Abstract Background Traditionally, total colonic aganglionosis (TCA) was managed with enterostomy +/− pull-through. Since 1998, primary laparoscopic endorectal pull-through (PLEP) was offered to ...patients with TCA in our unit. A retrospective study was conducted and early results reviewed. Method Patient data were collected retrospectively. Before 1998, enterostomy followed by open Duhamel pull-through was performed. From 1998, patients were assessed to receive staged operation or PLEP. Results From June 1990 to May 2007, 10 patients (6 males) were treated. All presented in the neonatal period. Seven patients, with transition zone within proximal 15 cm of terminal ileum, had pull-through performed. Three had staged pull-through, whereas 4 had PLEP. Two had extensive small bowel involvement with high output stoma pending reconstruction. One had total intestinal aganglionosis and died. The 3 patients with staged pull-through had normal bowel habit without soiling (mean follow-up, 13 years). For PLEP, all procedures were accomplished laparoscopically without intraoperative complication (mean operative time, 6 hours 50 minutes). The mean bowel motion is 5× per day, but most were too young to evaluate continence (mean follow-up, 3.5 years). Conclusion Primary laparoscopic endorectal pull-through is feasible in TCA with limited small bowel involvement and has the advantage of a single-stage operation, avoiding a stoma and its related complications.
Aim
There were only a few reports on laparoscopic portoenterostomy for biliary atresia in children. We report our experience on laparoscopic Kasai operation for biliary atresia.
Material and methods
...A retrospective review of all children who had biliary atresia underwent laparoscopic portoenterostomy from January 2002 to September 2006 were included and analyzed.
Results
Sixteen children (five boys and eleven girls) with a mean age of 66 days (range 47–106 days) at operation were included in this study. All patients had type III biliary atresia. There was no conversion to open procedure. The operative time ranged from 193 to 435 min (mean 292 min). At a median follow-up of 72 months (range 33–89 months), eight patients were free of jaundice with bilirubin level <20 μmol/L and did not require liver transplantation. Seven patients underwent liver transplantation. One patient who had persistent elevated bilirubin defaulted follow-up. One patient complicated with volvulus of intestine post-operatively. All patients survived except one patient who had combined liver and intestine transplantation.
Conclusion
Laparoscopic portoenterostomy in children with biliary atresia is technically feasible. 50% of children who had type III biliary atresia were free of jaundice and did not require liver transplantation. A longer follow-up is required to assess the long-term outcome.
Pediatric Rome III criteria of functional dyspepsia (FD) has eliminated the mandatory use of upper endoscopy and recommended a symptom-based approach. In the absence of alarm symptoms, FD can be ...positively diagnosed in children having normal physical findings without exclusionary investigations. We aimed to investigate the effectiveness of Rome III guidelines to discriminate organic diseases from FD and to identify the predictors for positive endoscopic findings.
A prospective study was conducted on consecutive children fulfilling Rome III criteria of FD. Upper endoscopy was performed in all subjects, both with and without alarm features.
Eighty consecutive children ages 7 to 15 were recruited. Nine (11.3%) had experienced alarm features. Five (6.3%) had organic diseases confirmed in upper endoscopy: duodenal ulcer (n = 2), duodenitis with erosion (n = 2), and gastritis with erosion (n = 1), 33.3% of children having alarm features had organic pathology, compared with 2.8% of those without (P < 0.01). A male predominance (80% vs 25.3%, P < 0.01), higher prevalence of alarm features (60% vs 8%, P < 0.01), and higher prevalence of Helicobacter pylori infection (80% vs 5.3%, P < 0.01) were found in children with organic diseases, compared with FD. Multivariate analysis identified H pylori infection (odds ratio 23.2; 95% confidence interval 1.5-333) and nocturnal pain (odds ratio 26.3; 95% confidence interval 1.2-500) to be independent predictors for positive endoscopic findings.
Rome III recommendations of screening dyspeptic children for alarm features and investigation for H pylori are effective to identify children who have a higher likelihood of organic diseases and require upper endoscopy before making a diagnosis of FD.
Colonoscopy in Hong Kong Chinese children Tam, Yuk Him; Lee, Kim Hung; Chan, Kin Wai ...
World journal of gastroenterology : WJG,
03/2010, Letnik:
16, Številka:
9
Journal Article
Odprti dostop
To investigate the safety and diagnostic yield of colonoscopy in Chinese children in whom the procedure is not often done.
We conducted a retrospective review of all colonoscopies in consecutive ...children who underwent their first diagnostic colonoscopy from Jan 2003 to 2008.
Seventy-nine children (48 boys, 31 girls; mean age 9.2 +/- 4.2 years) were identified and reviewed with a total of 82 colonoscopies performed. Successful caecal and ileal intubation rates were 97.6% and 75.6% respectively. Forty patients (50.6%) had a positive diagnosis made in colonoscopy and that included colonic polyps (23), Crohn's disease (12), ulcerative colitis (1), and miscellaneous causes (4). 80% of polyps were in the rectosigmoid colon. All but one were juvenile hamartomatous polyps. The exception was an adenomatous polyp. The mean ages for children with inflammatory bowel disease (IBD) and polyps were 11.3 and 4.3 years respectively. There was no procedure-related complication.
Colonoscopy is a safe procedure in our Chinese children. The increasing diagnosis of IBD in recent decades may reflect a rising incidence of the disease in our children.
Objectives To report the surgical technique and the early outcomes of nephrectomy and heminephroureterectomy by single-incision laparoscopic surgery (SILS) in children using conventional laparoscopic ...instruments only. Methods Three consecutive children (aged 3, 4 and 7 years) who underwent nephrectomy for multicystic dysplastic kidney (n = 2) and upper moiety heminephroureterectomy for duplex kidney (n = 1) by SILS were retrospectively reviewed. A standardized infraumbilical incision was used for the insertion of 3 reusable ports of 3 and 5 mm. The SILS procedure was performed by the technique of crossing 2 straight instruments. Results All 3 procedures were successfully performed by SILS without any intraoperative complications or need for conversion. The 2 nephrectomies were each completed in 120 minutes, whereas the heminephroureterectomy took 400 minutes. Only 1 dose of narcotic analgesic was required by 1 patient, and 2-6 doses of oral acetaminophen were taken for postoperative pain control. All 3 children recovered smoothly from surgery without complications. Conclusions Nephrectomy and heminephroureterectomy by SILS using conventional instruments are technically feasible in young children. Further studies are required to investigate whether the SILS approach can become a sound alternative to standard laparoscopy.
The aim of this study is to investigate the differences in the characteristics between Helicobacter pylori-positive and H pylori-negative primary ulcers in Chinese children.
We conducted a ...retrospective review of children with primary peptic ulcers. Demographic data, clinical presentations, endoscopic features, histological findings, H pylori prevalence, and ulcer recurrences were studied.
Forty-three Chinese children with primary peptic ulcers were diagnosed over 8 years and were reviewed. There were 31 boys and 12 girls (median age 12 years, range 3-16 years). Thirty children (70%) presented with acute gastrointestinal bleeding, whereas only 19 had a history of epigastric pain. Twenty-three patients (53.5%) were H pylori positive. H pylori-positive ulcers developed in older children (median age 12 vs 10 years, P<0.05) and affected more males (91.3% vs 50%, P<0.01) than the H pylori-negative group. The annual ulcer recurrence rates were estimated to be 5.2% (95% CI 4.2-6.3) and 11.4% (95% CI 9.1-13.6) for positive and negative groups, respectively (P<0.05). Multivariate logistic regression suggested H pylori-negative status and ulcer size >1cm were indepen-dent risk factors for recurrence.
Our report suggests that H pylori-negative primary ulcers exist in children with their own distinct features. In contrast to H pylori-positive ulcers, H pylori-negative ulcers develop in younger children, affect both sexes equally, and carry a higher recurrence risk.
Aim
Studies comparing the efficacy of radiofrequency ablation (RFA) in terms of overall survival, disease‐free survival and local recurrence in recurrent hepatocellular carcinoma (HCC) are limited. ...We carried out the present study to compare the survival of recurrent HCC after RFA with that of first‐occurrence HCC.
Patients and Methods
A total of 170 patients with HCC smaller than 5 cm who received RFA in a tertiary academic hospital were recruited. Clinical data were prospectively collected, reviewed and compared between recurrent and first‐occurrence HCC groups. Patients who received RFA for post‐ablation recurrent HCC were excluded.
Results
There was no significant difference in the complication, incomplete ablation, recurrence and survival rates between the recurrent HCC and the first‐occurrence HCC groups. The tumour size in the recurrent HCC group was significantly smaller than that in the first‐occurrence group (1.8 vs 2.5 cm), and the recurrent HCC group had a significantly higher proportion of Child's A cirrhosis.
Conclusions
When detected and treated early, the overall survival of recurrent HCC treated RFA was comparable to that of first‐occurrence HCC. The advantages of RFA, especially when percutaneous route is feasible, over hepatectomy should be extended to recurrent HCC in suitable cases.
Background: Data of Helicobacter pylori prevalence in children and its risk factors provide clues to the health authority to estimate burden of H. pylori‐associated diseases usually encountered in ...adulthood and facilitate healthcare planning.
Materials and Methods: A cross‐sectional population‐based study was conducted in Chinese children in elementary and high schools. Schools were selected from all three major areas of Hong Kong. H. pylori infection was defined by a positive 13C‐urea breath test. Study subjects were stratified into six age groups for estimation of prevalence. Potential risk factors were analyzed from data of self‐administered questionnaires.
Results: A total of 2480 children (aged 6–19, male: 47.3%) participated in the study. Overall, 324 (13.1%) were positive for H. pylori. There was no difference in prevalence between sexes, and no statistical trend in the prevalence across the six age groups. Multivariate logistic regression identified lack of formal education of mother (OR = 2.43, 95%CI 1.36–4.34), family history of gastric cancer (OR = 2.19, 95%CI 1.09–4.41), and household member > 5 (OR = 1.57, 95%CI 1.12–2.19) to be positively associated with H. pylori infection in our children.
Conclusions: The H. pylori prevalence of Hong Kong children is comparable to the data of developed countries. The association with family history of gastric cancer justifies further study to investigate the cost‐benefit of community screening program for such children to decrease the incidence of gastric cancer in adulthood.
Objective: To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion.
Design: A prospective, randomized, controlled ...trial.
Setting: A university teaching hospital.
Patient(s): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization.
Intervention(s): Routine surgical evacuation or medical evacuation of the uterus using misoprostol.
Main Outcome Measure(s): Immediate, short-term (2–3 weeks), and medium-term (6 months) medical complications.
Result(s): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia.
Conclusion(s): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.
This study examines the relationship between personal empowerment and life satisfaction among self-help group members in Hong Kong. Personal empowerment is viewed as a form of social capital derived ...from engagement in the social relations within the self-help group that allows members to obtain benefits such as increasing their life satisfaction. Sense of mastery and self-esteem are introduced as intervening variables between personal empowerment and life satisfaction. A path model is constructed to compare the direct effects and indirect effects of personal empowerment, sense of mastery, and self-esteem on life satisfaction. The same model is also tested across various sociodemographic subgroups. Findings support a significant and positive relationship between personal empowerment and life satisfaction and show that there are sociodemographic differences in the effect of the former on the latter. Implications of the findings for future research and services pertaining to personal empowerment and its outcomes in Hong Kong are discussed.
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