Subject(s)
Cysts/pathology , Female Urogenital Diseases/pathology , Infant, Newborn, Diseases/pathology , Cysts/diagnosis , Cysts/surgery , Diagnosis, Differential , Female , Female Urogenital Diseases/diagnosis , Female Urogenital Diseases/surgery , Humans , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/surgeryABSTRACT
INTRODUCTION: Experience in the use of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of pancreaticobiliary disorders is relatively limited in children. This report reviews the experience in a single institution with pediatric ERCPs and documents the indications, success rate, diagnostic and therapeutic yields, complications, and the impact on patient management. PATIENTS AND METHODS: The data of all consecutive patients aged < or = 18 years who underwent ERCP procedures between the years 1997 and 2007 were retrospectively identified through a computer database search. The database prospectively recorded the indications, findings, therapies, and complications. RESULTS: During the study period, 32 ERCP procedures were performed in 28 children with a median age of 13 (range 8 - 18) years. ERCPs were performed for biliary pathology in 21 (75 %) and for pancreatic pathology in 7 (25 %) patients. The most common biliary indications were suspected choledocholithiasis and postoperative bile leaks. Hydatid disease was the most common diagnosis that yielded bile leaks. The pancreatic indications were recurrent pancreatitis and traumatic pancreatic duct disruption. Cannulation of the desired duct was successful in all procedures. An endoscopic sphincterotomy, stone/sludge removal or a stent placement was performed in 20 (63 %) procedures. According to the long-term follow-up, avoidance from any further surgical interventions was achieved in 11 (65 %) children, in whom ERCP was undertaken as a therapeutic intervention. The complication rate was 6 % with the development of mild self-resolving pancreatitis in one patient and stent occlusion in another. CONCLUSIONS: ERCP in the pediatric population has a high success rate, both as a diagnostic tool and for therapeutic interventions, provided it is performed by experienced endoscopists. The delicate delineation of the anatomy by ERCP and its therapeutic potential make it absolutely superior to other less invasive tools such as magnetic resonance cholangiopancreatography.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Adolescent , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/therapy , Child , Female , Humans , Male , Pancreatic Diseases/diagnosis , Pancreatic Diseases/therapySubject(s)
Hematologic Diseases/surgery , Splenectomy , Adolescent , Adult , Anemia, Hemolytic/surgery , Child , Child, Preschool , Elective Surgical Procedures , Female , Follow-Up Studies , Humans , Male , Purpura, Thrombocytopenic, Idiopathic/surgery , Retrospective Studies , Spherocytosis, Hereditary/surgery , Treatment Outcome , beta-Thalassemia/surgerySubject(s)
Albendazole/therapeutic use , Anthelmintics/therapeutic use , Echinococcosis, Pulmonary/drug therapy , Echinococcosis, Pulmonary/surgery , Adolescent , Child , Child, Preschool , Combined Modality Therapy , Echinococcosis, Pulmonary/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Postoperative Complications , Radiography , Treatment Outcome , TurkeyABSTRACT
The features of the rare interstitial hernia, as seen in four children, are described. All were boys ranging in age from 7 days to 7 years. The presenting sign was swelling in the right side of the abdomen associated with undescended testis. The hernias arose at the deep inguinal ring and expanded superiorly between the internal and external oblique muscles. Repair involved a standard herniotomy and orchidopexy through an oblique inguinal incision-except in one patient with a vanishing testis. The importance of being aware of this rare type of hernia is stressed.
Subject(s)
Hernia, Inguinal/diagnosis , Child , Cryptorchidism/complications , Cryptorchidism/surgery , Hernia, Inguinal/complications , Hernia, Inguinal/surgery , Humans , Infant , Infant, Newborn , Male , Retrospective StudiesABSTRACT
Gastrointestinal mucosal blood flow is dependent on a balanced release of vasoactive substances from endothelium. Nitric oxide (NO) may increase the flow by vasodilatation and/or antiaggregation whereas endothelin (ET) may decrease it by vasoconstriction and aggregation. NO and ET may have counterbalancing effects on each other in tissue damage. In order to test this hypothesis, in this study on rats, L-arginine to increase NO levels and N(G)-nitro-L-arginine methyl esther (L-NAME) to decrease NO levels have been used in an intestinal ischemia/ reperfusion (I/R) injury model and portal vein ET response was evaluated. Lipid peroxidation product measurements and chemiluminescence (CL) studies were also carried out in ileal tissue samples. Intestinal I/R injury caused an increase in portal venous ET levels with levels of 9.4+/-0.5 fmol/ml in sham operation and 14.8+/-1.6 fmol/ml in I/R group. ET level of L-NAME-sh group was lower than that of sham-operated group and also ET level of L-NAME-I/R group was lower than that of I/R group. This yielded the conclusion that inhibition of NO synthesis decreases portal venous ET levels in this model. Increased NO production by L-arginine caused increased ET levels in sham operated groups but this effect was not observed in I/R injury state. This study also showed that inhibition of NO synthesis has a protective role by reducing the reperfusion damage in this model. It is likely that NO and ET have a feedback effect on each other both under physiologic conditions and I/R injury.
