Children with Hirschsprung disease exhibited alterations in host-microbial co-metabolism after pull-through operation.

PURPOSE: This study aims to compare the fecal metabolome in post pull-through HD with and without HAEC patients and healthy young children using nuclear magnetic resonance (NMR) spectroscopy. METHODS: Fresh fecal samples were collected from children under 5 years of age in both post-pull-through HD patients and healthy Thai children. A total of 20 fecal samples were then analyzed using NMR spectroscopy. RESULTS: Thirty-four metabolites identified among HD and healthy children younger than 5 years were compared. HD samples demonstrated a significant decrease in acetoin, phenylacetylglutamine, and N-acetylornithine (corrected p value = 0.01, 0.04, and 0.004, respectively). Succinate and xylose significantly decreased in HD with HAEC group compared to HD without HAEC group (corrected p value = 0.04 and 0.02, respectively). Moreover, glutamine and glutamate metabolism, and alanine, aspartate, and glutamate metabolism were the significant pathways involved, with pathway impact 0.42 and 0.50, respectively (corrected p value = 0.02 and 0.04, respectively). CONCLUSION: Differences in class, quantity, and metabolism of protein and other metabolites in young children with HD after pull-through operation were identified. Most of the associated metabolic pathways were correlated with the amino acids metabolism, which is required to maintain intestinal integrity and function.

A comparison of surgical site infections in children after stoma reversal between purse-string and linear closure.

BACKGROUND: To reduce the surgical site infections (SSI), the purse-string closure technique has been widely performed and has also been recommended in adult stoma reversal. However, for children, some debate still exists. This study aims to compare the SSI rates in children between the purse-string and the linear for the skin closure of stoma reversal. METHODS: The data were collected from pediatric patients, who had undergone either purse-string or linear closure for elective surgery of stoma reversal from two university hospitals between January 2016 and December 2019. RESULTS: The purse-string and linear closure had been performed on 31 and 45 patients, respectively. At 30 days after surgery, three patients in the purse-string closure group had developed SSI compared to 14 patients in the linear closure group (9.7 vs. 31.1%, p = 0.028). Furthermore, there had been no significant difference in the overall post-operative complications. In multivariate analysis, the SSI had been significantly lower in patients with purse-string closure (OR 0.21, 95% CI 0.05-0.86, p = 0.029). CONCLUSION: By employing the purse-string closure technique for skin closure of stoma reversal, there had been a significantly lower SSI rate compared to linear closure with no difference in the length of hospital stay.

Vascular Anomalies: The Epidemiological Profile at Srinagarind Hospital.

BACKGROUND: Vascular anomalies or vascular birthmarks can be divided in to 2 major groups: (i) vascular tumors and (ii) vascular malformations. Currently, there are many treatment modalities for these diseases and the treatment plans are varied among sub-specialty physicians. OBJECTIVE: To explore the epidemiology of vascular anomalies at Srinagrind Hospital during 2009-2011. MATERIAL AND METHOD: Retrospective chart was reviewed from the out patient clinic's database at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. RESULTS: There were total of 126 vascular anomalies cases. 89 cases were diagnosed with vascular tumors and 37 cases were vascular malformations. Among 89 cases of vascular tumors, infantile hemangiomas are the most common type (95.5%). The treatment methods for vascular tumors were medical treatments, which were used in majority of the cases (60%), followed by surgical excision, laser treatment, intralesional corticosteroids injection, and the combination of medical, laser and surgical treatment. There were total of 37 cases of vascular malformations. Most of the cases were venous and lymphatic malformations. Treatment methods for these patients were surgical excision, bleomycin injection, and radiation. CONCLUSION: Vascular anomalies have various presentations. Treatment is challenging and multidisciplinary teams are involved in taking care the patients with this entity of disease. Setting up vascular anomalies clinic is essential and suggested for the patients with vascular anomalies' problems.