Pancreatic injuries in children

Pancreatic injuries over an 11-year period were reviewed. Pedestrian motor vehicle accidents accounted for 45% of the injuries. Diagnosis was made clinically and on raised serial serum amylase levels. Eighty per cent of the patients were managed conservatively. Two patients required emergency surgery for pancreatic trauma. There were no deaths. It is concluded that a conservative approach is successful in most paediatric patients with pancreatic trauma.     

Short-course antibiotic prophylaxis in penetrating abdominal injuries: ceftriaxone versus cefoxitin

This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.     

The scope of emergency paediatric surgery in Tanzania

This article helps to outline the scope of emergency paediatric operations in Tanzania by quantifying the nature of cases seen over a 12 month period in a teaching hospital. Data collected at the Kilimanjaro Christian Medical Centre (KCMC) showed that operative paediatric surgical emergencies represented 4% of all paediatric admissions. Of emergency procedures, 47 (43%) were for congenital abnormalities, 32 (29%) for infections, 19 (17%) for trauma and 12 (11%) for other reasons. Emergency operative mortality was 34%. The challenges to meet patient needs in the African setting include: a scarcity of surgeons with training in paediatric surgery, the variety of conditions which all surgeons must manage, a lack of equipment (e.g., neonatal ventilators) and educational resources. Potential avenues for overcoming these challenges are discussed, including the promotion of paediatric surgery as a profession, by the expansion of existing facilities, promoting African associations of paediatric surgery and highlighting the need for resources and continued education and training. We argue that surgical training in developing countries should include the skills needed to treat those paediatric conditions most likely to require urgent surgical intervention.     

Omental lipoblastoma in a child: diagnosis based on CT density measurements

A 2-year-old girl presented with an abdominal mass which on CT was central and hypodense. Housefield units measured -60 which made the diagnosis of a fatty mass. The diagnosis of an omental lipoblastoma was confirmed after surgery on histology.     

The incidence of complications following primary inguinal herniotomy in babies weighing 5 kg or less

The aim of this study was to quantify the incidence of complications following inguinal herniotomy in small babies weighing 5 kg or less. This was a retrospective review of inguinal herniotomies performed in our unit between December 1997 and March 2002 on babies weighing 5 kg or less. A total of 154 patients underwent hernia repair, of which 125 patients (221 hernias) were available for review (81%). The median weight at surgery was 3.6 kg (range 1.7–5 kg) and 84 patients (67%) were classified as premature (< 36 weeks gestation). Thirty-three patients presented with an irreducible hernia, in whom all but one were successfully reduced prior to surgery. Patients were reassessed at a clinic following surgery and follow-up data was obtained from the clinic notes after a median follow-up of 3 months (range 1–60 months). Five cases of hernia recurrence occurred in four patients (2.3%) and the incidence of testicular atrophy was 2.7% (six patients). In the testicular atrophy group, four of the six patients presented with an incarcerated hernia and of these, three were noted to have evidence of ischaemia at operation. There were six cases of high testes requiring subsequent orchidopexy (2.7%). Although neonatal inguinal herniotomy is a technically demanding procedure, this series has demonstrated a low complication rate. Testicular atrophy was associated with a history of preoperative incarceration in the majority of cases.     

Follow-up of children with isolated fetal echogenic bowel with particular reference to bowel-related symptoms

OBJECTIVES: To determine whether there was any evidence of long-term bowel pathology in children, apparently healthy at birth, who had a prenatal second-trimester diagnosis of isolated grade 2 fetal echogenic bowel. METHODS: This was a retrospective study using data from the Oxford Congenital Anomaly Register. Fetuses with isolated grade 2 fetal echogenic bowel and date of delivery from 1994 to 2000 inclusive were identified. Information about the health of the children, particularly relating to bowel symptoms, was obtained from hospital records and from a questionnaire sent to the general practitioner. RESULTS: A total of 109 cases were identified, with delivery details available for 108. There was one unexplained intrauterine death, and additional problems were subsequently diagnosed in four cases (cystic fibrosis (2), Down syndrome (1), and VACTERL (1)). Questionnaires were sent to the GPs of the 103 who had no problems identified at the time of discharge from the maternity hospital. Age at follow-up ranged from one to four years. Responses to the questionnaires were received from 83 (81%). Of these, 74 (89%) had not reported bowel symptoms to the GP, 9 (11%) reported symptoms relating to constipation (6), chronic abdominal pain (1), infantile colic with milk intolerance (1) and gastro-oesophageal reflux (1). CONCLUSION: This small study provides some reassurance that there was no evidence of any serious long-term bowel pathology associated with isolated fetal echogenic bowel.     

Potency and stability of C terminal truncated human epidermal growth factor

INTRODUCTION: Epidermal growth factor (EGF) is normally present as EGF(1-53). A variety of C terminal truncated forms have been used in preliminary trials for treating gastrointestinal injury but their relative potency and stability when used in a clinical setting are unclear. Therefore, we compared the biological activity of recombinant EGF(1-53), EGF(1-52), EGF(1-51), and the C terminal peptides EGF(44-53) and EGF(49-53). METHODS: Purity of forms was confirmed by mass spectrometry. Bioactivity of the different EGF forms was determined using [methyl-(3)H] thymidine incorporation into primary rat hepatocytes and their ability to reduce indomethacin (20 mg/kg subcutaneously)/restraint induced gastric injury in rats. Stability of EGF peptides was determined by serial sampling from a syringe driver system containing EGF/4% albumin in saline. RESULTS: Biological activity assays of EGF(1-53), EGF(1-52), and EGF(1-51) gave almost identical thymidine uptake dose-response curves (maximal responses increasing baseline uptake from 4400 (600) cpm (mean (SEM)) to about 22 000 (2000) cpm when EGF was added at 1. 6 nM). EGF(44-53) and EGF(49-53) did not stimulate (3)H thymidine uptake. Control rats had 47 (4) mm(2) damage/stomach, EGF(1-51), EGF(1-52), and EGF(1-53) at 0.16 and 0.80 nmol/kg/h each reduced gastric injury by about 50% and 80%, respectively (both doses p<0.01 compared with control but no significant difference between the different forms). EGF was stable at room temperature for seven days but biological activity decreased by 35% and 40% at two and three weeks, respectively (both p<0.01). Exposure to light did not affect bioactivity. CONCLUSION: EGF(1-51) and EGF(1-52) are as biologically active as full length EGF(1-53) but the C terminal penta- and decapeptides are ineffective. Clinical trials of EGF can probably use infusion systems for at least 48 hours at room temperature and with exposure to light, without reducing biological efficacy.     

Surgical correction of tracheo-oesophageal fistula and oesophageal atresia in infants with VACTERL association: a retrospective case–control study

Introduction

VACTERL is a rare, non-random association comprising at least three major component features defined by the acronym, and including Vertebral anomalies, Anorectal malformations, Cardiac defects, Tracheo-oEsophageal fistula with or without oesophageal atresia (TOF/OA), Renal abnormalities and Limb anomalies. The aim of this study was to compare the post-operative outcomes following surgical correction of TOF/OA in infants with VACTERL and isolated TOF/OA.

Methods

A retrospective case–control study comparing infants with VACTERL (case group) versus infants with isolated TOF/OA (control group) that underwent surgical correction of TOF/OA at our centre between January 2006 and December 2011. Patient demographics, types of anomalies, operative techniques and post-operative outcomes were collected using inpatient and outpatient records.

Results

We identified 30 consecutive infants with TOF/OA. Five infants had VACTERL (17?%) and 15 infants had isolated TOF/OA (50?%). There was no significant difference in the gestational age (P?=?0.79), birth weight (P?=?0.69) or operative repair (P?=?0.14) between groups. Overall, surgical correction of TOF/OA led to satisfactory morbidity. Infants with VACTERL were not at higher risk of post-operative complications, such as oesophageal stricture (P?=?0.17) or gastro-oesophageal reflux (P?=?1.0), compared to infants with isolated TOF/OA.

Conclusions

VACTERL association does not increase the risk of post-operative complications following TOF/OA repair.     

Effect of isoflurane on brain tissue oxygen tension and cerebral autoregulation in rabbits

Oxygen tension (PO(2)) was measured in rabbit whisker barrel cortex using oxygen sensitive electrodes to investigate the impact of isoflurane anesthesia on oxygen autoregulation. Responses to 90s episodes of 100% oxygen inspiration were obtained from rabbits before anesthesia, and then when the animals were anesthetized with 0.5% or 1.5% isoflurane. For each episode, ΔPO(2) (i.e., hyperoxic PO(2) minus baseline PO(2)) was computed. Compared to the conscious state, brain ΔPO(2) increased during anesthesia with 1.5% isoflurane (0.73 MAC) by an average of 116%, whereas 0.5% isoflurane produced an insignificant average increase of 31%. The results suggest that moderate levels of isoflurane impaired autoregulation of brain tissue oxygen tension.