Recurrence and complications of pediatric inguinal hernia repair over 5 years

Introduction and aim Inguinal hernia is one of the most common pediatric diseases in children and it presents most commonly during the first year of life. The aim of this study was to determine epidemiologic indexes and complications of inguinal hernia repair in pediatric patients who underwent inguinal hernia surgery.Patients and methods This retrospective study was carried out in the Imam Khomeini and the Abuzar hospitals. All inpatients who underwent surgery for inguinal hernia from 2003 to 2004 were included in this study. Their hospital records were reviewed till 2007 for age, sex, wound infection, recurrence, and other complications. The v2-test was used for analysis using SPSS, version 13.0.Results In this study, 269 children were included. Of all the patients, 237 (88.1%) were boys and 32 (11.9%) were girls (P < 0.001). The median age at the first reference to the surgeon was 2.93 years. Right-side and left-side inguinal hernia was observed in 136 (50.55%) and 92 (34.20%) cases, respectively. Bilateral inguinal hernia was observed in 41 (15.25%) cases. The frequency of recurrence was 2.2%, and was observed only in boys. Postoperative complications were observed in 5.2% of the cases. The most common of them was anesthetic complication.Conclusion Most of the cases involved male patients. All of the recurrences were in male patients. Postoperative complications were observed in 5.2% of the cases. Keywords: complication, inguinal hernia, pediatric, recurrenc

Evaluation of epidemiologic indices of neonate’s diseases in the Pediatric Surgery Ward of the Ahvaz Jundishapur University hospitals during the period 1993–1996 and 2002–2005

Introduction and aim The neonatal period is a critical time for infants, and 2/3 of first-year mortality occurs during this period. In developing countries, surgical diseases are the most important cause of neonatal mortality. Mortality was reduced in the past decade due to the availability of well-trained pediatric surgeons and the development of sophisticated instruments. The aim of this study was to show neonatal mortality and other indices in the period when there were no pediatric surgeons compared with the period when pediatric surgeons were available. Patients and methods This retrospective study was conducted in the Imam Khomeini and Abuzar Hospital during the period 1993–1996 and 2002–2005. All neonates admitted in the surgical wards of the Imam Khomeini and Abuzar Hospital were included in this study. Only cases of those patients who died before data accumulation was completed or discharged against medical advice were excluded from our study. In the first period, no pediatric surgeon was available and all surgeries were performed by general surgeons. In the second period, pediatric surgeons were available. Data were statistically analyzed and χ2-test was used to compare noncategorical data. A P value of less than 0.05 was considered to be significant. This study was approved by the ethics committee of the hospital, and no intervention was used. Results In our study, 88 cases (males = 60.2%, female =39.8%) in the first period and 452 cases (males =61.7%, females= 38.3%) in the second period were included. The mean age at admission time in the first and second period was 6 days for both groups. The mean weights in the first and second period were 2886 ±766 g and 2915± 658 g, respectively. The mean lengths of hospital stay in the first and second period were 5 days and 10.5 days, respectively. In the first period, 68 cases (37.3%) were admitted in the first 7 days of life and 54 cases (61.4%) had a birth weight of 2500–3500 g. Of the 88 cases, 40 cases died (45.5%). In the second period, 353 cases (78.1%) were admitted in the first 7 days of life and 278 cases (61.5%) had a birth weight of 2500–3500 g. Of the 452 cases, 101 cases died (22.3%). Conclusion In our study, the most common surgical diseases in both the periods were imperforate anus, esophageal atresia with or without tracheoesophageal fistula (TEF), Hirschsprung’s disease, and jejunoileal atresia; these were similar to results found in other studies.Keywords: Hirschsprung’s disease, imperforate anus, inguinal hernia, pediatric, surger

Etiology of acute scrotal pain in children and adolescent patients admitted in Ahvaz Educational Hospitals

Purpose Acute scrotum is an emergency condition requiring rapid intervention. The aim of this study was to evaluate the clinical and epidemiological specifications of acute scrotum.Patients and methods This retrospective study was carried out on patients less than 21 years admitted with a diagnosis of acute scrotum in the surgical and medical wards from 2009 to 2010. One hundred and thirty-nine patients were included in this study. Epi-info version 6.4 (CDC) was used for data analysis.Results The final diagnoses were as follows: spermatic cord torsion (n =57, 41.00%), incarcerated inguinal hernia (n =30, 21.60%), epididymo-orchitis (n= 28, 20.14%), missed torsion (n =15, 10.79%), testicular trauma (n=5, 3.60%), and torsion of the appendix of the testis (n= 4, 2.87%). The most common age groups in relation to the diagnoses were as follows: testicular torsion and missed torsion (10–15 years, 34.7%), torsion of appendix testis (10–15 years, 100%), epididymo-orchitis (15–21 years, 85.71%), and incarcerated inguinal hernia with two peaks of age ( <5 years, 46.7%). Fifty-eight patients (41.72%) visited the hospital less than 6 h after the onset of pain. Twenty-eight patients underwent orchiectomy or orchiopexy and 38 patients underwent detorsion and bilateral orchiopexy. A herniotomy was performed in 15 patients and herniorraphy in 10 patients. An appendectomy was performed in four patients. Other procedures were carried out in seven patients. Out of 72 patients diagnosed with torsion (57 patients) or missed torsion (15 patients), 38 patients (52.7%) underwent a testicular salvage surgery (detorsion and orchiopexy). Out of all patients (139 patients), 92 patients underwent surgery and the rest (47 patients) were treated conservatively. These 47 patients had epididymo-orchitis (n= 28), testicular trauma (n =4), incarcerated inguinal hernia (n= 5), and missed torsion and testicular torsion (n= 10). Out of 27 patients with abnormal urinary findings, 19 patients had epididymo-orchitis.Conclusion The most common important differential diagnosis for acute scrotum is spermatic cord torsion. Most of the abnormal urinary findings were observed in patients with epididymo-orchitis. Most of the patients underwent surgery less than 6 h of disease onset. In patients with spermatic cord torsion, the affected testis has to be evaluated and treated during the first 6 h of presentation.Keywords: epididymitis, epididymo-orchitis, herniotomy, hydrocele, inguinal hernia, orchiopexy, scrotum, testicular torsion, traum

Congenital anomalies in low- and middle-income countries: the unborn child of global surgery.

Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability

Complementary analysis of Mueller-matrix images of optically anisotropic highly scattering biological tissues

Background: Using optical techniques for tissue diagnostics (so-called ‘optical biopsy’) has been a subject of extensive research for many years. Various groups have been exploring different spectral and/or imaging modalities (e.g. diffuse reflectance spectroscopy, autofluorescence, Raman spectroscopy, optical coherence tomography (OCT), polarized light microscopy, etc.) for biomedical applications. In this paper, we report on using multi-wavelength imaging Mueller polarimetry combined with an appropriated image post-processing for the detection of tissue malignancy. Methods: We investigate a possibility of complementary analysis of Mueller matrix images obtained for turbid tissue-like scattering phantoms and excised human normal and cancerous colorectal tissue samples embedded in paraffin. Combined application of correlation, fractal and statistical analysis was employed to assess quantitatively the polarization-inhomogeneous scattered fields observed at the surface of tissue samples. Results: The combined analysis of the polarimetric images of paraffin-embedded tissue blocks has proved to be an efficient tool for the unambiguous detection of tissue malignant transformation. A fractal structure was clearly observed at spatial distributions of depolarization of light scattered in healthy tissues in a visible range of spectrum, while corresponding distributions for cancerous tissues did not show such dependence. We demonstrate that paraffin does not destroy a fractal structure of spatial distribution of depolarization. Thus, the loss of fractality in spatial distributions of depolarization for cancerous tissue is related to the structural changes in the tissue sample induced by cancer itself and, therefore, may serve as a marker of the disease. Conclusion: The obtained results emphasize that a combined use of statistical, correlation and fractal analysis for the Mueller-matrix image post-processing is an effective approach for an assessment of variations of optical properties in turbid tissue-like scattering media and biological tissues, with a high potential to be transferred to clinical practice for screening cancerous tissue samples

Polarimetric and spectral imaging approaches for quantitative characterization of inhomogeneous scattering media including biotissues

Abstract In this thesis, light-tissue interaction was investigated through different experimental and analytical methodologies to analyze optical and polarization properties over time and the obtained results were utilized in biomedical and food science applications. In this thesis, soft biological tissues (pork samples) were selected as a biological tissue due to their similarity to human tissue. First, the relative spectral changes of absorbance were studied by applying two different custom-built configurations. A Monte Carlo modelling and principal component analysis (PCA) method were applied further to the absorbance dataset to provide thorough studies for a spectroscopic approach. Second, a novel application of Mueller matrix (MM) imaging polarimetry was pioneered to visualize the dynamics of the tissue polarization properties over time with a custom-built Mueller matrix imaging polarimeter (MMIP). Frequency distribution histograms (FDHs) and the changes in the statistical moments of the MM elements were analyzed over time to provide qualitative and quantitative information of the tissue polarization properties. Finally, a new Stokes-polarimetry was introduced to examine optically thin histological sections from optically anisotropic biological tissues with different morphological structures. In summary, in spectroscopic and imaging polarimetry approaches, prominent changes in optical properties of the examined soft biological tissues were discriminated over time. The obtained results are promising in the development of a novel non-destructive tool for monitoring biological tissues for application in biomedical applications and the food industry. The Stokes-polarimetry method can provide a comparative analysis of different polarimetric techniques and prove the diagnostic potential of Stokes correlometry of pathological changes in the orientation-phase structure of biological tissues.Tiivistelmä Tässä opinnäytetyössä valon ja kudoksen vuorovaikutusta tutkittiin erilaisilla kokeellisilla ja analyyttisillä menetelmillä, jotta voitiin tunnistaa optisten ja polarisaatio-ominaisuuksien alkuvaiheita ja hyödyntää saatuja tuloksia biolääketieteellisissä ja elintarviketieteellisissä sovelluksissa. Tässä työssä pehmeäksi biologiseksi kudokseksi valittiin sianlihanäytteet niiden ja ihmiskudoksen samankaltaisuuden vuoksi. Ensiksi pehmeiden biologisten kudosten absorbanssin suhteellisia spektrimuutoksia tutkittiin soveltamalla kahta erilaista räätälöityä kokoonpanoa, jotka yhdistettiin. Monte Carlon mallintamista ja pääkomponenttianalyysimenetelmää (PCA) sovellettiin edelleen absorbanssiaineistoon, jota voitiin perusteellisesti tutkia spektroskooppisesti. Toiseksi Mueller-matriisin (MM) kuvantamispolarimetrian uudella sovelluksella pyrittiin visualisoimaan kudosten polarisaatio-ominaisuuksien dynamiikkaa ajan suhteen räätälöidyllä Mueller-matriisikuvauspolarimetrillä (MMIP). Taajuusjakauman histogrammit (FDH) ja MM-elementtien tilastolliset momenttimuutokset analysoitiin ajan suhteen, jotta saataisiin kvalitatiivista ja kvantitatiivista tietoa kudosten polarisaatio-ominaisuuksista. Lopuksi otettiin käyttöön uusi Stokesin polarimetrinen menetelmä, jotta voitiin tutkia optisesti ohuita histologisia leikkauksia anisotrooppisista biologisista kudoksista, joilla on erilainen morfologinen rakenne. Yhteenvetona voidaan todeta, että spektroskooppisesti ja kuvantamispolarimetrillä tutkittujen pehmeiden biologisten kudosten optisten ominaisuuksien huomattavat muutokset erotettiin selvästi ajan suhteen. Saadut tulokset ovat lupaavia, kun kehitetään uutta ainetta rikkomatonta työkalua biologisten kudosten seurantaan biolääketieteellisissä sovelluksissa ja elintarviketeollisuudessa. Stokesin polarimetrisella menetelmällä voidaan tuottaa vertaileva analyysi erilaisista polarimetrisistä tekniikoista ja todistaa Stokesin korrelometrian diagnostinen potentiaali biologisten kudosten orientaatiovaiheen rakenteessa

Assessment of meat freshness and spoilage detection utilizing visible to near-infrared spectroscopy

Abstract Visible to near-infrared spectroscopy have been applied for non-invasive assessment of meat freshness. The reduction of oxymyoglobin absorbance associated with freshness drop is clearly seen in the visible range of spectra, as well as supplementary fat, water, and proteins contents variations are observed in the near-infrared range. A table-top spectrophotometer equipped with an integrating sphere was utilized for a shallow probing depth (80 μm) and covered 400–1700 nm spectral range. A fiber-optic linear array was coupled to a portable spectrophotometer (measurement range 400–1000 nm) for increasing the average probing depth up to 570 μm. The studied samples of meat experienced an immediate loss of superficial freshness, while kinetics of spoilage was detected after about 2.5 hours. The fiber-optic approach capable for sensing freshness and spoilage process shows promise for design of a compact, portable device for a variety of users at the meat supply chain

Esophageal atresia: comparison between survivors and mortality cases who underwent surgery over a 2-year period in two referral hospitals, Tehran, Iran

Introduction and aim The aim of this study was to compare the type of suture, technique of suture, and technique of anastomosis between survivors and mortality cases.Patients and methods This study was conducted in Bahrami Hospital and Children’s Medical Center on cases with esophageal atresia who underwent surgery for esophageal atresia and/or tracheoesophageal fistula repair. The places of study were Bahrami Hospital and Children’s Medical Center, two referral centers for pediatric surgery in Tehran. The duration of the study was 2 years, starting from April 1999. Survivors and mortality cases were compared with regard to sex, type of surgery, suture material, and technique of anastomosis. Gross classification was used for typing of anomaly. All data were analyzed again using SPSS ver. 13.0 and Epi-info ver. 6.04d (CDC,WHO). The v2-test was used for comparison.Results In this study, 21 (male = 9, female =12) mortality cases and 53 (male = 29, female =24) survivors were included. Among them, 18 (85.7%) mortality cases and 51 (96.2%) survivors had type C atresia (P = 0.23). Thoracotomy and repair of atresia was performed in 10 (47.6%) mortality cases and 51 (96.2%) survivors. Gastrostomy and tracheoesophageal fistula repair was performed in eight (38.1%) mortality cases. Gastrostomy and cervical esophagostomy was performed in three (14.7%) mortality cases and two (3.8%) survivors. Anastomotic leak was noted in eight mortality cases and 10 survivors who underwent thoracotomy and atresia repair (P = 0.0005). End-to-end anastomosis was performed for nine mortality cases and 45 survivors (P = 0.7). Extrapleural thoracotomy was performed in nine mortality cases and 45 survivors (P = 0.7). Single-layer anastomosis was performed in eight mortality cases and 36 survivors (P = 0.82). There were no significant differences between survivors and mortality cases with regard to sex and type of atresia (P =0.23). Thoracotomy and atresia repair was more frequently performed in survivors than in mortality cases (P = 0.000004). Anastomotic leakage was significantly higher in mortality cases compared with survivors (P = 0.0005).Conclusion Anastomosis leakage was associated with higher mortality. The rate of thoracotomy and atresia repair surgery is higher in survivors compared with mortality cases. Keywords: esophageal atresia, risk factors, surgical repai