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Law ZW, Ong CCP, Yap TL, Loh AHP, Joseph U, Sim SW, Ong LY, Low Y, Jacobsen AS, Chen Y. Extravesical vs. intravesical ureteric reimplantation for primary vesicoureteral reflux: A systematic review and meta-analysis. Front Pediatr 2022; 10:935082. [PMID: 36340705 PMCID: PMC9633941 DOI: 10.3389/fped.2022.935082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This study aims to compare the outcomes of extravesical (EVUR) and intravesical (IVUR) ureteric reimplantation for primary vesicoureteral reflux (VUR) via systematic review and meta-analysis. METHODS Literature review from Medline, Embase, and Cochrane since inception to March 2022 was performed. Meta-analysis was conducted on eligible randomized controlled trials (RCT) and observational cohort studies (OCS) comparing outcomes between EVUR and IVUR. RESULTS Twelve studies were included, comprising 577 patients (778 ureters) operated by EVUR and 395 patients (635 ureters) by IVUR. Pre-operative VUR grade, postoperative VUR persistence and hydronephrosis was not statistically significant. EVUR had shorter operative time [mean differences (MD) -22.91 min; 95% confidence interval (CI), -44.53 to -1.30, P = 0.04] and hospital stay (MD -2.09 days; 95% CI, -2.82 to -1.36, P < 0.00001) compared to IVUR. Bilateral EVUR had higher risk of postoperative acute urinary retention (ARU) (8.1%) compared to bilateral IVUR (1.7%) (OR = 4.40; 95% CI, 1.33-14.58, P = 0.02). No patient undergoing unilateral EVUR or IVUR experienced ARU. CONCLUSION Both EVUR and IVUR are equally effective in correcting primary VUR. Operative time and hospital stay are shorter after EVUR compared to IVUR. However, bilateral EVUR is associated with higher risk of postoperative ARU.
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Affiliation(s)
- Zhi Wei Law
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Caroline C P Ong
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Te-Lu Yap
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Amos H P Loh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Udayan Joseph
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Siam Wee Sim
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lin Yin Ong
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Low
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Anette S Jacobsen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yong Chen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
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Jacobsen AS, Loh AHP, Joseph VT. A history of paediatric surgery in Singapore. Singapore Med J 2021. [DOI: 10.11622/smedj.2021077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Othman MY, Blair S, Nah SA, Ariffin H, Assanasen C, Soh SY, Jacobsen AS, Lam C, Loh AHP. Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia. JCO Glob Oncol 2020; 6:1328-1345. [PMID: 32886560 PMCID: PMC7529532 DOI: 10.1200/go.20.00284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor boards (MDTBs) are lacking in low- and middle-income countries (LMICs). We aimed to profile the landscape of pediatric solid tumor care and practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMICs. METHODS Using online surveys, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, one pediatric surgeon and one pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. RESULTS In 37 (80.4%) of 46 identified PSTUs, availability of pediatric-trained specialists was as follows: oncologists, 94.6%; surgeons, 91.9%; radiologists, 54.1%; pathologists, 40.5%; radiation oncologists, 29.7%; nuclear medicine physicians, 13.5%; and nurses, 81.1%. Availability of pediatric-trained surgeons, radiologists, and pathologists was significantly associated with the existence of MDTBs (P = .037, .005, and .022, respectively). Among 43 (89.6%) of 48 respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported > 50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between oncologists and surgeons. The majority agreed that MDTBs helped to improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations were the top barriers. CONCLUSION This first known profile of pediatric solid tumor care in Southeast Asia found that availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs in this region. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathologic diagnoses were the most common limitations for MDTBs. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- Department of Pediatric Surgery, Hospital Tunku Azizah (Women’s and Children’s Hospital), Kuala Lumpur, Malaysia
| | - Sally Blair
- Vietnam Pediatric Hematology Oncology Programme, Ho Chi Minh City, Vietnam
- Division of Pediatric Haematology and Oncology, Department of Pediatrics, National University of Singapore, Singapore
| | - Shireen A. Nah
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Ariffin
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chatchawin Assanasen
- Vietnam Pediatric Hematology Oncology Programme, Ho Chi Minh City, Vietnam
- Southeast Asia Pediatric Hematology Oncology, Division of Hematology/Oncology Department of Pediatrics, UT Health San Antonio, San Antonio, TX
| | - Shui Yen Soh
- Haematology/Oncology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - Anette S. Jacobsen
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- SingHealth-Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
| | - Catherine Lam
- St Jude Global, St Jude Children’s Research Hospital, Memphis, TN
| | - Amos H. P. Loh
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- SingHealth-Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
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Chiang JJY, Angus MI, Nah SA, Jacobsen AS, Low Y, Choo CSC, Yap TL, Chen Y. Time course response of inflammatory markers in pediatric appendicitis. Pediatr Surg Int 2020; 36:493-500. [PMID: 32088741 DOI: 10.1007/s00383-020-04620-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We aim to evaluate the diagnostic value and time course response of the triple inflammatory markers: white blood cell count (WBC), neutrophil percentage (Neu), and C-reactive protein (CRP) in pediatric acute appendicitis. METHODS A retrospective review of clinical data pertaining to 1391 patients admitted with suspicion for pediatric appendicitis from 2012 to 2017 was conducted. Triple inflammatory markers were acquired upon admission. Appendicitis was confirmed histologically post-appendectomy. The diagnostic value and time course response of these markers was trended in relation to the duration of abdominal pain on admission. RESULTS 718 patients had histologically confirmed appendicitis. WBC and Neu demonstrate high sensitivity for early appendicitis at 94.6% and 80.0% at Day 1, while CRP demonstrates highest sensitivity of 97.9% at Day 4. The triple markers had poor overall diagnostic value when interpreted individually, however, had a high combined sensitivity of 99.7% and negative predictive value of 98.7% regardless of duration of disease. Overall negative appendectomy rate was 6.7% (n = 52). Among 19 patients with triple markers negative who underwent appendectomy, 17 (89.5%) were histologically normal. CONCLUSIONS The triple inflammatory markers have limited diagnostic value when interpreted individually, but are strong discriminators of pediatric appendicitis when combined. Their high sensitivity and negative predictive value could potentially help patients avoid unnecessary admissions or costly imaging studies, and reduce negative appendectomy rates. In addition, their objective nature confers an advantage over existing clinical scoring systems which comprise subjective elements.
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Affiliation(s)
- Jayne J Y Chiang
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Mark Ian Angus
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Shireen A Nah
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Division of Surgery, Duke-NUS Medical School, Singapore, Singapore
| | - Anette S Jacobsen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Division of Surgery, Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee Low
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Division of Surgery, Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Candy S C Choo
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Te-Lu Yap
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yong Chen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Division of Surgery, Duke-NUS Medical School, Singapore, Singapore.
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Madsen B, Salewski M, Huang J, Jacobsen AS, Jones O, McClements KG. Velocity-space tomography using prior information at MAST. Rev Sci Instrum 2018; 89:10D125. [PMID: 30399877 DOI: 10.1063/1.5035498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
Velocity-space tomography provides a way of diagnosing fast ions in a fusion plasma by combining measurements from multiple instruments. We use a toroidally viewing and a vertically viewing fast-ion D-alpha diagnostic installed on the mega-amp spherical tokamak (before the upgrade) to perform velocity-space tomography of the fast-ion distribution function. To make up for the scarce amount of data, prior information is included in the inversions. We impose a non-negativity constraint, suppress the distribution in the velocity-space region associated with null-measurements, and encode the belief that the distribution function does not extend to energies significantly higher than those expected neoclassically. This allows us to study the fast-ion velocity distributions and the derived fast-ion densities before and after a sawtooth crash.
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Affiliation(s)
- B Madsen
- Department of Physics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - M Salewski
- Department of Physics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - J Huang
- Institute of Plasma Physics, Chinese Academy of Sciences, P.O. 1126, 230031 Hefei, Anhui, China
| | - A S Jacobsen
- Max-Planck-Institut für Plasmaphysik, Garching, Germany
| | - O Jones
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - K G McClements
- CCFE, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
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Nah SA, Ong CCP, Saffari SE, Ong LY, Yap TL, Low Y, Jacobsen AS. Anorectal malformation & Hirschsprung's disease: A cross-sectional comparison of quality of life and bowel function to healthy controls. J Pediatr Surg 2018; 53:1550-1554. [PMID: 28916047 DOI: 10.1016/j.jpedsurg.2017.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/14/2017] [Accepted: 08/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with anorectal malformation (ARM) and Hirschsprung's disease (HD) face long-term disturbance in bowel function even after definitive surgery. This study evaluates the quality of life (QOL) of patients with ARM and HD, and compares them to healthy controls using self-report questionnaires. METHODOLOGY A prospective study was performed recruiting patients with ARM or HD from September 2013 to December 2014 who had primary surgery done in our institution at least 2 years prior to participation. Age-matched and gender-matched controls were enrolled from our patients with minor outpatient complaints. All participants completed the following PedsQL™ scales (maximum score 100): 4.0 Generic Core Scales, 3.0 General Well-Being (GWB) Scale and 2.0 Family Impact (FI) Module. All were also scored on bowel function (BFS), with a maximum score 20. Appropriate statistical analysis was performed, with significance level <0.05. RESULTS There were 193 participants: 87 controls, 62 ARM, 44 HD. When comparing Core, GWB and FI scores, there were no significant differences between groups although controls had best scores indicating best QOL and general wellbeing, with least impact of the child's health on the family. BFS was significantly different with controls having best and ARM worst scores. There were no significant differences in scores between parent and child indicating intradyad consistency. There was significant positive correlation between BFS and Core (p<0.0001), and between BFS and GWB scores (p<0.005); and significant negative correlation between BFS and FI scores (p<0.0001). CONCLUSIONS Bowel function impacts quality of life. Those with ARM and HD can achieve good quality of life comparable to controls, based on patient and caregiver self-reported outcomes. TYPE OF STUDY Prospective comparative study LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Caroline C P Ong
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | | | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Te-Lu Yap
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Yee Low
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Anette S Jacobsen
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore.
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Galdon-Quiroga J, Garcia-Munoz M, McClements KG, Nocente M, Hoelzl M, Jacobsen AS, Orain F, Rivero-Rodriguez JF, Salewski M, Sanchis-Sanchez L, Suttrop W, Viezzer E. Beam-Ion Acceleration during Edge Localized Modes in the ASDEX Upgrade Tokamak. Phys Rev Lett 2018; 121:025002. [PMID: 30085760 DOI: 10.1103/physrevlett.121.025002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/09/2018] [Indexed: 06/08/2023]
Abstract
The acceleration of beam ions during edge localized modes (ELMs) in a tokamak is observed for the first time through direct measurements of fast-ion losses in low collisionality plasmas. The accelerated beam-ion population exhibits well-localized velocity-space structures which are revealed by means of tomographic inversion of the measurement, showing energy gains of the order of tens of keV. This suggests that the ion acceleration results from a resonant interaction between the beam ions and parallel electric fields arising during the ELM. Orbit simulations are carried out to identify the mode-particle resonances responsible for the energy gain in the particle phase space. The observation motivates the incorporation of a kinetic description of fast particles in ELM models and may contribute to a better understanding of the mechanisms responsible for particle acceleration, ubiquitous in astrophysical and space plasmas.
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Affiliation(s)
- J Galdon-Quiroga
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, Junta de Andalucia, Consejo Superior de Investigaciones Cientificas (CSIC), Parque Cientifico y Tecnologico Cartuja, c/Thomas Alva Edison, 7 41092 Seville, Spain
| | - M Garcia-Munoz
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, Junta de Andalucia, Consejo Superior de Investigaciones Cientificas (CSIC), Parque Cientifico y Tecnologico Cartuja, c/Thomas Alva Edison, 7 41092 Seville, Spain
| | - K G McClements
- CCFE, Culham Science Centre, Abingdon OX14 3DB, United Kingdom
| | - M Nocente
- Dipartimento di Fisica G Occhialini, Universita di Milano-Bicocca, Milano, Italy
| | - M Hoelzl
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - A S Jacobsen
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - F Orain
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - J F Rivero-Rodriguez
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, Junta de Andalucia, Consejo Superior de Investigaciones Cientificas (CSIC), Parque Cientifico y Tecnologico Cartuja, c/Thomas Alva Edison, 7 41092 Seville, Spain
- Department of Mechanical Engineering and Manufacturing, University of Seville, Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - M Salewski
- Department of Physics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - L Sanchis-Sanchez
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, Junta de Andalucia, Consejo Superior de Investigaciones Cientificas (CSIC), Parque Cientifico y Tecnologico Cartuja, c/Thomas Alva Edison, 7 41092 Seville, Spain
| | - W Suttrop
- Max Planck Institute for Plasma Physics, Boltzmannstrasse, 2 85748 Garching bei Munchen, Germany
| | - E Viezzer
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, Junta de Andalucia, Consejo Superior de Investigaciones Cientificas (CSIC), Parque Cientifico y Tecnologico Cartuja, c/Thomas Alva Edison, 7 41092 Seville, Spain
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Jacobsen AS, Binda F, Cazzaniga C, Eriksson J, Hjalmarsson A, Nocente M, Salewski M, Tardini G. Velocity-space sensitivities of neutron emission spectrometers at the tokamaks JET and ASDEX Upgrade in deuterium plasmas. Rev Sci Instrum 2017; 88:073506. [PMID: 28764505 DOI: 10.1063/1.4991651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Future fusion reactors are foreseen to be heated by the energetic alpha particles produced in fusion reactions. For this to happen, it is important that the energetic ions are sufficiently confined. In present day fusion experiments, energetic ions are primarily produced using external heating systems such as neutral beam injection and ion cyclotron resonance heating. In order to diagnose these fast ions, several different fast-ion diagnostics have been developed and implemented in the various experiments around the world. The velocity-space sensitivities of fast-ion diagnostics are given by so-called weight functions. Here instrument-specific weight functions are derived for neutron emission spectrometry detectors at the tokamaks JET and ASDEX Upgrade for the 2.45 MeV neutrons produced in deuterium-deuterium reactions in deuterium plasmas. Using these, it is possible to directly determine which part of velocity space each detector observes.
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Affiliation(s)
- A S Jacobsen
- Max-Planck-Institut für Plasmaphysik, Garching, Germany
| | - F Binda
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
| | - C Cazzaniga
- ISIS Facility, Rutherford Appleton Laboratory, Science and Technology Facilities Council, Didcot OX11 0QX, United Kingdom
| | - J Eriksson
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
| | - A Hjalmarsson
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
| | - M Nocente
- Dipartimento di Fisca "G. Occhialini," Università degli Studi di Milano-Bicocca, Milano, Italy
| | - M Salewski
- Department of Physics, Technical University of Denmark, Kongens Lyngby, Denmark
| | - G Tardini
- Max-Planck-Institut für Plasmaphysik, Garching, Germany
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Yap TL, Chen Y, Low WWX, Ong CCP, Nah SA, Jacobsen AS, Shen L, Low Y. A new 2-step risk-stratification clinical score for suspected appendicitis in children. J Pediatr Surg 2015; 50:2051-5. [PMID: 26477755 DOI: 10.1016/j.jpedsurg.2015.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 08/24/2015] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to develop a new Children's Appendicitis Score (CAS) by combining 3 inflammatory markers and a set of predictors for suspected appendicitis in children. METHODS 374 children aged 4-16years with suspicion of appendicitis were prospectively enrolled for the derivation cohort. Demographic characteristics, clinical features, laboratory, and histology data were collected. The outcome measure was the histological presence or absence of appendicitis. Backward logistic regression was employed to select predictors for construction of a score. Diagnostic performance of CAS was compared with the Pediatric Appendicitis Score (PAS) on a separate validation cohort. RESULTS The combination of normal white blood cell count (WBC), neutrophil percentage, and C-reactive protein (CRP) had a 100% negative predictive value for appendicitis. We assigned 'coefficient A' as 'zero' when all triple markers were negative and 'one' when any one markers was positive. A second component of 6 predictors was identified for construction of the 'raw score': Localized right-lower-quadrant pain, generalized guarding, constant characteristic of pain, pain on percussion or coughing, WBC≥14000/L and CRP≥24g/L. CAS was generated by multiplying 'coefficient A' by 'raw score'. CONCLUSION CAS is superior to PAS in ruling out appendicitis. Risk stratification of equivocal patients could guide the need for further diagnostic imaging examination.
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Affiliation(s)
- Te-Lu Yap
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
| | - Yong Chen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Wilson Wei Xin Low
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Anette S Jacobsen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Liang Shen
- Department of Biostatistics, National University Health System, Singapore
| | - Yee Low
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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10
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Lim LY, Nah SA, Lakshmi NK, Yap TL, Jacobsen AS, Low Y, Ong CCP. Undescended testis: Level of knowledge among potential referring health-care providers. J Paediatr Child Health 2015; 51:1109-14. [PMID: 25939451 DOI: 10.1111/jpc.12911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2015] [Indexed: 11/27/2022]
Abstract
AIM Studies report that most boys with undescended testis(UDT) are referred and operated beyond the recommended age of 1 year, possibly due to lack of awareness of treatment guidelines. We investigate the level of knowledge of UDT among potential referring health-care providers. METHOD We devised a survey on the clinical features and appropriate management of UDT. Using convenience sampling, we approached health-care professionals with regular contact with paediatric patients and final year medical students. Respondents were allowed to remain anonymous. They were categorised according to specialty and level of experience/training. RESULTS Of 1179 approached, 203 responded. Thirty-six (24%) of 149 qualified doctors had never seen a case of UDT. Median score was 6 (range 1-9). There was no significant difference in scores when comparing specialty. Mean scores decreased significantly in trend according to level of experience. When questioned regarding timings of referral and orchidopexy, 24% of qualified doctors would not refer until 9 months of age, and 66% thought orchidopexy should be done after 1 year old. Half would stop examining for UDT after 2 years old. CONCLUSIONS Inexperience with UDT and outdated knowledge may contribute to delays in referral for UDT. Many would stop examining for UDT at 2 years old, placing undue reliance on accurate physical examination in early childhood and indicating lack of awareness of the ascending testis. Community health initiatives must emphasise recent changes in guidelines for management of UDT.
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Affiliation(s)
- Li Yan Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shireen A Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | | | - Te-Lu Yap
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Anette S Jacobsen
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Yee Low
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Caroline C P Ong
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
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11
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Jacobsen AS, Salewski M, Eriksson J, Ericsson G, Hjalmarsson A, Korsholm SB, Leipold F, Nielsen SK, Rasmussen J, Stejner M. Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET. Rev Sci Instrum 2014; 85:11E103. [PMID: 25430282 DOI: 10.1063/1.4885477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR.
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Affiliation(s)
- A S Jacobsen
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
| | - M Salewski
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
| | - J Eriksson
- Association Euratom - VR, Uppsala University, Department of Physics and Astronomy, Uppsala, Sweden
| | - G Ericsson
- Association Euratom - VR, Uppsala University, Department of Physics and Astronomy, Uppsala, Sweden
| | - A Hjalmarsson
- Association Euratom - VR, Uppsala University, Department of Physics and Astronomy, Uppsala, Sweden
| | - S B Korsholm
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
| | - F Leipold
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
| | - S K Nielsen
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
| | - J Rasmussen
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
| | - M Stejner
- Association Euratom - DTU, Technical University of Denmark, Department of Physics, Kgs. Lyngby, Denmark
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Stejner M, Nielsen S, Jacobsen AS, Korsholm SB, Leipold F, Meo F, Michelsen PK, Moseev D, Rasmussen J, Salewski M, Schubert M, Stober J, Wagner DH. Resolving the bulk ion region of millimeter-wave collective Thomson scattering spectra at ASDEX Upgrade. Rev Sci Instrum 2014; 85:093504. [PMID: 25273723 DOI: 10.1063/1.4894199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Collective Thomson scattering (CTS) measurements provide information about the composition and velocity distribution of confined ion populations in fusion plasmas. The bulk ion part of the CTS spectrum is dominated by scattering off fluctuations driven by the motion of thermalized ion populations. It thus contains information about the ion temperature, rotation velocity, and plasma composition. To resolve the bulk ion region and access this information, we installed a fast acquisition system capable of sampling rates up to 12.5 GS/s in the CTS system at ASDEX Upgrade. CTS spectra with frequency resolution in the range of 1 MHz are then obtained through direct digitization and Fourier analysis of the CTS signal. We here describe the design, calibration, and operation of the fast receiver system and give examples of measured bulk ion CTS spectra showing the effects of changing ion temperature, rotation velocity, and plasma composition.
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Affiliation(s)
- M Stejner
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - S Nielsen
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - A S Jacobsen
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - S B Korsholm
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - F Leipold
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - F Meo
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - P K Michelsen
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - D Moseev
- Max-Planck-Institut für Plasmaphysik, EURATOM-Association, Boltzmannstr. 2, 85748 Garching, Germany
| | - J Rasmussen
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - M Salewski
- Department of Physics, Association EURATOM-DTU, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - M Schubert
- Max-Planck-Institut für Plasmaphysik, EURATOM-Association, Boltzmannstr. 2, 85748 Garching, Germany
| | - J Stober
- Max-Planck-Institut für Plasmaphysik, EURATOM-Association, Boltzmannstr. 2, 85748 Garching, Germany
| | - D H Wagner
- Max-Planck-Institut für Plasmaphysik, EURATOM-Association, Boltzmannstr. 2, 85748 Garching, Germany
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13
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Nah SA, Yeo CSW, How GY, Allen JC, Lakshmi NK, Yap TL, Jacobsen AS, Low Y, Ong CCP. Undescended testis: 513 patients' characteristics, age at orchidopexy and patterns of referral. Arch Dis Child 2014; 99:401-6. [PMID: 24225274 DOI: 10.1136/archdischild-2013-305225] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Undescended testis (UDT) affects 1-6% of males. Current recommendations are to correct maldescent by 1 year of age. We identify the population characteristics of children referred and managed for UDT, age at referral and orchidopexy, and patterns of referral. DESIGN, SETTING AND PATIENTS Retrospective 5-year review of all patients operated for UDT from 2007 to 2011 in our institution. Patient demographics, neonatal diagnosis of UDT, age at referral, referral source and age at first orchidopexy were recorded. Data are reported as median (range). RESULTS There were 513 boys with 576 undescended gonads; 450 (88%) had unilateral UDT. Congenital (present at birth) UDT was diagnosed in 287 (56%) children. Seventy-nine (15%) were premature births, 41 (8%) had associated major genitourinary abnormalities. Median age at referral was 1.1 (0-16.2) years; median age at first orchidopexy was 1.6 (0-17.2) years. When corrected for age, those with a history of prematurity and associated major genitourinary malformations were referred and operated on earlier. There was no difference in age at referral and orchidopexy when comparing unilateral versus bilateral maldescent, and palpability of UDT. Of those with congenital UDT, 70% were operated at beyond 1 year of age. Those referred from public tertiary hospitals were younger than those referred from community clinics (p<0.0001) and private healthcare institutions (p=0.003). CONCLUSIONS Despite early diagnosis in many patients with UDT, most are referred and operated after 1 year of age, even in congenital UDT. Premature babies, those with major genitourinary anomalies, and those seen in public tertiary hospitals are referred earlier. Community health initiatives must emphasise prompt referral to allay the impact of delayed surgery.
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Affiliation(s)
- Shireen A Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, , Singapore, Singapore
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14
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Leipold F, Salewski M, Jacobsen AS, Jessen M, Korsholm SB, Michelsen PK, Nielsen SK, Stejner M. Polarizer design for millimeter-wave plasma diagnostics. Rev Sci Instrum 2013; 84:084701. [PMID: 24007082 DOI: 10.1063/1.4816724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Radiation from magnetized plasmas is in general elliptically polarized. In order to convert the elliptical polarization to linear polarization, mirrors with grooved surfaces are currently employed in our collective Thomson scattering diagnostic at ASDEX Upgrade. If these mirrors can be substituted by birefringent windows, the microwave receivers can be designed to be more compact at lower cost. Sapphire windows (a-cut) as well as grooved high density polyethylene windows can serve this purpose. The sapphire window can be designed such that the calculated transmission of the wave energy is better than 99%, and that of the high density polyethylene can be better than 97%.
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Affiliation(s)
- F Leipold
- Department of Physics, Technical University of Denmark, DK-4000 Roskilde, Denmark
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15
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Nah SA, Ong CCP, Lakshmi NK, Yap TL, Jacobsen AS, Low Y. Anomalies associated with anorectal malformations according to the Krickenbeck anatomic classification. J Pediatr Surg 2012; 47:2273-8. [PMID: 23217888 DOI: 10.1016/j.jpedsurg.2012.09.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/01/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE We evaluated the incidence of congenital anomalies associated with anorectal malformations (ARMs) in relation to the anatomic type of ARM as defined by the Krickenbeck classification. METHODS We reviewed 99 children with ARM in our institution from 2002 to 2011. Data were collected on patient demographics, type of ARM, and associated congenital anomalies, which were categorized according to organ systems. Statistical analysis was performed for comparison between groups using 'perineal fistula' as the base group. RESULTS There were 62 (63%) male patients. The majority had perineal fistulas (35, 35%). Seventy-seven (78%) had at least one associated malformation. The most frequent malformations seen were genitourinary (28, 28%) and spinal anomalies (26, 26%). Those with rectovesical fistula had the highest proportion of genitourinary malformations (Odds Ratio [OR], 41.3; 95% confidence interval [CI], 4.7-363.4). Those with cloaca (OR, 49.5; 95% CI, 3.4-718.9) and those with rectovestibular fistula (OR, 12.4; 95% CI, 2.3-65.6) were most likely to have major spinal abnormalities, with tethered cord seen in all groups. The rectovestibular group was also most likely to have other associated malformations (OR, 8.6; 95% CI, 2.2-32.8). CONCLUSION More than 75% of children with anorectal malformation have other associated malformations. Genitourinary anomalies are the most common. Major spinal anomalies are seen in all groups, affecting nearly half of those with rectovestibular fistula and those without fistula. The incidence of associated malformations in the rectovestibular group is higher than described in the literature. Thorough systematic evaluation of all infants with ARM should be done regardless of type of ARM.
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Affiliation(s)
- Shireen A Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore 229899, Singapore
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16
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Fung W, Hasan MY, Loh AHP, Chua JHY, Yong MH, Knight L, Hwang WS, Chan MY, Seow WT, Jacobsen AS, Chui CH, Seow WT, Tew SW, Jacobsen AS, Chui CH, Hon CC. Gene expression of TRK neurotrophin receptors in advanced neuroblastomas in Singapore--a pilot study. Pediatr Hematol Oncol 2011; 28:571-8. [PMID: 21728718 DOI: 10.3109/08880018.2011.575443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical hallmark of neuroblastoma is heterogeneity. Biologically, ploidy and N-Myc amplification are currently the only 2 features used to define risk group and to determine therapy. Tyrosine kinase neurotrophin receptors (Trks, including TrkA, TrkB, and TrkC) are important in the clinical and biological behavior of neuroblastomas. The authors aim to study Trks gene expression in their local population of advanced neuroblastoma patients. Multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay on the expression of TrkA, TrkB, TrkB-truncated, and TrkC was performed on a total of 19 advanced neuroblastoma archival tumors, diagnosed in KK Women's and Children's Hospital between 2003 and 2007. Of the 19 tumors investigated, Trks expression was present in 14 (73.6%) cases. Of these cases, 8 (42.1%), 10 (52.6%), 7 (36.8%), and 6 (31.6%) expressed TrkA, TrkB, TrkB-truncated, and TrkC receptor mRNAs, respectively. Subsequently, the authors compared Trks expression with N-Myc amplification status of the 19 patients. N-Myc was amplified in 5 (26.3%) of the cases. Within the non-N-Myc-amplified group, Trks expression was present in 9 (64%) of the 14 cases. The significant expression of Trk isoforms among advanced neuroblastoma cases as evident from this study support their role as possible risk assessment tools alongside N-Myc amplification status.
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Affiliation(s)
- Winnie Fung
- Division of Surgery, KKWomen’s and Children’s Hospital, 100 Bukit Timah Road, Singapore.
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17
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Loh AHP, Ong LY, Liew WK, Arkachaisri T, Lee VKM, Narasimhan KL, Jacobsen AS. Multiple indomethacin-induced colonic perforations in an adolescent. Singapore Med J 2011; 52:e82-e84. [PMID: 21552780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Colonic perforation is an uncommon cause of acute abdomen in paediatric patients, and can present a diagnostic enigma as well as management challenge to the paediatric surgeon. An adolescent developed multiple colonic perforations following a short course of oral indomethacin, requiring emergency hemicolectomy. This is the youngest known case of enteral non-steroidal anti-inflammatory drug (NSAID)-mediated large bowel injury. We review current evidence on NSAID-related enteropathy, and postulate potentiating mechanisms that may have accounted for the unusually rapid clinical course of our patient.
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Affiliation(s)
- A H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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18
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Lee RM, Ong CP, Jacobsen AS, Chan MY, Hwang WS. Malignant peripheral nerve sheath tumor mimicking carotid body tumor--case report and review. J Pediatr Surg 2011; 46:554-8. [PMID: 21376209 DOI: 10.1016/j.jpedsurg.2010.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 10/10/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
Malignant peripheral nerve sheath tumor is a rare neurogenic tumor that usually presents in geriatic patients. Typically, it is found in the trunk and extremities and rarely presents in the head and neck region. It may mimic a carotid body tumor when it presents in the neck. We report the first case of malignant peripheral nerve sheath tumor of the vagus nerve in an adolescent boy. He presented with an asymptomatic lateral neck lump that was thought to be a benign schwannoma on preoperative imaging. We describe the diagnostic dilemma and management difficulties in this patient and review the literature.
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Affiliation(s)
- R M Lee
- Department of Paediatric Surgery, Kandang Kerbau Women and Children's Hospital, Singapore.
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19
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Chiang LW, Jacobsen AS, Ong CL, Huang WS. Persistent sterile pyuria in children? Don't forget tuberculosis! Singapore Med J 2010; 51:e48-e50. [PMID: 20428732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Genitourinary tuberculosis (GUTB) is exceptionally uncommon among the local paediatric population. A 10-year-old Chinese girl with no risk factors for tuberculosis presented with recurrent sterile pyuria. Despite extensive renal investigations, no apparent cause could be ascertained for her obstructed left drainage system. The diagnosis was eventually confirmed with urine acid-fast bacilli culture, after a computed tomography scan suggested possible renal tuberculosis. Left nephroureterectomy had to be performed owing to deteriorating left kidney function. This report discusses the importance of considering tuberculosis when assessing a local paediatric patient with an atypical urinary tract infection. Early diagnosis of renal tuberculosis can prevent the sequelae of GUTB, including renal impairment.
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Affiliation(s)
- L W Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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20
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Ong CPC, Chan TKN, Chui CH, Jacobsen AS. Antibiotics and postoperative abscesses in complicated appendicitis: is there any association? Singapore Med J 2008; 49:615-618. [PMID: 18756343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Complicated appendicitis has significant infective postoperative morbidity. There is no universally-accepted antibiotic regime, although traditionally, triple antibiotics are recommended. Our complicated appendicitis clinical pathway recommends ceftriaxone and metronidazole. The study aimed to determine if choice of antibiotics influenced the risk of infective complications. METHODS We reviewed all paediatric appendicectomy patients between January 1, 2005 and December 31, 2005. All patients with intraoperative diagnosis of perforated appendicitis were recruited, excluding infants, immunocompromised patients, and patients allergic to the guideline antibiotics. All operations were performed by registrar/consultant surgeons and were laparoscopic, unless technically not feasible. RESULTS There were 82 patients with perforated appendicitis. 62 patients (76 percent) followed pathway antibiotics, and 20 patients (24 percent) deviated from the pathway by receiving additional empiric gentamycin. We compared the pathway compliant and deviation groups, and found no significant differences in patient characteristics, clinical presentation, operation, length of stay and infective complications. Overall there was one wound infection and five (six percent) postoperative abscesses. Initial peritoneal cultures and subsequent drainage cultures of patients who developed abscesses were sensitive to treatment antibiotics. CONCLUSION In complicated appendicitis, empirical perioperative addition of gentamycin to ceftriaxone and metronidazole did not reduce the risk of developing intra-abdominal abscess, compared to changing antibiotics on clinical grounds. Patients developed postoperative abscesses despite initial peritoneal cultures growing organisms sensitive to treatment antibiotics.
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Affiliation(s)
- C P C Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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21
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Chui CH, Chan MY, Tan AM, Low Y, Yap TL, Jacobsen AS. Appendicitis in immunosuppressed children: Still a diagnostic and therapeutic dilemma? Pediatr Blood Cancer 2008; 50:1282-3. [PMID: 18306278 DOI: 10.1002/pbc.21554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Acute appendicitis in the immunosuppressed patients are often difficult to diagnose and are associated with increased morbidity and mortality. Recent debates on primary appendicitis and typhlitis-associated appendicitis have contributed to the diagnostic and therapeutic dilemma. We retrospectively reviewed all our immunosuppressed patients with appendicitis. The most frequent presenting symptom was fever followed by non-specific intermittent abdominal pain. The median delay in diagnosis was 4 days. CT scan was useful in making the diagnosis, but the presence of adjacent bowel thickening has contributed to the dilemma in diagnosis and treatment.
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Affiliation(s)
- Chan-Hon Chui
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
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Abstract
We report a case of neonatal intestinal volvulus around a persistent right vitelline artery, presenting as an aberrant parieto-mesenteric band on exploratory laparotomy. To our knowledge, this is the first case report in the English literature of a persistent right vitelline artery causing axial intestinal volvulus in a neonate. A review of the literature and the embryopathogenesis is discussed, as well as the importance of emergent diagnoses of such lesions.
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Affiliation(s)
- Amos H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital , Singapore, Singapore.
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Abstract
BACKGROUND Despite routine use of air enema reduction in childhood intussusceptions, some still require operative management. This study evaluated the role of surgery and identified factors associated with failed air enema reduction and bowel resection. METHODS We reviewed 24 patients who underwent laparotomies for intussusception between 1 July 1999 and 31 July 2002. Demographic data, clinical presentations, investigations, surgical interventions and their outcomes were reviewed. RESULTS Twenty-four (14.5%) of 166 patients treated for intussusceptions between 1 July 1999 and 31 July 2002 underwent laparotomies. A significant proportion (45.8%) was younger than 3 months and older than 36 months of age. Intussusception was diagnosed on ultrasonography in 21 patients. Eighteen underwent attempted air enema reduction. Ileocolic intussusceptions occurred in 54.2% of patients. Five patients had small bowel intussusceptions, all of whom required bowel resection. Seven patients (29.2%) had pathological lead points. Presence of pathological lead points and intussusceptions occurring outside the ileocolic region strongly predicted the need for bowel resection. CONCLUSION Air enema reductions are less likely to succeed in patients less than 3 months old and those more than 3 years old. Bowel resection is most likely required when pathological lead points are present and when intussusceptions occur outside the ileocolic region. Early surgical intervention may obviate the need for bowel resection in selected patients, thereby reducing surgical morbidity.
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Affiliation(s)
- Joyce H Y Chua
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
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Abstract
OBJECTIVES Kikuchi disease is a benign, self-limiting condition of unknown aetiology, often manifesting as cervical lymphadenopathy and fever. The disease usually manifests itself in adulthood and paediatric reports are uncommon. The aims of this study are to report the features of Kikuchi disease in the local paediatric population, and to raise the awareness of this entity among clinicians involved in treating these children. METHODS This is a retrospective series of nine paediatric cases of Kikuchi disease treated in KK Women's and Children's Hospital, Singapore. The clinical presentation, subsequent clinical course and laboratory findings of these patients were reviewed. RESULTS The patients ranged in age from 7 to 16 years, and included six males and three females. All nine patients presented with fever and cervical lymphadenopathy. Hepatosplenomegaly was present in one child. The erythrocyte sedimentation rate was raised to variable extents, but there was no other significant haematological, serological or microbiological abnormality. In all cases the diagnosis was made on the basis of histological findings. CONCLUSIONS Kikuchi disease in the paediatric population is not as uncommon as previously thought, and should be considered in the differential diagnosis of any child with fever of unknown origin or cervical lymphadenopathy. Early recognition will minimize unnecessary investigations and prolonged empirical treatments.
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Affiliation(s)
- Ching K Chen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
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25
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Prasad TRS, Low Y, Tan CE, Jacobsen AS. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. Ann Acad Med Singap 2006. [DOI: 10.47102/annals-acadmedsg.v35n1p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: Although a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children.
Clinical Picture: Four children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases.
Treatment: Oesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval.
Outcome: All patients did well after the procedure with no complications.
Conclusions: Swallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications.
Key words: Complications, Ingestion, Treatment
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Affiliation(s)
| | - Y Low
- KK Women’s and Children’s Hospital, Singapore
| | - CE Tan
- KK Women’s and Children’s Hospital, Singapore
| | - AS Jacobsen
- KK Women’s and Children’s Hospital, Singapore
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26
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Sai Prasad TR, Low Y, Tan CE, Jacobsen AS. Swallowed foreign bodies in children: report of four unusual cases. Ann Acad Med Singap 2006; 35:49-53. [PMID: 16470275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Although a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children. CLINICAL PICTURE Four children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases. TREATMENT Oesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval. OUTCOME All patients did well after the procedure with no complications. CONCLUSIONS Swallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications.
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Affiliation(s)
- T R Sai Prasad
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
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27
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Goh BKP, Chui CH, Yap TL, Low Y, Lama TK, Alkouder G, Prasad S, Jacobsen AS. Is early laparoscopic appendectomy feasible in children with acute appendicitis presenting with an appendiceal mass? A prospective study. J Pediatr Surg 2005; 40:1134-7. [PMID: 16034758 DOI: 10.1016/j.jpedsurg.2005.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The management of an appendiceal mass remains controversial with 2 schools of thought; early surgical intervention vs nonoperative management with or without interval appendectomy. The aim is to determine the role and safety of early laparoscopic appendectomy (LA) in children with acute appendicitis presenting with an appendiceal mass. METHODS This is a prospective study of 88 consecutive pediatric patients who underwent attempted LA for suspected acute appendicitis at KK Women's and Children's Hospital, Singapore, between May and October 2003. RESULTS A total of 88 patients with a mean age of 10 +/- 3 years (range, 3-16 years) underwent LA for an appendiceal mass (n = 22), simple appendicitis (n = 36), other complicated (gangrenous or perforated) appendicitis (n = 23), and a normal appendix (n = 7). There were 7 conversions to open appendicectomy, 3 of which occurred in patients with an appendiceal mass. There were no perioperative or postoperative mortalities. Morbidity occurred in only one patient who underwent LA for perforated appendicitis. He had prolonged sepsis that resolved after 2 weeks of intravenous antibiotics. None of the patients with an appendiceal mass developed complications. Patients who underwent early LA for an appendiceal mass had a statistically significant (P < .05) longer operating time (median, 103 minutes; interquartile range, 90-151 minutes, vs median, 87 minutes; interquartile range, 71-112 minutes), prolonged time to ambulation (median, 2.0 days; interquartile range, 2-2.5 days, vs median, 1.0 days; interquartile, 1-2 days), increased time to resumption of diet (median, 4 days; interquartile, 3-5 days, vs median, 2 days; interquartile, 2-3 days), and longer postoperative stay (median, 6.0 days; interquartile, 5.5-6.5 days, vs median, 4.0 days; interquartile, 3-5.5 days) compared with patients presenting with appendicitis without mass formation. However, there was no statistical difference in these parameters when LA for an appendiceal mass was compared with LA for other complicated appendicitis (perforated and gangrenous). CONCLUSION Although early LA for an appendiceal mass is a technically demanding procedure, it can be performed safely in children with minimal morbidity and mortality. In an era where patients' demand for "key-hole" surgery is rising, early LA is a safe and viable option in the management of children with an appendiceal mass. It also offers the advantage of avoiding misdiagnoses and the need for a second hospitalization.
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Affiliation(s)
- Brian K P Goh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 229899, Singapore.
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Abstract
Our aim was to study the advantages of glue versus sutures for circumcision in children. A randomised prospective controlled study was conducted with 152 boys; glue was used on 80 and sutures on 72. The procedures were quicker and the duration and severity of postoperative pain were significantly less (p < 0.001) in the cases in which glue was used. The tissue glue is a perfectly feasible alternative to sutures for circumcision in children and has potentially significant advantages.
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Affiliation(s)
- R Subramaniam
- Department of Paediatric Urology, St. James University Hospital, 8th Floor, Gledhow Wing, Beckett Street, Leeds LS9 7TF, UK.
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29
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Abstract
The aims of this study were to determine the pattern of presentation of childhood mediastinal masses in our community and to identify factors associated with the development of acute airway compromise. The authors retrospectively reviewed the records of 29 consecutive patients with mediastinal masses managed at their institution between January 1995 and December 2001. Demographic data, mass characteristics, clinical presentation, and surgical procedures were recorded. Seven patients (24.1%) were asymptomatic at presentation. Eight (27.6%) were classified as having acute airway compromise at presentation. Respiratory symptoms and signs were the most common mode of presentation (58.6% and 55.2%, respectively). The most common histological diagnosis was neurogenic mass (37.9%), followed by lymphoma (24.1%). Most masses were located in the superior mediastinum (41.1%). Factors associated with the development of acute airway compromise were (1) anterior location of the mediastinal mass (P=0.019), (2) histological diagnosis of lymphoma (P=0.008), (3) symptoms and signs of superior vena cava syndrome (P=0.015 and 0.003, respectively), (4) radiological evidence of vessel compression or displacement (P=0.015), (5) pericardial effusion (P=0.015), and (6) pleural effusion (P=0.033). Clinical presentation of childhood mediastinal masses is often nonspecific or incidental. Yet they have the propensity of developing acute airway compromise, which is closely associated with superior vena cava obstruction. Such patients should be managed as a complex cardiorespiratory syndrome, termed "critical mediastinal mass syndrome", by an experienced multidisciplinary team.
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Affiliation(s)
- J C M Lam
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
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30
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Goh SK, Chui CH, Jacobsen AS. Childhood acute pancreatitis in a children's hospital. Singapore Med J 2003; 44:453-6. [PMID: 14740774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To analyse the cases of acute pancreatitis presented to a children's hospital in Singapore. METHODS Clinical charts of all children, aged under 18 years, who presented to our hospital for the first time with pancreatitis (ICD search criteria = 577.x) between the period of 1998 and mid-2002 were reviewed. Parameters analysed included presenting features, aetiology of the acute pancreatitis, length of hospital stay, complications, treatment and outcome. RESULTS There were 12 cases in the review period, and the attributable causes in these cases were, in descending order, trauma, drug-induced, anatomical anomalies, poisoning and idiopathic. Of interest were two patients whose pancreatitis were results of child abuse. The most common symptoms were abdominal pain (n=11) and vomiting (n=7), though only five patients localised the pain to the epigastrium. Abdominal tenderness could be elicited in all the patients. Eleven had evidence of acute pancreatitis from computerised tomography (CT) whilst the twelfth was diagnosed with ultrasonography. The peak amylase levels amongst these patients were not high, with a median of 512.5 U/L. In the acute stage, only one patient required operative intervention whilst the remainder were managed conservatively. The mean length of hospital stay was 12.41 +/- 4.54 days. The complications encountered included pseudocyst formation, ascites, hypocalcaemia, pleural effusion and coagulopathy. CONCLUSIONS The diagnosis of acute pancreatitis in children can be difficult. This is often due to ambiguous symptoms, signs and laboratory results. CT and ultrasound are essential investigations in the diagnosis and subsequent follow-up.
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Affiliation(s)
- S K Goh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
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31
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Ong CCP, Jacobsen AS, Joseph VT. Comparing wound closure using tissue glue versus subcuticular suture for pediatric surgical incisions: a prospective, randomised trial. Pediatr Surg Int 2002; 18:553-5. [PMID: 12415411 DOI: 10.1007/s00383-002-0728-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2001] [Indexed: 10/27/2022]
Abstract
Tissue adhesives have gained favour for quicker and painless closure of lacerations. To compare the tissue adhesive 2-octylcyanoacrylate with our current standard subcuticular suture for closure of surgical incisions in children, looking at outcome measures of time efficiency, cosmesis, and wound complications, a prospective, randomised, controlled trial was conducted at our institution's ambulatory surgery centre. All healthy patients undergoing unilateral or bilateral herniotomies were recruited prospectively with informed consent and randomly allocated to suture or glue. The exclusion criteria were neonates or children with allergy to tissue glue. Time of wound closure was measured from the subcutaneous layer to application of the dressing. An independent, blinded observer assessed cosmesis at 2 to 3 weeks using a validated wound scale ranging from worst (0) to best (6). Parent satisfaction with wound appearance was recorded on a 100-mm visual analogue scale (VAS). A total of 59 patients were recruited into the study with 26 in the glue group and 33 in the suture group. There was no difference in mean time of closure (glue 181 +/- 62 s vs suture 161 +/- 45 s, P = 0.18). Two patients in each group had a suboptimal Hollander wound score of 5 (7.7% glue, 6.1% suture). There was also no difference in parent satisfaction (VAS: glue 78 +/- 19 mm vs suture 81 +/- 15 mm, P = 0.68). No patient reported any rash, wound infection, or dehiscence. Tissue glue is easy to use with no complications and has equivalent cosmetic results, but is not faster than a subcuticular suture.
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Affiliation(s)
- C C P Ong
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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32
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Low SCS, Jacobsen AS, Teo ELHJ. Clinics in diagnostic imaging (73). Left hydronephrosis due to pelvi-ureteric junction obstruction. Singapore Med J 2002; 43:265-9. [PMID: 12188081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A full-term male infant was antenatally diagnosed to have left hydronephrosis. Post natal ultrasonography (US) and diuretic renography confirmed the diagnosis of left pelvi-ureteric junction obstruction. His clinical course was complicated by one episode of urinary tract infection. Serial US and diuretic renography showed no improvement in the obstruction. The patient underwent an Anderson-Hynes pyeloplasty at nine months of age with no post-operative complications. The diagnosis and management of antenatally-diagnosed hydronephrosis are discussed.
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Affiliation(s)
- S C S Low
- Department of Paediatric Surgery, Kandang Kerbau Women's and Children's Hospital, Singapore.
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33
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Lai AHM, Phua KB, Teo ELHJ, Jacobsen AS. Intussusception: a three-year review. Ann Acad Med Singap 2002; 31:81-5. [PMID: 11885503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Intussusception is the commonest cause of intestinal obstruction in infants and young children. MATERIALS AND METHODS This report reviews the clinical presentation, investigations and outcomes of patients with intussusception treated at the KK Women's and Children's Hospital between 1 May 1997 and 30 April 2000. RESULTS The study population comprised 160 consecutive patients treated for intussusception at our hospital over this 3-year period. The commonest symptom was vomiting; present in 135 patients (84.4%). A palpable abdominal mass was present in 90 patients (56.3%). The classical features of vomiting, abdominal pain, abdominal mass and rectal bleeding were present together in only 12 patients (7.5%). Abdominal ultrasonography was performed in 155 patients. One hundred and fifty-two patients (98.1%) had the classical target lesion on ultrasonography. Air enema reduction was attempted in all except 6 patients. In the majority of patients (130 or 84.4%), the intussusception was reduced successfully by air enema reduction. There was no association between the duration of symptoms before radiological reduction and the outcome of radiological reduction. CONCLUSIONS As the four classical features of intussusception were present together in only 7.5% of our patients, a high index of suspicion is necessary when any of the signs and symptoms are present in an infant or young child. Abdominal ultrasonography is the diagnostic investigation of choice. Air enema reduction was successful in 84.4% of patients and the duration of symptoms did not reduce the success rate. Thus, air enema reduction should be attempted in most patients unless they have absolute contraindications.
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Affiliation(s)
- A H M Lai
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
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34
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Jacobsen AS. Spirit and unity: Orsted's fascination by Winterl's chemistry. Centaurus 2001; 43:184-218. [PMID: 18642474 DOI: 10.1111/j.1600-0498.2000.cnt430303.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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35
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Jacobsen AS. A.W. Hauch's role in the introduction of antiphlogistic chemistry into Denmark. Ambix 2000; 47:71-95. [PMID: 11640224 DOI: 10.1179/amb.2000.47.2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- A S Jacobsen
- History of Science Department, University of Aarhus, Ny Munkegade, DK-8000, Aarhus, C., Denmark
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Chui CH, Jacobsen AS. Laparoscopy in the evaluation of the non-palpable undescended testes. Singapore Med J 2000; 41:206-8. [PMID: 11063168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
AIM OF STUDY To examine the role of laparoscopy in the evaluation of the non-palpable undescended testes in paediatric patients. METHOD A review of all laparoscopies performed for the evaluation of the non-palpable undescended testes in a children's hospital over a 12-month period was conducted. Special attention was paid to the patients' age, the location of the testes at the time of laparoscopy, the subsequent surgical procedures and the complications. RESULTS Sixteen boys underwent laparoscopy to localise 20 nonpalpable testes. 12 patients had unilateral disease while 4 had bilateral disease. 15 non-palpable testes were intraabdominal, 3 had inguinal testicular remnants and 2 had 'vanished'. A contralateral inguinal hernia was incidentally found in one patient. A patient with epididymal-gonadal non-union was not apparent at laparoscopy. There were no post-laparoscopic complications in all 16 patients. CONCLUSION Laparoscopy is safe and accurate in the evaluation of non-palpable testes in children. The accurate localisation of intraabdominal testes facilitates the development of an optimal surgical strategy.
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Affiliation(s)
- C H Chui
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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37
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Abstract
A total of 44 patients with preauricular sinus underwent one-stage surgical treatment. There were 32 unilateral and 12 bilateral cases giving a total of 56 sinuses. Of these 16 were infected at the time of presentation. Based on the observation that preauricular sinus represents the duct of a preauricular gland which is closely adherent to the fibrocartilage of the ear, the authors propose a method for the complete cure of this lesion by excising the whole gland and duct together. This technique was used in all cases including 16 patients with infected sinuses. There were three recurrences, two of which were due to incomplete excision of the gland. The third case was found to have a fistula leading to an atretic external auditory canal. All other patients have shown no evidence of recurrence on follow up of six months or longer. Our experience has shown that preauricular sinus can be effectively treated at any stage by a simple surgical technique based on a clear understanding of the underlying anatomy of the lesion.
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Affiliation(s)
- V T Joseph
- Department of Paediatric Surgery, Singapore General Hospital
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