one patient. A patient with a history of recurrent attacks of preoperative enterocolitis developed mild enterocolitis 2 weeks after the operation. Adhesive intestinal obstruction occurred in one patient. Recurrence of symptoms occurred in two patients because of stricture at the anastomotic site, one responded to repeated dilatation and the other required internal sphincterotomy.Conclusion Transcolostomy endorectal pullthrough has the following advantages: it is associated with less pain and a shorter hospitalization than the classic endorectal pullthrough. Wound complications are rare. The cosmetic result is better than the classic Soave operation. It has no specific technique-related complications. Long-term outcome and functional results are good. To our knowledge, this approach has not been described before. Keywords: Hirschsprung’s disease, leveling colostomy, pullthroug

Tapping for pneumoperitoneum in neonates and infants

Purpose The aim of this study was to shed some light on the presence of pneumoperitoneum in neonates and infants and to present and evaluate our method for its treatment.Materials and methods This study included 33 patients diagnosed with pneumoperitoneum during 2004–2011, of whom 19 were girls and 14 were boys, and their ages ranged from 1 week to 5 months; 21 patients were neonates and seven of them were premature; two were aged less than 32 weeks and had mild pneumoperitoneum, which could be treated conservatively and five were aged between 32 and 34 weeks. Tapping was performed for all patients. Tapping can help in selection of patients with necrotizing enterocolitis needing exploration when the aspirate is bilious or feculent. Tapping could be performed as a temporary measure before exploration to decrease respiratory distress and the occurrence of abdominal compartment syndrome and also as a routine procedure in patients with pneumoperitoneum. Tapping is an easy procedure and can be performed with the patient in bed or in the incubator. Pneumoperitoneum is not an absolute indication for surgical exploration and a small subset of patients should be managed by laparotomy. Each patient with pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain, or surgical exploration. Pneumoperitoneum occurs in neonates more frequently than in infants, and most cases are idiopathic.Results A total of 29 patients were treated by tapping alone (in nine patients, tapping was performed once; in 13, it was performed twice, and in the other seven, it was performed three to four times). Rapid improvement in the general condition and respiratory distress occurred in most patients. Six patients (five neonates and one infant) were explored because of: (a) aspiration of a bile-stained or feculent fluid in two patients and (b) failure of conservative treatment in four patients.Conclusion Pneumoperitoneum occurs in neonates more than infants and most cases are idiopathic. Each case of pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain or surgical exploration. Pneumoperitoneum is not an absolute indication for surgical exploration and small subset of patients should be managed by laparotomy. Tapping is an easy job and can be done with the patient in bed or in the incubator. Tapping could be performed as a routine in cases of pneumoperitoneum. Tapping could be done as a temporary measure before exploration to decrease respiratory distress and abdominal compartment syndrome

Sero-prevalence of Hepatitis B Virus Infection and its Risk factors among Pregnant Women Attending Antenatal Clinic at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Neonates who contract the HBV have about 90% risk of developing chronic HBsAg carriage (HBsAg: hepatitis B surface antigen) and chronic liver disease. Neonatal immunization interrupts this vertical and perinatal transmission.Objectives: To determine the seroprevalence of HBsAg among pregnant women attending the antenatal clinic at Aminu Kano Teaching Hospital (AKTH) and to identify potential risk factors associated with HBV infection.Materials and Methods: A case control study was conducted involving a total of 303 pregnant women attending the antenatal clinic at AKTH and 303 nonpregnant women of childbearing age. Blood sample was collected from each woman and the serum tested for the presence of HBsAg using latex rapid agglutination slide test kit (Cal-Tech Diagnostic Inc., USA) in the laboratory of the hospital. Reactive samples were stored at -20ºC and further confirmed for HBsAg using enzyme-linked immunosorbent assay (ELISA) kits (Bio-Rad, France). HBsAg-positive samples were tested for hepatitis B e antigen (HBeAg) using ELISA kits (Orgenics, Israel). A pretested, structured questionnaire was used for the collection of sociodemographic data and possible risk factors. Results: The prevalence of HBsAg among pregnant women and nonpregnant women were 7.9 and 7.6%, respectively. There was no statistically significant difference in the prevalence of HBsAg in pregnant and nonpregnant women. The presence of HBeAg was statistically significant among both pregnant and nonpregnant women who tested positive for HBsAg. The risk factors associated with HBV infection were blood transfusion, ear piercing, history of an affected sibling with HBV infection, tattooing, and abortion among pregnant women.Conclusion: The prevalence of HBsAg in this study was not statistically different in pregnant and nonpregnant women. There was a high level of HBeAg infection among pregnant women who tested positive for HBsAg. History of an affected sibling with HBV infection, tattoo, and abortion were significant risk factors for HBV infection. Keywords: Africa, hepatitis B, pregnancy, risk factor

Pattern of Complicated Unsafe Abortions in Niger Delta University Teaching Hospital Okolobiri, Nigeria: A 4 Year Review.

Background: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70,000 women die globally as a result, with majority occurring in the developing world. This study aims to determine the pattern of complicated unsafe abortions in Niger delta University Teaching Hospital (NDUTH) Okolobiri.Methods: The study is a four-year retrospective analysis of cases of complicated unsafe abortion managed at the Niger Delta University Teaching Hospital Okolobiri, Bayelsa state.Results: The prevalence of complicated unsafe abortion during the study period was 4.1% of all deliveries and 14.0% of all gynaecological admissions. Majority (55.6%) of the patients had secondary education, while 31.8% were teenagers. Two thirds had a history of previous termination of pregnancy and 87.3% of the patients had never used any form of modern contraceptive. 'Quacks' accounted for 47.6% of the abortions and 53.9% of the abortions were performed late in the first trimester. Genital sepsis, retained products of conception, pelvic abscess and septicaemia were the most frequent complications occurring in 88.9%, 82.5%, 22.2% and 19.1% respectively. Surgical management was employed in 87.3% of the patients. The case fatality ratio was 4.8%, contributing 17.6% of all maternal deaths during the study period. The commonest cause of death was septicaemia (66.7%).Conclusion: There is a high prevalence of unsafe abortions in our environment. It continues to be a major contributor to maternal morbidity and mortality in the Niger Delta. Most of its victims are single adolescent school girls. Efforts directed at reducing unintended pregnancy by comprehensive family planning programs and effective post abortal care services will reduce the problem.Keywords: Unsafe abortion, morbidities, outcome

Earthworm-assisted bioremediation of petroleum hydrocarbon contaminated soil from mechanic workshop

The use of earthworms (Eudrilus eugenia) for vermi-assisted bioremediation of petroleum hydrocarbon contaminated mechanic workshop soils was investigated. Parameters of interest where earthworm survival, microbial count and identification, carbon and nitrogen contents of the soil and total petroleum hydrocarbon content of the soil. Earthworm survival was found to be dependent on the concentration of petroleum hydrocarbon and nature of the mechanic workshop. The survival of the worms in the as-obtained mechanic workshop soil was much lower than the survival in mechanic workshop soil diluted with petroleum hydrocarbon free soil. Earthworm inoculation also resulted in lower soil C and N contents after 35 days of vermi-assisted bioremediation. After 35 days of treatment, earthworm inoculation effected a higher drop in total petroleum hydrocarbon contents as compared to the samples without worms, indicating that earthworms may be used as biocatalysts in the bioremediation process.Key words: Eudrilus eugeniae, total petroleum hydrocarbon, mechanic workshop soil

Low Voltage Distribution Networks Modeling and Unbalanced (Optimal) Power Flow: A Comprehensive Review

The rapid increase of distributed energy resources (DERs) installation at residential and commercial levels can pose significant technical issues on the voltage levels and capacity of the network assets in distribution networks. Most of these issues occur in low-voltage distribution networks (LVDNs) or near customer premises. A lack of understanding of the networks and advanced planning approaches by distribution network providers (DNSPs) has led to rough estimations for maximum DERs penetration levels that LVDNs can accommodate. These issues might under- or over-estimate the actual hosting capacity of the LVDNs. Limited available data on LVDNs' capacity to host DERs makes planning, installing, and connecting new DERs problematic and complex. In addition, the lack of transparency in LVDN data and information leads to model simplifications, such as ignoring the phase imbalance. This can lead to grossly inaccurate results. The main aim of this paper is to enable the understanding of the true extent of local voltage excursions to allow more targeted investment, improve the network's reliability, enhance solar performance distribution, and increase photovoltaic (PV) penetration levels in LVDNs. Therefore, this paper reviews the state-of-the-art best practices in modeling unbalanced LVDNs as accurately as possible to avoid under- or over-estimation of the network's hosting capacity. In addition, several PV system modeling variations are reviewed, showing their limitations and merits as a trade-off between accuracy, computational burden, and data availability. Moreover, the unbalanced power flow representations, solving algorithms, and available tools are explained extensively by providing a comparative study between these tools and the ones most commonly used in Australia. This paper also presents an overview of unbalanced optimal power flow representations with their related objectives, solving algorithms, and tools

The Technical, Operational and Energy Policy Issues for Developing Photovoltaic Systems: A Review

© 2018 IEEE. In recent years, photovoltaic (PV) units are getting popular in different countries, including Australia, as they contribute to reducing green-house gas (GHG) emissions and enhancing energy efficiency. However, several technical and economic challenges need to be addressed to ensure maximum benefit from this renewable generation. Moreover, the development of energy policies and regulations also affects the development of such systems. Therefore, this paper aims to review several technical, operational and energy policy issues for developing reliable and efficient PV systems. In addition, this paper summarizes the existing modeling and sizing methods, the maximum power point tracking (MPPT) techniques, and the interface power-electronic devices in this field. Moreover, recommendations for future researchers and investors for developing such systems are provided in this research paper