A simple technique for small-diameter urethrocutaneous fistula repair: Ligation

OBJECTIVE

To describe a simple and effective technique for repairing a small-diameter urethrocutaneous fistula.

METHODS AND TECHNIQUE

A total of 13 patients with a solitary and small-diameter (≤2 mm) urethrocutaneous fistula underwent repair with a ligation technique.

RESULTS

None of the patients had voiding difficulties. One recurrent urethrocutaneous fistula occurred and it was successfully repaired with the same technique.

CONCLUSION

This is a simple, quick and useful technique, particularly for small-diameter (≤2 mm) urethrocutaneous fistulas.

Removal of Some Heavy Metal Cations from Aqueous Solution by Adsorption onto Natural Kaolin

The adsorption removal of some heavy metal cations such as Cu(II), Zn(II) and Co(II) from aqueous solution onto kaolin has been studied using the batch method with initial metal ion concentrations within the range 15–70 mg/l. The percentage adsorption and equilibrium concentrations were determined by means of atomic absorption flame photometry as a function of adsorbate concentration, pH and temperature.

Ion-exchange studies showed that over the complete concentration range studied the adsorption ratios for metal cations adsorbed onto kaolin correlated with the linear forms of the Langmuir, Freundlich and Dubinin—Kaganer—Radushkevich (DKR) adsorption isotherms. The cationexchange capacity of kaolin towards each metal ion studied was evaluated. It was found that the adsorption phenomena depended on the charge density and diameter of the hydrated ion. The equilibrium studies demonstrated that the selectivity of the ions followed the sequence Zn(II) > Cu(II) > Co(II) at pH 7.0. Calculation of thermodynamic parameters such as the standard enthalpy (ΔH0), Gibbs free energy (ΔG0) and entropy (ΔS0) showed that the adsorption of the heavy metal ions studied onto kaolin was an endothermic process which was favoured at higher temperatures.

These results show that natural kaolin has a considerable potential for the removal of heavy metal cationic species from aqueous solution and wastewater.

Pediatric gastric outlet obstruction following corrosive ingestion

PURPOSE

Corrosive substance ingestion is still a major medical and social problem for children. Gastric injury after corrosive ingestion is relatively uncommon as compared with esophageal injury. Gastric outlet obstruction (GOO) is a significant complication of corrosive ingestion.

METHODS

Medical records of 20 consecutive patients with GOO due to corrosive ingestion during an 8-year period between 2002 and 2009 were retrospectively reviewed.

RESULTS

There were 10 boys and 10 girls with a mean age of 5.1 years (1.5-15 years). Ingested material was acid in all the patients. Two patients had associated esophageal stricture. The mean time between the ingestion and the development of GOO was 27.8 days (range 21-45 days) and all the patients presented with postprandial epigastric distension, nonbilious vomiting and weight loss. Surgical treatment included gastroduodenostomy (n = 8), Billroth I (n = 7), pyloroplasty (n = 5), and gastrojejunostomy (n = 2) procedures for GOO. Anastomotic stricture requiring a second operation developed in two patients. There was no surgical mortality. The mean follow-up is 3.3 years and all patients are free of symptoms.

CONCLUSION

GOO is one of the most common gastric complications of corrosive ingestion that may require surgical treatment. Prevention of corrosive ingestion has great importance to avoid such complications.

Effects of whole-body hypoxic preconditioning on hypoxia/reoxygenation-induced intestinal injury in newborn rats

PURPOSE

The precise cause of necrotizing enterocolitis (NEC) is elusive. Ischemia and reperfusion injury of the intestine has been considered to be a major contributing factor for NEC. Ischemic preconditioning is defined as one or more brief periods of ischemia with intermittent reperfusion that protects tissues against a sustained period of subsequent ischemia. Contribution of preconditioning to hypoxia/reoxygenation-induced intestinal injury in newborn rats has not been evaluated previously.

METHODS

The study was carried out on 1-day-old Wistar albino rat pups. Whole-body hypoxia and reoxygenation (H/R) was achieved by 10 min hypoxia using 95 % N (2) + 5 % CO (2) followed by 10 min reoxygenation with 100 % oxygen. Whole body hypoxic preconditioning (HP) cycles were performed with 3 min hypoxia and 5 min reoxygenation. Thirty-three pups were randomly allocated into 4 groups. Group 1 served as untreated controls. The pups in group 2 were subjected to H/R only. In groups 3 and 4, 1 cycle and 3 cycles of HP were performed prior to H/R, respectively. Animals were killed at the end of the protocols. Intestine specimens were obtained to determine the histological changes, as well as to measure the tissue malondialdehyde (MDA) and nitric oxide (NO) levels, and xanthine oxidase (XO) and myeloperoxidase (MPO) activities.

RESULTS

The microscopic lesions in H/R rat pups were virtually the same as those seen in neonatal NEC, with severe destruction of villi and crypts, in some cases extending to the muscularis. In both HP groups, the lesions were found to be milder. H/R resulted in a marked elevation in MDA and NO levels, and XO and MPO activities compared to the untreated controls. Both 1 cycle and 3 cycles of HP prior to H/R resulted in an obvious decrease in all biochemical parameters. Differences of the biochemical results between both HP groups were not statistically significant.

CONCLUSION

This study revealed that whole-body hypoxic preconditioning is beneficial for hypoxia/reoxygenation-induced intestinal injury in newborn rats.

Conservative management of intrahepatic perforation of the gallbladder secondary to acalculous cholecystitis

Gallbladder (GB) perforation is a rare complication of acute acalculous cholecystitis. This complication mostly manifests as acute free perforation into the peritoneal cavity, subacute pericholecystic abscess, or chronic perforation with cholecystoenteric fistula. Perforation of the GB into the liver is extremely rare, and was reported only in adults, of whom all were treated surgically. The authors present an intrahepatic GB perforation secondary to acute acalculous cholecystitis, and its successful conservative management in a 13-year-old boy.

Paraurethral cyst: is conservative management always appropriate?

Paraurethral cyst, arising from cystic dilatation of a paraurethral gland in a girl, is rarely reported in infancy. Although the lesion has a reported incidence of between 1 in 2000 and 1 in 7000 live female births, only 41 examples have been reported previously in the English literature. The management of this lesion is controversial. Surgical excision has been advocated, but spontaneous rupture has also been reported. The latter has prompted some authors to recommend non-operative treatment. We report a female infant whose paraurethral cyst failed to resolve despite a 6-month observation period. She eventually required surgery. The management of our case and the experience in the literature is discussed.

Laparoscopic management of malfunctioning peritoneal dialysis catheters

BACKGROUND

Continuous ambulatory peritoneal dialysis (CAPD) is an established alternative method to hemodialysis for treating end-stage renal disease patients. However, this method is associated with a significant number of complications, such as catheter malposition, omental wrapping, and infection. The purpose of this study was to determine the efficacy of laparoscopy in the treatment of malfunctioning CAPD catheters.

METHODS

Between November 1994 and June 1999, a total of 16 patients with CAPD underwent laparoscopy for the evaluation and management of CAPD catheter dysfunction. Two trocars (10-mm and 5-mm) were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed, complications, and catheter outcome.

RESULTS

The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in eight cases, malpositioning in five cases, and infection in the remaining three cases. Adhesiolysis was performed in the eight cases with adhesions. In the five cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn because of infection. In one case with tunnel infection, the catheters were exchanged simultaneously. There was only one perioperative complication, consisting of temporary dialysate leakage. There were no mechanical or infection problems. The overall success rate of catheter function (>30 days after laparoscopy) was 100%, except for two cases in which the catheters had to be removed.

CONCLUSION

Laparoscopy is a highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction.

Segmental dilatation of the jejunum

A 6 months old girl with segmental dilatation of the jejunum is described. Clinical findings were intermittent colic, severe pain and bilious vomiting, mimicking intussusception. At laparatomy dilated jejunal segment was encountered and resection performed. Histological examination showed normal ganglion cells with normal bowel structures. Postoperative course was uneventful.