Bicycle handlebar injuries in children: Is “ring sign,” an indicator of intra‑abdominal organ injuries?

Background: Children are vulnerable to a wide range of bicycle-related traumatic injuries. Bicycle handlebar injuries often causediagnostic dilemma and delay in diagnosis due to trivial nature of the incident. Objectives: To study the bicycle handlebar injuriesin children and their management. Materials and Methods: A retrospective review of all the children with blunt abdominal injuriessecondary to bicycle handlebar injuries at our institution, between April 2011 and March 2015 was done. The patient medical recordswere examined, and all the data pertaining to the demographic information, clinical history, hematological investigations, imagingstudies, operative technique, post-operative recovery and complications, and duration of hospitalization were obtained. Results: Duringthe study period of 48-month, 26 children with blunt abdominal injuries were treated at our institution. Among these patients, 7 childrenhad bicycle handlebar abdominal injuries. All 7 patients were male. Mean age of the patients was 9.6 years (range 5-12 years). Theaverage time gap between trauma and presentation to our institution was 46 h (range 22-96 h). All the 7 children had circular patternedabrasion of the bicycle handlebar over the abdominal wall. Mean duration of hospital stay was 16.1 (range: 9-28) days, and the averageduration of follow-up was 35.6 months (range 7-55 months). Conclusion: “Ring sign” indicates a higher probability of associated intraabdominalinjury, and these children should be thoroughly evaluated and managed with close observation, repeated clinical examination,appropriate imaging studies, and surgical or endoscopic intervention as required

Bedside reduction of gastroschisis: A feasible option

Background: Gastroschisis is a common neonatal malformation, with an incidence of 0.4-3 per 10,000 live births worldwide.Objective: This study was planned to assess the feasibility of bedside reduction of gastroschisis (BRG) in the neonatal intensive care unit(NICU) at our institution. Materials and Methods: Retrospective analysis of newborns with gastroschisis managed at our institutionbetween September 2008 and May 2013. Initial bedside reduction in NICU was attempted in all the neonates procedure was done underlocal anesthesia. Incision was extended transversely on the lateral aspect when required. Gradual reduction of bowel loops done withmonitoring of parameters. Complete abdominal wall closure in multiple layers/skin closure only was done based on intra-abdominaltension. The final outcome was recorded. Results: During the study period of 60-month, 10 children were treated for gastroschisis atour institution. The sex ratio among them was 8:2 in favor of males. The average age was 23 h (range: 4-72 h). The average birth weightof the babies was 2290 g (range: 1700-2600 g). Six patients were in the high-risk group and 4 in the low-risk group. The BRG wassuccessful in 7 patients and a silo was placed in 3 patients who did not tolerate BRG. General anesthesia was required in 3 patients onlyfor subsequent repair. The overall survival was 70%. Conclusion: BRG is a feasible and safe option. Selective use of silo, gradual stagedbowel reduction, and delayed primary closure of the defect can be done on the bedside when attempted BRG is unsuccessful

Utility and safety of laparoscopy for intra-abdominal cysts in small children: Single center experience

Objectives: The objective of this study is to study the utility and safety of laparoscopy in the management of intra-abdominal cysts in small children. Materials and Methods: This is a retrospective analysis of patient data that underwent laparoscopy for intra-abdominal cystic lesions. The study period was from March 2010 to April 2015. Patients with adequate follow-up and complete data were included for study. The patients were divided into 3 age groups for analysis of the outcome viz. neonates, infants, and children between 1 and 5 years of age. The data were analyzed for spectrum of lesions managed, surgical procedure performed, operative time, intraoperative events, need for conversion, time to discharge, and the overall outcome. Results: A total of 106/121 patients with adequate follow-up are included for the study and most of the patients (63.6%) belonged to children between 1 to 5 years. Wide spectrums of lesions were managed laparoscopically, and majority 45 (42.4%) had cysts arising from the hepatobiliary system whereas genitourinary system lesions formed 2nd largest group with 21 (19.8%) patients. The procedure was completed laparoscopically in 86.6% (92) of the patients. The morbidity including wound infection, re-exploration, and recurrences, were seen in 5% of patients. The average duration of hospital stay was 4.6 days (range 2-21 days), and the average duration of follow-up was 96 months (range 6-180 months). Conclusion: Laparoscopic surgery is a fascinating technical development for pediatric surgeons. It is applicable for the wide variety of intra-abdominal cystic lesions in children. Excisional surgeries are best performed by laparoscopic technique even in small infants and neonates. In the hands of experienced surgeons, reconstructive surgeries have good outcome with minimal morbidity

Prevalence and risk-factors of early childhood caries among 2–6-year-old Anganwadi children in Nellore district, Andhra Pradesh, India: A cross-sectional survey

Purpose/Objectives: The objective of this study is to study the prevalence and associated risk determinants of early childhood caries (ECC) among preschool children. Materials and Methods: A cross-sectional descriptive study was designed to assess the ECC prevalence and associated risk factors among preschool children in Anganwadi of Nellore district using a standardized questionnaire. Results: A total of 550 study participants of age 2–6 years are enrolled in this cross-sectional study. Mean age of the participants was 4.39 ± 0.89 years. Most of the study participants (38%) were in the age of 5 years. When gender wise comparison was made girls represented 62% and boys 38% of the total population. When the risk factors were assessed for their association with caries experience, socioeconomic status, mother's schooling at child's birth, duration of using bottle, and bottle feeding while sleeping and plaque scores showed significant association with caries experience. Conclusion: ECC was more prevalent among 5-year-old children as compared to other age groups and moreover demographic factors such as mother's occupation, education, socioeconomic status, developmental characteristics such as enamel hypoplasia, feeding habits like prolonged and nocturnal bottle feeding and clinical parameters like plaque scores showed significant correlation with ECC

Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases

Aim: To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve. Materials and Methods: This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58). Results: 89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days. Conclusion: Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience