Traumatic posterior urethral disruptions in boys: experience with the perineal/perineal—transpubic approach in ten cases

The management of traumatic posterior urethral disruption in children has ranged from primary realignment/repair to delayed urethroplasty. The operative approach may be perineal or transpubic; the advocates of either cite comparable outcome. The anatomic considerations in a child differ from the adult and the management is individualized .We present our experience with the perineal/perineal–transpubic approach in the management of traumatic posterior urethral disruptions in ten boys. A preliminary suprapubic cystostomy was followed by a delayed urethroplasty after comprehensive investigations to delineate the pathoanatomy of the disruption. The urethroplasty began with a perineal exposure and progressed to varying extents to achieve a satisfactory urethral anastomosis. Four cases of bulbomembranous disruption were repaired by perineal approach, whereas six cases of prostatomembranous disruption required a perineal–transpubic approach. Permutations of operative techniques (circumurethral mobilization, corporeal separation/urethral rerouting, pubectomy and omentoplasty) were used. The follow-up assessed micturition patterns, urinary continence and penile erections. At a mean follow-up of 5 years (1.5–12 years), all ten boys void in a good stream and are continent. All have normal penile erections, posture and gait. The paper discusses the rationale and outcome of our management.     

Bone marrow transplantation for hematological disorders—Shiraz experience

Objective : In the past 8 years, 120 cases of hematological disorders were transplanted from the HLA identical donors.Method: Using chemotherapy based conditioning regimen with cyclophosphamide 200 mg/kg and busulfan 15–16 mg/kg, 80 cases of β-thalassemia major and 35 cases of leukemia and five patients with aplastic anemia had received bone marrow transplantation.Result : The five-year-survival in thalassemic group was 72%, for leukemic group (acute and chronic) was 58%, and also for aplastic anemia 65%. Transplantation related mortality was the cause of death in 29 cases. The two major causes of death were acute graft versus host disease and poor medical condition of patients before marrow transplantation.Conclusion : At the present time, allogenic marrow transplantation is curative mode of treatment for many hematological diseases.     

Community organisation for prevention of mental deficiency— Pediatrician's view

Summary Community involvement is all the essential in prevention of mental deficity in under-developed and developing country where poverty and illiteracy make greatest contribution to the development mental deficiency. A model of community organisation for prevention of mental of ency is proposed. Objectives of preventy services have been defined. Community programmes in order to be effective and have perpetuating effect in our country be rural based and should apart from viding services, lay stress on awareness, acceptance and effective tion of these services. The community organisation has been viewed as “community responsible for community welfa Proper fermulation of its structure accurate defining of its areas of working the essential prerequisites which have dealt with in detail. Centres of health satellite areas of health care, social welfa centres, centres for physically handicaphy individuals,balwadis andangan-wadis, pan and family guidance centres, have by suggested as the operational areas community services. Importance of adequience maternal and child health services, community oriented nutrition programmer public health education in prevention mental retardation has been emphasise With community organised programmer is possible to prevent mental deficiency a great extent by reducing the influence factors related to poverty and social deprevation on mental development. From the Department of Paediatrics, Government Children's Hospital, Government Medical College, Jammu, (Kaahmir). Presented before the III Conference of Asian Federation for the Mentally Retarted held at Bangalore November 1977.     

A genetic reason for male excess in infant respiratory mortality?

Male infants have a 50% higher risk of death from respiratory diseases and a number of congenital heart diseases that can lead to cerebral hypoxia. The most important of these diseases are infant respiratory distress syndrome and sudden infant death syndrome.

Conclusion: The mechanism behind the excess peri-mortality rate in male infants is not known. A genetic factor leading to reduced tolerance to hypoxia is possible.     

The “Freddy Frog” lateral view of the chest in children

A special new lateral view of the chest, called the Freddy Frog view, was used in 50 children between the ages of 5 and 7 years. This resulted in optimal demonstration of the superior mediastinal and superior bony structures without superficial overlying soft tissues and can replace the separate lateral views of the neck and chest in cases of stridor.     

T1ρ-mapping for assessing knee joint cartilage in children with juvenile idiopathic arthritis — feasibility and repeatability

Background

Ongoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage.

Objective

To study the feasibility and repeatability of T_1ρ for assessing knee cartilage in JIA and also to describe T_1ρ values and study correlation between T_1ρ and conventional MRI scores for disease activity.

Materials and methods

Thirteen children with JIA or suspected JIA underwent 3-tesla (T) knee MRI that included conventional sequences and a T_1ρ sequence. Segmentation of knee cartilage was carried out on T_1ρ images. We used intraclass correlation coefficient to study the repeatability of segmentation in a subset of five children. We used the juvenile arthritis MRI scoring system to discriminate inflamed from non-inflamed knees. The Mann-Whitney U and Spearman correlation compared T_1ρ between children with and without arthritis on MRI and correlated T_1ρ with the juvenile arthritis MRI score.

Results

All children successfully completed the MRI examination. No images were excluded because of poor quality. Repeatability of T_1ρ measurement had an intraclass correlation coefficient (ICC) of 0.99 (P<0.001). We observed no structural cartilage damage and found no differences in T_1ρ between children with (n=7) and without (n=6) inflamed knees (37.8 ms vs. 31.7 ms, P=0.20). However, we observed a moderate correlation between T_1ρ values and the juvenile arthritis MRI synovitis score (r=0.59, P=0.04).

Conclusion

This pilot study suggests that T_1ρ is a feasible and repeatable quantitative imaging technique in children. T_1ρ values were associated with the juvenile arthritis MRI synovitis score.

     

Who should pay for intensive behavioural intervention in autism? A parent's view

The evidence that early intensive behavioural intervention (IBI) is effective for young children with autism has persuaded parents worldwide to finance and advocate for IBI. Intensive behavioural intervention uses applied behavioural analysis to address the deficits of autism with an individualized and systematic approach. Communication, social, cognitive and adaptive gains are seen in the majority of children; a sizeable minority can catch up to near normal functioning, under ideal conditions. However there is not universal acceptance amongst professionals that IBI is the most proven intervention. What level of evidence is required for Australian states to provide adequate public funds for IBI?     

The abdominal radiographic series in children with suspected bowel obstruction--should the second view be abandoned?

OBJECTIVE: To determine whether the addition of a second (horizontal beam) view to the supine abdominal radiograph improves diagnostic accuracy in the diagnosis of paediatric bowel obstruction. MATERIALS AND METHODS: The abdominal radiographs of 72 paediatric patients were retrospectively evaluated for the presence of bowel obstruction by 22 independent observers (radiologists, surgeons and emergency physicians) of varying experience. Evaluation involved initial assessment of the supine radiograph alone, followed by reassessment with the addition of an upright or decubitus radiograph. RESULTS: When observers evaluated supine radiographs alone, their sensitivity was 66%, specificity 72% and accuracy 70%. With the addition of the second view sensitivity was 78%, specificity 75% and accuracy 76%. The mean change in accuracy was 6% with no statistically significant difference between radiologists, surgeons or emergency staff. CONCLUSIONS: The value of the routine second radiograph in the accuracy of diagnosis of bowel obstruction is limited, and its use should be restricted to selected cases in which diagnostic uncertainty persists.     

Pedimune in recurrent respiratory infection and diarrhoea—The Indian experience—The PRIDE study

Objective

To evaluate the efficacy and tolerability of bovine colostrum in preventing recurrent episodes of upper respiratory tract infections and diarrhoea in children

Methods

605 children (1–8 yrs) having recurrent episodes of upper respiratory tract infections or diarrhea received Bovine Colostrum (Pedimune^®) for 12 weeks. Total no of episodes of recurrent infections, hospitalization rate, overall well being and adverse events were assessed at every 4 weeks.

Results

Episodes of URTI and diarrhoea reduced significantly by 91.19% and 86.60% at the end of therapy respectively. High to average improvement in overall well-being in 96% of the patients were found by pediatrician while overall well-being stated by the patient/care taker was very good to good in 90.56% of the patients.

Conclusion

Bovine colostrum was highly effective in the prophylactic treatment of recurrent URTIs and diarrhea in reducing not only the episodes but also the hospitalization due to them.