Original Articles

Epidemiological Aspects, Clinical Features and Treatment Outcome in Children Suffering Hepatoblastoma

Leily Mohajerzadeh, Nooshin Faraji , Ahmad Khaleghnejad Tabari, Mohsen Rouzrokh , Javad Ghoroubi , Shahin Shamsian

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 1-8

Introduction: Hepatoblastoma (HBL) is the most common primary liver tumor within childhood. Entire tumor resection is basis for ultimate cure for HBL and supports the only pleasant chance of long-standing disease-free survival.

Objectives: In the current survey, we attempted to evaluate the long-term survival of children with HBL with surgical resection in a referral children hospital in Iran within the last decade.

Materials and Methods:This retrospective descriptive study was conducted on all children who suffered HBL and undergone surgery between 2006 and 2016. Reviewing the recorded hospital files led to a sample of 30 eligible patients. The baseline characteristics of the patients were all collected by reviewing the files.

Results:In total, 30 consecutive children (21 male and 9 female) suffering HBL were described. Of those, 40.0% aged less than 12 months and only 6.7% aged higher than 36 months. The most common clinical manifestations were asymptomatic abdominal mass (in 66.7%) followed by fever (in 10.0%) and pain (in 10.0%). In more than half of the patients (53.3%), right lobe involved, while left lobe involved in 16.7%. based on histologicalreport,marginal involvement was found in 75.0% of children, margin intact in 15.0% and margin free feature in 5.0%. Forty percent of children suffered from epithelial subtype of tumor, 20.0% from mixed epithelial and mesenchymal subtypes, and 13.3% from embryonal pattern. In total, 63.3% were scheduled for complete surgical resection followed by chemotherapy. Postoperatively, 40.0% of children remained free of complications, whereas postoperative bleeding occurred in 20.0% and biloma in 40.0%. Overall, 76.9% of patients were completely cured, 7.7% suffered from pulmonary metastasis and 3.9% required liver transplantation. Postoperative death occurred in 11.5%.

Conclusions: Considering surgical resection followed by chemotherapy leads to high cure rate, however a notable number of affected children suffer postoperative complication, requiring liver transplantation, pulmonary metastasis, or even non-survived emphasizing a serious review of the treatment protocols.   

Evaluation of Omphalocele Treatment Using New Surgical Technique

Shahnam Askarpour, Mehran Peyvasteh, Alireza Sadeghi, Hazhir Javaherizadeh

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 9-14

Introduction: The aim of this study was to evaluate a new technique for treatment of omphalocele using mesh fixation to skin with preserved omphalocele sac.

Materials and Methods:  Chart of patients who treated with mesh fixation were reviewed. Demographic features, mortality and morbidity following treatment were recorded.

Results: in the current study 68 patients (f=32, m=36) were included. Of 68 csaes, 44(64.7%) had giant omphalocele. Among all cases, 20(29.4%) had isolated omphalocele. Mortality was 26.5%(18 of 68).  Of survived cases, 21(42%) had detached mesh. Adhesion band was seen in 4(8.2%) of cases. Sepsis was seen in 11.8% of the cases.

Conclusion: According to the result of the study, suggested technique is promising and had several benefits. Duration of hospital staying, duration of intubation was less than previous techniques

Head Trauma in Children: An Epidemiological Study

Davoud Badebarin, Saeed Aslan Abadi, Ebrahim Farhadi, Amir Hossein Ladan, Seyed Ehsan Mousavi Toomatari

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 15-21

Introduction: Brain injury is one of the most common causes of death among victims of trauma in various accidents. The type of accident and outcome could be different in children from adults. Therefore, we aimed to investigate the epidemiology of traumatic head injury in children.

Materials and Methods: In this cross-sectional study, 114 patients (age≤15 years) with head trauma, who were admitted to trauma ward of Imam Reza hospital in 2018 were enrolled in the study. Data regarding the demographic characteristics, mechanism of trauma, season of trauma, hemodynamic findings and outcome of the patients were collected.

Results: The mean age amongst victims of trauma was 6.52±3.95 years and majority of them (70.2%) were male. Most of traumatic accidents took place in the spring (27.2%) and summer (32.5%). Traffic accidents (pedestrians or passenger) (55.3%) and falling (39.5%) were the most common mechanism of trauma. Also, epidural hematoma (EDH) and brain contusion were the most encountered type of brain injury (1.75%). Nine patients (7.89%) underwent brain surgery. Eventually, eight patients (7.17%) died.

Conclusion: Falling and vehicle accidents are the main causes of head injury among children. Increasing the parents’ awareness toward these types of accidents and proper preventive measures can reduce traumatic brain injury.

Anesthesia Depth Measurement with Bispectral Index Monitoring during Minor Surgery among Children With and Without Cerebral Palsy

Tahereh Chavoshi, Seyed Alireza Mahdavi, Seyed Sajad Razavi, Amir Shafa, Mahmoud Hajipour, Nastaran Sadat Mahdavi, Mohammadreza Moshari

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 22-30

Introduction: Unfortunately, few studies have been performed on the pharmacodynamic effects of anesthesia in children suffering cerebral palsy(CP).Patients were candidates for surgeryfor various reasons. Due to the lower need for anesthesiain these children, side effects of various anesthetic agents, adverse drug reactions, delayed awareness and higher costs can be prevented in these children. The present study aims to evaluate and compare the depth of anesthesia in minor surgeries using Bispectral Index (BSI) in children sufferingCP.

Materials and Methods: This cohort study was performed on 64 children aged two to ten years in two groups with and without cerebral palsy inMofid Hospital, Tehran, Iran in 2020. BIS index, mean arterial blood pressure and heart rate were measured before and after anesthesia induction, every ten minutes during operation, after extubation and when being able to respond to verbal stimulation.

Results: This studyexamined 64 patients equally divided into two study groups “with and without cerebral palsy”. The mean BIS level in children suffering CP was lower than children without cerebral palsy. The dosage of isoflurane gas used for anesthesia in CPpatientswas meaningfully lower than itsdosage in children without cerebral palsy.

Conclusion: Monitoring of anesthesia in this study, showed that use of BIS could reduce the use of anesthetic agents and related side effects to provide the appropriate depth of anesthesia.

Evaluation of Complications of Peritoneal Dialysis Catheter in Children: A Retrospective Single Center Study

Leily Mohajerzadeh, Mostafa Sharifian, Mohsen Rouzrokh, Javad Ghoroubi, Mohammad Amiri, Ehsan Ghandchi, Shohra Qaderi

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 31-41

Introduction:Peritoneal dialysis is a long-term method of dialysis for children. Peritoneal dialysis, when performed effectively, saves valuable time for children with advanced kidney transplant, till they reach the appropriate age for the kidney transplant. In children, due to their rapid physical growth and the large catheter size, as well as the thin and weak abdominal wall, especially before the age of 4, the complications of catheterization such as catheter leak and incisional hernia are higher than that of adult population. In this study we aim to evaluatethedysfunction and complications of the cathetersof peritoneal dialysis in children.

Materials and Methods:We assessedmedical records of all patients, who underwent peritoneal dialysis since 2006 till 2015 at Mofid hospital, Tehran, Iran. Total number of 41 records were evaluated, of which 11 cases were excluded dueto incomplete data and 30 patients were analyzed eventually.Complications of catheter were recorded.

Results:We studied 30 patients, 14 males and 16 females; the mean age of the children was 72.6 months(5 to 12 years old). The leading cause of end stage renal disease(ESRD) were primary glomerulopathies. There were total of 3 catheterreplacements,mostly due to peritonitis and catheter obstruction. The incidence of infectious complications was 40.3%. The incidence of all complications was 1 out of 6.4 patients/month.

Conclusion: Regarding the high prevalence of catheter-related complications in children undergoing chronic peritoneal dialysis, especially infectious complications, adopting standard surgical technique of catheter insertion accompanied bywell trained peritoneal dialysis team isessential to prevent the complications and to increase the functional life span of the catheter and to enhance the quality of life of the patient.

Effect of Total Macroscopical Sampling of the Pediatric Appendectomy Specimen on Histopathological Diagnosis

Ebru Cakir, Mustafa Onur Oztan, Samir Abdullazade, Sumeyye Ekmekci, Gokhan Koyluoglu

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 42-49

Introduction: Acute appendicitis is considered the most common abdominal surgery in children. Pathological examination of the appendectomy specimen mainly is performed to document the presence or absence of inflammation and confirm the clinical diagnosis. If the diagnosis made by the pathologist is as ‘no appendicitis’, then clinical work up for other causes should be performed. Routine macroscopic evaluation of the appendectomy specimen consists of obtaining one section each from the base, body and the tip of the appendix and additional sections obtained from exuding or perforated areas. The aim of this study is to evaluate if the final pathological diagnosis would change when the appendectomy specimen is sampled totally.

Materials and Methods: In the present study, we performed conventional macroscopical sampling from the tip, body and base of the appendix and embedded these tissues in the first two cassettes, then the rest of appendix was completely sampled in additional two to five casettes. The histopathological diagnosis of conventionally sampled tissues and the histopathological diagnosis of total macroscopical sampling were analyzed and compared.

Results: A total of 87 appendectomies were evaluated, of which 58.6 % were male, and the mean age was 11.7 (1 years-18 years). The initial histopathological diagnosis was changed in 14 (16%) cases. In 8 (9.2%) cases, the initial diagnosis of reactive lymphoid hyperplasia changed to acute focal appendicitis (early appendicitis). In 4 (4.6%) cases the initial diagnosis of acute suppurative appendicitis changed to acute suppurative and perforated appendicitis, and in 2 (2.2%) cases acute perforated appendicitis changed to acute perforated and gangrenous appendicitis.

Conclusion: Total macroscopical sampling of the appendectomy specimen in cases of negative appendicitis would improve the diagnosis and can document early appendicitis in pediatric cases.

Case Report

Fetus-in-Fetus: Our Case Series and Review of the Literature

Saeid Aslanabadi, Davoud Badebarin, Mohammad A Baky Fahmy, Amir Hossein Ladan, Ebrahim Farhadi, Sina Zarrintan

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 50-56

Fetus in fetu is a rare condition commonly presenting as an epitomized pedunculated vertebrated fetiform mass in a newborn infant. Different kinds of presentation and locations have been reported in the hosts. Although numbers of instances have been reported the fascination and curiosity about other presentations and genesis of fetus in fetu remains confirmed. In Tabriz pediatric surgery ward we have had five different presentations of fetus in fetu. The aim of this case series and a subtle literature review is gathering these interesting presentations.

Acute Midgut Volvulus in a Previously Healthy 9- Year Boy

kumait issa, Wajeeh Ali

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 57-61

Intestinal malrotation is an uncommon cause of bowel obstruction after the first month of life. Nevertheless, this abnormality can be diagnosed even at older ages. In this case, we present a 9-year-old, healthy, well-nourished boy who came in Emergency Department with intermittent cramping abdominal pain, associated with bilious vomiting. After clinical examination, plain AXR, and ultrasonography with no important findings, we performed doppler ultrasound screening of the abdominal vessels, in which abnormal orientation of superior mesenteric vessels was found. After that, contrast-enhanced CT scan was performed, which confirmed the diagnosis of intestinal malrotation, and revealed the "Whirlpool Sign", confirming the diagnosis of midgut volvulus. He underwent laparotomy and Ladd´s procedure was done for him. We recommend investigation for the possibility of intestinal malrotation in all patients of non-specific abdominal pain regardless of age, even if there is no intestinal obstruction.

Clinical Characteristics and Mortality of a Hospitalized 13 Years Old Patient with Covid-19: A Case Report

Tahereh Chavoshi, Alireza Mahdavi, Mohsen Rouzrokh, Amir Shafa, Sedigheh Rafiei Tabatabaei, Seyed Alireza Fahimzad, Ali Dabbagh, Azar Marbout

Iranian Journal of Pediatric Surgery, Vol. 7 No. 1 (2021), , Page 62-67

The corona virus is a global problem that threatens human life. According to the latest data from different countries the mortality of this virus in children is less than adult.

A 13-year-old girl was hospitalized for 6 months following a gunshot trauma and its complications. When her general condition was finally improving, she was diagnosed with the corona virus and passed away.

Children who are suffering from underlying diseases and need medical care are at a higher risk of death from the corona virus.