Pediatric surgery international
-
Pediatr. Surg. Int. · May 2002
Lichen sclerosus et atrophicus in children with phimosis and hypospadias.
This prospective study was designed to evaluate the incidence of lichen sclerosus et atrophicus (LSA) in a pediatric population with hypospadias and phimosis in order to discuss the indications for circumcision and utilization of preputial skin for urethral surgery. All 115 boys, 55 with congenital phimosis, 45 with acquired phimosis, 13 with hypospadias, and 2 with recurrent chronic balanitis, underwent full-thickness biopsies of the foreskin that were examined by a single pathologist. Of the patients with acquired phimosis, 88% showed inflammatory features in the foreskin; 60% had LSA. ⋯ Of the patients operated upon for hypospadias, 61% showed histologic findings of chronic inflammation of the foreskin and LSA was evident in 15%. The high incidence of LSA in the prepuce of patients with phimosis suggests that circumcision should be performed to correct this disease. The frequent presence of chronic inflammation is a possible cause of stenosis when the foreskin is used to perform a urethroplasty in patients with hypospadias.
-
Pediatr. Surg. Int. · Mar 2002
Case ReportsCostal cartilage grafting for repair of a recurrent tracheoesophageal fistula in a 1.6-kg baby with esophageal atresia.
A large intraoperative tracheal tear occurred during correction of a type III esophageal atresia in a 1,630-g premature baby. It was repaired by primary suture. Recurrence of the tracheoesophageal fistula (TEF) was treated operatively with esophageal exclusion and costal cartilage grafting (CCG) onto the tracheal defect. ⋯ On 27-month follow-up, the child was symptom-free and thriving. Surgical options for TEF recurrence and intraoperative management of the tracheal air leak are discussed. CCG is advocated as an attractive material for tracheal repair even in low-weight prematures.
-
The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim of this study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. ⋯ In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multiloculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.
-
Pediatric surgery in sub-Saharan Africa is disadvantaged by the large number of sick children, disease patterns specific to the region, late presentation, and advanced pathology. In addition, it is practiced in an environment of limited resources and facilities and other health priorities. ⋯ Demonstrating that childhood surgical conditions are a significant public health-care problem is the most likely way to change health-care policy and to ensure adequate resources for PSC. Other priorities should be to define a cost-effective package of pediatric surgical services, improve PSC at the community level, and strengthen pediatric surgical-education.
-
With better understanding of neonatal physiology and improvements in diagnostic facilities and neonatal intensive care units (NICU), the outcome of neonatal surgery has improved in developed countries. In developing countries, however, neonatal surgery is problematic, particularly in the emergency setting, but there are few reports from these countries. A retrospective analysis of 154 neonates who had emergency surgery over a 10-year period at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. ⋯ Other factors considered to have contributed to morbidity and mortality were late referral and presentation and a lack of NICUs. Thus, emergency neonatal surgery is attended by high morbidity and mortality in our environment at the present time. Early referral and presentation and provision of NICUs should improve the outcome.