Inflammatory duodenal necrosis complicating gastroschisis.

Babies with gastroschisis have an increased risk of necrotizing enterocolitis (NEC) that can lead to short bowel syndrome, a long-term parenteral nutrition requirement, and its associated complications. To our knowledge, this is the first case report of recurrent duodenal ischemia and necrosis associated with gastroschisis in the absence of NEC totalis.

Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study.

Intralesional purified protein derivative (PPD) or mumps, measles, rubella (MMR) were not previously compared regarding their efficacy or mechanism of action in treatment of warts. We aimed to compare their efficacy in treatment of multiple warts and investigate their effect on serum interleukin (IL)-4 and IL-12. Thirty patients with multiple warts were included (10 treated with PPD, 10 with MMR, and 10 with normal saline (control)). Injection was done every 3 weeks until clearance or maximum of three treatments. Clinical response of target and distant warts was evaluated. Serum ILs-4 and -12 were assessed before and after treatment. A significantly higher rate of complete response was found in target and distant warts with PPD (60% each) and MMR (80%, 40%, respectively) compared with controls (0%), with no significant difference between both treatments. After treatment, the control group showed the lowest serum IL-12 and IL-4 levels compared with the MMR- and PPD-treated groups with statistically significant difference in between. MMR resulted in a significantly higher serum IL-12 than PPD. With PPD, IL-4 was increased with statistically significant change compared with pretreat-ment level. Intralesional PPD and MMR show comparable efficacy and safety in treatment of multiple warts. Serum ILs-4 and-12 increase following antigen injection.

Complicated vascular access port removals: incidence, antecedents and avoidance.

PURPOSE: Port removal is usually a straightforward procedure delegated to trainees. However, some port removals are complicated by central venous catheter (CVC) fragmentation, a challenge for even experienced surgeons. This study aimed to determine the incidence of, and risk factors for, complicated port removal in children. METHODS: A single-centre study assessed the outcome of removal for all paediatric ports inserted from 1996 to 2012. Data were recorded detailing patient, insertion, device and removal characteristics. Risk factors for complicated removals were scrutinised using Chi-square tests; p < 0.05 significant. RESULTS: Of 628 ports inserted from 1996 to 2012, 443 were subsequently removed at the same centre. 8/443 (1.8%) removals were complicated by CVC fragmentation, a median of 3.3 (2.4-3.9) years after insertion. Of complicated cases, 8/8 underwent formal neck dissection, 3/8 intravascular dissection, and 1/8 endovascular retrieval. 2/8 cases have retained intravascular CVC fragments. Risk factors for complication were CVC caliber <6Fr (p < 0.001) and use duration >2 years (p < 0.001). CONCLUSION: Greatest care and senior supervision should be ensured when removing ports with CVC caliber <6Fr and/or >2 years since insertion. However, complications also occur with larger CVCs or after shorter durations. Therefore, the key to avoiding complicated port removal may simply be: preparation, preparation, neck preparation.

Major surgical conditions of childhood and their lifelong implications: comprehensive review.

BACKGROUND: In recent decades, the survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these 'grown-ups' in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood. METHODS: A comprehensive literature review was performed to identify relevant publications. Research studies, review articles and guidelines were sought, focusing on the paediatric management and long-term outcomes of surgical conditions of childhood. The article has been written for adult surgeon readership. RESULTS: This article describes the aforementioned conditions, their management in childhood and their lifelong implications, including: oesophageal atresia, tracheo-oesophageal fistula, malrotation, short bowel syndrome, duodenal atresia, gastroschisis, exomphalos, choledochal malformations, biliary atresia, Hirschsprung disease, anorectal malformations, congenital diaphragmatic hernia, congenital lung lesions and paediatric cancer. CONCLUSION: The increasing survivorship of children affected by surgical conditions will translate into a growing population of adults with lifelong conditions and specialist healthcare needs. The importance of transition from childhood to adulthood is becoming realized. It is hoped that this timely review will enthuse the readership to offer care for such vulnerable patients, and to collaborate with paediatric surgeons in providing successful and seamless transitional care.

Delayed finding of congenital duodenal obstruction following congenital diaphragmatic hernia repair.

Congenital diaphragmatic hernia (CDH) is encountered in just under 1 in 6000 live births, while congenital duodenal obstruction is seen once every 8000 live births. These congenital anomalies have only been reported together as part of the VACTERL syndrome and therefore in isolation represent an incredibly rare occurrence. This is a case report of a girl born at 34 weeks gestation who had an antenatal diagnosis of left CDH. Five days following operative repair of this, there was extensive pneumoperitoneum and pneumothorax. Upper gastrointestinal contrast study showed a perforation of the duodenum and at laparotomy, a duodenal web was found in the fourth part of the duodenum with perforation immediately proximal. Following duodenoduodenostomy, the postoperative recovery was good. She achieved full enteral feeds and was discharged home. This case highlights the importance of considering rare associations if postoperative recovery is not as expected to prevent delay in undergoing definitive treatment.

Metal chalcogenides (CuS or MoS2)-modified TiO2 as highly efficient bifunctional photocatalyst nanocomposites for green H2 generation and dye degradation.

Herein, we report the modification of TiO2 nanostructures with two different metal chalcogenides (CuS or MoS2). The effect of the preparation scheme (hydrothermal and coprecipitation methods) and the mass ratio of metal chalcogenides were investigated. The as-synthesized photocatalyst nanocomposites were fully characterized by various techniques. Moreover, the photo/electrochemical analysis were performed to investigate the photoelectric properties and photocatalytic mechanism. The photocatalytic performance was evaluated using two test reactions. In the case of H2 generation via water splitting, it was found that 0.5 wt% CuS-TiO2 synthesized via the coprecipitation method exhibited an initial hydrogen evolution rate (HER) of 2.95 mmol h-1 g-1. While, the optimized 3 wt% MoS2-TiO2 synthesized by the hydrothermal method, showed an HER of 1.7 mmol h-1 g-1. Moreover, the degradation efficiency of methylene blue dye was 98% under UV-Vis light irradiation within 2 h over 0.5 CT_PP and 3MT_HT. Under visible irradiation, the degradation efficiency was 100% and 96% for 3MT_PP and 0.5CT_HT in the presence of H2O2, respectively. This study has proven that metal chalcogenides can act as effective, stable, and low-cost bifunctional co-catalysts to enhance the overall photocatalytic performance.

Clonal heterogeneity by fluorescence in situ hybridization in multiple myeloma: enhanced cytogenetic risk stratification.

Background: Multiple myeloma (MM) is a proliferation of monoclonal plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Cytogenetic analysis is a challenge in MM because of the low mitotic activity and the rapid loss of plasma cells viability in bone marrow culture. Adding mitogens such as interleukin 6 (IL6) is known to promote the in vitro growth of myeloma cell lines and enhance the fluorescence in situ hybridization application. This study aims to evaluate the prognostic impact of cytogenetic abnormalities detected by enhanced interphase fluorescence in situ hybridization (iFISH) technique in Egyptian MM patients. Results: Patients who had hyperdiploidy significantly presented with higher Hb level and lower calcium levels compared to non-hyperdiploid patients. They were staged as stage I and II by International staging system (ISS) and considered as standard risk showing better response to treatment. On the contrary, features associated with a worse outcome were patients having del 17p and those belonged to intermediate and high risk groups. Conclusion: In conclusion, adding interleukin 6 to MM cell culture promotes the in vitro growth of myeloma cells and enhances the successful application of FISH technique. A comprehensive FISH probe set investigating high, intermediate and low-risk cytogenetic abnormalities is needed for accurate risk stratification. Hyperdiploid-myeloma is a favorable risk genetic subtype of MM associated with rapid response to therapy compared to patients having del 17p, t(4;14), and other 14q rearrangements rather than t(11;14) and t(6;14).

Studies on the photo-catalytic activity of semiconductor nanostructures and their gold core-shell on the photodegradation of malathion.

This work is devoted to the synthesis of different semiconductor nanoparticles and their metal core-shell nanocomposites such as TiO2, Au/TiO2, ZnO, and Au/ZnO. The morphology and crystal structures of the developed nanomaterials were characterized by transmission electron microscopy (TEM) and x-ray diffraction (XRD). These materials were used as catalysts for the photodegradation of malathion, which is one of the most commonly used pesticides in developing countries. The degradation of 10 ppm malathion under ultraviolet (UV) and visible light in the presence of different synthesized nanocomposites was analyzed using high performance liquid chromatography (HPLC) and UV-visible spectra. A comprehensive study was carried out for the catalytic efficiency of the prepared nanoparticles. Moreover, the effects of different factors that could influence catalytic photodegradation, such as different light sources, surface coverage and the nature of the organic contaminants, were investigated. The results indicate that the core-shell nanocomposite of semiconductor-gold serves as a better catalytic system than the semiconductor nanoparticles themselves.

Pathology findings following interval appendectomy: Should it stay or go?

PURPOSE: Interval appendectomy following nonoperative management of complicated appendicitis remains controversial. The aim of this study was to evaluate surgical pathology and clinical outcomes after pediatric interval appendectomy. METHODS: Pathology results from children with complicated appendicitis who underwent interval appendectomy at a single children's hospital from 2010 to 2017 were reviewed. The primary outcome was pathology results. Secondary outcomes included complications and readmission following initial treatment and after interval appendectomy. RESULTS: Among 149 patients (median age 11 years; range, 1-18), all had evidence of persistent inflammation on surgical pathology, 25 (17%) had an appendicolith, and no neoplasms were identified. Median duration of the initial admission was 8 days (range, 2-28) and 70% received a percutaneous drain prior to appendectomy. Interval appendectomy was performed at a median of 7.5 weeks (range, 2.9-29.1). Thirty-six (24%) returned to the hospital prior to their scheduled appendectomy and 6 (4%) required appendectomy earlier than planned. Nine patients (6%) experienced a complication following interval appendectomy, of which superficial surgical site infection was the most common (n = 4). CONCLUSION: All children had evidence of ongoing inflammation on surgical pathology. While the clinical implications of persistent inflammation remain uncertain, these findings suggest that interval appendectomy is an appropriate treatment following medical management of complicated appendicitis in children. LEVEL OF EVIDENCE SECTION: IV, Case series with no comparison groups.

Newly discovered variant of oesophageal atresia: 'Type Y'.

Multiple variations of oesophageal atresia (OA) have been described. We present two cases of a new variant of OA ('Type Y') where the fistula enters the trachea in a Y-shaped configuration. Awareness of this is important. Bronchoscopy will reveal a single fistula opening and therefore there will initially be no suspicion of anatomical variation. It may be that only one bifurcation of the 'Y' fistula is patent which poses a risk of incomplete fistula closure.

Development of a new immunosensor for the detection of dopamine.

Graphite immunoelectrodes as immunosensors using indirect immobilization of a hapten were investigated for their applicability to detect dopamine hydrochloride at low levels. Conditions were optimized to achieve the highest sensitivity using the indirect immobilization of dopamine hydrochloride through a polymerized glutaraldehyde network on microtiter plates using ELISA technique. The conditions were later transferred to the graphite rods (phi 0.8 m x 20 mm) and a comparison between the two different sensitivities (IC50 midpoint of test) was carried out. Graphite electrodes showed higher sensitivity towards dopamine than ELISA, since they were able to detect dopamine with a midpoint of test of 0.2 mmol/l while using ELISA they were able to detect dopamine hydrochloride at 2 mmol/l.

Comparison of an indirect format ELISA on modified graphite and polystyrene surfaces against triazines.

An indirect format enzyme-linked immuno-sorbent assay (ELISA) on graphite rods ( 0.8 mm x 20 mm) and, for comparison, on microtiter plates has been developed against terbuthylazine. For this purpose, a series of 2-aminoalkyl-4-chloro-6-terbuthyl-s-triazine-2,6-diamine ELISA haptens with alkyl spacer lengths of 2, 4, 6, and 8 CH2 groups has been synthesized. The graphite rods or the microtiter plates were covered by a polymerized glutaraldehyde network, and the ELISA haptens have been coupled by imino coupling to the free aldehyde groups of that network. epsilon-Aminocaproic acid has been used as an agent to block unspecific binding sites. The ELISA was run in a competitive mode, where the immobilized ELISA hapten and the solute terbuthylazine as a target analyte compete for the solute antibody.

Spectroscopic characterization of magnetic Fe3O4@Au core shell nanoparticles.

The magnetic nanoparticles iron oxide (Fe3O4) nanoparticles and iron oxide/gold core-shell (Fe3O4/Au) nanoparticles were synthesized and their catalytic photo-degradation activity towards malathion as example of organophosphorus pesticides were reported. Iron oxide (Fe3O4) magnetic nanoparticle was successfully prepared through co-precipitation method by the reduction of ferric chloride (FeCl3) using ascorbic acid. The morphology of the prepared nanoparticles was characterized by the TEM and XRD (X-ray diffraction) techniques. Degradation of 10 ppm of malathion in the presence of these nanoparticles under UV radiation was monitored using (HPLC) and UV-visible spectra. Fe3O4/Au nanoparticles showed higher efficiency in photo-degradation of malathion than Fe3O4 ones.

Preservation of small bowel with the selective use of heparin and second look laparotomy in acute mesenteric ischaemia: A case report.

INTRODUCTION: Acute mesenteric ischaemia may occur due to mesenteric arterial embolus, thrombosis, non-occlusive mesenteric ischaemia or venous thrombosis resulting in ischaemia of the bowel wall. PRESENTATION OF CASE: A 41year old woman presented with worsening abdominal pain, decreased appetite, nausea and vomiting. Examination revealed right lower quadrant tenderness. Investigations revealed elevation of her inflammatory markers. At laparotomy two separate segments of ischaemic but potentially viable small bowel were identified secondary to mesenteric venous thrombosis. Bowel salvage was attempted with the use of intravenous unfractionated heparin and this was confirmed following a second look laparotomy. DISCUSSION: Despite a normal platelet count at presentation a diagnosis of JAK-2 positive essential thrombocythaemia was made thus explaining the acquired prothrombotic state underlying the venous thrombosis. The selective use of intravenous unfractionated heparin and second look laparotomy may provide a means for bowel preservation in these cases. CONCLUSION: This case highlights the potential of bowel salvage can be achieved following an episode of acute mesenteric ischaemia with the use of intravenous unfractionated heparin and selective second look laparotomy and the importance of considering underlying myeloproliferative disease in such cases even in the absence of a thrombocytosis at presentation.

Paget's disease of the breast in a male with lymphomatoid papulosis: a case report.

INTRODUCTION: Paget's disease is an eczematous skin change of the nipple that is usually associated with an underlying breast malignancy. Male breast cancer represents only 1-3% of all breast malignancies and Paget's disease remains very rare. CASE PRESENTATION: We present the case of a 67-year-old Caucasian man with lymphomatoid papulosis who was diagnosed with Paget's disease of the nipple and who was treated successfully with surgery alone. We discuss the presentation, investigations, management and pathogenesis of Paget's disease of the nipple. CONCLUSION: The case highlights the need to be vigilant when new skin lesions arise in the context of an underlying chronic skin disorder.

Lipid profile, apolipoproteins A and B in children with epilepsy.

In this study, lipid profile was assessed, and the intimal wall thickness of both carotid arteries in children with idiopathic epilepsy was measured. The study comprised 22 children with idiopathic epilepsy on either carbamazepine or valproate. A profile including triglycerides, total cholesterol, low-density and high-density lipoproteins cholesterol, apolipoproteins AI and B, and Duplex estimation of intimal wall thickness of carotid arteries were performed. Patients on carbamazepine showed increase in total cholesterol, low-density and high-density lipoproteins cholesterol, and decrease in apolipoprotein AI levels compared with controls. Levels of total cholesterol, low-density lipoproteins cholesterol, and apolipoprotein AI were reduced in patients receiving valproate compared with controls, whereas total cholesterol, high-density lipoproteins cholesterol, and apolipoprotein AI were reduced compared with those receiving carbamazepine. Carotid arteries intimal wall thickness was not significantly changed in any of the studied groups. Although atherogenic ratios are not changed, the lowered apolipoprotein AI levels may suggest an increased risk for coronary heart disease.