Gastric Tube Interposition for Esophageal Replacement in Children, Is it the best option?

Introduction: Replacement of esophagus can be accomplished using different parts of the gastrointestinal tract, in various positions and in single and multiple stages. The aim of this study is to present the results of gastric tube interposition in children with congenital esophageal anomalies and severe acquired esophageal stricture.Material and Methods: This series describes 22 patients who underwent gastric tube interposition procedures for esophageal replacement at Mofid Children’s Hospital Tehran, Iran between 1996 and 2014. Clinical data including the indication for esophageal replacement, technique and timing of repair, early and late complications, and long-term follow-up were retrospectively gathered from patients’ medical records.Results: Patients consisted of 17 Male and 5 female, aged 8 months to 14 years (mean 47.8 months). Twenty one patients had normal oral feeding and proper weight gain. The mean time of follow up was 9.25 years (9 months to 18 years). One of our cases developed failure to thrive although he had no difficulty in swallowing and was eventually put on supplementary feeding by gastrostomy.There were 3 strictures: one in the neck anastomosis which was treated by dilatation and revision of anastomosis, one in the hiatal level which was because of tight hiatus and was treated by widening of hiatus. The last patient had a stricture at mid-portion of gastric tube, and was treated by dilatation, which resulted in perforation and was treated by stricturoplasty. Three leaks occurred at the neck anastomosis, two healed spontaneously and one resulted in intra thoracic leak and mediastinitis that led to death after 3 months. Another child with lymphocyte adhesion deficiency died due to infected neck wound and severe bleeding from carotid artery 22 days postoperatively, a third death occurred many years after the original operation due to mediastinitis which was the result of dilatation for stricture formation.Conclusions: Although gastric tube replacement in posterior mediastinum seems an ideal replacement because of adequate length which makes it easily reachable to pharynx, good blood supplies, straight and proper size; the management of complicated cases such as mediastinal leaks and strictures is very challenging and rules out this method of esophageal replacement as the best option possible

The Efficacy and Safety of Oxcarbazepine as Add-On Therapy in Intractable Epilepsy in Children

Objective1-3% of the population suffer from epilepsy. Up to 30% of them develop refractory epilepsy and their seizures occur more than once per month despite receiving at least 2 first line antiepileptic drugs. In  this group, more efficacious antiepileptics are needed. This study was undertaken to evaluate the efficacy and safety of Oxcarbazepine as an adjunction therapy in children with refractory epilepsy.Materials & MethodsFrom Feb 2004 until Sep 2006, 30 patients with refractory epilepsy aged between 4 and 14 years were evaluated in a before and after type study.The patients had seizure ranging from once monthly to more than 10 times daily and none of them had used Oxcarbazepine previously. They received Oxcarbazepine 30 to 50 mg/kg/day orally in  combination with their current antiepileptic drugs and were regularly assessed for seizure frequency and side effects for 10 months.ResultsWith Oxcarbazepine adjunction therapy, 10% of the patients became seizure-free, 36.6% experienced more than 50% reduction in seizure frequency, and 13.3% had increasing seizures. The drug was  especially effective in the patients with partial seizures (77.7%). Brief and transient adverse effects were seen in 36.6% of the patients which disappeared with treatment continuation. Wilcoxon signed ranks test showed that oxcarbazepine was effective in the treatment of refractory seizures (P=0.003) and as shown by Fisher's exact test, it was more effective in partial seizures (P=0.0043).ConclusionThe results showed that Oxcarbazepine was a useful medication in the treatment of refractory epilepsy, especially the partial type, in children.

Full-Thickness Rectal Prolapse in children: Sclerotherapy versus Lockhart Mummery Rectopexy

Introduction: Rectal prolapse is a relatively common disorder in childhood. In this phenomenon, the whole layers of the rectum protrude throughout the anus. Self-limiting cases of rectal prolapse are more common in children below four years old, and overall prevalence is higher in the first year of life, with a predominance of male children. Formerly, the therapeutic efforts insisted on surgery. Nowadays, noninvasive methods like Sclerotherapy have entered the arena. Materials and Methods: This study aimed to compare the efficacy and postoperative complications of 56 children suffering from full-thickness rectal prolapse retrospectively randomized in two groups of conventional surgery and Sclerotherapy referring to the Mofid children's hospital from 2017 to 2020. The authors have used Lockhart mummery rectopexy and Sclerotherapy methods with hypertonic dextrose 50%. Results: Our results revealed a statistically significant difference in mean hospital stay (P-value <0.0001) and follow-up time (P-value=0.009) in the sclerotherapy group compared to other group, but surgical complications (P-value=0.58) and recurrence rate (P-value= 0.62) were statistically non-significant in both groups. Conclusion: careful selection of patients based on symptoms has a vital role in the success of the chosen method for treating rectal prolapse in children. &nbsp

Epidemiological Aspects, Clinical Features and Treatment Outcome in Children Suffering Hepatoblastoma

Introduction: Hepatoblastoma (HBL) is the most common primary liver tumor within childhood. Entire tumor resection is basis for ultimate cure for HBL and supports the only pleasant chance of long-standing disease-free survival. Objectives: In the current survey, we attempted to evaluate the long-term survival of children with HBL with surgical resection in a referral children hospital in Iran within the last decade. Materials and Methods:This retrospective descriptive study was conducted on all children who suffered HBL and undergone surgery between 2006 and 2016. Reviewing the recorded hospital files led to a sample of 30 eligible patients. The baseline characteristics of the patients were all collected by reviewing the files. Results:In total, 30 consecutive children (21 male and 9 female) suffering HBL were described. Of those, 40.0% aged less than 12 months and only 6.7% aged higher than 36 months. The most common clinical manifestations were asymptomatic abdominal mass (in 66.7%) followed by fever (in 10.0%) and pain (in 10.0%). In more than half of the patients (53.3%), right lobe involved, while left lobe involved in 16.7%. based on histologicalreport,marginal involvement was found in 75.0% of children, margin intact in 15.0% and margin free feature in 5.0%. Forty percent of children suffered from epithelial subtype of tumor, 20.0% from mixed epithelial and mesenchymal subtypes, and 13.3% from embryonal pattern. In total, 63.3% were scheduled for complete surgical resection followed by chemotherapy. Postoperatively, 40.0% of children remained free of complications, whereas postoperative bleeding occurred in 20.0% and biloma in 40.0%. Overall, 76.9% of patients were completely cured, 7.7% suffered from pulmonary metastasis and 3.9% required liver transplantation. Postoperative death occurred in 11.5%. Conclusions: Considering surgical resection followed by chemotherapy leads to high cure rate, however a notable number of affected children suffer postoperative complication, requiring liver transplantation, pulmonary metastasis, or even non-survived emphasizing a serious review of the treatment protocols.  &nbsp

The role of routine transanastomotic T tube ostomy in jejunoilealatresia:A prospective, randomized study

Introduction: Jejunoileal atresia (JIA) is a common cause of neonatal intestinal obstruction and is a common surgical emergency. The aim of this study was to compare primary anastomosis without resection of the dilated segment with transanastomotic T tube jejunostomy (TATTO) versus resection of the dilated segment without T tube as the control group for treatment of patients with JIA.Material and Methods: During 2008 to 2013, 105 patients were diagnosed with JIA at the time of surgery and were recruited for this study. Data relating to efficacy and procedural complications were compared among patients. The criteria for exclusion were duodenal obstruction, colonic atresia, intestinal perforation, malrotation, and also JIA patients with associated other anomalies like meconium ileous, gastroschisis and anorectal malformation.Results: A total of 125 patients were diagnosed and 16 patients were excluded. Our patients were divided into a control group (n=52) and a TATTO group (n=57). The TATTO group had a significantly shorter postoperative hospital stay (12 vs. 23 days, p=0.001) and time to start feeding (9 vs. 13 days, p=0.003) compared with the control group. Sepsis (12.0% vs. 32.7% p=0.004), other complications (3.6% vs. 15.4% p=0.001) and the associated morbidity were significantly lower in the TATTO group.Conclusion: The findings suggest that the TATTO technique was a better method for the treatment of children with JIA, as study showed lesser morbidity and mortality rates.

The Late presenting Bochdalek hernia; A Case report and review of literature

We report a 22-month-old boy who referred due to nausea, vomiting, abdominal pain and watery non-bloody diarrhea and after thorough evaluation, a large defect in the left postero-lateral side of diaphragm and presence of bowel loops, spleen, stomach and left lobe of liver in the left hemi-thorax were detected. So, he was operated and managed with the impression of Bochdalek hernia. We have also reviewed the similar case reports in the past 10 years, briefly, in order to map the presentations and clinical course of cases with Bochdalek hernia which were diagnosed late, for giving physicians a better insight on this issue

Evaluation of Complications of Peritoneal Dialysis Catheter in Children: A Retrospective Single Center Study

Introduction:Peritoneal dialysis is a long-term method of dialysis for children. Peritoneal dialysis, when performed effectively, saves valuable time for children with advanced kidney transplant, till they reach the appropriate age for the kidney transplant. In children, due to their rapid physical growth and the large catheter size, as well as the thin and weak abdominal wall, especially before the age of 4, the complications of catheterization such as catheter leak and incisional hernia are higher than that of adult population. In this study we aim to evaluatethedysfunction and complications of the cathetersof peritoneal dialysis in children. Materials and Methods:We assessedmedical records of all patients, who underwent peritoneal dialysis since 2006 till 2015 at Mofid hospital, Tehran, Iran. Total number of 41 records were evaluated, of which 11 cases were excluded dueto incomplete data and 30 patients were analyzed eventually.Complications of catheter were recorded. Results:We studied 30 patients, 14 males and 16 females; the mean age of the children was 72.6 months(5 to 12 years old). The leading cause of end stage renal disease(ESRD) were primary glomerulopathies. There were total of 3 catheterreplacements,mostly due to peritonitis and catheter obstruction. The incidence of infectious complications was 40.3%. The incidence of all complications was 1 out of 6.4 patients/month. Conclusion: Regarding the high prevalence of catheter-related complications in children undergoing chronic peritoneal dialysis, especially infectious complications, adopting standard surgical technique of catheter insertion accompanied bywell trained peritoneal dialysis team isessential to prevent the complications and to increase the functional life span of the catheter and to enhance the quality of life of the patient

Management and outcomes of hidden penis in children

Introduction: Hidden penis may have different categories: Concealed, trapped, and buried types. The aim of this study was to evaluate the results and outcomes of repaired cases.Material and Methods: A total of 40patients (5months -12years old) underwent surgical repair for different types of hidden penis from April 2010 to December 2015 in our hospital. Multiple surgical procedures were performed for each type. Data were collected and evaluated for number of patient’s, type of anomalies, surgical techniques, outcome and follow-up.Results: All forty cases underwent surgical repair. In all cases of concealed and buried penis penile degloving and penile fixation was used. In all of our cases improved function and good outcome was reported.Conclusions: Patients with hidden penis are in great psychological risks. The aim of hidden penis repair is to restore an aesthetic and functional penis which we are happy that we provided for our patients

Relation between cold weather and testicular torsion in children

Introduction: Reports were recently published in relation to cold weather and testicular torsion (TT) that is why we decided to evaluate this hypothesis risk factor at our children’s hospital.The aim of this study is to evaluate the relation between cold weather and testicular torsion in children.Material and Methods: In this retrospective and descriptive study from January 2011 to December 2015, onehundredseventypatients were admitted at Mofid Children’s Hospital due to acute scrotum. According to our center guidelines, those patients who had proven TT were candidates for this study. The records of all operated children wereanalyzed according toage, season of year, and operation type.Results: A total of one hundred seventy patients were included in this study within five years, with a mean age of 28.6+ 32.9months (range1 to 144).Winter season was the peak time for testicular torsion (42%).Conclusion: The incidence of testicular torsion increases during cold weather

Clinical Characteristics and Mortality of a Hospitalized 13 Years Old Patient with Covid-19: A Case Report

The corona virus is a global problem that threatens human life. According to the latest data from different countries the mortality of this virus in children is less than adult. A 13-year-old girl was hospitalized for 6 months following a gunshot trauma and its complications. When her general condition was finally improving, she was diagnosed with the corona virus and passed away. Children who are suffering from underlying diseases and need medical care are at a higher risk of death from the corona virus