HighlightsCecal volvulus is a very rare cause of intestinal obstruction in children.Novel association between Congenital dilated cardiomyopathy and cecal volvulus.Cecal volvulus should be suspected in a child presenting with bilious vomiting.

This study was proposed to develop an optimized sertraline hydrochloride (SER)–loaded bilosomal system and evaluate its potential for enhancement of drug oral bioavailability. A full 23 factorial design was used to prepare SER-loaded bilosomal dispersions by thin film hydration using span 60, cholesterol (CHL), and sodium deoxycholate (SDC). The investigated factors included the total concentration of span 60 and CHL (X1), span 60:CHL molar ratio (X2), and SER:SDC molar ratio (X3). The studied responses were entrapment efficiency (EE%) (Y1), zeta potential (Y2), particle size (Y3), and in vitro % drug released at 2 (Y4), 8 (Y5), and 24 h (Y6). The selected optimal bilosomal dispersion (N1) composition was 0.5% w/v (X1), 1:1 (X2), and 1:2 (X3). Then, N1 was freeze dried into FDN1 that compared with pure SER for in vitro drug release, ex vivo permeation through rabbit intestine, and in vivo absorption in rats. Moreover, storage effect on FDN1 over 3 months was assessed. The optimal dispersion (N1) showed 68 ± 0.7% entrapment efficiency, − 41 ± 0.78 mV zeta potential, and 377 ± 19 nm particle size. The freeze-dried form (FDN1) showed less % drug released in simulated gastric fluids with remarkable sustained SER release up to 24 h compared to pure SER. Moreover, FDN1 showed good stability, fivefold enhancement in SER permeation through rabbit intestine, and 222% bioavailability enhancement in rats’ in vivo absorption study compared to pure SER. The SER-loaded bilosomal system (FDN1) could improve SER oral bioavailability with minimization of gastrointestinal side effects. Graphical abstract

Background and objective: There are several forms of relevant epi-aortic branching anomalies, and perhaps that is why different views as to the best approach have been reported. To help resolve this dilemma, we examined the unforeseen arch anomalies found at thoracoscopic repair of esophageal atresia and the outcomes. Methods: In a retrospective cohort, all consecutive patients who were thoracoscopically approached for esophageal atresia over a 5-year period with unforeseen aortic/epi-aortic branching were identified and grouped. Thoracoscopic views, operative interventions, and outcomes were studied. Results: A total of 121 neonates were thoracoscopically approached for EA, of whom 18 cases with aberrant aortic architecture were selected. Four (3%) cases were diagnosed on a preoperative echocardiography as a right-sided aortic arch, whereas unforeseen anomalous anatomies were reported in 14 cases (11.6%): left aortic arch with an aberrant right subclavian artery (ARSA) (n = 10), right-sided aortic arch with an aberrant left subclavian artery (ALSA) (n = 3), and mirror-image right arch (n = 1). Single postoperative mortality was reported among the group with left arch and ARSA (10%), whereas all the cases with right arch and ALSA died. Conclusions: In all, 11.6% of the studied series exhibited unexpected aberrant aortic architecture, with higher complication rates in comparison to the typical thoracoscopic repairs. For EA with left aortic arch and ARSA, the primary esophageal surgery could safely be completed. Meanwhile, curtailing surgery—after ligating the TEF—to get advanced imaging is still advised for both groups with the right arch due to the significant existence of vascular rings.

Purpose We report our experience with a thoracoscopic repair of esophageal atresia, pitfalls made and how avoiding them yielded a better outcome for our patients. Methods Prospective cohort study was conducted to thoracoscopically repaired type-C EA patients between November 2016 and November 2022. Group A included patients, who were managed during the initial phase of our study and presented with different respiratory symptoms. Group B, that included patients who had their repair done later in the study period after refining our surgical techniques to overcome the earlier fallacies. Results In group A, 26 patients had successful repair, 15 patients developed respiratory-related symptoms due to esophageal causes (3/15) and tracheal causes (12/15). Tracheomalacia (11/15), tracheal diverticulum (10/15) and recurrent tracheoesophageal fistula (rTEF) (3/15) were detected in that group. In group B, which included 57 patients, significant reduction in the number of symptomatizing patients was noticed, from 58 to 30%. Seventeen patients developed symptoms, secondary to esophageal origin (12/17), rTEF (4/17) and tracheomalacia in addition to the rTEF in one patient. Conclusions Tracheal abnormalities with EA need more attention. Not only is bronchoscopy an informative initial step before attempting repair, but it may also reveal the possible need for primary tracheopexy.

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