Background: To find out a practicable, cost effective and easily available alternative of commercial stoma care devices for pediatric patients in a developing country. Methods: The study was conducted in the department of Pediatric Surgery in Dhaka Medical College Hospital, Bangladesh, during two years period from May 2009 to April 2011. Number of patients was 162 with age range 2 days to 7 years, mean age 2.3 years. As early as a colostomy or ileostomy had started functioning, a central hole was made in a betel leaf. The hole could just snugly accommodate the stoma. After applying a layer of zinc oxide paste over the peristomal skin the leaf was placed as such the stoma rotrudes through the hole. The smooth shiny surface of the leaf would face upwards and rough surface downwards. Another intact betel leaf with the shiny surface also facing upwards would cover the stoma. The leaves did not act as a reservoir rather simply acted as a barrier between the effluent and the peristomal skin. Fifty seven patients with colostomy and 11 with leostomy used stoma appliances (wafer with bag). Eighty six patients with colostomy and 8 patients with ileostomy used betel leaves and zinc oxide paste. Mean length of time between creation and closure of a colostomy was 9 months and that of an ileostomy was three months. It was ensured that each individual patient had used his or her respective stoma care method till closure of the stomas. Two parameters were used to evaluate the outcome of the above mentioned stoma care methods: (a) peristomal skin excoriation and (b) insultto the stomal mucosa in the form of ulceration. Results: Among the patients who used stoma appliances 21.53% developed peristomal skin excoriation, 7.69% developed mucosal ulceration and 6.34% patients developed local hypersensitivity reaction to stoma adhesive. On the contrary, patients who were managed with betel leaves 20.93% developed peristomal skin excoriation and 8.13% developed mucosal ulceration. No incidence of allergic reaction to local application of betel leaf and zinc oxide occurred. Average cost for betel leaves was less than 0.50 US$ per month in comparison to about 30 US$ for ostomy appliances. Conclusion: Betel leaves may be used as a cheap, easily available, non irritant and effective alternative of commercial appliances to protect the stomas and peristomal skin in pediatric patients. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19534
{"title":"Use of Betel Leaves in Pediatric Stoma Care","authors":"Md. Ashraf Ul Huq, A. Rahman, Tahmina Hossain","doi":"10.3329/JPSB.V1I2.19534","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19534","url":null,"abstract":"Background: To find out a practicable, cost effective and easily available alternative of commercial stoma care devices for pediatric patients in a developing country. Methods: The study was conducted in the department of Pediatric Surgery in Dhaka Medical College Hospital, Bangladesh, during two years period from May 2009 to April 2011. Number of patients was 162 with age range 2 days to 7 years, mean age 2.3 years. As early as a colostomy or ileostomy had started functioning, a central hole was made in a betel leaf. The hole could just snugly accommodate the stoma. After applying a layer of zinc oxide paste over the peristomal skin the leaf was placed as such the stoma rotrudes through the hole. The smooth shiny surface of the leaf would face upwards and rough surface downwards. Another intact betel leaf with the shiny surface also facing upwards would cover the stoma. The leaves did not act as a reservoir rather simply acted as a barrier between the effluent and the peristomal skin. Fifty seven patients with colostomy and 11 with leostomy used stoma appliances (wafer with bag). Eighty six patients with colostomy and 8 patients with ileostomy used betel leaves and zinc oxide paste. Mean length of time between creation and closure of a colostomy was 9 months and that of an ileostomy was three months. It was ensured that each individual patient had used his or her respective stoma care method till closure of the stomas. Two parameters were used to evaluate the outcome of the above mentioned stoma care methods: (a) peristomal skin excoriation and (b) insultto the stomal mucosa in the form of ulceration. Results: Among the patients who used stoma appliances 21.53% developed peristomal skin excoriation, 7.69% developed mucosal ulceration and 6.34% patients developed local hypersensitivity reaction to stoma adhesive. On the contrary, patients who were managed with betel leaves 20.93% developed peristomal skin excoriation and 8.13% developed mucosal ulceration. No incidence of allergic reaction to local application of betel leaf and zinc oxide occurred. Average cost for betel leaves was less than 0.50 US$ per month in comparison to about 30 US$ for ostomy appliances. Conclusion: Betel leaves may be used as a cheap, easily available, non irritant and effective alternative of commercial appliances to protect the stomas and peristomal skin in pediatric patients. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19534","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133778312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When it comes to health care delivery, people are now demanding an increase in quality and services and a decrease in cost. Increasing the quality of health care delivery may require that a health care facility invest in new technologies, which may be costly and often involves a steep learning curve for practitioners. Change is the only constant in health care, however, so practitioners need to be aware of the changes that are on the horizon for the health care industry and find ways to successfully deal with the inevitable challenges these changes will bring.
{"title":"Laparoscopy in Children, A Brief Outline and Bangladesh Perspective","authors":"M. Hannan","doi":"10.3329/JPSB.V2I2.19541","DOIUrl":"https://doi.org/10.3329/JPSB.V2I2.19541","url":null,"abstract":"When it comes to health care delivery, people are now demanding an increase in quality and services and a decrease in cost. Increasing the quality of health care delivery may require that a health care facility invest in new technologies, which may be costly and often involves a steep learning curve for practitioners. Change is the only constant in health care, however, so practitioners need to be aware of the changes that are on the horizon for the health care industry and find ways to successfully deal with the inevitable challenges these changes will bring.","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"37 24","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113976187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
1. Western HealthWestern & Sunshine Hospitals, Footscray Vic 3011 2. Paediatric Urologist/Surgeon, Sunshine Specialist CentreKind Cuts for Kids, 147 Furlong Road, St Albans Vic 3021 3. Royal Children Hospital, Melbourne, Email: padma.rao@ rch.org.au Correspondence to: Dr. Mugahid Al-Hassan, Pediatric Surgeon, Western HealthWestern & Sunshine Hospitals, Footscray Vic 3011, E-mail: moalhassan@hotmail.com would benefit from an early surgical intervention, highlighting the need to have a multi data point, jigsaw puzzle-like approach.
{"title":"Postnatal Management of Prenatal Obstructive Hydronephrosis","authors":"M. Al-Hassan, P. Dewan, P. Rao","doi":"10.3329/JPSB.V1I2.19529","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19529","url":null,"abstract":"1. Western HealthWestern & Sunshine Hospitals, Footscray Vic 3011 2. Paediatric Urologist/Surgeon, Sunshine Specialist CentreKind Cuts for Kids, 147 Furlong Road, St Albans Vic 3021 3. Royal Children Hospital, Melbourne, Email: padma.rao@ rch.org.au Correspondence to: Dr. Mugahid Al-Hassan, Pediatric Surgeon, Western HealthWestern & Sunshine Hospitals, Footscray Vic 3011, E-mail: moalhassan@hotmail.com would benefit from an early surgical intervention, highlighting the need to have a multi data point, jigsaw puzzle-like approach.","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115517101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tahmina Hossain, Md. Ruhul Amin, M. Siddiqui, Md. Ashraf Ul Huq, Md Matiur Rahman
Background: Head and Neck region of the body has a rich network of lymphatic channel and intervening nodes. Out of total approximately 800 lymph nodes in the body about 300 are scattered in organized fashion in the neck region which are affected by various regional and systemic diseases. The conventional method of excisional biopsy is used to diagnose etiological causes of lymphadenopathy. In comparison to open surgical biopsy, FNAC is a simple, reliable and acceptable tool for the etiological diagnosis of lymphadenopathies. FNAC was first practiced by Grieg and Gray for the diagnosis of trypanosome in lymphnode in 1904. Now a day it is widely practiced in United States, United Kingdom and many other countries. In Bangladesh, many studies on FNAC are carried out and the results are highly appreciable and reliable. Methods: A prospective study for a period of 24 months was carried out on 50 patients with enlarged cervical lymph nodes from July 2003 to June 2005. During the two years study period, 56 patients with cervical lymphadenopathies were selected for FNAC and openbiopsy following certain inclusion and exclusion criteria, in the Department of Pediatric Surgery, Bangabandhu Sheikh Mujiib Medical University, Dhaka. Patients with acute lymphadenitis and lymphadenopathy due to leukaemia were excluded. Six cases were deleted from the study as smears from those revealed inadequate material and hence only 50 cases were available for study in the present series. Clinical findings, FNAC and biopsy reports were available in all the cases and were correlated with each other. Results: On biopsy, 27 cases were diagnosed as tuberculous lymphadenopathies, 15 cases as lymphoma and 8 cases as reactive changes. On FNAC, there were 2 false positive and 5 false negative cases in case of tuberculosis; 2 false positive and 1 false negative cases in lymphoma; 4 false positive and 2 false negative cases in cases with reactive hyperplasia. Sensitivity of FNAC in comparison to histopathological findings was 92.6% in case of tuberculosis; 86.7% in case of lymphoma and 50% in case of nonspecific lymphadenitis. Specificity of FNAC in comparison to histological findings was 78.3% in case of tuberculosis; 94.2% in case of lymphoma and 95.3% in case of nonspecific lymphadenitis. Accuracy of FNAC in comparison to histopathological findings was 86% in case of tuberculosis; 94% in case of lymphoma and 88% in case of reactive changes. Conclusions: The present study indicates that, FNAC is a simple, reliable and acceptable procedure for various lesions of cervical lymph nodes. It can be repeated if necessary. It also concludes that FNAC helps to confirm the clinical impression without open biopsy. Open biopsy can be avoided in many benign and malignant lesions of cervical lymph nodes. Fine needle aspiration cytodiagnosis can eliminate the need of hospitalization and surgery. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19526
{"title":"Correlation Between FNAC and Open Biopsy in Cervical Lymhadenopathy in Children","authors":"Tahmina Hossain, Md. Ruhul Amin, M. Siddiqui, Md. Ashraf Ul Huq, Md Matiur Rahman","doi":"10.3329/JPSB.V1I2.19526","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19526","url":null,"abstract":"Background: Head and Neck region of the body has a rich network of lymphatic channel and intervening nodes. Out of total approximately 800 lymph nodes in the body about 300 are scattered in organized fashion in the neck region which are affected by various regional and systemic diseases. The conventional method of excisional biopsy is used to diagnose etiological causes of lymphadenopathy. In comparison to open surgical biopsy, FNAC is a simple, reliable and acceptable tool for the etiological diagnosis of lymphadenopathies. FNAC was first practiced by Grieg and Gray for the diagnosis of trypanosome in lymphnode in 1904. Now a day it is widely practiced in United States, United Kingdom and many other countries. In Bangladesh, many studies on FNAC are carried out and the results are highly appreciable and reliable. Methods: A prospective study for a period of 24 months was carried out on 50 patients with enlarged cervical lymph nodes from July 2003 to June 2005. During the two years study period, 56 patients with cervical lymphadenopathies were selected for FNAC and openbiopsy following certain inclusion and exclusion criteria, in the Department of Pediatric Surgery, Bangabandhu Sheikh Mujiib Medical University, Dhaka. Patients with acute lymphadenitis and lymphadenopathy due to leukaemia were excluded. Six cases were deleted from the study as smears from those revealed inadequate material and hence only 50 cases were available for study in the present series. Clinical findings, FNAC and biopsy reports were available in all the cases and were correlated with each other. Results: On biopsy, 27 cases were diagnosed as tuberculous lymphadenopathies, 15 cases as lymphoma and 8 cases as reactive changes. On FNAC, there were 2 false positive and 5 false negative cases in case of tuberculosis; 2 false positive and 1 false negative cases in lymphoma; 4 false positive and 2 false negative cases in cases with reactive hyperplasia. Sensitivity of FNAC in comparison to histopathological findings was 92.6% in case of tuberculosis; 86.7% in case of lymphoma and 50% in case of nonspecific lymphadenitis. Specificity of FNAC in comparison to histological findings was 78.3% in case of tuberculosis; 94.2% in case of lymphoma and 95.3% in case of nonspecific lymphadenitis. Accuracy of FNAC in comparison to histopathological findings was 86% in case of tuberculosis; 94% in case of lymphoma and 88% in case of reactive changes. Conclusions: The present study indicates that, FNAC is a simple, reliable and acceptable procedure for various lesions of cervical lymph nodes. It can be repeated if necessary. It also concludes that FNAC helps to confirm the clinical impression without open biopsy. Open biopsy can be avoided in many benign and malignant lesions of cervical lymph nodes. Fine needle aspiration cytodiagnosis can eliminate the need of hospitalization and surgery. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19526","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129814546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To determine the prognostic factors of the functional outcome of patients surgically treated for acute extradural haematoma. Methods: Sixty three cases of extradural haematoma was studied over a period of two years from July 2001 to July 2003 in dept of neurosurgery Dhaka Medical college & Hospital. Study was prospective for their clinical profile and operative measures. Clinical characteristics, radiologic findings, and the time intervals with regard to treatment course were investigated to determine the interactions between all these factors and functional outcome. Their clinical presentation varied from intense headache to deep coma and fixed pupil. Patients were divided into two groups on the basis of the GCS level on admission and also on the basis of the operative time interval. All patients were treated surgically and haematoma evacuated. Results: Out of 63 cases 26 cases (41.3%) were in 3rd decade. Male to female ratio was 14:1, where males were 93.6% (59 cases) out of total 63. Most common mode of injury causing EDH was due to RTA 57% followed by assault (26.9%) & fall from height (15.8%). CT scan confirms site of EDH which was more common in temporal region in 26 cases(41.2%) followed by frontal 13 cases (20.6%), parietal 11 cases (17.4%), temporoparietal region 10 cases (15.8%)& occipital region 3 cases(4.76%). The mean interval between injury and operation in two groups were 36 hours & 5 days(Av). Most important finding was the operative outcome where mortality was 30.1%.This mortality was dependent on the GCS level rather than the preoperative time. But the number of patients achieved good recovery (resume normal life GOS 5) was significantly more among them who were treated within 3 days (mean 24.15 hours) than those who were treated within 5.26 days . Conclusion: This study identifies the risk factors involved in the functional outcome of patients who underwent surgical treatment for acute epidural hematomas. Excessive delay occurred in recognizing the condition and in subsequent transfer of patients. Early intervention in traumatic EDH cases should not be delayed. It gives not only the better result but also reduces the number of disabled vegetative person and reduces morbidity and above all reduces social burden, hospital staying and cost. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19522
{"title":"Operative Outcome of Acute Extradural Haematoma, Operated at Different Time Interval and Review of International Guidelines","authors":"M. Haque, S. Sultana, S. Ahamed, M. Alamgir","doi":"10.3329/JPSB.V1I2.19522","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19522","url":null,"abstract":"Objective: To determine the prognostic factors of the functional outcome of patients surgically treated for acute extradural haematoma. Methods: Sixty three cases of extradural haematoma was studied over a period of two years from July 2001 to July 2003 in dept of neurosurgery Dhaka Medical college & Hospital. Study was prospective for their clinical profile and operative measures. Clinical characteristics, radiologic findings, and the time intervals with regard to treatment course were investigated to determine the interactions between all these factors and functional outcome. Their clinical presentation varied from intense headache to deep coma and fixed pupil. Patients were divided into two groups on the basis of the GCS level on admission and also on the basis of the operative time interval. All patients were treated surgically and haematoma evacuated. Results: Out of 63 cases 26 cases (41.3%) were in 3rd decade. Male to female ratio was 14:1, where males were 93.6% (59 cases) out of total 63. Most common mode of injury causing EDH was due to RTA 57% followed by assault (26.9%) & fall from height (15.8%). CT scan confirms site of EDH which was more common in temporal region in 26 cases(41.2%) followed by frontal 13 cases (20.6%), parietal 11 cases (17.4%), temporoparietal region 10 cases (15.8%)& occipital region 3 cases(4.76%). The mean interval between injury and operation in two groups were 36 hours & 5 days(Av). Most important finding was the operative outcome where mortality was 30.1%.This mortality was dependent on the GCS level rather than the preoperative time. But the number of patients achieved good recovery (resume normal life GOS 5) was significantly more among them who were treated within 3 days (mean 24.15 hours) than those who were treated within 5.26 days . Conclusion: This study identifies the risk factors involved in the functional outcome of patients who underwent surgical treatment for acute epidural hematomas. Excessive delay occurred in recognizing the condition and in subsequent transfer of patients. Early intervention in traumatic EDH cases should not be delayed. It gives not only the better result but also reduces the number of disabled vegetative person and reduces morbidity and above all reduces social burden, hospital staying and cost. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19522","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133425106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: There are many circumcisions done by the surgeons due to physiological phimosis which need no intervention. General practitioners inappropriately refer those cases due to fear of obstructed voiding. Materials & Methods: From July 2005 to April 2007 total 33 boys with physiological phimosis were assessed in BSMMU.Among them 20 cases were without ballooning and 13 cases with ballooning. All the boys had upper tract and bladder USG followed by uroflowmetry and USG determined postvoid residual urine volume. Data were compared between boys with and without ballooning of foreskin. Results: In all 33 boys with physiological phimosis completed uroflowmetry and USG. Ballooning of the foreskin was present in 13 boys (mean age 22.08 months range from 18 to 25 months) and non ballooning were 20 (mean age- 22.7 months range from 18 to 28 months). Upper tract USG and bladder wall thickness were normal in all boys. The mean Maximum flow rate (Q max) was not significantly different in boys with ballooning and those with non ballooning (mean 8.4ml/s maxi-10.3 mini-6.7-) vs (8.5 ml/s, maxi-10.7,mini -6.7). In addition all Qmax values were within normal range. The two groups had comparable mean PVR (0 .92 ml SD-0.9, range -0 to7) vs (.85 ml SD-0.8 range 0 to 8). Conclusions: The non-invasive assessment of voiding efficiency in boys with physiological phimosis with or without ballooning of foreskin showed no evidence of obstructed voiding. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19530
背景:有许多外科医生因生理性包茎而行包皮环切术，无需干预。全科医生由于担心排尿受阻而不恰当地转诊这些病例。材料与方法:2005年7月至2007年4月对33例生理性包茎男生进行BSMMU评估。其中未充气20例，有充气13例。所有男孩均行上尿路和膀胱USG，然后行尿流仪和USG测定空后残余尿量。数据比较了有和没有包皮膨胀的男孩。结果:33例生生性包茎男生均完成尿流测定和USG。包皮肿胀13例(平均年龄22.08个月，18 ~ 25个月)，非包皮肿胀20例(平均年龄22.7个月，18 ~ 28个月)。所有男孩的上尿路USG和膀胱壁厚度均正常。充气男孩和非充气男孩的平均最大流速(Q max)无显著差异(平均8.4ml/s, max -10.3 - mini-6.7-) vs (8.5 ml/s, max -10.7,mini -6.7)。所有Qmax值均在正常范围内。两组的平均PVR (0.92 ml SD-0.9，范围-0至7)与(0.92 ml SD-0.9，范围-0至7)具有可比性。结论:对生理包茎伴或不伴包皮膨胀的男孩进行无创性排尿效果评估，未发现排尿障碍的证据。DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19530
{"title":"Study of Voiding Obstruction in Physiological Phimosis","authors":"S. Islam, A. Morshed, S. Hoque","doi":"10.3329/JPSB.V1I2.19530","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19530","url":null,"abstract":"Background: There are many circumcisions done by the surgeons due to physiological phimosis which need no intervention. General practitioners inappropriately refer those cases due to fear of obstructed voiding. Materials & Methods: From July 2005 to April 2007 total 33 boys with physiological phimosis were assessed in BSMMU.Among them 20 cases were without ballooning and 13 cases with ballooning. All the boys had upper tract and bladder USG followed by uroflowmetry and USG determined postvoid residual urine volume. Data were compared between boys with and without ballooning of foreskin. Results: In all 33 boys with physiological phimosis completed uroflowmetry and USG. Ballooning of the foreskin was present in 13 boys (mean age 22.08 months range from 18 to 25 months) and non ballooning were 20 (mean age- 22.7 months range from 18 to 28 months). Upper tract USG and bladder wall thickness were normal in all boys. The mean Maximum flow rate (Q max) was not significantly different in boys with ballooning and those with non ballooning (mean 8.4ml/s maxi-10.3 mini-6.7-) vs (8.5 ml/s, maxi-10.7,mini -6.7). In addition all Qmax values were within normal range. The two groups had comparable mean PVR (0 .92 ml SD-0.9, range -0 to7) vs (.85 ml SD-0.8 range 0 to 8). Conclusions: The non-invasive assessment of voiding efficiency in boys with physiological phimosis with or without ballooning of foreskin showed no evidence of obstructed voiding. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19530","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122942155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
physical change. Various factors can lead to constipation in children. Common culprits include faulty early toilet training and changes in diet. Fortunately, most cases of constipation in children are temporary. Encouraging the child to make simple dietary changes, such as eating more fiber-rich fruits and vegetables and drinking more fluids can go a long way toward alleviating constipation. Usually paediatricians deal with constipation by giving such advice and adding laxatives. But they subsequently have to refer the baby to a Paediatric Surgeon when it does not get cured by the first line methods of treatment. Then it becomes the duty of the surgeon to act properly for its cure.
{"title":"‘Constipation in Children' – Think Twice Before Starting Treatment","authors":"Md. Kabirul Islam","doi":"10.3329/JPSB.V1I2.19521","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19521","url":null,"abstract":"physical change. Various factors can lead to constipation in children. Common culprits include faulty early toilet training and changes in diet. Fortunately, most cases of constipation in children are temporary. Encouraging the child to make simple dietary changes, such as eating more fiber-rich fruits and vegetables and drinking more fluids can go a long way toward alleviating constipation. Usually paediatricians deal with constipation by giving such advice and adding laxatives. But they subsequently have to refer the baby to a Paediatric Surgeon when it does not get cured by the first line methods of treatment. Then it becomes the duty of the surgeon to act properly for its cure.","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"362 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125652773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mondal, K. Hasina, Md. Ashraf Ul Huq, Md. Ansar Ali, M. Alam, M. M. Hoque, Jaglul Gaffer Khan, A. Rahman, S. Islam
Introduction: Approximately one in three men is circumcised globally, but there are relatively few data on the safety of the procedure1. Circumcision is a surgical procedure performed for centuries for medical, religious and several other reasons. Circumcision is the most common surgical procedure performed in boys through out the world. Meatal stenosis is one of its late complications. We evaluated the topical use of lubricant jelly (Vaseline- petroleum jelly) after circumcision in boys in order to reduce or prevent the risk of meatal stenosis. Objective: To see the effectiveness of use of lubricants and to determine the functional outcome, that is prevention of post circumcision meatal stenosis. Materials and Methods: A randomized control trial was performed, in which two groups of boys younger than two years old underwent circumcision according to dissection (sleeve) method . The parents in the study groups were strictly instructed to use petroleum jelly on the meatus and circumcision site at every morning or after each diaper change where necessary for three months, on the other hand parents in the control group were instructed not to use any lubricants or topical medication on the same site. The boys were followed up regularly and evaluated for meatal stenosis, bleeding and infection. Results: A total of 120 boys, 60 in each group completed the study. None of the boys in the study group develop meatal stenosis , but 6(10%) in the control group develop meatal stenosis ( p < 0.05 ). Infection of the circumcision site was seen in 1 (0.6%) and 3 (5%) children in the lubricant and control groups, respectively (p<0.05) and bleeding was seen in 3 (5.0%) and 6(10.0%) respectively. Conclusions: Based on the findings of this study, it seems logical to use a lubricant jelly for prevention of post circumcision meatal stenosis and other complications. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19528
{"title":"Lubrication of Meatus and Circumcision Site for Prevention of Post-circumcision Meatal Stenosis in Children Younger Than Two Years Old","authors":"S. Mondal, K. Hasina, Md. Ashraf Ul Huq, Md. Ansar Ali, M. Alam, M. M. Hoque, Jaglul Gaffer Khan, A. Rahman, S. Islam","doi":"10.3329/JPSB.V1I2.19528","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19528","url":null,"abstract":"Introduction: Approximately one in three men is circumcised globally, but there are relatively few data on the safety of the procedure1. Circumcision is a surgical procedure performed for centuries for medical, religious and several other reasons. Circumcision is the most common surgical procedure performed in boys through out the world. Meatal stenosis is one of its late complications. We evaluated the topical use of lubricant jelly (Vaseline- petroleum jelly) after circumcision in boys in order to reduce or prevent the risk of meatal stenosis. Objective: To see the effectiveness of use of lubricants and to determine the functional outcome, that is prevention of post circumcision meatal stenosis. Materials and Methods: A randomized control trial was performed, in which two groups of boys younger than two years old underwent circumcision according to dissection (sleeve) method . The parents in the study groups were strictly instructed to use petroleum jelly on the meatus and circumcision site at every morning or after each diaper change where necessary for three months, on the other hand parents in the control group were instructed not to use any lubricants or topical medication on the same site. The boys were followed up regularly and evaluated for meatal stenosis, bleeding and infection. Results: A total of 120 boys, 60 in each group completed the study. None of the boys in the study group develop meatal stenosis , but 6(10%) in the control group develop meatal stenosis ( p < 0.05 ). Infection of the circumcision site was seen in 1 (0.6%) and 3 (5%) children in the lubricant and control groups, respectively (p<0.05) and bleeding was seen in 3 (5.0%) and 6(10.0%) respectively. Conclusions: Based on the findings of this study, it seems logical to use a lubricant jelly for prevention of post circumcision meatal stenosis and other complications. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19528","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129020384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jaglul Gaffer Khan, M. Islam, M. Rahaman, J. Akter, K. Hasina, S. Mondal, Md. Ansar Ali
Background: Various innovative approach have been tried for the surgical management of vestibular fistula, most of them have post operative complication like wound infection, wound dehiscence, more hospital stay which compromise the functional out come, financial burden and aesthetic appearance of the perineum. This article details a new technique, Transfistula Anorectoplasty (TFARP), which includes minimal dissection without interruption of perineal body and perineal skin. Materials and methods: This cross sectional comparative study on 43 patients with vestibular fistula conducted in Dhaka Shishu (Children) Hospital from September 2008 to April 2010, about 20 months. Patients were operated according to parent choice after obtaining informed consent and standard bowel preparation. Data on demographics, operation time and ostoperative complications were analyzed systematically by SPSS program. Patients were followed up for a period of 2½ months postoperatively. Results: There is no statistical difference in patient population regarding age, geographical distribution and clinical presentation. Mean operation time was 76.5 min for TFARP and 84.34 min for ASARP. Two cases had wound infection after TFARP operation and 11 patients after ASARP operation. One patient developed partial wound dehiscence after TFARP and was healed after conservative treatment within 7 days. On the other hand 5 patients developed partial wound dehiscence and 4 patients developed complete wound disruption after ASARP which were also treated conservatively need more than 02 week on an average. Mean hospital stay were 6.45 days after TFARP operation and mean hospital stay were 7.87 days after ASARP peration. Twenty neonates and infant who were treated by TFARP operation have good bowel movement without laxative and symmetrical anal contraction after stimulation. Conclusion: TFARP is an operation which produces less morbidity and is more effective and superior procedure than that of ASARP operation and gives better aesthetic appearance of the perineum. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19525
{"title":"Comparison Between One Stage Correction of Vestibular Fistula by Transfistula Anorectoplasty (TFARP) and Anterior Sagittal Anorectoplasty (ASARP)","authors":"Jaglul Gaffer Khan, M. Islam, M. Rahaman, J. Akter, K. Hasina, S. Mondal, Md. Ansar Ali","doi":"10.3329/JPSB.V1I2.19525","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19525","url":null,"abstract":"Background: Various innovative approach have been tried for the surgical management of vestibular fistula, most of them have post operative complication like wound infection, wound dehiscence, more hospital stay which compromise the functional out come, financial burden and aesthetic appearance of the perineum. This article details a new technique, Transfistula Anorectoplasty (TFARP), which includes minimal dissection without interruption of perineal body and perineal skin. Materials and methods: This cross sectional comparative study on 43 patients with vestibular fistula conducted in Dhaka Shishu (Children) Hospital from September 2008 to April 2010, about 20 months. Patients were operated according to parent choice after obtaining informed consent and standard bowel preparation. Data on demographics, operation time and ostoperative complications were analyzed systematically by SPSS program. Patients were followed up for a period of 2½ months postoperatively. Results: There is no statistical difference in patient population regarding age, geographical distribution and clinical presentation. Mean operation time was 76.5 min for TFARP and 84.34 min for ASARP. Two cases had wound infection after TFARP operation and 11 patients after ASARP operation. One patient developed partial wound dehiscence after TFARP and was healed after conservative treatment within 7 days. On the other hand 5 patients developed partial wound dehiscence and 4 patients developed complete wound disruption after ASARP which were also treated conservatively need more than 02 week on an average. Mean hospital stay were 6.45 days after TFARP operation and mean hospital stay were 7.87 days after ASARP peration. Twenty neonates and infant who were treated by TFARP operation have good bowel movement without laxative and symmetrical anal contraction after stimulation. Conclusion: TFARP is an operation which produces less morbidity and is more effective and superior procedure than that of ASARP operation and gives better aesthetic appearance of the perineum. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19525","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127884601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Hasina, A. Hanif, Sms Alam, S. Reza, N. Islam, Akmm Rahman, Sms Huda, Mmm, Pervez, SK Mondal, S. Islam
Introduction: The aim of this study was to determine the feasibility, safety, cost effectiveness and functional outcome between single stage and multiple stage operation of anorectal malformation (ARM) with rectovestibular fistula (RVF). Materials & Methods: This interventional study was conducted on 40 female children born with ARM with RVF from July 2007 to June 2009 in the Department of Pediatric Surgery, Dhaka Medical College Hospital. Their age range was from 3 months to 7 years. Anterior sagittal anorectoplasty (ASARP) was done as definitive treatment of RVF. 20 out of 40 patients underwent single stage procedure and the rest underwent multiple stage procedure. Good preoperative bowel preparation and postoperative wound care were ensured for optimum outcome. Results: Mean operating time was 70 minutes in single stage and 80 minutes in multi stage definitive procedure. Average hospital stay was 10 days in single stage procedure where as 22-24 days in multi stage procedure. Partial perineal wound dehiscence occurred in two patients with single stage procedure and one patient with multi stage procedure. Wound infection was seen in two patients of single stage and also two patients of multi stage procedures. Fecal continence was good in all patients older than 3 years. Average number of bowel movement was 2-3 times daily in older patients and 2-4 in younger patients. Constipation developed in three patients with multiple stage procedure and in two patients with single stage procedure. Both groups were managed conservatively for all complications. In Dhaka Medical College Hospital, treatment cost is mostly free, so we could not compare this cost but the incidental expenses in single stage treatment was Tk. 10,000.00 and Tk. 30,000.00 in multistage treatment in three settings. Conclusion: Adequate preoperative bowel preparation, good surgical skill, proper analgesia and postoperative wound care remain the key factors to produce a cost effective excellent outcome of single stage correction of RVF. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19523
{"title":"Single Stage Correction of Rectovestibular Fistula","authors":"K. Hasina, A. Hanif, Sms Alam, S. Reza, N. Islam, Akmm Rahman, Sms Huda, Mmm, Pervez, SK Mondal, S. Islam","doi":"10.3329/JPSB.V1I2.19523","DOIUrl":"https://doi.org/10.3329/JPSB.V1I2.19523","url":null,"abstract":"Introduction: The aim of this study was to determine the feasibility, safety, cost effectiveness and functional outcome between single stage and multiple stage operation of anorectal malformation (ARM) with rectovestibular fistula (RVF). Materials & Methods: This interventional study was conducted on 40 female children born with ARM with RVF from July 2007 to June 2009 in the Department of Pediatric Surgery, Dhaka Medical College Hospital. Their age range was from 3 months to 7 years. Anterior sagittal anorectoplasty (ASARP) was done as definitive treatment of RVF. 20 out of 40 patients underwent single stage procedure and the rest underwent multiple stage procedure. Good preoperative bowel preparation and postoperative wound care were ensured for optimum outcome. Results: Mean operating time was 70 minutes in single stage and 80 minutes in multi stage definitive procedure. Average hospital stay was 10 days in single stage procedure where as 22-24 days in multi stage procedure. Partial perineal wound dehiscence occurred in two patients with single stage procedure and one patient with multi stage procedure. Wound infection was seen in two patients of single stage and also two patients of multi stage procedures. Fecal continence was good in all patients older than 3 years. Average number of bowel movement was 2-3 times daily in older patients and 2-4 in younger patients. Constipation developed in three patients with multiple stage procedure and in two patients with single stage procedure. Both groups were managed conservatively for all complications. In Dhaka Medical College Hospital, treatment cost is mostly free, so we could not compare this cost but the incidental expenses in single stage treatment was Tk. 10,000.00 and Tk. 30,000.00 in multistage treatment in three settings. Conclusion: Adequate preoperative bowel preparation, good surgical skill, proper analgesia and postoperative wound care remain the key factors to produce a cost effective excellent outcome of single stage correction of RVF. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19523","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131531715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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