Original Articles

Esophageal burn injuries with alkali in children: A four year comprehensive analysis study

Ali Forotan, Mehrdad Soveyd, Abbas Banani, Seyed Hesamaddin Banihashemi, Hamidreza Forotan

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 57-62

Introduction: The incidence of caustic ingestion injuries in developed countries has been decreasing, while it still remains a great concern in developing countries including Iran. In this study we focused on alkali esophageal injuries in children which occur frequently in southern Iran, due to both, unsafe products and unfamiliarity of families with the alkali consumption hazards.

Materials and Methods: In a cross-sectional study, sixty four children who were admitted due to alkali ingestion atNemazee hospital, Shiraz, Iran during a 4 year period, were evaluated for hospital stay, hospital charges and number of admissions. Data were obtained from medical records and through a phone survey.

Results: All ingestions were unintentional. Children had a prolonged hospital stay (m=13.2 day) and needed multiple admissions (m=7.8 admission). The mean hospital charge was $14,580.00 USD for each patient.

Conclusion: High incidence and complications of alkali ingestion in south of Iran suggests a need for prompt preventive actions to stop the production of highly concentrated alkali and educating families for proper use of these substances.

Relation between cold weather and testicular torsion in children

Afsaneh Sadeghi, Alireza Mirshemirani, Ahmad Khaleghnejad, Naser Sadeghian, Javad Ghoroubi, Mohsen Rouzrokh, Leili Moahajerzadeh

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 63-65

Introduction: Reports were recently published in relation to cold weather and testicular torsion (TT) that is why we decided to evaluate this hypothesis risk factor at our children’s hospital.The aim of this study is to evaluate the relation between cold weather and testicular torsion in children.

Material and Methods: In this retrospective and descriptive study from January 2011 to December 2015, onehundredseventypatients were admitted at Mofid Children’s Hospital due to acute scrotum. According to our center guidelines, those patients who had proven TT were candidates for this study. The records of all operated children wereanalyzed according toage, season of year, and operation type.

Results: A total of one hundred seventy patients were included in this study within five years, with a mean age of 28.6+ 32.9months (range1 to 144).Winter season was the peak time for testicular torsion (42%).

Conclusion: The incidence of testicular torsion increases during cold weather.

The predicting values of Pao2/Fio2 ratio in survival of neonates with Congenital Diaphragmatic Hernia

Mohamad Hadi Rafeie, Mahdi Musavi, Bahareh Ahmadi, Mehrdad Hosseinpour

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 66-70

Introduction: Respiratory failure is one of the most important related factors in morbidity and mortality of neonates with congenital diaphragmatic hernia (CDH). Determining indexes that could ultimately and perceivably predict the disease severity and its prognosis is crucial. This study aimed to evaluate the predictive value of Pao2/Fio2 ratio(P/F ratio) in neonates with CDH.

Materials and Methods: In this retrospective study, medical records of all neonates with CDH admitted to Alzahra (Isfahan, Iran) hospitalfrom 2005 to 2015 were checked. Thirty-five neonates with CDH were studied. Data collected were: gestational age, sex, weight, Pao2, Fio2 and clinical outcome.

Results: In this survey 24 neonates with CDH were studied. The mean P/F ratio in the survival group was 2.12 ±0.90 and in the non-survival group, 1.38± 0.48. According to these results the P/F ratio in the survival group was higher than the other group and this difference was statistically significant (P= 0.02).  Based on the ROC curve, the specificity of P/F ratio in predicting survival is 72.2 percent and its sensitivity in predicting death is 80 percent.

Conclusion: P/F ratio is a useful index for predicting the outcome of neonates with CDH.

Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia in children undergoing herniorrhaphy

Afsaneh Sadeghi, Ahmad Khaleghnejad Tabari, Seyed Sajad Razavi, Ahmad Eghbali, Alireza Mahdavi, Amirhossein Farrokhiaski

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 71-76

Introduction: Neostigmine and midazolam are each added to bupivacaine for the purpose of caudal anesthesia. In this study, we compared neostigmine and midazolam, each coadministered with bupivacaine, in terms of analgesia and side effects during pediatric inguinal hernia operations.

Material and Methods: We included 60 children 1–6 years-old, candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group received bupivacaine 25% 1 ml/kg with neostigmine 2 µg/kg through the caudal route. Heart rate, mean arterial pressure, and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at two, four, six, 12, and 24 hours after the operation, along with rescue analgesia dosage, vomiting, and respiratory depression.

Results: Mean duration of analgesia in the midazolam group was similar to the neostigmine group (18.8±9 vs. 20.4±7.5; P= 0.44).The analgesic dosage required was not significantly lower in the neostigmine group compared to the midazolam group (58.3±121.7 VS .70.8±125.8; P=0.63).The number of patients who needed analgesic agents was similar in both groups (P= 0.76). Nausea (P= <0.05) and vomiting (P=0.01) rates were higher in the neostigmine group.

Conclusion: Midazolam (50 µg/kg) compared to neostigmine (2 µg/kg) provided higher sedation along with lower incidence of postoperative nausea and vomiting. 

Postoperative apnea among premature or anemic infants undergoing inguinal hernia repair

Alireza Mahdavi, Leili Mohajerzadeh, Sajad Razavi, Mehdi Ghahremani, Hossein Moeini, Afsaneh Sadeghi, Parastou Ariana

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 77-80

Introduction: Premature or anemic newborns undergoing hernia repair are prone to more postoperative complications than full-term infants. The incidence of respiratory complications among these patients is more than 30%, being postoperative apnea the most common. Some investigators found that gestational and postconceptional age, the presence of continuing apneic episodes and anemia are the main determinants of postoperative apnea. It seems that infants who do not receive intravenous anesthetics experience less respiratory complications. Intravenous anesthetics have hepatic metabolism for elimination and the immature liver of the premature has not sufficient elimination capacity. 

Materials and Methods: Study participants were 1047 neonates with post conceptual age (PCA) lower than 60 weeks undergoing inguinal hernia operation. Sevoflurane gas mask was used for anesthesia induction and during deep anesthesia, caudal block was administered using 1cc/kg bupivacaine 2%. The neonates were managed with spontaneous breathing with Sevoflurane gas mask or endotracheal tube until the end of the operation. 

Results: In the present study, 916 (87.5%) male and 131 (12.5%) female neonates were included. Mean gestational age and PCA were 36.62 ± 38.0 and 46.80 ± 45.60 weeks respectively. Postoperative apnea did not occur in any patient. 

Conclusion: Many studies confirm our findings that inhaled sedative drugs without hepatic or renal metabolism are safe for sedation of premature or anemic infants.

Prospective follow up of children with anorectal malformation: our center experience until 10 years of age.

Leili Mohajerzadeh, Mohsen Rouzrokh, Ahmad Khaleghnejad Tabari, Alireza Mirshemirani, Naser Sadeghian, Javad Ghoroubi, Fatollah Roshanzamir, Alireza Mahdavi, Maryam Kazemi, Sayeh Hatefi, Arameh Abbasian

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 81-86

Introduction: the aim of our study was to perform a longitudinal follow-up in patients with anorectal malformations(ARMs) in order to determine the anorectal function problems and help to solve them.

Material and Methods: This study included 262 patients with ARM who were operated between 2006 until 2013.Children whose definitive reconstruction was performed at another hospital and underwent reoperation in our center were excluded. Patients who expired or did not come for follow-up were not included in the study either. Bowel function was prospectively assessed by using a questionnaire answered by the children’s parents. supplementary bowel management with enemas, laxatives and the use of diapers were documented as well.

Results: Interviews were completed in 242 children, ages ranging from 3 to 10 years. More than thirty seven (37.7%) patients had constipation.32.5% Grade 1 (controllable by altering in diet), 54.3% Grade 2 (requiring laxatives) and 13.2% Grade 3(opposed to stool softeners and diet).

18.6% of patients had fecal soiling, 31.5% Grade 1: infrequently (once or twice for every week), 24% Grade 2: daily (no community difficulty) and 44.5% Grade 3: Constant (social problem).

Conclusion: In the present study several bowel function problemswere found in ARM children. physicians who perform the definitive operation on anorectal malformations should  notloose follow up of patients as they grow upbecause they may present with  great troubles during their adolescence.

Umbrella repair of giant omphalocele, A new technique.

Mehran Hiradfar, Reza Shojaeian, Mahmoud Reza Ashab Yamin

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 87-91

Introduction: Although many techniques have been described for reconstruction of the giant omphalocele, we present a simple , effective and safe new technique.

Materials and Methods: We have studied 11 neonates with giant omphalocele that were treated by a new technique, Umbrella repair, in Sarvar pediatric hospital of Mashhad, Iran. In this new technique we released the skin around the omphalocele membrane just near the junction and a purse string suture is placed at the edge of the skin with beads beneath each bite and graded tightening of the suture in order to pushing the omphalocele toward the abdominal cavity. Finally we compare the results.

Results: Among total 11 patients, mean age and weight at the time of operation were 2.18 days and 2150 grams respectively. comparing the results between groups, we observed significant less operative time and number of surgeries in neonatal period among patients who managed by umbrella repair. Post-operative complications, morbidity and mortality in umbrella repair group were also less than coventional methods.

Conclusion: Umbrella repair provide a rapid and safe method for management of giant omphalocele with acceptable results and low morbidity and mortality.

Case Report

A curious case of attempted infanticide by percutaneous needles insertion: diagnosis and laparoscopic management.

Meriem Braiki, Mongi Mekki, Besma Gafsi, Amine Ksia

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 92-95

This is the case of a 6 month-old boy victim of an attempted infanticide by means of sharp long needles inserted through the abdominal wall. He was successfully managed by laparoscopic approach.

Case presentation: villous tumor of rectum in a child

Samia Belhassen, Nahla Kechiche, Rachida Laamiri, Imed Krichen, Sana Mosbahi, Amine Ksiaa, Mongi Mekki, Nouri Abdellatif

Iranian Journal of Pediatric Surgery, Vol. 2 No. 2 (2016), 11 February 2017, Page 96-100

Introduction: The rectum villous tumour is an uncommon pathology in paediatrics, it represents 1% of all the children’s malignant tumours.

Case Presentation: An eleven-year-old girl presented a rectal adenocarcinoma arising from a villous tumour. The aim of this study is to overview of the literature, asses the frequency of rectum villous tumours, specify the value of the clinical examination, of the radiologic findings in the assessment of the loco-regional extension of villous tumours and rectum adenocarcinoma and finally to discuss the treatment modalities.

Conclusion: The rectum villous tumour symptomatology in children is not very specific. Therefore, a good knowledge of its clinical presentation and the predisposing pathological situations can improve the prognosis of this rare disease.