Journal of Indian Association of Pediatric Surgeons最新文献

Context: Remote ischemic conditioning (RIC) protects distant organs from ischemia-reperfusion injury (IRI) through brief, nonlethal ischemic episodes. In pediatric intestinal IRI, such as in midgut volvulus and necrotizing enterocolitis, RIC may enhance bowel viability and reduce the need for extensive resections.

Aims: This study aimed to evaluate the protective effects of RIC on intestinal IRI (IIRI) in a rat model by assessing histopathological changes, gene expression, and intestinal motility when RIC is applied during the ischemic or reperfusion phase.

Settings and design: An experimental animal study conducted at a tertiary hospital, over 20 months. Twenty four male Wistar rats were employed and randomly assigned into four groups: Sham, IIRI, RIC during ischemia (RIperC), and RIC during reperfusion (RIpostC).

Subjects and methods: Intestinal ischemia was induced by clamping mesenteric vessels for 45 min. RIC was performed through four cycles of 5-min hind limb occlusion followed by reperfusion, either during the intestinal ischemia (RIperC) or during the intestinal reperfusion (RIpostC) phase. Rats were sacrificed after 24 h of reperfusion, and intestinal tissues were analysed for histopathological changes, gene expression (interleukin-6, tumor necrosis factor-alpha, Ki-67, Bax, heme oxygenase-1), and motility patterns.

Results: Histopathological analysis did not reveal any signs of mucosal damage attributable to intestinal ischemia in any of the groups. Similarly, gene expression analysis did not demonstrate any statistically significant difference among the groups. Furthermore, no significant difference was detected in the contractility parameters. These findings indicate that our experimental model did not induce sufficient ischemia in the bowel to produce any histopathological or molecular changes.

Conclusion: There is a lack of standardized protocols in intestinal ischemia-reperfusion models, leading to inconsistent results. Establishing a robust and standardized experimental model is essential before evaluating therapeutic interventions like RIC in intestinal IRI.

The collections of paraganglia located just below the origin of the inferior mesenteric artery are referred to as the Nebenorgane or Organs of Zuckerkandl. Occasionally, these Nebenorgane can give rise to pelvic neuroblastoma, presenting a diagnostic and therapeutic challenge. We present the case of a 16-year-old male who experienced painless hematuria. Imaging studies and a biopsy confirmed the presence of a pelvic ganglioneuroblastoma. Surgical exploration revealed a well-defined mass adjacent to the left vesicoureteral junction, which did not originate from the urinary bladder, rectum, or presacral region, indicating origin from an aberrant Nebenorgane. This case highlights the importance of recognizing atypical presentations of neuroblastoma for effective diagnosis and treatment.

Background: Recurrent abdominal pain (RAP) in children presents a complex diagnostic challenge, with causes ranging from organic to functional and psychological. While most cases are benign, chronic appendicitis remains a rare but important consideration. Its atypical presentation and overlap with other gastrointestinal disorders make diagnosis difficult. Among the various diagnostic tools, barium meal studies, though not primarily designed to assess the appendix, can provide useful insights when combined with small bowel follow-through, potentially revealing subtle indicators of appendiceal pathology in children with RAP.

Methods: A retrospective review was conducted on 20 children with RAP lasting 3-18 months, all previously evaluated for both functional and organic causes without a diagnosis. Ultrasound was unremarkable in all, and 17 had normal computed tomography scans. After clinical evaluation, all underwent barium meal and follow-through studies. Findings suggestive of chronic appendicitis, such as nonvisualization, mucosal irregularities, or filling defects, prompted laparoscopic appendectomy. All patients underwent regular postoperative follow-ups.

Results: All children demonstrated imaging features consistent with chronic appendicitis and underwent laparoscopic appendectomy. Intraoperative findings were unremarkable aside from the appendix. Histopathology confirmed chronic inflammation, with mucosal fibrosis, lymphoid hyperplasia, and inflammatory infiltrates. Postsurgery, all patients reported complete symptom resolution.

Conclusion: Though largely superseded by modern imaging, the barium meal with follow-through can still serve as a valuable adjunct in pediatric RAP cases, especially when conventional modalities are inconclusive or inaccessible. While no longer central in diagnosis, it remains a potentially useful tool in the broader diagnostic arsenal.

Objective: Surgeons performing ureteric reimplantation (UR) often face physical challenges and discomfort during surgery due to prolonged periods of standing, awkward body positions, and repetitive movements. We aimed to compare surgeon-reported health outcomes between open versus robotic UR.

Methods: This single-surgeon prospective comparative study compared surgeon-reported physical discomfort for two surgical approaches, open (Group A) and robotic (Group B) UR, while accounting for the potential influence of operating room time. The outcomes were measured using multiple Likert scale items related to "neck stress," "fatigue," and "shoulder pain," with higher scores indicating worse symptoms, and these were assessed using a standardized questionnaire administered immediately postsurgery. We conducted Ordinary Least Squares regression analyses using the Python Stats models library to investigate the relationships between the independent variables (surgical technique, operative time, and length of stay) and the dependent variables (neck stress, fatigue, and shoulder pain).

Results: Group A included 30 cases, whereas Group B included 21 cases. Overall, the results indicated that the surgeon reported significantly worse outcomes in terms of neck stress, fatigue, and shoulder pain for Group A compared to Group B (P < 0.001 in all three models), even after applying the Bonferroni correction. Operative time was a significant contributing factor to both fatigue and shoulder pain (P = 0.012).

Conclusion: Surgeons performing robotic UR experience significantly less physical discomfort, fatigue, and improved overall surgical experiences compared to those performing open procedures.

Bronchial mucoepidermoid carcinoma in children is rare, often presenting with nonspecific respiratory symptoms, causing diagnostic delays. Complete surgical excision is the primary treatment, with excellent outcomes for low-grade tumors. Pediatric considerations include minimizing anastomotic tension and preserving lung function. The prognosis is favorable with low recurrence after R0 resection.

We report a case of a 5-month-old female infant who presented with multiple liver lesions. In view of initial imaging characteristics suggestive of multiple liver metastases, a workup for the primary lesion was instituted, which revealed the lesions to be a rare presentation of disseminated tuberculosis in an infant.

Chylothorax is a serious postoperative risk in pediatric esophagectomy due to thoracic duct injury. This case report demonstrates the feasibility and safety of indocyanine green fluorescence with near-infrared imaging for real-time thoracic duct visualization, enabling duct preservation and potentially reducing complications during thoracoscopic esophagectomy in a child with corrosive stricture.

Aim: To evaluate the impact of nurse-led intervention program on the knowledge and confidence of mothers regarding home-based care of children with solid organ tumor.

Subjects and methods: A quasi-experimental study was conducted among 60 mothers of children with solid organ tumors at the pediatric surgery ward of a tertiary hospital. The intervention group received a nurse-led video-based program on home-based care, while the control group received standard care. A structured knowledge questionnaire and confidence assessment scale were used to assess mothers' knowledge and confidence before and after intervention at 1 week and 4 weeks.

Results: The experimental group's mean knowledge and confidence scores were significantly higher at 1 week and 4 weeks than the control group (P < 0.05). The majority of the experimental group demonstrated good knowledge at both time points. No significant association was found between knowledge/confidence and mothers' demographics. However, a positive correlation between knowledge and confidence was noted in both the chemotherapy and postoperative groups at 4 weeks (r = 0.525 and r = 0.729, respectively).

Conclusion: Video-based nursing intervention was effective in increasing knowledge and confidence among the mothers of children with solid organ tumors for imparting home-based care.

Pancreatic pseudocysts are uncommon in pediatrics and rarely present with pleuropulmonary complications. We present the case of a 5-year-old girl with abdominal pain and respiratory distress, who was managed nonsurgically, even after multiple complications. The successful management of the case underscores the importance of multidisciplinary care, as well as minimally invasive approaches, including endoscopic management and interventional embolization.