فهرست مطالب

Pediatric Surgery - Volume:3 Issue: 2, Jan 2017

Iranian Journal of Pediatric Surgery
Volume:3 Issue: 2, Jan 2017

  • تاریخ انتشار: 1396/11/18
  • تعداد عناوین: 8
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  • Sima Sinafar, Anahid Maleki, Alireza Ebrahimsoltani, Rahman Khosravi, Maneli Sadeghi Pages 51-57
    Perioperative hypothermia is common during anesthesia and surgery and is accompanied by several complications. Compared to adults, children are at a greater risk of hypothermia and its complications. The aim of this study was to compare forced air and warmer in maintaining normothermia during pediatric surgery. This randomized controlled trial was performed on 90 children undergoing elective hernia repair equally distributed in three groups of warmer, forced air and control. Patient's body temperature was recorded preoperatively, intraoperatively, at the end of surgery and at the end of the postoperative care unit (PACU) stay. Time between anesthetic discontinuation and tracheal extubation and duration of PACU stay were also noted. Intraoperative and postoperative body temperature and body temperature on exit from PACU were significantly higher in forced air group compared to warmer and control groups and in warmer group compared to control group (P
    Keywords: Unintended hypothermia, forced air, warmer, children
  • Saeid Aslanabadi, Hatef Alizadeh Aghdam, Masoud Jamshidi, Davoud Badebarin, Sina Zarrintan Pages 58-68
    Background
    Anorectal malformations (ARM) occur in approximately 1 in 5000 live births and affects males and females almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, long-term outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of the present study was to assess the outcomes of children undergoing surgical correction of ARMs.
    Materials and Methods
    In a prospective follow-up study, we wanted to assess occurrences of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea and FTT at follow-up visits. In addition, the decision of research team on patients at follow-up visits was considered as secondary outcomes.
    Results
    Two hundred ninety patients were studied. Of the study patients, 174 children (60.4%) were boys and 114 children (39.6%) were girls. Mean age of boys was 4.8 ± 2.0 years of age and mean age of girls was 5.0 ± 2.0 years of age. The mean follow-up period of patients was 39.5 ± 29.1 months. During the study follow-up period, 63 patients (21.7%) had complications. The most common complication was constipation. It was present in 21 patients (33.3%). Soiling, incontinence, dilated sphincter, FTT, stenosis, abdominal distension and diarrhea were present in 21 (33.3%), 11 (17.5%), 9 (14.3%), 6 (9.5%), 6 (9.5%), 5 (7.9%), 3 (4.8%) and 2 (3.3%) patients respectively.
    Conclusion
    We found that the commonest complications following ARM surgery are constipation, soiling, incontinence, dilated sphincter, FTT, stenosis, distension and diarrhea. The overall complication rate was 21.7%. 7.2 % and 3.1% of study population experienced constipation and incontinency respectively. 3.1% of study population required reoperation. We revealed that outcome of surgical correction of ARMs is considerably good and complication rates are acceptable. Continence rate was acceptable.
    Keywords: Anorectal malformation, Congenital anomaly, Incontinence, Constipation
  • Mehdi Karami, Reza Khaleghnejad, Fatemeh Karami Pages 69-77
    Background
    Bone age determination is used in situations such a migration and sports. Radiography, MRI and ultrasound are different methods of determining bone age. This study was designed to evaluate the effectiveness of ultrasound in determining bone age in 14 -18 year olds.
    Method
    100 male and 100 female students between 14 and 18 years old were evaluated. The thickness of the epiphysis of the left distal radius in the ventral, dorsal and lateral views, were measured.
    Results
    In the females most of the growth plates were closed and the rest were inconclusive therefore ultrasound cannot be used in females in this age group. In the males, a minimum thickness of 0.7mm in dorsal and 0.8mm in ventral view in 14 and 15 year olds can be used to differentiate them from the 16 and 17 year olds. A maximum thickness of 1.6mm in dorsal and 1.1mm in ventral view can be used to differentiate 16 and 17 year olds from 14 and 15 year olds. Finally a maximum thickness of 0.8mm in the dorsal view can be used to differentiate 17 year olds from 16 year olds and younger.
    Conclusion
    Bone age determination via sonographic evaluation of the distal radius is an easy, fast and radiation free method that if confirmed by future studies can be used to differentiate 15 and younger from 16 and older boys. Ultrasound cannot be used to differentiate 14 to 18 year old girls.
    Keywords: Bone age, Skeletal age, Ultrasound, Sonography, Distal radius, Growth plate
  • Bahar Ashjaee, Saeedeh Azary, Amin Khalifeh-Soltani Pages 78-86
    Background
    Since the abdominal tumors are one of the common causes of childhood death,studying theclinico-pathologic features of tumors is important for early diagnosis. The aim of this study was to determine these features in Iranian children and to evaluate the accuracy of Ultrasonography in determining the abdominal masses in children.
    Method
    In this retrospective case series study data about the sex, age, primary chief complaint, physical examination, imaging report, Pathology finding of 156 children with abdominal tumor, who admittedtothe childrenmedical centerin last 6 years.
    Results
    Male to female ratio was 0.69. The most common type of tumor in this study wasWillm’s (37.5%) and Neuroblastoma (35.7%). The mean age in children with Willm’s tumor and Neuroblastoma was 38.95 and 26.65 months old respectively.Ultrasonographyhas lower accuracyin patients with tenderness, children with Willm’s tumor, female patients and children under 5 years old.
    Conclusion
    The observed differences in tumor type and distribution in comparison with previous studies may be attributed to genetic and geographic variations. In addition, this study shows that the accuracy of Ultrasonography in children with abdominal tumors depends on children’s sex, age, pain and type of tumor.
    Keywords: Abdominal tumor in children, Ultrasonography, Willm's tumor, Neuroblastoma
  • Maryam Ghavami Adel, Bahar Ashjaei, Sima Sinafar, Jaleh Parizad, Leili Maghbouli, Rahman Khosravi, Behdad Gharib Pages 87-93
    One of the suggested methods for the treatment of Hirschprung disease is of Evaluation of one-stage Tran's anal Endo rectal pull-through (TERPT).The purpose of this study is to evaluate the status of deification and complications of surgery in patients undergoing pull-through surgery in THERAN pediatrics Medical center during past 10 years.
    Materials and Methods
    This descriptive study was performed on patients undergoing one-stage Transanal Endo rectal pull-through operation in Tehran pediatrics Medical center over past 10 years.
    Exclusion Criteria include the parent's lack of consent to participate in the study, age below 3 years, and inability to complete the checklist. For all patients, a check list including: Age/ family history of disease/ readmission/ age / Follow-up time/ presence of soiling/ complete & partial fecal incontinence/ constipation/ laxative use/ use of Boogie/ the presence & absence of RAIR in manometers, TR stricture and enterocolitis before & after surgery, Was gathered. Data analysis was performed using spss 19.
    Results
    4.81% of the subjects were male. 3.9% of them had underlying disease, such as heart & kidney disease. And only 6.81% of them had to be re-admitted because of enterocolitis. 5.39% of patients had soiling, and complete & partial fecal incontinence were 3.2% and 7.4% .respectively total incidence of fecal incontinency was 7%. 6.11% of cases had constipation. 3/9% of cases did not have RAIR in manometery.the incidence of rectal stenosis was 7%. 93%of patients had TZ in barium enema befor the operation. The result showed that there was no significant relationship between post- operative complications in both sexes. (o5DISCUSSION &
    Conclusion
    This study shows that the complications of Endo rectal Trans anal pull-through surgery as a method for treatment of Hirschsprung disease are infrequent, therefore this method can be considered as a selective method. Further investigations are recommended to prove the hypothesis.
    Keywords: Hirsch sprung, Trans anal, Endo rectal, pull-through, Soiling, fecal Incontinency, constipation
  • Alireza - Mirshemirani_Ahmad Khaleghnejad Tabari_Mohsen Rouzrokh_Javad Ghoroubi_Leily Mohajerzadeh_Saran Lotfollahzadeh Pages 94-99
    Objective
    Hidden penis may have different categories: Concealed, trapped, and buried types. The aim of this study is to evaluate the results and outcomes of repaired cases.
    Material &
    Methods
    Totally 40patients (5months -12years old)were surgically repaired due to different types of hidden penis from April 2010toDecember 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, of which all concealed and buried patients had penile degloving and penile fixation, that all reported improved in function, and good in outcome.
    Conclusions
    Patients with hidden penis are in psychological risks. The aim of hidden penis is to restore an aesthetic and functional penis.
    Keywords: Hidden penis, Surgical repair, Buried
  • Amine Ksia, Meriem Braiki, Nahla Kechiche, Lassaad Sahnoun, Sabrine Ben Youssef, Mongi Mekki, Abdellatif Nouri Pages 100-103
    Background
    Foreign bodies ingestion is considered as a common pediatric problem, it is mostly encountred in infants between 6months and 2 years. Ingestion of magnets was documented in only few reports.
    Case report:We report two uncommon cases of bowel perforations owing to magnets ingestion. Patients were respectively aged of 10 months and 20 months .they were successfully managed.

    Conclusion
    Once ingested, magnetic objects would attach each other through intestinal wall leading subsequently to intestinal necrosis. Thus their surgical removal is unavoidable.
    Keywords: Emergency, ingestion, Intestinal perforation, magnet
  • Amir Molaei, Hamidreza Alizadeh Otaghvar, Mohammadreza Tarahomi, Daryanaz Shojaei, Leili Mohajerzadeh, Maryam Baghoori Pages 104-106
    Peutz - jegher’s syndrome (PJS) is a rare autosomal dominant disorder with gastro intestinal and mucosal pigmentations. We present a 2 y/o boy with a lesion prolapsing from his rectum that could not be reducted. We found him to have PJS and a familial history of PJS in his parents.
    Keywords: Peutz - jegher's syndrome_Pediatric_Rectal prolapse