Increased PDW combined with elevated WBC and neutrophil counts maybe used as diagnostic tests in the cases of acute appendicitis, while MPV and RDW levels were not useful diagnostic markers.

The purpose of this study was to compare the results of traditional and accelerated Ponseti techniques to clarify whether this technique can be done safely in reduced time with complete correction of the deformity and without complications. A total of 66 feet in 41 children with idiopathic club foot and with Pirani score no <4 were included; of these, 34 feet in 20 children were managed with the traditional Ponseti method with one cast a week, in the other 32 feet in 21 children, an accelerated technique was used with casting twice a week, and the Pirani score was used for initial assessment and for follow-up. The results were comparable for both groups; the mean number of casts for full correction was 4.88 ± 0.88 in the traditional group and 5.16 ± 0.72 in the accelerated group. Initial correction was obtained in all cases in both groups, and relapses were observed in 14.7 % in the traditional group and in 15.6 % in the accelerated group. Deformities required from four to seven casts for correction in both groups. There was a statistically significant reduction in the mean time required for correction from onset of manipulation till tenotomy or correction of equines without tenotomy which was 33.36 ± 6.69 days (21-42 days) in the traditional Ponseti group and 18.13 ± 3.02 days (11-22 days) in accelerated Ponseti (P = 0.001). Accelerated Ponseti technique significantly reduces the correction time without affecting the final results; it is quite as safe and effective as the traditional Ponseti.

Twenty patients (11 males and nine females) with cubitus varus deformity were treated with corrective dome osteotomy through the paratricipital approach. Patients presented after an average 3 years of appearance of the deformity. The average age of the patients was 8.5 years (range 6-14 years). All patients had a previous history of supracondylar fracture. Preoperatively, carrying angle, lateral condylar prominent index, and range of motion were recorded. There were no intraoperative complications. Postoperatively, three patients developed a superficial skin infection. No patient had unsightly scarring or a prominent lateral condyle. No patient reported pain, motor weakness, or atrophy of the arm musculature. There was no fixation failure or loss of correction during the healing stage and no revision surgery was needed. The results were graded according to the preoperative and postoperative carrying angle, movement of flexion and extension, and lateral condylar prominence index and they were evaluated statistically. Preoperative and postoperative extension, carrying angle, and lateral condylar prominence index were statistically significant. Corrective dome osteotomy using the paratricipital approach seems to be a reliable technique for correction of cubitus varus in children. The procedure is relatively simple and enables correction of the deformity without inducing lateral condylar prominence.

The purpose of this study was to report a new entity of epiphyseal slipping, which is a slipping of the upper humeral epiphysis in neonates due to birth trauma, and reporting the results of their management. Eight neonates presented with pseudo-paralysis with associated shoulder swelling and pain on passive movements of the upper limb; the radiographs revealed slipping of the proximal humeral epiphyses in six cases and associated shoulder dislocations in the other 2 cases. Failed attempts of closed reduction were done for all cases; they were managed through open reduction of the slipping and relocation of the glenohumeral joint when dislocated. The deltopectoral approach was used for management, and the slipping was fixed with k-wires through the skin. A full painless range of motion of the shoulder was achieved in all patients; no limb-length discrepancy or deformity was detected and no recurrent shoulder dislocation. In the last follow-up, all radiographs showed an anatomic reduction of the epiphyses, and all the epiphyseal plates were open. All cases showed normally growing well-formed epiphyses with no evidence of a vascular necrosis or collapse. A new entity of epiphyseal slipping was reported in this study; slipping of the upper humeral epiphysis in neonates due to birth trauma whether it is associated with shoulder dislocation or not is a benign injury with excellent results with open reduction.

The aim of this work was to evaluate the results of rigid nailing of pediatric femoral shaft fractures inserted antegrade through the tip of the greater trochanter. Twenty-three femoral shaft fractures in 23 children were fixed with rigid interlocking nails inserted through the tip of the greater trochanter at Mansoura Emergency Hospital in the period between June 2009 and August 2011. The average age of the patients at the time of injury was 12.6 years (range 9.2-15 years). The final follow-up radiographs were assessed for evidence of avascular necrosis (AVN) of the femoral head and any deformity of the proximal femur, the neck-shaft angle, the articulotrochanteric distance, and the femoral neck diameter. Patients were followed to a mean period of 31 months (range from 25 to 36 months) postoperatively. All fractures united in a range of 9 weeks (from 8 to 13 weeks) with no limb length discrepancy more than 2 cm and no clinically evident rotation in either direction; no case had a vascular necrosis of the femoral head or significant proximal femoral deformity by the final follow-up. Fixation of fractures of the shaft of the femur in children with rigid interlocking nails inserted through the tip of the greater trochanter is a rigid way for fixation controlling rotation and length. It is a safe technique without causing AVN of the femoral head or proximal femoral deformity.

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Introduction: Gallstone (GS) formation is common in obese patients, particularly during rapid weight loss. This study aimed to determine the incidence of GS in patients underwent bariatric surgery (BS) and the influence of weight loss on GS formation. Methods: This was a prospective study including 148 consecutive patients underwent BS. Patients with preoperative negative abdominal ultrasound (US) for GS were followed-up for at least 12 months. Patients underwent abdominal ultrasound (US) at 3, 6, 9 and 12 months and were clinically screened for symptomatic or complicated cholelithiasis. No GS lowering prophylaxis was used. Clinical and demographic characteristics were compared at baseline and 12 months after surgery. Results: At time of surgery GS was found in 40.6% of the studied patients and history of previous laparoscopic cholecystectomy (LC) was in 6.8% of the studied patients. The incidence of post bariatric GS at 12 months was 22.7% with significant difference (P-value<0.05), (Laparoscopic Sleeve Gastrectomy (LSG): 18.8%, Single anastomosis sleeve ileal bypass (SASI): 33.3%, Mini Gastric Bypass (MGB): 40%, LRYGB 50%). BS operations, rapid weight loss and gastro esophageal reflux disease (GERD) patients are at a higher risk for GS. Conclusions: The incidence of post bariatric GS at 12 months was high (22.7%) with significant difference and we recommend routine US every 3, 6, 9 and 12 months during the first year after BS.

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