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Inverted papilloma is a benign but locally aggressive sino-nasal tumour. Although relatively uncommon, involvement of the frontal sinus by this tumour represents a significant surgical challenge. The objective of the study is to propose a scheme for management of inverted papilloma involving the frontal sinus, based upon the findings of the current study. All cases of inverted papilloma operated upon between July 1995 and June 2008 were retrospectively reviewed to identify cases in which the tumour involved the frontal sinus. Among 34 patients with inverted papilloma, 4 were found to have tumours involving the frontal sinus (11.76%). These patients were initially treated by endonasal endoscopic resection. At time of initial surgical excision, the tumour was found to involve the frontal sinus by expansion from the ethmoids in three of these patients. In the fourth patient, the tumour was found to be massively involving the frontal sinus mucosa. After a mean follow-up of 16.3 months, no recurrences were detected in the first three patients. In the patient with massive mucosal involvement, recurrence was detected 4 years after the initial endonasal endoscopic resection. Subsequently, an osteoplastic flap was performed to resect the tumour. Fifty months later the patient remained disease free. Surgeons managing patients with frontal sinus inverted papilloma should have a clear management scheme before embarking on surgery. The patient's consent should be obtained pre-operatively for a possible osteoplastic flap. Tumours just expanding into the frontal sinus can be managed by either endoscopic or nonendoscopic approaches. On the other hand, in tumours significantly involving the frontal sinus mucosa, an osteoplastic flap is warranted to ensure complete tumour resection.

Introduction Traditionally, exploratory laparotomy was used to treat penetrating abdominal trauma (PAT). At present, minimally invasive surgery (for diagnostic and therapeutic purposes) has developed and represents a rapidly evolving modality for dealing with PAT in stable children. In this article, we aim to present our experience, evaluate the effectiveness, and report the results of minimally invasive surgery (MIS) for PAT in stable pediatric patients. Materials and Methods This prospective study involved 117 hemodynamically stable pediatric cases of PAT (caused by gunshots, stab, and accidental stab), admitted, and managed according to the severity of injury. The information recorded for analysis included demographic data, the anatomical location of injury, the initial vital data and scoring systems, the organs affected, the procedures done, operative time, need for conversion to laparoscopic-assisted approach, length of hospital stay, complications, missed injury, and mortality rate. Results Among 117 pediatric patients with PAT, 15 cases were treated conservatively and 102 cases were managed by MIS. They were 70 males and 47 females with a mean age of 7.3 ± 0.6 years (range = 1–14 years). They included 48 cases of gunshot injury, 33 cases of abdominal stab, and 36 cases of accidental stab. Laparoscopy was diagnostic (DL) in 33.3% (n = 34) and therapeutic (TL) in 66.7% (n = 68) of cases. Of the 68 TL cases, we completely managed 59 cases (86.8%) by laparoscopy, while 9 cases (13.2%) were converted to limited laparotomy. The mean operative time was 17 ± 1 minutes (range = 12–25 minutes) for DL, 85 ± 9 minutes (range = 41–143 minutes) for complete TL cases, and 89 ± 3 minutes (range = 47–149 minutes) for laparoscopic-assisted procedures. For DL cases, the mean length of hospital stay was 2 ± 0.4 days, while for complete TL cases, it was 5.4 ± 0.83 days, and for laparoscopic-assisted cases, it was 5.8 ± 0.37 days. Postoperative complications occurred in eight cases (7.84%), with five cases (4.9%) required reintervention. No missed injury or mortality was recorded in the study. The patients were followed up for a median period of 52 months. Conclusion For management of PAT in children, MIS has 100% accuracy in defining the injured organs with zero percent missed injuries.

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Eighty children with End Stage Renal Disease (ESRD) were treated in our unit over a six year period. Forty-eight were treated with CAPD (mean age = 5.8 years) and thirty-two with HD (mean age = 8.2 years). The average duration of treatment was 14.8 months in the CAPD group and 14.2 months in the HD group. There were 22 failures of peritoneal catheter in the CAPD group out of 70 catheters compared to 19 failures of vascular access devices out of 45 in the HD group. Peritoneal catheter failure was due to resistance or recurrent peritonitis in 10 (45.4%) and obstruction in nine (41%), whereas vascular access device failure was due to thrombosis in six (31.5%) and infection in five (26.3%). Fifteen (31.3%) of the CAPD patients died and eight (16.7%) transferred to HD, whereas five (15.6%) HD patients died and four (12.5%) transferred to CAPD. The three year actuarial rates for CAPD were 81% at one year, 55% at two years and 42% at three years, while for HD was 94%, 85% and 64%, respectively. In this unique experience at the Kingdom so far, we found that a fully integrated service of dialysis including both CAPD and HD are essential. Such a system allows the optimal mode of treatment to be chosen for a child at any time and allows the child to move freely from one treatment to another when needed. Ann Saudi Med 1993;13(6) Renal transplantation is the mainstay of treating children with end stage renal disease (ESRD), while dialysis is a way station en route to renal transplantation. In many instances, due to an increasing pool of children with ESRD or shortage of kidneys for transplantation, or choice of nontransplantation, dialysis might be a long-term matter. Several dialysis options have become available now and include hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and chronic intermittent peritoneal dialysis (IPD). Of the different dialysis options, CAPD and HD are the ones used in this Kingdom [1].In Saudi Arabia, CAPD was the earliest method of treating children with ESRD [2]. However, introduction of Pediatric HD facilities in the late 1980s' was associated with great enthusiasm and according to the National Kidney Foundation (NKF) data, 72.5% of children receiving dialysis therapy now are on HD [1]. Since we have the only independent pediatric HD unit in the Kingdom so far, we therefore weighed the pros and cons of CAPD and HD treatment based upon six years of experience in our center. Patients and MethodsOur CAPD program started in November 1986 and HD in October 1987. All children diagnosed to have ESRD and dialyzed at the Renal Unit of Maternity and Children's Hospital from the start of the programs until the end of December 1992 were included in this study. Eighty children fulfilled these criteria. The selection of children for either CAPD or HD was based on the age, residence, and parents' attitudes. The technique of CAPD and peritoneal catheter care was performed as described previously [3,4]. HD was performed in accordance with publis...

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Congenital diaphragmatic hernia (CDH) is an uncommon neonatal pediatric surgical problem. About 5-25% of cases had delayed presentation, making diagnostic challenge and requiring a high index of suspicion. Combination of diaphragmatic hernia and severe pneumonia with rapid deterioration of the case up to respiratory failure is a rare occasion. Herein, we present a case of 2-years-old female referred to our hospital intubated, ventilated due to type 2 respiratory failure resulting from dual chest pathology (severe pneumonia and left sided congenital diaphragmatic hernia). She was admitted at the pediatric intensive care unit (PICU), stabilized then operated for repair of her diaphragmatic hernia. Post-operatively, she remained intubated, ventilated for 7 days then weaned gradually from the ventilator. The cardiorespiratory status has much improved and she started oral feeding by the 8th post-operative day and discharged home in a stable condition.

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