Evaluation of Magnetic Resonance Imaging (MRI) Findings following posterior Sagital Ano-Recto Plasty (PSARP) in Severe Incontinent Children with High Imperforate Anus (IA).

Background: The aim of this study was to evaluate pelvic MRI accuracy for measurement of anatomical land marks in severe fecal incontinent (FI) children with high imperforate anus (IA). Materials and Methods: A total of 80 children (40 cases and 40 controls) aged more than 4 years with severe FI were assessed. Magnetic resonance imaging was performed by a radiologist with the same device. For pelvic anatomical land marks measurement, we measured the ano-rectal angel and hiatal/pc ratio. Results: The mean of ano-rectal angel was 118.67 ± 25.2 mm in cases and 132.07 ± 13.8 mm in control group (P = .004). H/PCR was 0.63 ± 0.05 in cases and 0.62 ± 0.45 in controls (P = NS). There was no significant correlation between (r = 0.25, P = 0.36) or ano-rectal angle measurement (r = 0.16, P = 0.05) and FI score in patients with severe FI. Conclusions: Pelvic magnetic resonance imaging could be accurately used is measuring the ano-rectal angle is high IA children with severe FI which leads to selected patients who may have benefits of reoperation.

Evaluation of Bowel Management Program on Quality of Life in Children with Fecal Incontinence.

Background: Fecal incontinence (FI) is a common disorder that affects the psychological, social, and mental aspects in children. It was showed that the quality of life (QoL) in children with FI was in low level. Bowel management program (BMP) is one of the most effective and low-cost therapies in selected children with FI, but it has also significant effects on mental functions. This study was conducted to evaluate the impact of BMP on the QoL of children with FI. Materials and Methods: In a case series study, we prospectively included all school-age children suffering from FI who had visited in colorectal follow-up center of Isfahan University of Medical Sciences. Patient eligibility included children with FI between 8 and 12 years who were candidate of BMP. The QoL was assessed by Persian version of pediatric QoL (PedsQL) 4.0. Results: In this study, 24 children with FI were studied. Our results showed that total QoL score is significantly different after BMP. The mean score of physical performance before and after BMP was significantly different (P = 0.02). In terms of emotional performance, the mean score of this dimension before and after starting of BMP was significantly different (P = 0.06). In terms of social performance, the mean score of this dimension before and after starting of BMP was significantly different (P = 0.008). Conclusion:: BMP is a low-cost and affordable treatment that can have a significant impact on improving the QoL of the child by improving intestinal function.

Incidence and Associated Factors of Major Congenital Anomalies in Newborns in Chaharmahal and Bakhtiari, Southwest of Iran.

Background: Congenital anomalies are among the causes of disability and death in infants. This study aimed to determine the incidence of major congenital anomalies (MCA) recorded at birth and also their relationship with some related factors in neonates born. Methods: In this cross-sectional study, all infants born from March 2016 to March 2017 in the hospitals of Chaharmahal and Bakhtiari Province were evaluated for MCA at birth. Information recorded in the medical file including parent and infant characteristics is extracted from the maternal and newborn electronic files. Data were analyzed using Generalized Linear Model with function of Poisson. Results: Of the 19666 newborns studied, 63 (3.2 per 1000) had MCAs at birth. Variables such as number of pregnancies, parity, gestational age, neonatal birth weight, height, and head circumference were found to be significantly associated with MCA based on the crude model (P value < 0.05). Using adjusted model 1, the incidence of MCA was found to be significantly related to mother's place of residency and her parity. Finally, in adjusted model 2, the incidence of MCA was found to be related to gestational age, neonatal birth weight, and head circumference. Conclusions: In some MCA, early diagnosis and treatment can prevent disability. Consequently, the emphasis on public education to consider appropriate gestational age, proper nutrition before and during pregnancy, and prenatal care is necessary to inhibit MCA.

Sacrum Ultrasonography: An Accurate Alternative to Radiography for Measuring Sacral Ratio in Infants.

INTRODUCTION: The aim of this study was to compare the compliance of sacrum ultrasonography with radiography for the measuring of sacral ratio in infants. MATERIALS AND METHODS: A total of 129 infants under the age of 6 months, who were a candidate for abdominal and/or pelvic radiographs, were assessed. Sacrum ultrasonography and radiography were performed by a single radiologist using the same device. The sacral ratio was calculated for all patients undergoing ultrasonography and radiography. Agreement between two methods was calculated by Bland-Altman's chart. RESULTS: The mean of sacral ratio was 0.70 ± 0.11 radiographically and 0.72 ± 0.05 ultrasonographically. Based on Bland-Altman's chart, the mean difference between ultrasonography and radiology was 4.6 mm (confidence intervals of 8.18 ± 5.6). CONCLUSION: Sacrum ultrasonography could be safely used in the investigation of sacral ratio to detect sacrum abnormalities in infants.

Mechanical Bowel Preparation versus No Preparation in Duhamel Procedure in Children with Hirschsprung's Disease.

INTRODUCTION: Mechanical bowel prep (MBP) prior to surgical treatment of Hirschsprung's disease (HSCR) has been a great problem of pediatric surgeons for a long time. We conducted a single-institution randomized controlled trial to evaluate the efficacy of no MBP in children with HSCR undergoing the Duhamel procedure. MATERIALS AND METHODS: In this study, children with HSCR who were candidate for the Duhamel procedure were included (40 cases vs. 40 controls). In the case group, intraoperatively after transection of the bowel at the level of transitional zone, feces bulk was pulled up from the upper part of the rectum to the sigmoid colon above the peritoneal reflection and aganglionic bowel was resected. Inspissated stool in the distal of the rectum was removed by rectal washout intraoperatively. In the control group, routine MBP was performed. Cleanness of the rectum was evaluated intraoperatively. RESULTS: In this study, a total of 80 children were enrolled. In 32 patients (80%), the goal of MPB was achieved in 4 hours. Mean polyethylene glycol volume was 1372.3 ± 231.9 mL. Preoperative rectal washout fluid was 635 ± 233.3 mL. There was no statistically significant difference in individual complication rates between groups. Four patients (5%) had intra-abdominal infection and 16 (20%) had wound infection. We had no anastomotic leak in our groups. All children or parents in the control group described the preoperative MBP as the most unpleasant part of the hospital administration. CONCLUSION: For young children with HSCR who were scheduled for Duhamel operation, we had found no clear benefit of MBP. However, a multicenter randomized controlled trial is needed to more definitely determine the best preoperative approach for children with HSCR.

A Modified Approach for Single-Port Laparoscopic Repair of Inguinal Hernias in Children.

BACKGROUND: Although traditional open groin incision repair has been used routinely for decades, the benefit of the minimally invasive surgery has challenged the traditional open method. Nowadays, laparoscopic herniorraphy has evolved to making it more minimally invasive from 3 to 2 and now single port and from intracorporeal to extracorporeal knotting. This study aimed to evaluate a new modification of single port laparoscopic herniorraphy in children with congenital inguinal hernia. MATERIALS AND METHODS: In this single-institution randomized case-control study 190 children who suffered from congenital inguinal hernia were divided into two groups randomly: Group 1 (N = 73) undergone a single-port modified extracorporeal purse-string sutures (laparoscopic surgery [LS]) and Group 2 (N = 117) undergone open surgery (OS). RESULTS: The mean age of the patients at operation time was 28.79 ± 11.45 months. Overall, three patients (1.57%) had intraoperative retroperitoneal hemorrhage. The duration of anesthesia and operation for those undergoing bilateral operation were significantly shorter in LS group. There was no statistically significant difference in individual postoperative complication rates between the groups. The proportion of overall post-operative complications was 4 (5.4%) in LS and 13 (11.1%) in OS group (P = 0.18). Proportion of trapped cryptorchidism was significantly higher in the OS group. CONCLUSION: In conclusion for children with inguinal hernia, we had found the benefits of single-port modified extracorporeal purse-string for reduction the operative time, trapped testes and better cosmetics and parents' satisfaction.

Trans-scrotal Incision Approach versus Traditional Trans-scrotal Incision Orchiopexy in Children with Cryptorchidism: A Randomized Trial Study.

BACKGROUND: Although undescended testis (UDT) is the most prevalent malformation in male neonates, the best mode of UDT treatment remains controversial. This study aimed to compare trans-scrotal incision approach with traditional trans-scrotal incision orchiopexy in children suffering from cryptorchidism. MATERIALS AND METHODS: This single-blind randomized clinical trial was done on 100 children with UDT who needed surgery. The participants were alternately undergoing trans-scrotal incision orchiopexy (Group I) and traditional inguinal incision orchiopexy (Group II). The success rate and incidence of postoperative complications were evaluated 1 week and 1 month and 6 months after the operation in the two groups. RESULTS: Both the groups were similar in baseline characteristics including age and laterality (P > 0.05). There was no significant difference between the two groups in terms of the incidence of wound infection, testicular atrophy, testicular hypotrophy, and relapse (P > 0.05). In addition, the success rates were 98% in Group I and 94% in Group II (P > 0.05). CONCLUSION: Both surgical methods have a high success rate, and there is no significant difference in the incidence of complications; however, in terms of beauty, satisfaction, and shortening the duration of surgery and the duration of hospitalization, trans-scrotal approach was more successful than the traditional method.

Osseous Metaplasia in Rectal Polyp: A Case Report with Review of Probable Pathogenesis.

Heterotopic bone formation is a rare event in gastrointestinal lesions, especially in the pediatric population. Osseous metaplasia is exceedingly rare in colonic polyps. We present a case of rectal juvenile polyp with stromal osseous metaplasia in a 10-year-old male child. This histologic finding is very rare in children with colorectal polyps.

Ultrasound-guided percutaneous central venous catheterization in infants: Learning curve and related complications.

BACKGROUND: This study was performed to evaluate the learning curve and related complications of ultrasound (US) guided central venous catheter (CVC) insertion in infants. MATERIALS AND METHODS: This study was performed in Imam Hosein Hospital of Isfahan from September 2014 to March 2015. Participants were infants consecutively candidate for CVC insertion. Three steps were designed to complement the learning. For each step of learning, 20 patients were considered and for every patient one CVC was inserted: (1) In the first step, venous puncture and guide wire passage was performed by an experienced radiologist and the surgeon was taught how to do it, then CVC was placed by the surgeon. (2) In the second step, venous puncture and guide-wire passage was performed by the surgeon under the supervision of the same radiologist, and then CVC was placed by the surgeon. (3) In the third step, US-guided CVC insertion was performed by the surgeon completely, and the radiologist came to the operating room only if it was necessary. In each of these steps, the time spent of the US probe on the skin until the guide wire passage into the vein was recorded for every patient. All perioperative complications were recorded. RESULTS: The mean point for the time spent of the US probe on the skin until the guide wire passage into the vein was 84.9 ± 13.6, 119.1 ± 15.2, and 90.3 ± 11.2 s in the step 1, 2 and 3, respectively (P = 0.04). There was no significant difference between the frequencies of complications among tree steps. CONCLUSION: US-guided percutaneous CVC insertion is a safe and reliable method which can be easily and rapidly learned.

A comparison between foley and nelatone urinary catheters in causing urinary tract infection in animal models.

BACKGROUND: Urinary catheterization is one of the main measures used to treat and care for hospitalized patients. Several complications have been attributed to the presence of latex with routine Foley catheters. Therefore, some studies have recommended that Nelatone catheters be substituted for the ordinary Foley catheters to prevent these complications. OBJECTIVES: This study aimed to compare the rates of urinary tract infection (UTI) in rabbits catheterized either with Foley or with Nelatone catheters. MATERIALS AND METHODS: A randomized controlled trial was conducted on 60 rabbits that were randomly assigned to three groups of twenty. The first group was catheterized using Nelatone catheter; the second group was catheterized using Foley catheter and the third group was studied without performing any catheterization. After seven days, urine samples were collected using suprapubic aspiration and were sent to the laboratory for culture. Descriptive statistics were calculated. Moreover, chi-square and Fisher's exact tests were used for data analysis. RESULTS: At the end of the study, four cases in the Nelatone group and 12 cases in the Foley group presented with UTI (P = 0.01). No positive urine cultures were found in the control group. CONCLUSIONS: The Nelatone catheters, compared with the Foley ones, had a lower risk of UTI in the long term use. Verifying this claim by further studies can have an important role in reducing UTIs in patients using urinary catheters.

Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits.

BACKGROUND: The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle's maneuver), continuous prolonged clamping results in liver ischemia. OBJECTIVES: The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models. MATERIALS AND METHODS: In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers. RESULTS: There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation. CONCLUSIONS: Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.

Prehospital Care and In-hospital Mortality of Trauma Patients in Iran.

INTRODUCTION: The aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center. METHODS: This study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome. RESULTS: Two thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001). CONCLUSION: In-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.

Safety of latex urinary catheters for the short time drainage.

BACKGROUND: In this study, we attempt to identify the most appropriate catheter (silicone vs. latex) for short-term urinary catheterization. We compared the post-operative clinico-pathological complications between latex and silicone for short term catheterization in rabbits with hypospadias. MATERIALS AND METHODS: Forty rabbits were used in our study to compare complications of catheterization. They were divided in two groups. Hypospadias like defect was created by a 1 cm long excision of the ventral urethra. For urethroplasty, we used tubularized incised plate technique. Latex and silicon catheters were used in groups 1 and 2, respectively. Post-operatively, routine laboratory urine test and complications (allergy, infection, bleeding) were compared in groups. RESULTS: A total of 40 rabbits underwent hypospadias repair. Findings showed that there were no significant differences between groups based on urine test indices (P = NS). Urinary tract infection rate was 10% (2 rabbits) in latex and 0% in silicone groups (P = NS). There were no significant differences between groups regarding of cystitis grades between study groups (P = NS). CONCLUSION: It seems that urinary tract catheterization with latex catheters is a safe, feasible, and in-expensive procedure for short-term post-operative course in hypospadias surgery in patients without latex hypersensitivity.

Peritoneal Potassium and pH Measurement in Early Diagnosis of Acute Mesenteric Ischemia in Rats.

BACKGROUND: In contemporary practice, acute mesenteric ischemia (AMI) remains a serious cause of morbidity and mortality in abdominal emergencies. OBJECTIVES: We report the measurement of peritoneal fluid potassium and pH on a small series of rats that developed extensive AMI following the surgical ligation of superior mesenteric vessels and compare the results with control groups. MATERIALS AND METHODS: A total of 32 rats were used in our study. They were divided into four groups with eight rats in each one and received following treatments: group I (G-I), 60-minute controls; group II (G-II), 120-minute controls; group III (G-III), 60-minute cases; and group IV (G-IV), 120-minute cases. In case groups, the small bowel mesenteric root was double-ligated and an arrow single-lumen central venous catheter was passed through the skin to the peritoneum. In control groups, the catheter was placed without any intervention. Postoperatively, peritoneal lavage was performed at 60 (G-I, G-III) and 120 minutes (G-II, G-IV). RESULTS: The mean peritoneal potassium values were 1.3 ± 0.3, 1.97 ± 1.06, 2.14 ± 0.89, and 3.28 ± 0.66 mmol/L in G-I, G-II, G-III, and G-IV, respectively. There were significant differences between G-III and G-IV (P = 0.002), between G-I and G-III (P = 0.024), and between G-II and G-IV (P = 0.001). The mean values of peritoneal fluid pH were 7.1 ± 0.26, 6.82 ± 0.22, 6.66 ± 0.16, and 6.78 ± 0.04 in G-I, G-II, G-III, and G-IV, respectively, which indicated significant differences between G-I and G-III (P = 0.001) and between G-II and G-IV (P = 0.018). There was a significant correlation between peritoneal fluid potassium and intestine ischemic grade (F = 4.77, P = 0.048). CONCLUSIONS: Our findings show that for early detection of bowel ischemia, an evaluation of intraperitoneal potassium and pH was useful and with prolongation of ischemia, potassium changes were more significant.

Work-related injuries with child labor in Iran.

AIM: Accurate present-day child labor information is difficult to obtain. The aim of this study was to evaluate the characteristics of child labor patients according to worker status and identify the proportion of work-related injuries that could be prevented by protection devices. PATIENTS AND METHODS: This study was performed in one of the largest pediatric trauma center in the central part of Iran. In a prospective case series study, injured children with age less than 15 years who were consecutively admitted to the trauma center for management of their trauma were evaluated. In each patient data such as age, sex, worker status, anatomic site of injury, and costs were collected. RESULTS: In this study, a total of 127 children were evaluated. Most of the injuries (80.3%) occurred in urban areas. In most of the injured patients, the main reason of working was to help pay own family debts or supplement family income. Industrial workroom was the most common place for injury (58.2%). Falling from height or in horizontal surface was the most common mechanism of injury (44%). None of the patients had preventable device at the time of injury. Cuts (49.6%) were the most commonly reported injuries. The lengths of hospitalization were 1.23 + 0.88 days. There was no death reported in our cases. The mean of cost of hospitalization was US $29.9 ± 20.36. CONCLUSION: Our study showed that child labor injury in the central part of Iran mainly occurred in nonagricultural sector due to falling. These injuries are nonfatal and might be prevented by protective equipment.

Perforated acute appendicitis in a pre-term neonate.

Acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. We report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. Complete ultrasound of abdomen and pelvis was normal. In plain Radiographs of chest and abdomen with the exception of Air-filled stomach and intestine, there was no abnormality. Due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and Surgical exploration revealed perforated appendix. Appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion.

Epidemiology of livestock-related injuries in a major trauma center in Kashan, Iran.

OBJECTIVE: Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011. METHODS: In a prospective study, patients with livestock-related injuries who were consecutively admitted to the trauma center in Kashan, Iran between 2006 and 2011 were evaluated. The data collected included patient's demographics, place and nature of accident, damaged organ, educational level, transport and outcome. Data were expressed as mean +/- standard deviation. RESULTS: A total of 129 patients were included in this study, accounting for 0.3% of all trauma admission (40 273 cases). The mean age was (55.27 +/- 14.45) years. Men were affected four times more than women. Falling down from livestock is the main mechanism of trauma in all groups. Upper and lower extremities were most frequently injured (n equal to 72), followed by the head, neck and spine (n equal to 33 for each). There was one death resulting from livestock-related injury in this study. CONCLUSION: Despite the low incidence, livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important.

Pediatric elbow fractures in a major trauma center in iran.

BACKGROUND: Elbow fractures are one of the most common traumatic fractures in the pediatric population. Since severe complications may occur, appropriate diagnosis and treatment are imperative when dealing with this type of fracture. OBJECTIVES: The aim of this study was to evaluate the epidemiology of elbow fracture in children admitted in Alzahra hospital, Isfahan, IR Iran over a one year period. PATIENTS AND METHODS: During a one year period, a prospective study was conducted on 300 patients under the age of 16 who had sustained elbow fractures. Data included age, gender, mechanism of trauma, type of elbow fractures, complications, and outcomes. RESULTS: The mean age of the patients was 8.1 ± 2.31 years old. Boys were injured 2.6 times more often than the girls. Falling was the major cause of pediatric elbow fractures (86%). Supra condylar were the most common type of fracture. There was a significant association between gender and type of injury (P < 0.01). CONCLUSIONS: Supracondylar fracture is the most common fracture type resulting from 4 - 8 year old boys' falls. Our findings indicate the critical nature of appropriate treatment in order to prevent severe complications.

Pre-hospital trauma care in road traffic accidents in kashan, iran.

BACKGROUND: Iran has one of the highest rates of road traffic accidents (RTAs) worldwide. Pre-hospital trauma care can help minimize many instances of traffic-related mortality and morbidity. OBJECTIVES: The aim of this study was to assess the characteristics of pre-hospital care in patients who were injured in RTAs, admitted to hospital. The focus was mainly directed at evaluating pre-hospital trauma care provided in city streets and roads out of the city. PATIENTS AND METHODS: This retrospective study was carried out on all trauma patients, transported by the emergency medical service (EMS) system, who were admitted to Kashan Shahid-Beheshti hospital during the period from March 2011 to March 2012. The patients' demographic data, location of accident, damaged organs, mechanism of injury, injury severity, pre-hospital times (response, scene, transport), pre-hospital interventions and outcomes, were extracted from the data registry and analyzed through descriptive statistics using SPSS 18 software. RESULTS: Findings of this study showed that, 75% of RTAs occurred on city streets (n = 1 251). Motor-car accidents were the most frequent mechanism of RTA on city streets (n = 525) (42%), while car rollover was the most frequent mechanism of RTA on roads out of the city (n = 155) (44.4%). The mean pre-hospital time intervals (min); response, scene, and transport for all patients were 6.6 ± 3.1, 10.7 ± 5 and 13 ± 9.8, respectively. The mean pre-hospital time intervals (response, scene, transport) in roads out of the city were higher than those in city streets. There was a significant difference (P = 0.04) in the mortality rates due to RTAs between city streets (n = 46) and roads out of the city (n = 32). CONCLUSIONS: In comparison with road traffic accidents on city streets, trauma patients in RTAs on roads out of the city have longer pre-hospital time intervals and more severe injuries; therefore, this group needs more pre-hospital resuscitation interventions.