Mohammad M Saleem

Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery.

Background The present study was designed to assess whether an intraoperative administration of dexmedetomidine would decrease the intraoperative and postoperative analgesic requirements for paediatric patients undergoing hypospadius surgery. Methods Forty-eight children (American Society of Anesthesiologists-1) aged 1–12 years undergoing hypospadius repair under general anaesthesia were randomly assigned into dexmedetomidine or placebo groups, D and P, respectively. Group D received a loading dose of dexmedetomidine 1 μg kg−1 after induction of anaesthesia, followed by a continuous infusion at a rate of 0.7 μg kg−1 h−1. Group P received a volume-matched 0.9% saline. Both groups received fentanyl for intraoperative analgesia and intravenous morphine and oral paracetamol for postoperative analgesia. For both groups, heart rate, blood pressure and fentanyl requirements were recorded intraoperatively. During their stay for 2 h in the recovery room, heart rate, blood pressure, pain scores, behaviour scores and total morphine requirements were recorded. After discharge from postanaesthesia care unit, paracetamol requirements over 24 h were also recorded. Results Intraoperatively, the dexmedetomidine-treated group had significantly fewer fentanyl requirements, slower heart rate and lower mean arterial blood pressure (P < 0.001). In the postanaesthesia care unit, this group also consumed significantly less morphine, had lower pain scores, lower behaviour score in the immediate postoperative period, lower heart rates and mean arterial blood pressures when compared with the placebo group (P < 0.001). Group D consumed significantly less paracetamol than group P in the ward over 24 h. Conclusion Intravenous administration of dexmedetomidine intraoperatively during hypospadius repair in children reduces intraoperative and postoperative analgesic requirements and lowers heart rate and blood pressure.

Scrotal abscess as a complication of perforated appendicitis: A case report and review of the literature

IntroductionAbscess formation following appendectomy is well known, especially when complicated by perforation. Infectious complications are the most common. Intraabdominal abscess formation, Pelvic abscess and wound infection are the most common sites of infection. Scrotal abscess following acute perforated appendicitis is very rare.Cases presentationWe report two cases of scrotal abscess following perforated appendicitis, one was 1983 and the other in 1997. The first patient developed acute left hemiscrotum two weeks following correction of a tetralogy of Fallot that was diagnosed since infancy. Scrotal drainage as well as open appendectomy and abdominal drainage were followed by uneventful recovery. Six weeks later left groin exploration revealed patent processus vaginalis which was ligated. The second patient developed redness, swelling and pain in his left hemiscrotum 10 days after open appendectomy for perforated appendicitis. Groin exploration, ligation of a PPV and scrotal drainage was made. Recent reports on the subject, review of the literature, the rarity of the complication, and the possible association with recent introduction of laparoscopic appendectomy.ConclusionAcute scrotal swelling is frequently a surgical emergency. Developing in the post-operative period is no exception. Symptoms and signs may be hampered by analgesia, pain, and antibiotics, usually administered in this period. Reporting these rare complications following such a common procedure, especially now a day in the era of laparoscopic surgery. Only high degree of suspicion and vigilant intervention will accomplish a safe diagnosis and treatment. The appropriate time and approach to both abscess and PPV is still controversial. Until enough case reports treatment is to be individualized.

Foreign body aspiration in children: A study of children who lived or died following aspiration

Foreign body aspiration (FBA) is a preventable cause of mortality and morbidity in children. We conducted a chart review of children who presented to a university hospital due to FBA in the period 1999-2014. Children were either managed with bronchoscopy for removal of the foreign body or died due to FBA. A total of 103 children were seen due to FBA including 27 deaths. The majority of children were boys and were less than 3 years old. Most aspirated foreign bodies were food-related, mainly peanuts. The majority of children presented with acute choking incidents, a smaller number presented with recurrent chest infections, and few childrens choking incidents were unwitnessed. X-ray had a high rate of false negatives and bronchoscopy was the gold standard technique for assessment and management. Aspiration of foreign bodies is a preventable, life-threatening condition that calls for increased parent education and awareness.

Amoebic liver abscess – a cause of acute respiratory distress in an infant: a case report

IntroductionThe usual presentation of amebic liver abscess in children is extremely variable and unpredictable. It presents with a picture of common pediatric illness that is fever, lethargy, and abdominal pain, and can go on to develop into a rare complication of rupture into the pleura to cause acute respiratory distress, which is another common pediatric illness. In our patient, diagnosis was not made or suspected in these two stages.Case presentationThis is the report of a 2-year-old male infant who presented with a 2-week history of anorexia, fever, and abdominal pain. A few hours after admission, he suddenly developed acute respiratory distress; chest X-ray demonstrated massive right pleural effusion that failed to response to tube thoracostomy. Limited thoracotomy revealed a ruptured amebic liver abscess through the right cupola of the diaphragm. The content of the abscess was evacuated from the pleural cavity, which was drained with two large chest tubes. Serological examination confirmed the diagnosis of ruptured amebic liver abscess. Postoperative treatment with antibiotics including metronidazole continued until full recovery.ConclusionDiagnosis of such a rare disease requires a high degree of suspicion. In this patient, the diagnosis was only made postoperatively. The delay in presentation and the sudden onset of respiratory distress must be emphasized for all those physicians who care for children.

Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child

BackgroundWe report a case of acute scrotal condition that presented in a four year old male child one year after being treated for an idiopathic rectal prolapse utilizing Thiersch wire.Case presentationThe acute scrotum had resulted from spreading perianal infection due to erosion of the circlage wire. The condition was treated with antibiotics and removal of the wire. The child made an uneventful recovery.ConclusionThis case highlights that patients with Thiersch wire should be followed until the wire is removed. Awareness of anal lesions as a cause of acute scrotal conditions, and history and physical examination are emphasized.

Cholecystoenteric fistula: a rare complication of necrotizing enterocolitis

An infant treated with necrotizing enterocolitis, had a cholecystoenteric fistula, which was found incidentally on routine contrast study of his intestinal tract before closure of his ileostomy. To the best of the authors knowledge this complication has not been reported before.

Acute Scrotum in Children : Jordan University Hospital Experience = الصفن الحاد عند الأطفال : خبرتنا في مستشفى الجامعة الأردنية

المقدمة: الصفن الحاد واحدة من حالات الطوارئ الجراحية الشائعة في الأطفال. وعلى الرغم من العديد الاحتمالات في التشخيص التفاضلي، معظم الظروف ليست عاجلة؛ المهم هنا هو التشخيص السريع والعلاج الجراحي لالتواء الحبل المنوي لتجنب الأضرار الناتجة عن نقص التروية الدائمة للخصية. مع تاريخ دقيق، والفحص السريري، والتصوير بالسونار إذا اقتضى الأمر ذلك، ويمكن عادة إجراء تشخيص دقيق. في هذه الدراسة نقدم خبرتنا في مستشفى الجامعة الأردنية في علاج الصفن الحادة في الأطفال. الطريقة: تم استعراض السجلات الطبية لجميع الأطفال الذين قدموا قسم الطوارئ بالصفن الحادة من آذار 2008 إلى آذار 2013. وسجلت خصائص الأعراض، والنتائج السريرية والتصوير قبل العملية والنتائج ونوع العلاج المقدم. النتائج: أجريت عملية الاستكشاف للصفن في 59 حالة، أربعة منها كانت التواء الخصية (7%). 28 حاله التواء زائدة الخصية (48٪)، اثني عشر حالة (22%) من التهاب البربخ، حالتين من فتق اربي منسد (3%)، وثلاث حالات تجمع دموي بالخصية (5%) وحالتان استسقاء الخصية (3%)، وأربع حالات (7%) كانت طبيعية. الاستنتاجات: نسبيا ارتفاع نسبة الحالات الجراحية الإيجابية (التواء الخصية، الخصية التواء التذييل، الفتق المسجون) بين الحالات من الصفن الحاد عند الأطفال حيث يتم التشخيص قبل الجراحة وهذا يبرر ممارستنا في الاستكشاف المبكر لحالات الصفن الحاد.