The comparison of effectiveness, safety, and clinical outcome of one steppercutaneous abscess aspiration versus drainage by insertion of a drainage catheter in children with post-appendectomy abscess

Introduction: Although radiologic guided abscess drainage with a drainage catheter has been a successful method for treatment of appendicular abscess after surgery, single stage aspiration technique could also be used as a good option in children with intra-abdominal abscess. The aim of this study was to compare efficacy, safety and clinical outcome of percutaneous abscess drainage versus aspiration in pediatric patients with post-appendectomy abscess formation.Materials and Methods: This randomized control trial was conducted under the supervision of Mashhad University of medical sciences. Children were enrolled in the study with suspicion of post-appendectomy abscess formation. Patients were divided into two groups (drainage or aspiration) with simple sampling method. Demographic characteristics and clinical outcome were compared between the two groups. Data analysis was done using SPSS version 16.Results: Fifty children with post-appendectomy abscess were enrolled in this study. Their mean age was 10.4 ± 4.1 year (range from 5 to 19yrs). Drainage was successful in 88% of patients and the succeed rate in aspiration group was 96% and this difference was not significant statistically (p=0.609). Duration of hospital stay was longer in the drainage group in comparison with aspiration (2.8 ± 0.55 vs. 2.1 ± 0.47, p-value < 0.001).Conclusion: Efficacy, safety and other clinical outcomes of percutaneous abscess drainage and aspiration were the same in pediatric patients with smaller than 5 cm post-appendectomy abscess. Due to lower cost and parental satisfaction, aspiration would be a good choice in children with small post-appendectomy abscess

Thoracoscopic Congenital Diaphragmatic Hernia repair in neonate: The First Experience of Iranian Group

Background: Congenital diaphragmatic hernia (CDH) occurs due to a failure in closing pleuroperitoneal membrane thus resulting in an incomplete diaphragm formation1, which allows passage of the abdominal viscera into the thorax.1,3 Until 1995, the standard method for treatment of CDH was performed by open surgery through the abdomen or thoracic cavity. Minimally invasive approach via thoracoscopy or laparoscopy is applicable for treatment of CDH since 1995.4 Now a day’s thoracoscopic repair of CDH (T’Scopy CDH) is performed in many centers. In this paper, we present our experience of T’Scopy CDH repair from Iran.Patients and Methods: From 2011 to 2015, 74 patients with CDH were admitted to Pediatric Surgery Department of Dr. Sheikh (Sarvar) Pediatric Hospital. Twenty one patients (28%) met our inclusion criteria and underwent T’Scopy CDH repair. The median age at the time of repair was 5 days (2-daysold to 4-years-old patients). Inclusion criteria were weight over 2 kg and stable hemodynamics and arterial blood gas. Fourteen cases were intubated before entering the operating room. The defect was in the left side except in two cases. In 8 cases, we used thoracic wall as part of repair. Also, mesh support was utilized in 8 cases even in cases were primary repair of diaphragm was possible in order to reinforcing the repair (5 cases). Of these 8 cases, in 3 patients, whole repair was accomplished by mesh due to presence of a large defect.Results: The mean time of operation was 80 minutes (40-230 minutes). Intraoperative mortality was zero. In hospital, mortality occurred in two cases due to septicemia in one and respiratory and cardiac failure in another. Conversion to open surgery was required in 6 cases. Late recurrence was observed in 2 cases. The mean time of follow up was 14.6 months (3-36 months).Conclusion: It seems that appropriate case selection and liberal use of thoracic wall and mesh as a part of repair may cause better results and decreased chance of early and late recurrence

The clinical application of Circulating tumor cells and DNAs as prognostic and predictive biomarkers in gastrointestinal cancer

Gastrointestinal (GI) cancer is one of the most common cancers globally. Genetic and epigenetic mechanisms are involved in its pathogenesis. The conventional methods for diagnosis and screening for GI cancers are often invasive and have other limitations. In the era of personalized medicine, a novel non-invasive approach called liquid biopsy has been introduced for the detection and management of GI cancers, which focuses on the analysis of circulating tumor cells (CTCs) and circulating cell-free tumor DNA (ctDNA). Several studies have shown that this new approach allows for an improved understanding of GI tumor biology and will lead to an improvement in clinical management. The aim of the current review is to explore the clinical applications of CTCs and ctDNA in patients with GI cancer. Key words: Gastrointestinal cancer; Liquid biopsy; CTCs; ctDNA; biomarkers; tumor biolog

A Novel Experience in Treatment of Liver Hydatidosis in Pediatrics: A Clinical Trial Study

Background Hydatidosis is a conventional health public problem in most parts of the world. Safe treatment of patients with hydatidosis has been a topic of debate for a long time. Surgical treatment always was associated with high morbidity and mortality. Medical treatment is also controversial. In this study, alternative procedure named Percutaneous, Aspiration and hypertonic Saline Instillation (PAHSI) was applied to treat patients with hydatidosis. Materials and Methods In this single-blind clinical trial, thirty-eight patients, ranging in age between 6 months and 16 years, with 81 hepatic hydatid cysts underwent PAHSI treatment. The consecutive steps including sonographic guidance, aspiration of cyst content and injection of 15% saline hypertonic were carried out in this method. Patients with multiple cysts also were treated by this procedure. Results Participants were 18 boys (47.3%) and 20 girls (52.6%) with mean age of 8.08+ 3.92 years. Almost half of the patients had single cyst (52.63%). During 2- year follow- up, no recurrences were observed; therefore, re-hospitalization and possible complications reduced considerably. Furthermore, this method was applicable to cure multiple cysts. Conclusion In PAHSI strategy, it seems that the complications of surgery (laparotomy and anesthesia) decreased since no complications observed after procedure, and cosmetic results in future are much better due to avoidance of incision

Solid Pseudopapillary Tumor of Pancreas in a 14-year-old Adolescent Presenting With Melena: A Case Report

Background: The incidence of pancreatic neoplasms in infants and children is 1.8 cases per 1000000. Three of children’s most common primary pancreatic neoplasms are pancreatoblastoma, solid pseudopapillary neoplasm of the pancreas, and pancreatic endocrine neoplasms. Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor. Solid pseudopapillary neoplasm in children is presented with a palpable mass (60%), followed by abdominal pain (33.3%). Although duodenal invasion frequently occurs in patients with pancreatic cancer, massive gastrointestinal bleeding is seldom encountered. The most helpful imaging technique is the CT scan. Surgical resection is the treatment of choice for solid pseudopapillary neoplasms. Case Presentations: A 14 years old male adolescent was presented to our pediatric emergency department with fatigue, dizziness, fever, vomiting, and tachycardia. He had melena 5 days before admission. Crystalloids, pantoprazole, and packed red blood cells were administered to stabilize the patient. As the initial resuscitation measures stabilized the patient, endoscopic gastroduodenoscopy was performed, and a vascular lesion measuring 60×70 mm was noted in the second part of the duodenum. CT scan of the abdomen with intravenous and oral contrast showed a mass with solid and cystic components measuring 75×52 mm between the head of the pancreas and gallbladder origination from the head of the pancreas. The patient underwent Whipple surgery. The diagnosis of the pathologic evaluation was a solid pseudopapillary tumor of the pancreas. Conclusions: Most pediatric pseudopapillary tumors of the pancreas present with a palpable mass and abdominal pain, and gastrointestinal bleeding is a rare presentation not mentioned in previous case reports

Investigating the Relationship between Anxiety of School-age Children Undergoing Surgery and Parental State-trait Anxiety

Background: Surgery is a stressful experience for children, and preoperative anxiety in children could be affected by the level of parental anxiety. Aim: The aim of this study was to determine the relationship between anxiety in school-age children before surgery and parental state-trait anxiety. Method: This descriptive study was performed on 81 children within the age group of 6-12 years admitted for elective surgical operation and 128 parents in Doctor Sheikh Hospital, Mashhad, Iran, 2016. Children's anxiety and parental anxiety were measured before the entrance of the patients to the operating room via Revised Children's Manifest Anxiety Scale (RCMAS) and Spielberger’s State-Trait Anxiety Inventory, respectively. The data was analyzed in SPSS, version 16, using the relevant statistical tests. Results: The results of Pearson product-moment correlation test showed a positive correlation between children's anxiety and fathers' state anxiety and between children's anxiety and mothers' state anxiety (r=0.27, r=0.41; P=0.005, P=0.040, respectively). However, no statistically significant relationship was observed between children's anxiety and parents' trait anxiety, age of children, as well as parents' educational level, occupation, and level of trait anxiety. Implications for Practice: Considering the association between parents' state anxiety and children's anxiety, implementing preoperative interventions to prepare parents for surgery is recommended

Herniation of the appendix into the umbilical cord complicating umbilical vessel cannulation

Umbilical catheters (UC) have become the most common way to access neonatal veins and arteries especially after the increasing the number of preterm newborns. Significant clinical complications have been reported with this increased usage of UC. We present a rare complication of umbilical catheterization in a newborn with asphyxia that had meconium discharge after UC. Keywords: Umbilical catheter, Complicatio

Surgery and Anesthesia Management for Intraoral Synechia: A Case Report

Introduction: Intraoral synechia is a rare congenital condition, generally associated with other maxillo-facial malformations. We present a neonate with congenital intraoral bilateral synechia without any other facial anomalies.   Case Report: In this paper, we present a 19-day-old male neonate with congenital intraoral bilateral synechia without any other facial anomalies. We review the literature to discuss the surgical andanesthesia management of this rare congenital disease.   Conclusion: The disease manifested with a wide spectrum of symptoms. Most cases need surgery and airway management. In patients with a low risk of bleeding or a compromised airway, it is possible to manage them withfacemask-inhalation anesthesia and maintain spontaneous breathing

Controlled vs Spontaneous Ventilation for Bronchoscopy in Children with Tracheobronchial Foreign Body

Introduction Tracheobronchial foreign body aspiration is a common life-threatening condition in children. There are controversies in the management of this condition, including the type of ventilation during bronchoscopy.  This study aims to compare anesthesia with controlled ventilation versus spontaneous ventilation in rigid bronchoscopy in children with foreign body aspiration.  Materials and Methods: Patients who were candidates for rigid bronchoscopy due to foreign body aspiration were randomly assigned to either anesthesia with spontaneous ventilation or controlled ventilation. End tidal CO2 (ETCO2), electrocardiogram (ECG), heart rate (HR), oxygen saturation (SpO2), non-invasive blood pressure (NIBP) and complications and accidents during the surgery and recovery were recorded for each patient. Surgeon comfort during the procedure was also evaluated for each patient. A 20% change in HR or NIBP was considered significant. SpO2 values under 90% are considered desaturation.  Results: Fifty-one patients (31 male and 20 female) entered the study. The mean age was 26.76 months, ranging from 6 to 100 months. Choking and cough were present in 94% and 96.1% of the patients, respectively. Nuts were the most common foreign body (76.9%). The controlled ventilation group had significantly fewer complications, and surgeon comfort was significantly higher in this group. Oxygen desaturation was significantly more prevalent in the spontaneous ventilation group during laryngoscopy and bronchoscopy (