Objective: To determine the frequency of various foreign bodies (FBs) retrieved from the airway during bronchoscopy in children at the
Background and Aims: Epididymitis, orchitis, testicular torsion and appendix testis torsion causes most common and acute scrotal pain. The scrotal pain and complications could be diagnosed with Doppler ultrasound and histopathology post-surgery procedures. The current study aims to determine diagnostic accuracy of Doppler Ultrasonography for diagnosis of epididymis-orchitis in patients presenting with Scrotal Swelling. Materials and Methods: This cross-sectional study was carried out on 121 scrotal masses patients during the period from April 2020 to September 2020 at the radiology department ofLiaquat University of Medical and Health Sciences, Jamshoro. Individuals who met the inclusive criteria were enrolled and consent form was taken from each patient. The patient’s age range was 15 to 68 years old with mean ± SD 34.5 ± 12.4. All the patients were presented with scrotal swelling. After history taken from the individual, Doppler ultrasound (DUS) was conducted. The final outcomes were compared by radiologist and surgeon. All the patients were subjected to linear transducer and Toshiba Xario 200 with 11MHZ. Diagnostic accuracy of Doppler ultrasound was calculated from the sensitivity and specificity. Results: Doppler ultrasound diagnosed allthe epididymitis and orchitis, testicular torsion, hydrocele, spermatic cordinjury, and varicocele cases with specificity and sensitivity 100%. The frequencyof finally diagnoses performed by Doppler ultrasonography was orchitis (7),epididymitis-orchitis (45), testicular malignancy (15), spinal cord injuries(3), testicular torsion (5), hematocele (3), spermatic cord injuries (2),varicocele (14), hydrocele (25), and pyocele (2). Out of 15 testicular subjectsdiagnosed on DUS, only 14 were found to have malignancy. Two cases ofOrchitis were diagnosed falsely as amalignancy. In Orchitis 7 patients, 6 were diagnosed as orchitis but one hadseminoma (specificity 67% and sensitivity 88%). The overall DUS specificity andsensitivity were 67% and 98% respectively. Conclusion: The scrotal disease can be diagnosed with effective, reliable, and safe Doppler Ultrasonography. Testicular tumor diagnosis is an additional advantage of DUS besides minimizing unnecessary exploration operations numbers. Doppler ultrasonographyplays a vital role in need of immediate diagnosis of testicular torsion. Keywords: Doppler ultrasound scan, Scrotal pathologies, Epididymo-Orchitis
Aim: To determine the outcome of trans-fistula anorectoplasty (TFARP) in female children having anorectal malformation with recto-vestibular fistula. Study Design: A retrospective study. Place and Duration: Department of pediatric surgery during the period of February 2018 to February 2020. Methodology: A total of 87 female children who have imperforate anus with recto-vestibular fistula from the age of 3 months to 6 years were included in this study. Initially, we have started this technique with the covering sigmoid colostomy, then TFARP after 12 weeks interval & once new anus healed and hegar dilatation achieved then sigmoid colostomy closed after 24 weeks of the first procedure. When we were experienced then we start TFARP as a single-stage procedure. Post-operative data regarding early complications of local wound infections, prolapse of the rectal mucosa, and late complications for anal stenosis, rectal prolapse, and scarring in the perineal body were collected up to 2-3 months respectively. Results: A total of 87 patients were included in this study. The average operative time was 40 minutes. The total days of hospital stay were 3 to 5 days. Regarding early complications, skin excoriation was present in 21 (24%) followed by vaginal tear in 17 (19%) cases. Mucosal prolapse was a late complication observed in 17 (20%) cases. Continence was good (Score 0) in 33 (38%) cases, while it was fair (score 1) in 36 (41%) cases. Conclusion: Primary repair of recto-vestibular fistula by Trans-fistula anorectoplasty in children is a feasible procedure that has a good cosmetic appearance and anal continence. Single-stage reconstruction is possible in children with satisfactory results. It produces less morbidity and is a more efficient procedure.
Objective: The aim of this study is to determine the effectiveness of muscle sparing axillary skin incision (MISASCI) among patients of late paediatric empyema thoracic were undergone decortication. Study Design: A prospective study Place and Duration: The study was conducted at Children Hospital and Institute of Child Health Lahore and Women and Children Hospital Rajjar, Charsada during the period from December 2020 to May 2021. Methods: Total 50 children of both genders were presented in this study. Patients were aged 1 month-12 years. Patients’ detailed demographics age, sex and weight were calculated after taking informed written consent from authorities. Patients had late paediatric empyema thoracic were enrolled. MSASCI was used for decortication among all cases. Effectiveness of incision was calculated post-operatively in terms of visibility and size of scar, intraoperative exposure and access to the lobes. Complete data was analyzed by SPSS 23.0 version. Results: There were 30 (60%) male and 20 (40%) females with mean age 7.14±7.44 years. Mean body weight of the children was 16.58±9.74 kg. We found pyopneumothorax in 20 (40%), followed by encysted empyema in 12 (24%), multiloculated empyema in 9 (18%), bilateral Empyema thorax in 5 (10%),and diaphragmatic hernia in 4 (8%). Adequate exposure was seen among 49 (98%) cases. Chest tube was removed within 5.87±4.54 days. Good lung expansion was found in 47 (94%) cases. Air leak was found among 6 (12%) cases. Frequency of scars was very low only among 4 (8%) cases. Conclusion: We concluded in this study that MSASCI was effective for decortication among patients of late paediatric empyema thoracic in terms of post-operative good lung expansion, adequate exposure with minimum numbers of scars and less complications i.e air leak in all cases. Keywords: MSASCI, Paediatric Empyema Thoracic, Decortication, Complications
Objective:The aim of this study is to compare the outcomes between primary repair and ileostomy inpaediatric patients presented with typhoid perforation. Study Design:Comparative study Place and Duration:The study was conducted at pediatric surgery department of Children Hospital and Institute of Child Health, Lahore andBacha Khan Medical Complex, Swabifor duration of six months from June 2020 to December 2020. Methods: Total 100 patients of both genders were presented in this study. Patients were aged between 3-18 years. Detailed demographics of patients including age, sex and body mass index were recorded after taking informed written consent. Patients who had typhoid perforation were enrolled. Patients were equally divided into two groups. Group I had 50 patients and received primary repair and group II received ileostomy with 50 patients. Post-operative outcomes in terms of complications and mortality were assessed and compared among both groups. Complete data was analyzed by SPSS 26.0 version. Results:There were 72 males (36 in each group) and 28 females (14 in each group) in this study. Mean age of the patients were 11.14±7.44 years in group I and in group II mean age was 10.17±9.68 years. In group I 35 (70%) cases had low socio-economic status while in group II 33 (66%) cases had low socio-economic status. 60 patients were from rural areas (30 in each group). Wound infection was the most common complication 9 (18%) found in group I and 12 (24%) in group II followed by wound dehiscence in group I 5 (10%) and in group II 7 (14%). Mortality rate in group II 8 (16%) was significantly higher as compared to group I 3 (6%). Satisfaction among patients of group I was significantly higher as compared to group II with p value 0.05. Conclusion: We concluded in this study that the primary repair in patients with typhoid perforation was effective and useful as compared to ileostomy in terms of post-operative complications and mortality. Keywords: Mortality, Complications, Typhoid Perforation, Ileostomy, Primary Repair
Aim: To assess the outcome of germ cell tumors in children after surgical management. Study Design: A longitudinal study. Place and duration: Pediatric surgery and oncology department of the national institute of child health Karachi from January 2017 to December 2018. Methodology: A total of 79 children between the ages of 0 to 12 years were included in the study. Baseline, ultrasound, CT scan, tumor markers, and biopsy for tissue diagnosis were done. After surgical excision, they were followed up for 12 months with tumor markers, ultrasound and CT Scans for any recurrence. We just observed patients with mature teratoma and did surveillance for immature variety. The rest of the subtypes received JEB chemotherapy (carboplatin, etoposide, and bleomycin) as per UK-based chemotherapy protocol according to their disease stage. Results: Most common age of presentation was < 1 month old. The antenatal diagnosis was made in 2 (2.5%) children. Sacrococcygeal region 54 (68.3%) was the most commonly involved region followed by gonads in 17 (21.5%) cases. According to histology mature teratoma was present in 32 (40.5%) children. Complete resection was done in 52 (65.8%) children. Recurrence occurred in one child and 3 children expired. Conclusion: In the current study, the general outcome was good in terms of complete excision in most of the patients. Worst outcome noted in yolk sac tumor. There was a minimal recurrence rate.
Aim: To evaluate the advantages/benefits of a single cosmetic incision approach for the repair of bilateral inguinal hernia in children. Study design: A cross-sectional study Place and Duration of study: Pediatric surgery department, Liaquat University of Medical & Health Sciences Jamshoro from February 2017 and June 2022 Methodology: Bilateral inguinal herniorrhaphies were performed on a total of 178 children and infants who received treatment in succession. A single, transverse, 2.5-cm long suprapubic incision was performed in 89 (50%) of the patients, and the Scarpa fascia was punctured using cautery. The external ring was located and opened after retracting the wound, and the ilioinguinal nerve was safeguarded. After testicular vascular and sac separation from vas deference, the hernial sac is delicately Trans ligated with 3-0 Vicryl (Ethicon), closed was the external oblique aponeurosis. The wound was then retracted to the opposite side and treated there using the same technique. Results: Ages ranged from 3 months to 11 years at the time of operation (average, 29.8 months). 56.93% of the patients—96—were under the age of one, with 51 of them—28.65%—being under the age of six months. 48 patients were 1 to 5 years old, and 24 were over the age of 5. The average operating time was 8–10 minutes shorter than it had been in the past for children who had undergone bilateral inguinal incisions, which typically took 30–40 minutes. The visual look and overall outcomes have pleased the patients and parents. There haven't been any recurrences so yet. Conclusion: In order to improve therapeutic impact and lower the risk of complications and recurrence, we develop a single incision method for bilateral inguinal herniorrhaphies. Depending on the availability of a paediatric surgeon with the necessary experience and skills, a single incision technique for treating a child's bilateral inguinal hernia is practical, safe, and can be provided to patients. Keywords: single incision approach, inguinal herniorrhaphies, children, cosmetics
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