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AACN Advanced Critical Care     Full-text available via subscription   (Followers: 11, SJR: 0.31, h-index: 32)
Academic Medicine     Full-text available via subscription   (Followers: 44, SJR: 1.936, h-index: 91)
ACSMs Health & Fitness J.     Full-text available via subscription   (Followers: 7, SJR: 0.135, h-index: 7)
Addictive Disorders & Their Treatment     Hybrid Journal   (Followers: 3, SJR: 0.27, h-index: 11)
Advanced Emergency Nursing J.     Full-text available via subscription   (Followers: 25, SJR: 0.279, h-index: 6)
Advances in Anatomic Pathology     Hybrid Journal   (Followers: 5, SJR: 1.435, h-index: 51)
Advances in Neonatal Care     Full-text available via subscription   (Followers: 21, SJR: 0.565, h-index: 23)
Advances in Nursing Science     Full-text available via subscription   (Followers: 18, SJR: 0.528, h-index: 38)
Advances in Skin & Wound Care     Full-text available via subscription   (Followers: 8)
Adverse Drug Reaction Bulletin     Full-text available via subscription   (Followers: 3, SJR: 0.12, h-index: 6)
AIDS     Hybrid Journal   (Followers: 9, SJR: 3.701, h-index: 173)
Alzheimer Disease & Associated Disorders     Hybrid Journal   (Followers: 8)
Alzheimer's Care Today     Full-text available via subscription   (Followers: 1, SJR: 0.176, h-index: 6)
American J. of Clinical Oncology     Hybrid Journal   (Followers: 17, SJR: 0.951, h-index: 56)
American J. of Dermatopathology     Hybrid Journal   (Followers: 7, SJR: 0.689, h-index: 50)
American J. of Forensic Medicine & Pathology     Hybrid Journal   (Followers: 13)
American J. of Nursing     Full-text available via subscription   (Followers: 31, SJR: 0.321, h-index: 33)
American J. of Physical Medicine & Rehabilitation     Hybrid Journal   (Followers: 31)
American J. of Surgical Pathology     Hybrid Journal   (Followers: 14, SJR: 2.828, h-index: 146)
American J. of Therapeutics     Hybrid Journal   (Followers: 5, SJR: 0.491, h-index: 43)
Anesthesia & Analgesia     Full-text available via subscription   (Followers: 70, SJR: 1.737, h-index: 142)
Anesthesiology     Full-text available via subscription   (Followers: 49, SJR: 2.517, h-index: 158)
Annals of Pediatric Surgery     Full-text available via subscription   (Followers: 4, SJR: 0.163, h-index: 2)
Annals of Plastic Surgery     Hybrid Journal   (Followers: 10, SJR: 0.961, h-index: 60)
Annals of Surgery     Hybrid Journal   (Followers: 27, SJR: 4.261, h-index: 216)
Anti-Cancer Drugs     Full-text available via subscription   (Followers: 8, SJR: 0.82, h-index: 73)
Applied Immunohistochemistry & Molecular Morphology     Hybrid Journal   (Followers: 2)
ASA Refresher Courses in Anesthesiology     Full-text available via subscription   (Followers: 14)
ASAIO J.     Hybrid Journal   (SJR: 0.648, h-index: 44)
Asia-Pacific J. of Ophthalmology     Full-text available via subscription   (Followers: 1)
Behavioural Pharmacology     Full-text available via subscription   (Followers: 1, SJR: 1.125, h-index: 60)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 10)
Blood Coagulation & Fibrinolysis     Hybrid Journal   (Followers: 19)
Blood Pressure Monitoring     Hybrid Journal   (Followers: 1, SJR: 0.912, h-index: 46)
Burns & Trauma     Open Access  
Canadian J. of Rural Medicine     Full-text available via subscription   (SJR: 0.238, h-index: 12)
Cancer J.     Full-text available via subscription   (Followers: 2, SJR: 2.079, h-index: 52)
Cancer Nursing     Hybrid Journal   (Followers: 23, SJR: 1.047, h-index: 54)
Cardiology in Review     Hybrid Journal   (Followers: 2, SJR: 1.2, h-index: 37)
Cardiovascular Endocrinology     Hybrid Journal  
CIN Computers Informatics Nursing     Full-text available via subscription   (Followers: 9)
Clinical Dysmorphology     Hybrid Journal   (SJR: 0.287, h-index: 16)
Clinical J. of Pain     Hybrid Journal   (Followers: 7, SJR: 1.142, h-index: 89)
Clinical J. of Sport Medicine     Hybrid Journal   (Followers: 21, SJR: 0.901, h-index: 67)
Clinical Neuropharmacology     Hybrid Journal   (Followers: 1, SJR: 0.787, h-index: 59)
Clinical Nuclear Medicine     Hybrid Journal   (Followers: 3, SJR: 0.428, h-index: 42)
Clinical Nurse Specialist     Full-text available via subscription   (Followers: 15, SJR: 0.312, h-index: 22)
Clinical Nutrition Insight     Full-text available via subscription   (Followers: 9)
Clinical Obstetrics & Gynecology     Full-text available via subscription   (Followers: 15)
Clinical Pulmonary Medicine     Full-text available via subscription   (Followers: 2, SJR: 0.133, h-index: 12)
Cognitive and Behavioral Neurology     Hybrid Journal   (Followers: 1, SJR: 0.607, h-index: 47)
Contemporary Diagnostic Radiology     Full-text available via subscription   (Followers: 2)
Contemporary Neurosurgery     Full-text available via subscription   (Followers: 1)
Contemporary Spine Surgery     Full-text available via subscription   (Followers: 2)
CONTINUUM : Lifelong Learning in Neurology     Full-text available via subscription   (Followers: 1, SJR: 0.257, h-index: 7)
Cornea     Hybrid Journal   (Followers: 1, SJR: 1.514, h-index: 86)
Coronary Artery Disease     Hybrid Journal   (SJR: 0.604, h-index: 49)
Critical Care Medicine     Full-text available via subscription   (Followers: 294, SJR: 3.361, h-index: 196)
Critical Care Nursing Quarterly     Full-text available via subscription   (Followers: 9, SJR: 0.362, h-index: 22)
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 1, SJR: 0.706, h-index: 15)
Current Opinion in Allergy and Clinical Immunology     Hybrid Journal   (Followers: 6, SJR: 1.209, h-index: 57)
Current Opinion in Anaesthesiology     Hybrid Journal   (Followers: 23, SJR: 1.044, h-index: 39)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 3, SJR: 1.266, h-index: 57)
Current Opinion in Clinical Nutrition & Metabolic Care     Hybrid Journal   (Followers: 10)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 18, SJR: 1.298, h-index: 59)
Current Opinion in Endocrinology & Diabetes     Full-text available via subscription   (Followers: 20)
Current Opinion in Endocrinology, Diabetes and Obesity     Hybrid Journal   (Followers: 10, SJR: 1.526, h-index: 37)
Current Opinion in Gastroenterology     Hybrid Journal   (Followers: 9, SJR: 1.894, h-index: 53)
Current Opinion in Hematology     Hybrid Journal   (Followers: 12, SJR: 1.829, h-index: 74)
Current Opinion in HIV and AIDS     Hybrid Journal   (Followers: 7, SJR: 2.221, h-index: 30)
Current Opinion in Infectious Diseases     Hybrid Journal   (Followers: 9, SJR: 2.173, h-index: 69)
Current Opinion in Lipidology     Hybrid Journal   (Followers: 2, SJR: 2.585, h-index: 95)
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 7)
Current Opinion in Neurology     Hybrid Journal   (Followers: 9, SJR: 2.423, h-index: 84)
Current Opinion in Obstetrics & Gynecology     Hybrid Journal   (Followers: 10)
Current Opinion in Oncology     Hybrid Journal   (Followers: 9, SJR: 1.784, h-index: 70)
Current Opinion in Ophthalmology     Hybrid Journal   (Followers: 9, SJR: 1.557, h-index: 58)
Current Opinion in Organ Transplantation     Hybrid Journal   (Followers: 3, SJR: 1.007, h-index: 26)
Current Opinion in Otolaryngology & Head & Neck Surgery     Hybrid Journal   (Followers: 10, SJR: 0.862, h-index: 41)
Current Opinion in Pediatrics     Hybrid Journal   (Followers: 2, SJR: 1.109, h-index: 56)
Current Opinion in Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.451, h-index: 53)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 5, SJR: 1.281, h-index: 52)
Current Opinion in Rheumatology     Hybrid Journal   (Followers: 1, SJR: 1.919, h-index: 79)
Current Opinion in Supportive and Palliative Care     Hybrid Journal   (Followers: 11, SJR: 0.714, h-index: 20)
Current Opinion in Urology     Hybrid Journal   (Followers: 5, SJR: 0.957, h-index: 42)
Current Orthopaedic Practice     Hybrid Journal   (Followers: 7, SJR: 0.201, h-index: 15)
Current Sports Medicine Reports     Full-text available via subscription   (Followers: 12, SJR: 0.543, h-index: 25)
Dermatitis     Full-text available via subscription   (SJR: 0.384, h-index: 38)
Diagnostic Molecular Pathology     Full-text available via subscription   (Followers: 6, SJR: 1.055, h-index: 42)
Dimensions of Critical Care Nursing     Full-text available via subscription   (Followers: 4, SJR: 0.286, h-index: 18)
Diseases of the Colon & Rectum     Full-text available via subscription   (Followers: 5, SJR: 1.948, h-index: 120)
Ear & Hearing     Hybrid Journal   (Followers: 7)
Egyptian J. of Histology     Partially Free   (Followers: 1, SJR: 0.107, h-index: 1)
Egyptian J. of Oral and Maxillofacial Surgery     Partially Free   (Followers: 1)
Egyptian J. of Pathology     Partially Free   (Followers: 1)
Egyptian Liver J.     Partially Free   (Followers: 2, SJR: 0.101, h-index: 1)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Epidemiology     Hybrid Journal   (Followers: 35, SJR: 2.697, h-index: 118)
European J. of Anaesthesiology     Hybrid Journal   (Followers: 12, SJR: 1.138, h-index: 50)
European J. of Cancer Prevention     Full-text available via subscription   (Followers: 2, SJR: 1.046, h-index: 59)

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Journal Cover   Annals of Pediatric Surgery
  [SJR: 0.163]   [H-I: 2]   [6 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 1687-4137 - ISSN (Online) 2090-5394
   Published by Wolters Kluwer - Lippincott Williams and Wilkins Homepage  [289 journals]
  • Abstracts presented at the 10th Biennial Conference of Pan African
           Pediatric Surgical Association (PAPSA) in collaboration with 29th Annual
           meeting of the Egyptian Pediatric Surgical Association (EPSA).
    • Abstract: No abstract available
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459984.95839.7c
  • Announcements of future meetings
    • Abstract: No abstract available
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/
  • An artifice in the insertion of the Hickman catheter in small children
    • Authors: Ohya; Yuki; Asonuma, Katsuhiro; Kadohisa, Masashi; Honda, Masaki; Murokawa, Takahiro; Hayashida, Shintaro; Lee, Kwang-Jong; Inomata, Yukihiro
      Abstract: Although the Hickman catheter is commonly used in pediatric patients, it is difficult to place this catheter safely in small children, especially infants. A multiple-step method, starting with a thinner catheter, makes the placement easier and safer.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000456490.88971.ea
  • Report of the 10th Biennial conference of Pan African Pediatric Surgical
           Association, in collaboration with 28th annual meeting of the Egyptian
           Pediatric Surgical Association
    • Authors: Elhalaby; Essam
      Abstract: image This report highlights the 10th Biennial Conference of Pan African Pediatric Surgical Association (PAPSA), in collaboration with 28th annual meeting of the Egyptian Pediatric Surgical Association (EPSA), held at Semiramis Intercontinental, Cairo, Egypt, 12–14 November 2014, and the three precongress workshops held in Cairo University Children’s Hospital from 9 to 11 November 2014.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459981.50098.6d
  • Giant juvenile xanthogranuloma of the tongue presenting from birth in a
           1-month-old infant: a case report
    • Authors: Kurian; Jujju J.; Kabeer, Ahmed; Singh, Deepak Samson; Mathai, John
      Abstract: image Juvenile xanthogranuloma is a rare benign proliferative lesion of the non-Langerhans cell histiocytic group. Extracutaneous involvement is extremely rare. We present a case of a giant juvenile xanthogranuloma involving the tongue from birth.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459977.75249.43
  • Type IIA2 urethral duplication: report of an unusual case
    • Authors: Gupta; Amit; Pant, Nitin; Debnath, Pinaki R.; Yadav, Pratap S.; Agarwala, Surendra K.; Saxena, Rahul; Chadha, Rajiv
      Abstract: image Objective: This report describes a rare case of type IIA2 sagittal urethral duplication. Summary background data: The presentation, investigation, and management of this rare anomaly are briefly discussed. Methods: A 3½-year-old boy presented with urinary obstruction and recurrent urinary tract infection due to a stenosed dorsal urethra and segmental stenosis of the dominant ventral urethra. The child also had left-sided vesicoureteric reflux. Staged surgical management consisted of an initial vesicostomy followed by serial dilatation of the ventral urethral stricture, left ureteric reimplantation, and a 2-cm long distal urethrourethrostomy between the dorsal urethra, opening at the tip of the penis, and the ventral urethra, which had a hypospadic opening at the base of the glans. Results: The functional and cosmetic outcomes were satisfactory. Conclusion: The management needs to be individualized as best suited for the patient.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459985.72968.77
  • Prune belly syndrome with pouch colon with scaphoid megalourethra: a newer
           embryological and prognostic perspective
    • Authors: Garge; Saurabh; Bawa, Monika; Rao, Katragadda Lakshmi Narasimha
      Abstract: image We here report a rare association of megalourethra with pouch colon with prune belly syndrome. We also provide a newer embryological and prognostic perspective to this association.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000452064.76439.47
  • Congenital segmental dilatation of the colon
    • Authors: Al-Zaiem; Maher M.; Al-Garni, Abdulhadi F.; Asghar, Asim A.; Al-Zaiem, Feras M.; AL-Omari, Hatim
      Abstract: image Congenital segmental dilatation of the colon is a rare cause of intestinal obstruction in neonates. We report a case of congenital segmental dilatation of the colon and highlight the clinical, radiological, and histopathological features of this entity. Proper surgical treatment was initiated on the basis of preoperative radiological findings.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000452059.63870.bc
  • Diagnostic challenge of intestinal obstruction secondary to
           Henoch–Schonlein purpura
    • Authors: Ahmed; Ali M.; Al-Shahrani, Mohammad S.; Aljubab, Abdulwahab S.
      Abstract: image Henoch–Schonlein purpura is the most common form of vasculitis in pediatric age group. Gastrointestinal manifestations have been long recognized as part of the disease, but usually preceded by other manifestations. We present a case of a boy whose initial manifestation of the disease was bowel obstruction and ischemia requiring surgical intervention twice with diagnostic dilemma prior to diagnosis of Henoch–Schonlein purpura. Although common surgical diseases prove to be the culprit in most cases, a surgeon should always keep an open mind for possibility beyond surgical diseases. Multidisciplinary approach to situations where ambiguities in diagnosis exist proves to be a valuable tool aiding surgical decision.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459978.82873.8d
  • Urethral stripping for delicate excision of dorsal accessory urethra
    • Authors: Abou-Zeid; Amr A.
      Abstract: image Duplication of the urethra is a rare anomaly. The accessory urethra may be dorsal or ventral, relative to the orthotopic urethra. Dorsal urethral duplication describes a normally located meatus and another accessory epispadiac meatus. Excision of the dorsal accessory urethra is usually curative, on the condition that the ventral orthotopic urethra is normal. However, most reports recommend surgery only when there are significant functional or cosmetic problems, for fear of possible damage to the neurovascular bundle, or the continence mechanism during surgical excision. In this report, we describe a modification for excising the dorsal accessory channel by stripping with minimal disturbance to the glans. With continuous refinement of the surgical technique together with more reports confirming its safety, we believe that total excision of the dorsal accessory urethra can be offered to more patients as being the standard level of care.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/
  • An unexpected groin mass: infant ovarian herniation
    • Authors: Bramante; Robert M.; Choi, Andrew; Raio, Christopher C.
      Abstract: image Point-of-care ultrasound provides a safe, rapid, effective, and accurate tool for evaluating congenital groin masses in infants. We present a 4-week-old infant who presented to the emergency department with bilateral inguinal masses. Point-of-care ultrasonography discovered bilateral hernias with an ovary herniated through a patent processus vaginalis into the labium majora on the right side. The ovarian herniation reduced in the emergency department and the patient was discharged from the emergency department after arranging close follow-up with a pediatric surgeon for a prompt repair. Its use should be employed early, as delayed discovery of ovarian herniation can lead to subsequent infertility.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000452068.54461.19
  • Disseminated mucormycosis and necrotizing fasciitis in immune-compromised
           patients: two case reports
    • Authors: Mugambi; Machoki S.; Theron, Andre; Cox, Sharon; Pillay, Komala; Millar, Alastair J.W.; Numanoglu, Alp
      Abstract: image We present two case reports of disseminated mucormycosis and necrotizing fasciitis in an immune-compromised patient. First, a 3-month-old with untreated HIV infection presented in septic shock with abdominal wall-necrotizing fasciitis. Laparotomy revealed extensive abdominal wall necrosis, bowel, liver, kidney and subsequent retroperitoneal, posterior diaphragm and inferior vena cava involvement. Second, a 3-year-old on chemotherapy for Burkitt’s lymphoma presented with pancytopenia, sepsis, abdominal wall-necrotizing fasciitis and left lower limb ischaemia. At surgery, there was necrosis of the abdominal wall, the large bowel and the ureter and thrombosis of the iliac vessels. Histology in both cases showed necrosis with fungal invasion consistent with mucormycosis. Both patients suffered mortality. We discuss mucormycosis and review the literature regarding mucormycosis in immune-compromised paediatric patients.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459980.60002.27
  • Laparoscopic-assisted repair of Morgagni–Larrey hernia by anterior
           abdominal wall fixation technique: a report of two cases
    • Authors: Kaya; Mete; Ozcakir, Esra; Sancar, Serpil; Aydiner, Cagatay
      Abstract: image Various techniques have been described to repair Morgagni–Larrey hernia. There is still concerns on the sufficiency of a simple laparoscopic anterior abdominal wall fixation. We aim to report of two children undergoing the laparoscopic-assisted anterior abdominal wall repair for Morgagni–Larrey hernia, and to discuss this method.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459976.75249.0a
  • Trans-scrotal single-incision orchidopexy compared with conventional
           orchidopexy in palpable undescended testis in a Nigerian Tertiary Hospital
    • Authors: Talabi; Ademola O.; Sowande, Oludayo A.; Anyanwu, Lofty-John C.; Adejuyigbe, Olusanya A.
      Abstract: image Background: The standard method of treatment of palpable undescended testes is through inguinal mobilization and a scrotal sub-dartos pouch. Trans-scrotal single-incision orchidopexy may be a suitable alternative. Aim: The aim of this study was to assess as to how trans-scrotal orchidopexy compares with conventional orchidopexy in terms of the suitable placement of the testis in a dependent position in the scrotum and the surgical outcome. Patients and methods: Forty children with 42 palpable undescended testes were randomly allotted into the conventional and the trans-scrotal orchidopexy groups over an 18-month period. The age, the testicular position, the side involved, the length of the vas gained after isolation and the division of the processus vaginalis, as well as the placement of the testes in the sub-dartos pouch without tension, were recorded. Postoperative complications and the subjective score of the cosmetic appearance of the scars during follow-up for at least 6 months. Success was defined as suitable placement of the testes in the sub-dartos pouch during operation, no conversion of patients in the single-orchidopexy group to the conventional inguinal approach, no complications and excellent cosmetic appearance of scars. Results: The two study groups were well matched for age and testicular positions. About 22 (55%) patients had right-sided undescended testes and 16 (40%) had left-sided undescended testes, and in two (5%) patients, it was bilateral. All testes were satisfactorily placed in the sub-dartos pouch at surgery. Testicular retraction was observed in one patient in the conventional group, but in two patients in the trans-scrotal group. All wounds healed satisfactorily without infection. The overall wound complication rate in the trans-scrotal and the conventional groups were 2/21 and 3/21, respectively. In terms of the cosmetic appearance of the scar, patients in the trans-scrotal group had excellent cosmetic appearance as the scars were less visible and hidden in the rugal fold compared with the conventional method. Conclusion: Trans-scrotal orchidopexy for palpable undescended testis is simple, safe and has a better cosmetic scar compared with the conventional approach.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459597.41252.62
  • Management of ureteropelvic junction obstruction associated with
           congenital upper urinary tract anomalies in children: single-center
    • Authors: Sarhan; Osama M.; Alotay, Abdulhakim A.; Alghanbar, Mustafa S.; Nakshabandi, Ziad M.
      Abstract: image Purpose: We report our experience in the management of ureteropelvic junction obstruction in children with congenital upper urinary tract anomalies. Materials and methods: A retrospective review was performed for all children with primary ureteropelvic junction obstruction associated with upper urinary tract anomalies between 1999 and 2011 at our hospital. Medical records were reviewed for patient age, sex, type of urinary tract anomalies, affected side, indication of surgery, and operative details. Clinical and radiological outcomes were assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at final follow-up. Results: There were 12 children (10 boys and two girls) with mean age of 5.3 years (range 1–13 years). Anomalies included ectopic pelvic kidney in six patients, crossed fused ectopia in two, a horseshoe kidney in two, and duplex renal units in two. The left kidney was affected in seven and the right kidney in five children. All patients were managed by open dismembered pyeloplasty. No significant perioperative complications were encountered in the study group. The mean follow-up was 30 months (range 15–45 months). Overall success rate was 84%. Relief of obstruction was evident in 10 patients as documented by intravenous urography or diuretic renography. Secondary nephrectomy was necessitated in two patients; one had severely impaired ipsilateral renal function and the other had recurrent pyelonephritis without radiological improvement. Conclusion: Despite the anomalous renal anatomy and the challenging surgical exposure, dismembered pyeloplasty in children with upper urinary tract anomalies has a high success rate with excellent functional results.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459979.60002.41
  • Stentless pyeloplasty for ureteropelvic junction obstruction in children
    • Authors: Jan; Iftikhar A.; Hussain, Mussarat; Khan, Ejaz; Aurakzai, Hazrat Ullah; Hanif, Shahbaz
      Abstract: image Introduction: Stenting after pyeloplasty is an established practice and helps in ensuring a patent anastomosis until healing has completed. Stents, however, may cause complications such as infection and displacement and increase the cost of management; therefore, stentless pyeloplasty is now considered as feasible alternative. Patients and methods: From August 2008 to October 2010, we retrospectively analyzed the results of stentless surgery in patients with ureteropelvic junction (UPJ) obstruction. In all, 42 patients with UPJ obstruction were managed. Nine patients who were treated conservatively, one who underwent nephrectomy, and one pyelostomy for pyonephrosis in solitary kidney were excluded. Age range at surgery was 14 days–12 years with a mean age of 12.7 months. Results: There were 23 male patients and eight female patients with a male-to-female ratio of 3 : 1. Fourteen patients had left, 12 right, and five had bilateral UPJ obstruction. A total of 34 pyeloplasties were performed in 31 patients. Of the five patients with bilateral UPJ obstruction, three underwent bilateral pyeloplasty and remaining two underwent unilateral pyeloplasty with conservative management on the opposite sides. Two patients underwent laparoscopic pyeloplasties and 32 pyeloplasties by open technique. Double J stent was placed at initial surgery in three patients and 31 stentless pyeloplasties were performed. The mean operative time was 75 min. The mean perinephric drain removal time was 2 days. None of the patients had persistent urinary leak. The mean hospital stay was 3.2 days. Reduction in anteroposterior diameter was noticed in 91% cases on 12 weeks follow-up scan. Complications included persistent or increase in hydronephrosis in three (9%) patients. In all the three patients, cystoscopic stenting was attempted. In two patients, size 4 Fr double J stent was passed easily into the renal pelvis. One patient improved, whereas other still has a dilated pelvis with static anteroposterior diameter after removal of stent at 6 weeks; patient is kept on close surveillance on regular ultrasonography. Re-exploration was performed in one patient, which showed kinking at the anastomosis site. Pyeloplasty was revised and patient improved. Other complications included lumbar hernia in one patient, which improved at 6-month follow-up, and stitch granuloma in one patient, which improved after removal of residual stitch. Conclusion: Stentless surgery for UPJ obstruction is a safe and feasible technique; it reduces the cost of surgery and avoids multiple procedures.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000455092.43161.ed
  • Effect of endorectal pullthrough on external anal sphincter integrity (in
           cases of Hirchsprung’s disease) using EMG
    • Authors: el-Shafei; Ehab; el Zohiery, Abeer K.; el Hilaly, Rana; Abaza, Nouran
      Abstract: image Objective: The transanal mucosectomy of the aganglionic segment is a critical step in the transanal endorectal pullthrough procedure for the treatment of Hirchsprung’s disease. It exerts considerable traction on the anorectal tissue during dissection. Anal sphincter electromyography (EMG) is an indispensable parameter for the diagnosis of patients with any anorectal dysfunction. The aim of our study was to assess the integrity of the anorectal sphincter after transanal endorectal pullthrough using anal EMG. Methods: This prospective study was carried out on 25 infants and children with Hirchsprung’s disease who underwent the endorectal pullthrough (soave) procedure. Needle EMG was used to assess the sphincter preoperatively and postoperatively. Results: Preoperative EMG showed positive neuropathic changes in 28% of the patients. Postoperative EMG showed neuropathic changes in 60% of the patients, of whom 28% showed preoperative changes and 32% showed absolute postoperative findings, mostly related to difficult operative dissection. Conclusion: The functional results of the endorectal pullthrough procedure were acceptable overall. Significance: The reduced sphincter function encountered postoperatively was because of a combination of preoperative and intraoperative influences.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000455091.05043.1d
  • Intestinal obstruction in older children in Komfo Anokye Teaching
           Hospital: a tertiary referral centre in Kumasi, Ghana
    • Authors: Gyedu; Adam; Yifieyeh, Abiboye; Nimako, Boateng; Amoah, Michael; Abantanga, Francis A.
      Abstract: image Background: Childhood intestinal obstruction can either be congenital or acquired and both types result in high morbidity and mortality in developing countries, mainly as a result of late presentation and diagnosis. Patients and methods: From January 2007 to December 2010, a retrospective analysis of all older children with intestinal obstruction admitted to Komfo Anokye Teaching Hospital (Kumasi, Ghana) was carried out. This was to establish the causes of intestinal obstruction and to determine its morbidity and mortality among the children studied. Results: There were 98 children who were treated with a diagnosis of intestinal obstruction during the period. The mean age of the children, in months, was 34.7±5.0 SEM (range 3–180, median age 10 months), with a male : female ratio of 1.5 : 1. About 70.6% of the children were admitted with acquired causes of intestinal obstruction and 29.4% with congenital causes of intestinal obstruction. In all, 21.2% of the children, treated for intestinal obstruction, underwent bowel resection as a result of nonviability of a segment of the intestine; the majority of the bowel resections were performed in the intussusception group. The mean length of hospital stay, in days, was 8.2±5.7. There were 15 children (15.3%) with various postoperative complications, mainly surgical site infections; the mortality rate was 11.2%. Here again, most of the deaths occurred in the intussusception group of children. Conclusion: Intestinal obstruction is a serious emergency in children and must be diagnosed early and treated promptly to avoid high morbidity and unnecessary deaths among children in our subregion.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000455090.05043.54
  • The versatility of the transumbilical approach for laparotomy in infants
    • Authors: Elhalaby; Essam A.; Hassan, Hussam S.; Hashish, Mohamed S.; Hashish, Amel A.
      Abstract: image Background/purpose: Although the transumbilical approach became very popular for pyloromyotomy, it has not been widely used in other procedures in children. The aim of this work was to evaluate the safety and the versatility of this approach for laparotomy in infants. Patients and methods: All hemodynamically stable neonates and infants with gastrointestinal surgical problems or pelvic or abdominal cystic masses were considered candidates for this approach. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline in a cephalic or caudal direction depending on the site of the lesion. The bowel or the mass was delivered outside the peritoneal cavity, and the procedure was completed in the standard open manner. Patients were evaluated with regard to the feasibility of the surgery and or any difficulty to complete the surgery, any complications related to the approach, and the cosmetic outcome. Results: A total of 141 infants underwent transumbilical laparotomy during the period from June 2008 to December 2013. The primary pathology was hypertrophic pyloric stenosis (n=65), duodenal, small-intestinal atresia/stricture (n=22), colonic atresia (n=2), malrotation with/without volvulus (n=10), ovarian cysts (n=12), intussusception (n=9), spontaneous intestinal perforation (n=7), remnants of vitellointestinal duct (n=4), mesenteric cysts (n=3), patent urachus (n=3), postoperative complications of strangulated inguinal hernia (n=3), and complications in ventriculoperitoneal shunts (n=1). Their age ranged from 1 day to 22 months. The operating time ranged from 30 to 120 min. Three patients required transverse extension of the wound. Two (1.4%) patients developed dehiscence of the wound that required wound closure. Five (3.5%) patients had superficial periumbilical cellulitis and wound infections, and one patient had suture reaction treated conservatively. Late complications (adhesive intestinal obstruction) occurred in three (2%) patients. Parents were very satisfied with the final cosmetic outcome. Conclusion: The transumbilical approach is both a feasible and a safe approach for a broad spectrum of surgical procedures in neonates and infants. The cosmetic results are excellent.
      PubDate: Thu, 01 Jan 2015 00:00:00 GMT-
      DOI: 10.1097/01.XPS.0000459975.88923.a6
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