At the conclusion of Volume 19 of Pediatric Surgery International, the Editors-in-Chief wish to t... more At the conclusion of Volume 19 of Pediatric Surgery International, the Editors-in-Chief wish to thank members of the Editorial Board for their valuable editorial help. Special thanks to the following persons who gave up their precious time to review manuscripts for the journal and thus improve the quality of the articles that appear in the Journal. Pediatr Surg Int (2004) 19: 791–792 DOI 10.1007/s00383-004-1161-3 Springer-Verlag 2004
A nine-week-old male infant presented in extremis following a one week history of effortless, non... more A nine-week-old male infant presented in extremis following a one week history of effortless, non-bilious vomiting. Weighing 2.5kg, he was 30% below birthweight and had Cheyne-Stokes respiration. Severe hypochloraemic, hypokalaemic metabolic alkalosis (pH 7.72, pCO2 6.5 kPa, bicarbonate 70.9 mmol/L, Base Excess 44.7, potassium 1.9mmol/L, chloride <60mmol/L) was present. Ultrasound confirmed the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) (pyloric channel length 24mm, muscle thickness 7mm). Following stabilisation, he underwent a Ramstedt pyloromyotomy and his recovery was uneventful.
The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to de... more The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to determine the Irish national incidence of gastroschisis repairs (NIGR) over a 5 year period (2007- 2011) and clinical outcomes by a retrospective cohort review of cases admitted to all Irish paediatric surgical units. Seventy patients were identified. The NIGR per 10,000 live births was 1.96 (SD 0.51) per year. Fifty eight (82%) were antenatally detected. Twenty eight (40%) had primary repair day 1 with the remaining repaired in a median of 3(2-5.75) days. Thirty three (47%) experienced a central catheter related infection. Duration of stay was significantly correlated with decreasing gestational age (p=0.016), decreasing birthweight (p=0.005), increasing numbers of blood transfusions (p<0.001) and co-morbidity or complication (p<0.001). This study provides individual centres with patient outcomes and national data that can be provided to parents and clinical staff regarding the clin...
A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained... more A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.
A nine-week-old male infant presented in extremis following a one week history of effortless, non... more A nine-week-old male infant presented in extremis following a one week history of effortless, non-bilious vomiting. Weighing 2.5kg, he was 30% below birthweight and had Cheyne-Stokes respiration. Severe hypochloraemic, hypokalaemic metabolic alkalosis (pH 7.72, pCO2 6.5 kPa, bicarbonate 70.9 mmol/L, Base Excess 44.7, potassium 1.9mmol/L, chloride <60mmol/L) was present. Ultrasound confirmed the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) (pyloric channel length 24mm, muscle thickness 7mm). Following stabilisation, he underwent a Ramstedt pyloromyotomy and his recovery was uneventful.
Aim We aim to determine if the release of preputial adhesions (RPA) successfully managed symptoms... more Aim We aim to determine if the release of preputial adhesions (RPA) successfully managed symptoms related to physiological phimosis and prevented the need for circumcision. Methods We performed a retrospective review and analysed data on RPA procedures performed between January 2005 and December 2017. Results 534 RPA’s were performed. Median age at RPA was 52.7 months (range: 3-197 months). Mean follow-up was 108 months (range: 4.7 to 152.4 months). 44 children and 1 child subsequently required a circumcision or preputioplasty respectively (8.4% incidence). There was no statistical difference in the circumcision rates in children who had RPA over 5 years vs those that had RPA under 5 years old (6.6% vs 9.8%; p = 0.21). The histology of the 44 excised foreskins showed BXO in 2 (4.5%) and chronic inflammation in 11 (25%). Conclusion RPA is an effective alternative to circumcision where either reassurance on the benign and self-limiting nature of physiologic phimosis or steroid treatme...
A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained... more A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.
The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to de... more The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to determine the Irish national incidence of gastroschisis repairs (NIGR) over a 5 year period (2007- 2011) and clinical outcomes by a retrospective cohort review of cases admitted to all Irish paediatric surgical units. Seventy patients were identified. The NIGR per 10,000 live births was 1.96 (SD 0.51) per year. Fifty eight (82%) were antenatally detected. Twenty eight (40%) had primary repair day 1 with the remaining repaired in a median of 3(2-5.75) days. Thirty three (47%) experienced a central catheter related infection. Duration of stay was significantly correlated with decreasing gestational age (p = 0.016), decreasing birthweight (p = 0.005), increasing numbers of blood transfusions (p < 0.001) and co-morbidity or complication (p < 0.001). This study provides individual centres with patient outcomes and national data that can be provided to parents and clinical staff regarding ...
The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to de... more The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to determine the Irish national incidence of gastroschisis repairs (NIGR) over a 5 year period (2007- 2011) and clinical outcomes by a retrospective cohort review of cases admitted to all Irish paediatric surgical units. Seventy patients were identified. The NIGR per 10,000 live births was 1.96 (SD 0.51) per year. Fifty eight (82%) were antenatally detected. Twenty eight (40%) had primary repair day 1 with the remaining repaired in a median of 3(2-5.75) days. Thirty three (47%) experienced a central catheter related infection. Duration of stay was significantly correlated with decreasing gestational age (p = 0.016), decreasing birthweight (p = 0.005), increasing numbers of blood transfusions (p < 0.001) and co-morbidity or complication (p < 0.001). This study provides individual centres with patient outcomes and national data that can be provided to parents and clinical staff regarding ...
Paediatric chylothoraces are rare, particularly outside the operative setting. Cases of spontaneo... more Paediatric chylothoraces are rare, particularly outside the operative setting. Cases of spontaneous chylothorax are often demanding diagnostically and frequently associated with patient morbidity. We present a challenging case of paediatric chylothorax associated with inflammatory oesophageal perforation likely related to foreign body ingestion.
Acute scrotal pain is a common presentation to the paediatric emergency department. Testicular to... more Acute scrotal pain is a common presentation to the paediatric emergency department. Testicular torsion is one of the most common causes of acute scrotal pain. Testicular torsion is a surgical emergency requiring immediate surgical exploration to prevent permanent testicular damage or loss. The aim of this study was to determine the surgical outcome of all scrotal explorations and to assess the use of colour Doppler ultrasound (CDUS) in the assessment of acute scrotal pain in two tertiary referral paediatric units. A retrospective review of a prospectively maintained database was carried out for all scrotal explorations between 1999 and 2010. In total, 155 scrotal explorations were carried out for acute scrotal pain. The mean age was 9.1 years (range 0-15 years). The pathology in 46.5% (n = 72) was testicular torsion, 30.3% (n = 47) were torsion of a testicular appendage, 16.1% (n = 25) were epididymitis, 3.3% (n = 5) had no obvious pathology identified and other pathology accounted for 4%. There was a significant difference in age of presentation between those with testicular torsion and those with torsion of a testicular appendage (9 vs 10 years, p = 0.0074). CDUS was performed by a trained radiologist on 40 patients. Overall sensitivity, specificity, positive predictive value and negative predictive value for CDUS predicting testicular torsion were 96.9%, 88.9%, 96.9% and 89%, respectively. Overall, 36 patients (23%) with acute scrotal pain (50% of patients in the group with confirmed testicular torsion at exploration) required orchidectomy. This study supports the practice of immediate surgical exploration with a clinical suspicion of testicular torsion in a paediatric population.
Adriamycin is an anthracycline, anti-neoplastic drug with known teratogenic effects on foetal rat... more Adriamycin is an anthracycline, anti-neoplastic drug with known teratogenic effects on foetal rats in what is known as the Adriamycin rat model (ARM). This includes conditions similar to those in newborn humans, known collectively as the VACTERL association. This comprises vertebral (V), anorectal (A), cardiac (C), tracheoesophageal (TE), renal (R) and limb (L) anomalies. We designed this study to test the hypothesis that the administration of Adriamycin to chick embryos would cause similar anomalies to those in the VACTERL association seen in the ARM. Fertilized Ross eggs received Adriamycin doses from 2-50 microg into the air sac and from 0.9-6 microg into the albumin. Administration varied from day 0-3 (D(0-3)) with D(0) being the first day of incubation. Control eggs received saline. Embryos were incubated at 38 degrees C and a relative humidity of 70%. Embryos were recovered on D(14), paraffin-embedded and transverse sections studied for morphological abnormalities. In the air sac group ( n=142), 71% of Adriamycin embryos survived versus 86% of controls (n=29). In the albumin group (n=121), 42% of Adriamycin embryos survived versus 55% of controls (n=69). No embryos demonstrated anomalies consistent with the VACTERL association. Ventral defects affected 1% of surviving Adriamycin embryos versus 4% of controls in the air sac group. In the albumin group, 19.8% of surviving Adriamycin embryos had ventral defects compared to 15.7% of surviving controls. Anophthalmia affected 1% of the surviving embryos in the Adriamycin air sac group and 2% of the Adriamycin albumin group. No controls developed anophthalmia. Exencephaly affected 2% of the survivors in the Adriamycin air sac group but none of the albumin group or controls. The administration of Adriamycin to chick embryos in comparable doses and times to those used in the ARM does not appear to produce comparable effects in relation to developmental anomalies, such as the VACTERL association. Despite examining different administration routes and mimicking the ARM, by giving Adriamycin to embryos at gastrulation, we were unable to re-create the anomalies seen in the ARM.
At the conclusion of Volume 19 of Pediatric Surgery International, the Editors-in-Chief wish to t... more At the conclusion of Volume 19 of Pediatric Surgery International, the Editors-in-Chief wish to thank members of the Editorial Board for their valuable editorial help. Special thanks to the following persons who gave up their precious time to review manuscripts for the journal and thus improve the quality of the articles that appear in the Journal. Pediatr Surg Int (2004) 19: 791–792 DOI 10.1007/s00383-004-1161-3 Springer-Verlag 2004
A nine-week-old male infant presented in extremis following a one week history of effortless, non... more A nine-week-old male infant presented in extremis following a one week history of effortless, non-bilious vomiting. Weighing 2.5kg, he was 30% below birthweight and had Cheyne-Stokes respiration. Severe hypochloraemic, hypokalaemic metabolic alkalosis (pH 7.72, pCO2 6.5 kPa, bicarbonate 70.9 mmol/L, Base Excess 44.7, potassium 1.9mmol/L, chloride <60mmol/L) was present. Ultrasound confirmed the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) (pyloric channel length 24mm, muscle thickness 7mm). Following stabilisation, he underwent a Ramstedt pyloromyotomy and his recovery was uneventful.
The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to de... more The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to determine the Irish national incidence of gastroschisis repairs (NIGR) over a 5 year period (2007- 2011) and clinical outcomes by a retrospective cohort review of cases admitted to all Irish paediatric surgical units. Seventy patients were identified. The NIGR per 10,000 live births was 1.96 (SD 0.51) per year. Fifty eight (82%) were antenatally detected. Twenty eight (40%) had primary repair day 1 with the remaining repaired in a median of 3(2-5.75) days. Thirty three (47%) experienced a central catheter related infection. Duration of stay was significantly correlated with decreasing gestational age (p=0.016), decreasing birthweight (p=0.005), increasing numbers of blood transfusions (p<0.001) and co-morbidity or complication (p<0.001). This study provides individual centres with patient outcomes and national data that can be provided to parents and clinical staff regarding the clin...
A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained... more A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.
A nine-week-old male infant presented in extremis following a one week history of effortless, non... more A nine-week-old male infant presented in extremis following a one week history of effortless, non-bilious vomiting. Weighing 2.5kg, he was 30% below birthweight and had Cheyne-Stokes respiration. Severe hypochloraemic, hypokalaemic metabolic alkalosis (pH 7.72, pCO2 6.5 kPa, bicarbonate 70.9 mmol/L, Base Excess 44.7, potassium 1.9mmol/L, chloride <60mmol/L) was present. Ultrasound confirmed the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) (pyloric channel length 24mm, muscle thickness 7mm). Following stabilisation, he underwent a Ramstedt pyloromyotomy and his recovery was uneventful.
Aim We aim to determine if the release of preputial adhesions (RPA) successfully managed symptoms... more Aim We aim to determine if the release of preputial adhesions (RPA) successfully managed symptoms related to physiological phimosis and prevented the need for circumcision. Methods We performed a retrospective review and analysed data on RPA procedures performed between January 2005 and December 2017. Results 534 RPA’s were performed. Median age at RPA was 52.7 months (range: 3-197 months). Mean follow-up was 108 months (range: 4.7 to 152.4 months). 44 children and 1 child subsequently required a circumcision or preputioplasty respectively (8.4% incidence). There was no statistical difference in the circumcision rates in children who had RPA over 5 years vs those that had RPA under 5 years old (6.6% vs 9.8%; p = 0.21). The histology of the 44 excised foreskins showed BXO in 2 (4.5%) and chronic inflammation in 11 (25%). Conclusion RPA is an effective alternative to circumcision where either reassurance on the benign and self-limiting nature of physiologic phimosis or steroid treatme...
A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained... more A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.
The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to de... more The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to determine the Irish national incidence of gastroschisis repairs (NIGR) over a 5 year period (2007- 2011) and clinical outcomes by a retrospective cohort review of cases admitted to all Irish paediatric surgical units. Seventy patients were identified. The NIGR per 10,000 live births was 1.96 (SD 0.51) per year. Fifty eight (82%) were antenatally detected. Twenty eight (40%) had primary repair day 1 with the remaining repaired in a median of 3(2-5.75) days. Thirty three (47%) experienced a central catheter related infection. Duration of stay was significantly correlated with decreasing gestational age (p = 0.016), decreasing birthweight (p = 0.005), increasing numbers of blood transfusions (p < 0.001) and co-morbidity or complication (p < 0.001). This study provides individual centres with patient outcomes and national data that can be provided to parents and clinical staff regarding ...
The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to de... more The birth prevalence of gastroschisis worldwide has increased over the past decades. We aim to determine the Irish national incidence of gastroschisis repairs (NIGR) over a 5 year period (2007- 2011) and clinical outcomes by a retrospective cohort review of cases admitted to all Irish paediatric surgical units. Seventy patients were identified. The NIGR per 10,000 live births was 1.96 (SD 0.51) per year. Fifty eight (82%) were antenatally detected. Twenty eight (40%) had primary repair day 1 with the remaining repaired in a median of 3(2-5.75) days. Thirty three (47%) experienced a central catheter related infection. Duration of stay was significantly correlated with decreasing gestational age (p = 0.016), decreasing birthweight (p = 0.005), increasing numbers of blood transfusions (p < 0.001) and co-morbidity or complication (p < 0.001). This study provides individual centres with patient outcomes and national data that can be provided to parents and clinical staff regarding ...
Paediatric chylothoraces are rare, particularly outside the operative setting. Cases of spontaneo... more Paediatric chylothoraces are rare, particularly outside the operative setting. Cases of spontaneous chylothorax are often demanding diagnostically and frequently associated with patient morbidity. We present a challenging case of paediatric chylothorax associated with inflammatory oesophageal perforation likely related to foreign body ingestion.
Acute scrotal pain is a common presentation to the paediatric emergency department. Testicular to... more Acute scrotal pain is a common presentation to the paediatric emergency department. Testicular torsion is one of the most common causes of acute scrotal pain. Testicular torsion is a surgical emergency requiring immediate surgical exploration to prevent permanent testicular damage or loss. The aim of this study was to determine the surgical outcome of all scrotal explorations and to assess the use of colour Doppler ultrasound (CDUS) in the assessment of acute scrotal pain in two tertiary referral paediatric units. A retrospective review of a prospectively maintained database was carried out for all scrotal explorations between 1999 and 2010. In total, 155 scrotal explorations were carried out for acute scrotal pain. The mean age was 9.1 years (range 0-15 years). The pathology in 46.5% (n = 72) was testicular torsion, 30.3% (n = 47) were torsion of a testicular appendage, 16.1% (n = 25) were epididymitis, 3.3% (n = 5) had no obvious pathology identified and other pathology accounted for 4%. There was a significant difference in age of presentation between those with testicular torsion and those with torsion of a testicular appendage (9 vs 10 years, p = 0.0074). CDUS was performed by a trained radiologist on 40 patients. Overall sensitivity, specificity, positive predictive value and negative predictive value for CDUS predicting testicular torsion were 96.9%, 88.9%, 96.9% and 89%, respectively. Overall, 36 patients (23%) with acute scrotal pain (50% of patients in the group with confirmed testicular torsion at exploration) required orchidectomy. This study supports the practice of immediate surgical exploration with a clinical suspicion of testicular torsion in a paediatric population.
Adriamycin is an anthracycline, anti-neoplastic drug with known teratogenic effects on foetal rat... more Adriamycin is an anthracycline, anti-neoplastic drug with known teratogenic effects on foetal rats in what is known as the Adriamycin rat model (ARM). This includes conditions similar to those in newborn humans, known collectively as the VACTERL association. This comprises vertebral (V), anorectal (A), cardiac (C), tracheoesophageal (TE), renal (R) and limb (L) anomalies. We designed this study to test the hypothesis that the administration of Adriamycin to chick embryos would cause similar anomalies to those in the VACTERL association seen in the ARM. Fertilized Ross eggs received Adriamycin doses from 2-50 microg into the air sac and from 0.9-6 microg into the albumin. Administration varied from day 0-3 (D(0-3)) with D(0) being the first day of incubation. Control eggs received saline. Embryos were incubated at 38 degrees C and a relative humidity of 70%. Embryos were recovered on D(14), paraffin-embedded and transverse sections studied for morphological abnormalities. In the air sac group ( n=142), 71% of Adriamycin embryos survived versus 86% of controls (n=29). In the albumin group (n=121), 42% of Adriamycin embryos survived versus 55% of controls (n=69). No embryos demonstrated anomalies consistent with the VACTERL association. Ventral defects affected 1% of surviving Adriamycin embryos versus 4% of controls in the air sac group. In the albumin group, 19.8% of surviving Adriamycin embryos had ventral defects compared to 15.7% of surviving controls. Anophthalmia affected 1% of the surviving embryos in the Adriamycin air sac group and 2% of the Adriamycin albumin group. No controls developed anophthalmia. Exencephaly affected 2% of the survivors in the Adriamycin air sac group but none of the albumin group or controls. The administration of Adriamycin to chick embryos in comparable doses and times to those used in the ARM does not appear to produce comparable effects in relation to developmental anomalies, such as the VACTERL association. Despite examining different administration routes and mimicking the ARM, by giving Adriamycin to embryos at gastrulation, we were unable to re-create the anomalies seen in the ARM.
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