Background: Appendicitis is one of the most common pediatric surgical emergencies. The aim of the study is to determine the significance of total leukocyte count (TLC) in diagnosing appendicitis in the present era of rampant and injudicious antibiotic usage, and its relation to the duration of onset of symptoms.Methods: Study population consists of 148 pediatric patients who had confirmed appendicitis and underwent appendicectomy between January 2015 and December 2015. TLC was performed in all these patients as part of the routine work up. The population was categorized as: group I <24hrs, group II 24 to 4hrs and group III >48 hrs, based on symptom duration and group A and B based on antibiotics received or not respectively.Results: 64.9% (n = 96) were males and 35.1% (n = 52) were females. The ages ranged from 2.1 to 12.9 years (mean/SD being 8.3±1.2). The number of patients with elevated TLC was significantly lesser in Group B (62.2%, n = 92) when compared to the group A (37.8%, n = 56) which did not receive antibiotics (P <0.017). Significantly higher number of patients showed rise in TLC if it was done within 24 hours of onset of symptoms (66.6%, n =40).Conclusions: Our study shows that TLC proved more useful if it is performed within 24 hours of the onset of symptoms and is relevant only if antibiotics have not been administered.
Background: Physiological phimosis, a common complaint in the pediatric surgery outpatient department presenting as non-retractile foreskin is due to adhesions between the inner layer of the prepuce with glans penis or due to tight tip of the prepuce. These patients are managed with circumcision, preputial dilatation. In this study, we compare different outcomes measures in children treated with dilatation and those with application of Neosporin-hydrocortisone ointment.Methods: This prospective comparative study was conducted in the department of pediatric surgery outpatient department between 2015 and 2017. We followed up 50 patients who underwent only dilatation and other 66 patients who were advised to apply only hydrocortisone impregnated antibiotic cream twice daily over a period of six weeks. We recorded basic demographic features, parent anxiety, parental compliance, parent satisfaction, complete response and persistence of phimosis at the end of the treatment. All statistical tests were done using R statistical software.Results: Of the 116 children recruited to the study, 50(43%) belonged in the dilatation group and rest (66%) to the Neosporin-hydrocortisone (NH) group. The median age of the patients was 36 with inter-quartile range (23-48) months. Baseline characteristics were comparable across the groups. At the end of six weeks, there was statistically significant difference between the two groups with regard to all outcome measures namely parent compliance, parent satisfaction, symptom resolution with the NH group showing a better result (P value<0.0001). Moreover, Phimosis persisted in 18 (36%) of the patients treated with dilatation compared to 4 (6%) in Neosporin hydrocortisone ointment group which was statistically significant.Conclusions: Present study shows that local application of Neosporin-hydrocortisone ointment is a better alternative to using the painful preputial dilatation in children with phimosis.
Background: Lymphangioma, a benign slow growing tumor of lymphatic vessels, common to the pediatric age group usually presents as swelling with cosmetic deformity. Commonly affecting the head and neck region it may present with compressive symptoms like airway obstruction or dysphagia. Previously surgical excision was the treatment of choice but it involves significant risks and so sclerotherapy has gained popularity. We conducted this prospective observational study to hava a quantitative analysis of the effect of intralesional bleomycin in reducing the size of lymphangiomas in children in our setup.Methods: This observational study was conducted in the paediatric surgery department between 2014 and 2016. A total of 34 children who presented with swellings which were diagnosed to be lymphangiomas based on clinical and sonological basis were included in the study and underwent intralesional bleomycin sclerotherapy. Details like dimensions of the lesion before and after the treatment, ultrasound measurement, residual size, characteristic of the cyst like presence or absence of septation, micro or macrocytic were recorded along with demographic details like age and sex. Outcome after 4 weeks was evaluated and classified into 3 groups as in excellent response, good response or poor response. Statistical analysis was done using R statistical software.Results: Of the 34 patients 59% were males. The median age was 18 months with inter-quartile range 4-36 months. 88% of patients had macrocystic lesions. 4 weeks after bleomycin sclerotherapy excellent response was seen in 23 (68%) of the patients, good in 8 (26%) and poor in 3 (9%) of the patients. There was statistically significant association between post procedure swelling, type of cysts and presence of septations and the number of sittings required to the outcome (p value <0.05).Conclusions: Present study shows that intralesional bleomycin sclerotherapy is very effective in the treatment of lymphangiomas in children, with macrocystic lesions showing a significantly better response.
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