Biliary Tract Disease in Pediatric Surgery Department: 10 Years Experience in Khouzestan-IRAN

Introduction: Our aim was to evaluate clinical manifestation, and outcome of biliary tract disease in patients referred for treatment to two referral centers of pediatric surgery of Ahvaz.Materials and Methods: In this retrospective study, patients with biliary tract disease admitted in Imam Khomeini and Abuzar hospitals (two referral centers for pediatric surgery in Ahvaz) during a 10-year period starting from March 2000 were evaluated. Age, sex, clinical manifestation, type of surgery, imaging finding, laboratory finding, duration of hospital stay, blood product infusion, and mortality rates were recorded. Data was analyzed with SPSS Ver 13.0(Chicago, IL, USA). We used Chi-square and t-test for comparison.Results: Twenty cases (m=13, f=7) of biliary atresia were included in this study. Mean age at the time of diagnosis and operation was 82.11 days (30 days- 6.5 months). Jaundice (100%), acholic stool (55%), and dark brown urine (55%) were the most frequent clinical manifestation in patients with biliary atresia. Of all cases, 17 patients underwent surgery. Eighteen cases (m=11, f=7) of cholecystitis were included in this study. Abdominal pain (72%) was the most frequent sign. Eleven cases underwent surgery. Five cases of choledochal cyst (m=0, f=5) were included in this study. Abdominal pain and vomiting was the most common clinical manifestation in cases with choledocal cyst.Conclusion: Jaundice, acholic stool, and dark brown urine were the most frequent clinical manifestation in cases with biliary atresia. Mean age at the time of diagnosis and operation for biliary atresia was 82.11 days (30 days- 6.5 months). Abdominal pain was the most frequent sign of cholecystitis. Early referral and more experience are needed in order to increase survival of biliary atresia cases in our hospital

Evaluation of Omphalocele Treatment Using New Surgical Technique

Introduction: The aim of this study was to evaluate a new technique for treatment of omphalocele using mesh fixation to skin with preserved omphalocele sac. Materials and Methods:  Chart of patients who treated with mesh fixation were reviewed. Demographic features, mortality and morbidity following treatment were recorded. Results: in the current study 68 patients (f=32, m=36) were included. Of 68 csaes, 44(64.7%) had giant omphalocele. Among all cases, 20(29.4%) had isolated omphalocele. Mortality was 26.5%(18 of 68).  Of survived cases, 21(42%) had detached mesh. Adhesion band was seen in 4(8.2%) of cases. Sepsis was seen in 11.8% of the cases. Conclusion: According to the result of the study, suggested technique is promising and had several benefits. Duration of hospital staying, duration of intubation was less than previous technique

Outcome of patients with anorectal malformations after posterior sagittal anorectoplasty: a study from Ahvaz, Iran

Aim and purpose The aim of this study was to evaluate the outcome of patients who underwent posterior sagittal anorectoplasty (PSARP) for the treatment of low or high anorectal malformation (ARM).Patients and methods All patients who underwent standard PSARP were included in this study. Patients with mental retardation were excluded from our study. Patients were classified according to the Rintala score into four categories: poor (6–9); fair (9–11); good (12–17); and normal (18–20). We used a questionnaire introduced by Rintala. The type of anomaly was divided into two categories. We used low and high ARM definitions according to the relationship of the terminal colon to the levator muscles of the pelvic floor. The Student t-test, the Pearson v2-test, one-way analysis of variance, and the Levine test were used for data analysis using SPSS ver. 13.0.Results Sixty patients aged 3–17 years (13.63 ± 3.27 years) were included. The mean of score in patients with low-type ARM was 14.5± 2.6 and that in patients with hightype ARM was 13.19± 3.75 (P = 0.28). The mean of scores was 13.34± 3.5 among male patients and 13.94± 2.9 among female patients. There was no statistically significant difference (P = 0.46). The score was significantly higher in patients with fistula (n= 51, 13.9 ± 3.1) than in patients without fistula (n= 9, 11.8± 3.3; P= 0.03). Excluding two cases with scrotal-type fistula and rectal atresia, there was no significant difference between the two groups (P= 0.06).Conclusion There was no significant difference in the outcome after PSARP between boys and girls. There was no significant difference between low-type and high-type ARM. The mean of score was significantly higher among patients with fistula than among patients without fistula.Keywords: anoplasty, anorectal malformation, constipation, fistula, scrotal,vesical, vestibula

Esophageal atresia: our experiences in a university hospital

Introduction and aim Esophageal atresia is a relatively common congenital malformation occurring one in 2500–3000 live births. The aim of this study was to determine the frequency, type of anomaly, and mortality and to detect the associated anomaly in patients with esophageal atresia.Patients and methods All neonates with diagnosis of esophageal atresia who were referred to pediatric surgery ward of Imam Khomeini Hospital were included in this study. Duration of this study was 10 years from 20 March 1997 to 20 March 2006. For comparison, duration of the study was divided into two periods (1997–2001 and 2002–2006). Sex, mortality rate, associated anomalies, type of atresia, mortality, performing thoracostomy or gastrostomy, and packed cell infusion were studied. Gross classification was used for typing of anomaly. Analysis was performed using the Pearson v2-test and analysis of variance using SPSS.Results In this study, 198 (male = 100, female = 98) neonates were included. The most frequent type of atresia was type C (93.4%). Overall mortality rate was 50%. Mortality during the first period was 54.43% and during the second period was 47.05% (P = 0.384). The mean age at the second surgery was significantly higher in type D patients compared with others. The rate of gastrostomy was significantly higher during the first period (89.87%) compared with the second period of study (79.27%) (P = 0.002). The rate of cervical esophagostomy was decreased from 8.86 to 4.23% (P = 0.228).Conclusion Mortality rate has decreased in our hospitals. The rate of gastrostomy decreased during the second period of study. The age at the first surgery was significantly higher in type D classification patients.Keywords: esophageal atresia, gastrostomy, morbidity, mortality, thoracostomy, tracheoesophageal fistula, VACTERL syndrom

EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA Avaliação dos fatores de risco que afetam deiscência de anastomose após reparação de atresia esofágica

ABSTRACT -Background: Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage. RESUMO

An evaluation of ascitic calprotectin for diagnosis of ascitic fluid infection in children with cirrhosis

The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis. Materials and methods In this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA. Results Thirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease. Conclusion Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN

Langerhans Cell Histiocytosis with Thyroid Involvement in a 3 Year-Old Child - a Case Report

Langerhans cell histiocytosis (LCH), a monoclonal disease of histiocytes, may involve several organ systems but rarely primarily involves the thyroid gland. This report presents an extremely rare case of LCH of the thyroid in a 3-year-old boy who presented with a neck mass for several weeks. LCH of the thyroid should be considered in the differential diagnosis of a child with a thyroid mass. Pulmonary examination should be done in these patients

Hydatid Cyst Disease in Khozestan Province, Iran

Background: Hydatid cyst is endemic in Iran. Liver is the most common organ involved. Lung, brain, and other organs may also be involved. The aim of this study was to evaluate the clinical manifestation and complications of hydatid cyst disease in Khuzestan, Iran. Methods: This was a retrospective study. The study population included both children and adults admitted in Imam Khomeini hospital over a 5-year period starting from 2001. In this study, age, sex, place of residency, fever, jaundice were asked and recorded for each cases. data was analyzed by SPSS ver 16.0 (Chicago, IL,USA). T-test and Chi-square were used for comparison. Results: Of the 289 cases, 44.6% were males and 55.4% were females. Mean±SD of age was 41.6±7.59. Liver and lung involvements were seen in 174 (60.2%) and 97(33.7%) of cases respectively. The majority (64%) of all cases were from rural area. The recurrence rate was 19.3%. Frequency of clinical manifestion in descending order included abdominal pain (58.8%), dyspnea (32.9%), cough (23.9%), jaundice (22.9%), and fever (21.1%). The mean age in patients with jaundice was significantly higher than patients without jaundice (P<0.001). Icterus was more common in male cases than female cases (p=0.024). Dyspnea was more common in female cases (P=0.0024). There was a higher incidence of dyspnea in patients with dull abdominal pain than cases without abdominal pain (P<0.001). Conclusion: Most of the cases had liver and or lung involvement. Jaundice was more common in males than in females. Dyspnea was more common in female cases