Epidemiological Profile of Traumatic Brain Injuries in Children

Purpose: To inform about the excellent non-invasive scientific method in pediatric surgery and to establish a significance of anthropometry as first-line diagnostic method. We focused on the Slovak patients with craniosynostosis and pectusexcavatum in this study.

Methods: Anthropometric measurements are performed by standard anthropological technique according to Martin and Saller [1] and its modifications. Special instruments are required: the spreading caliper, the sliding caliper, the measuring tape and anthropometer. Patients are monitored longitudinally.

Results: We summarized the most important facts from anthropometrical evaluation in Slovak patients with craniosynostosis andpectusexcavatum deformity in this study.

Conclusion: Anthropometric measurements are helpful in accurate documentation of growth, longitudinal observation of the patient and can support decision concerning the type of surgery. We can predict trend of growth by anthropometric measurements in these deformities and we think that anthropometry should be performed prior to CT examination.

Purpose: To urge and remind authors in appropriate use of terminology to describe and classify orbital cellulitis subtypes including eyelid edema, peri-orbital or pre-septal cellulitis.

Methods: Review of classical and recent peer-reviewed literature.

Results: Historical classification of various stages of orbital cellulitis traces as far back as to the initial Hubert publication on orbital infections. Countless follow-up articles present periorbital cellulitis as the first of the 5 non-progressive types of orbital infections. Presently the orbital cellulitis classification, however, is associated to Chandler’s name. The only discrepancy between Hubert’s and Chandler’s classifications was the nature of eyelid edema. It is inflammatory as described by Hubert whereas it has a vascular origin as described by Chandler. Labeling an eyelid edema as pre-septal cellulitis is conceptually imprecise.

Conclusion: Proper use of orbital cellulitis in correlation to clinical symptoms and signs in the literature is paramount. This will lead to uniformity and a better understanding amongst surgeons. Eyelid edema without any radiological sign of orbital inflammation should not be referred as preseptal cellulitis. Eyelid edema is sufficient enough.

Cystic lymphangiomas are also called as cystic hygromas and are benign, congenital malformation of the lymphatic system, and reported to occur in the head and neck regions in 90% of the cases. This is a report of two cases of large cystic hygromas involved at the neck in both the cases, while in the second case also involved the face along with the neck. Case one was 45-days male and he was admitted with a large swelling at the right side of the neck, while the second case was 3-months-old female and she was admitted with a large swelling involved the right side of the neck and face as well, and she also had mild respiratory distress. Both were investigated with Ultrasonography (USG) and Computed Tomography (CT) scans of the swellings, which showed multiloculated, cystic hygromas. In both the cases complete surgical excision of the cystic hygromas was successfully accomplished. Immediate post-operative period in both the cases were uneventful. In first case, follow-up done 3 months after surgical excision of the cystic hygroma was good and he was doing well. In second case, follow - up was done after a month of surgical excision of cystic hygroma and she had features of neuropraxia of mandibular branch of right facial nerve, and was expected to correct with time.

Objective: To assess the routine surgical practices of consultant pediatric surgeon in the Maghrebian country in their management of peritoneal dialysis.

Methods: During the twelve Maghrebiancongess of pediatric surgery in Tunis May. 2012, a session of quiz survey (4 Questions) about the surgical aspect of pediatric peritoneal dialysis was dedicated. 60 surgeons participate to this session. An electronic voting system was used.

Results: 60% of surgeons practice a mini-laparotomy for catheter insertion. Half of the participants use a double cuff catheter while the other half uses a simple cuff catheter. 65% of participant allows initiation of dialysis within 7 days post catheter insertion. Only 13% of the pediatric surgeons perform an omentectomy at the time of the insertion of the catheter.

Conclusion: The placement of a PD catheter requires an experienced surgeon and should be given appropriate priority. Adhesions to guidelines may improve outcome of patient by reducing the early peritoneal dialysis catheter failure in children in our countries.

Critical Congenital Heart Disease’s (CCHD’s) are potentially life-threatening cardiac abnormalities where the systemic or pulmonary circulation is dependent on a patent ductus arteriosus and include those with duct-dependent pulmonary blood flow, inter-circulatory mixing, and systemic hypoperfusion. The seven main CCHD’s screening targets for neonatal pulse oximetry are hypoplastic left heart syndrome, pulmonary atresia (with intact ventricular septum), Tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia and truncus arteriosus. Early diagnosis improves outcomes.

Introduction: We performed a prospective study to assess the impact of Epididymal anomalies in index fertility of undescended testes comparing to a control group receiving Gonadotropin-Releasing Hormone (GnRH).

Materials and methods: Twenty-four boys with cryptorchidism were randomly divided into two groups: Those who were treated with GnRH before Surgery (group1) (n=12) and those who underwent orchidopexy only (group 2) (n=12). During Surgery, the relationship between the testis and epididymis was noted. In both groups, testicular biopsies were obtained and fertility index was determined.

Results: Epididymal anomalies were noted in 6 patients of group 1 and 7 patients of group 2. For all patients, there was a statistically significant difference regarding the index fertility between the two groups (p=0.002) (mean of fertility index: 0.88vs 0.49), which wasn’t noted in patients with Epididymal anomalies taken separately. For these, fertility index was considerably low compared to patients with normal epididymo-testis structure. For patients of group1, the mean fertility index was 0.7 in testes with Epididymal anomaly and 1.02 in those with normal epididymo-testis relationship.

Conclusion: These data suggests that the fertility impairment in patients with Epididymal anomalies associated with cryptorchidism should be reviewed; other studies with larger sample are needed, obstruction probably do not explain the future fertility in those patients.

Background: Non-traumatic acute intestinal perforation secondary to Enterocolitis is a severe event that requires immediate treatment. Exploratory laparotomy has been the gold standard in the past decades. Recently, several reports described that minimal invasive surgery has been successfully applied to colonic perforation in emergent settings for both adult and children. The aim of this study is to evaluate the efficacy of laparoscopy on non-traumatic intestinal perforation in children.

Method: Between June 2009 and September 2013, patients under 18 year-old who underwent laparoscopic surgery for non-traumatic acute intestinal perforation were enrolled. The demographics of the patients, operative details, postoperative complications and the time resuming oral intake were retrospectively collected by chart review.

Result: There were consecutive 7 patients, including 5 boys and 2 girls. The mean age was 8.3 ± 4.2years (range: 2-15 years). A diversity of operative procedures was undertaken, encompassing tube cecostomy in 1 case, primary repair with tube cecostomy in 1 case, primary repair in 4 cases, and appendectomy in 1 case. Conversion to laparotomy was not necessary. The time resuming oral feeding was between postoperative day (POD) 6.3 ± 1.4th (range: 5-8 days). For two cases receiving tube cecostomy, constant stool leaking beside the tube predisposed to chronic wound infection and granolomas which required further surgeries. Otherwise, there was no complication recorded, such as surgical site infection, intestinal obstruction.

Conclusion: Laparoscopic surgery for non-traumatic acute intestinal perforation in children is technically feasible and providing benefits of low complication rate and satisfactory cosmetic outcomes. Minimally invasive surgery could be considered as first-line approach for non-traumatic acute abdomen. For cases of solitary perforation, primary repair can be safely performed through laparoscopy.

Newborn presenting with ruptured omphalocele is an emergency which threatens the life of baby. We are reporting a case of a male newborn baby, born in hospital and had ruptured omphalocele sac during vaginal delivery. After reduction of herniated bowel excess omphalocele sac was excised and remaining sac was closed using absorbable suture material. Patient was kept NBM for 4 days and gradually started on feeds. On further evaluation patient was found to have Beck with –Widemann syndrome. Patient’s karyotype was normal. Patient kept on regular follow-up with serial USG-KUB after discharge. To our knowledge, there are only few reported cases of bed-side repair of ruptured omphalocele sac. This case is presented for its simple and effective bedside management.

We report a rare variant of exstrophy-epispadias complex, a duplicate bladder communicating with exstrophy bladder via a fistula. On presentation appeared to be a case of classical bladder exstrophy with diastasis of the pubis and rectus muscles, a low lying umbilicus and a form of epispadias. On careful examination phallus appeared normal with normal external urethral meatus.The micturating cysto-urethrogram was done which elicited a rare anomaly; duplicate bladder exstrophy.

Gastric perforation in neonates is an uncommon entity. Definite causes are found in few patients. Iatrogenic perforation secondary to introduction of a hard nasogastric tube has been reported in literature. Majority of cases have no obvious reasons.

We present two cases of gastric perforation in preterm babies probably caused by nasogastric tube. One baby had pneumoperitoneum while other one did not show gas under diaphragm. Etiopathogenesis of gastric perforation in preterm babies is discussed along with a comment on Spontaneous Intestinal Perforation (SIP).