Cm In Children Research Articles

Intra-observer reliability of the anthropometric measurements in South American children and adolescents: the SAYCARE Study

Introduction: the South American Youth/Child Cardiovascular and Environmental (SAYCARE) feasibility study aims to develop valid and reliable indicators to investigate health-related behavior and nutritional status in children and adolescents. Anthropometric measurements are one of the evaluated indicators in the study. The accuracy of the anthropometric data is very important and relies in the quality of the measurements. Objective: to describe the intra-observer reliability of ten anthropometric measurements: weight, height, circumferences (neck, arm, waist, hip) and skinfolds (triceps, subscapular, biceps and suprailiac) of children and adolescents from six South American cities: Lima, Medellin, Montevideo, Santiago, San Pablo and Teresina. Methods: prior to the study, fieldworkers from the seven centers participated in central training to ensure the application of standardized procedures in the anthropometric measurements. Intra-observer precision, technical error of measurement (TEM) and coefficient of reliability (R) were estimated for each measurement. Results: reliability of weight and height was above 99% in almost all cities. TEM for skinfold thickness was below 1.4 mm in children and 2.13 mm in adolescents, while reliability was above 95% in most of the skinfold measurements. TEM for circumferences was below 1.8 cm in children and 0.64 cm in adolescents, while reliability was above 99% in almost all circumferences. Conclusions: reliability of the anthropometric measurements in this study was high. In comparison with similar European or American studies, the reliability of the measurements taken in our study was, in most cases, similar or even higher.

Extracorporeal shock wave lithotripsy (ESWL) versus flexible ureteroscopy (F-URS) for management of renal stone burden less than 2 cm in children: A randomized comparative study

ObjectiveTo compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2 cm in children. Patients and methodsA randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2 cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications. ResultsFinally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient's demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively (p value = 0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group (p value = 0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively (p value = 0.5). ConclusionStone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy.

Verification of the Optimal Chest Compression Depth for Children in the 2015 American Heart Association Guidelines: Computed Tomography Study.

The 2015 American Heart Association guidelines recommended pediatric rescue chest compressions of at least one-third the anteroposterior diameter of the chest, which equates to approximately 5 cm. This study evaluated the appropriateness of these two types by comparing their safeties in chest compression depth simulated by CT. Retrospective study with data analysis conducted from January 2005 to June 2015 SETTING:: Regional emergency center in South Korea. Three hundred forty-nine pediatric patients 1-9 years old who had a chest CT scan. Simulation of chest compression depths by CT. Internal and external anteroposterior diameter of the chest and residual internal anteroposterior diameter after simulation were measured from CT scans. The safe cutoff levels were differently applied according to age. One-third external anteroposterior diameters were compared with an upper limit of chest compression depth recommended for adults. Primary outcomes were the rates of overcompression to evaluate safety. Overcompression was defined as a negative value of residual internal anteroposterior diameter-age-specific cutoff level. Using a compression of 5-cm depth simulated by chest CT, 16% of all children (55/349) were affected by overcompression. Those 1-3 years old were affected more than those 4-9 years old (p < 0.001). Upon one-third compression of chest anteroposterior depth, only one subject (0.3%) was affected by overcompression. Rate of one-third external anteroposterior diameter greater than 6 cm in children 8 and 9 years old was 16.1% and 33.3%, respectively. A chest compression depth of one-third anteroposterior might be more appropriate than the 5-cm depth chest compression for younger Korean children. But, one-third anteroposterior depth chest compression might induce deep compressions greater than an upper limit of compression depth for adults in older Korean children.

Laparoscopic versus open liver resection for solitary hepatocellular carcinoma less than 5 cm in child a cirrhotic patients: a prospective randomized study

Laparoscopic versus open liver resection for solitary hepatocellular carcinoma less than 5 cm in child a cirrhotic patients: a prospective randomized study

Laparoscopic versus open liver resection for solitary hepatocellular carcinoma less than 5 cm in child a cirrhotic patients: A prospective randomized study

Laparoscopic versus open liver resection for solitary hepatocellular carcinoma less than 5 cm in child a cirrhotic patients: A prospective randomized study

Estimation of optimal pediatric chest compression depth by using computed tomography.

ObjectiveThis study aimed to compare the optimal chest compression depth for infants and children with that of adults when the simulated compression depth was delivered according to the current guidelines.MethodsA total of 467 consecutive chest computed tomography scans (93 infants, 110 children, and 264 adults) were reviewed. The anteroposterior diameter and compressible diameter (CD) for infants and children were measured at the inter-nipple level and at the mid-lower half of the spine for adults. Compression ratio (CR) to CD was calculated at simulated 1/4, 1/3, and 1/2 antero-posterior compressions in infants and children, and simulated 5- and 6-cm compressions in adults.ResultsIn adults, the CRs to CD at simulated 5- and 6-cm compression depth were 41.7±0.16%, 50.0±7.3% respectively. In children and infants, the CRs to CD at 1/3 chest compression were 55.1±2.4% and 51.8±2.4%, respectively, and at 1/2 chest compression, CRs were 82.7±3.7% and 77.7±3.6%, respectively. The CRs to CD of 4-cm compression depth in infants and 5-cm compression depth in children were 74.4±10.9%, 62.5±8.7%, respectively. The CRs to CD for children and infants were significantly higher than in adults (P<0.001). The CR to CD of 4-cm compression depth in children was almost similar to that of 6-cm compression depth in adults (50.0± 6.9% vs. 50.0±7.3%, P=0.985).ConclusionCurrent pediatric guidelines for compression depth are too deep compared to those in adults. We suggest using 1/3 of the anteroposterior chest diameter or about 4 cm in children and less than 4 cm in infants.

MP54-09 COMPARISON OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR UROLITHIASIS BETWEEN CHILDREN AND ADULTS: A SINGLE CENTRE STUDY.

INTRODUCTION AND OBJECTIVES: To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. METHODS: From January 2011 to January 2015, ESWL was performed in 102 children and 605 adults for urolithiasis. We used Modulith SL X lithotripter 4th generation Storz medical equipment for ESWL. The stone free rates, number of ESWL sessions required, complication rates and auxiliary procedures used were evaluated in a comparative manner. RESULTS: Mean Stone size was 1.28 61 cm in adults while 1.08 0.59cm in children. Post ESWL stone clearance was 86.60% for children and 69% for the adults. In children group second session was required in 19 (23.5%) patients and third session was required in 3 (3.7%) patients while in adult group 2 sessions in 122 (20.1%) and 3 sessions in 48(7.9%) patients. In adults complications included steinstrasse in 12 patients (1.98%), fever in 30(4.95%), hematuria in 38(6.28%) and sepsis in 12(1.98%) patients while in children steinstrausse in 2 patients (2.5%), mild fever in 2 patients (2.5%), hematuria in 6 patients (7.4%) and sepsis was seen in 4 patients (4.9%). Complication rates were almost similar in both groups. In ancilliary procedures including DJ stent was used in 13 patients (16.04%) in children while in 29% of adults. CONCLUSIONS: The results of ESWL for urolithiasis in adults remains inferior to that of children. Children can achieve high stone-free rates. Complication rates were almost similar in both children and adult ESWL group in our study.

Pediatric retrograde intra-renal surgery for renal stones &lt;2 cm in solitary kidney

Introduction:Management of renal stones in children with a solitary kidney is a challenge. In the current study, the efficacy and safety of retrograde intrarenal surgery (RIRS) in these children were determined.Patients and Methods:Records of children with renal stones who were treated at our institute between August 2011 and August 2014 were retrospectively assessed. Inclusion criteria were: Children with single renal stone <2 cm size, in a solitary kidney. A 7.5 Fr flexible ureteroscope (FURS) was introduced into the ureter over a hydrophilic guidewire under visual and fluoroscopic guidance - applying a back-loading technique. The stone was completely dusted using 200 μm laser fiber (0.2–0.8 joules power and 10–30 Hz frequency). At the end of the maneuver, a 5 Fr JJ stent was inserted into the ureter. The children were discharged home 24 h postoperative - provided that no complications were detected.Results:Fourteen children (3 girls and 11 boys) with median age 9.5 years (range 6–12) were included. The mean stone burden was 12.2 ± 1.5 mm (range 9–20). Stones were successfully accessed in all of the cases by the FURS except for 2 cases in whom a JJ stent was inserted into the ureter and left in place for 2 weeks to achieve passive dilatation. All of the stones were dusted completely. The immediate postoperative stone-free rate (SFR) was 79%, and the final SFR was 100% after 3 weeks. No intraoperative complications were observed.Conclusions:RIRS for renal stone <2 cm in children with a solitary kidney is a single-session procedure with a high SFR, low complication rate, and is a minimally invasive, natural orifice technique.

A new chest compression depth indicator would increase compression depth without increasing overcompression risk

PurposeAdequate chest compression (CC) depth is critical for effective cardiopulmonary resuscitation. Pediatric resuscitation guidelines recommend that CC be at least one-third of the anterior-posterior (AP) chest diameter or approximately 4 cm in infants and 5 cm in children. We aimed to find a better indicator of CC depth that maximizes CC depth while also minimizing injury. Basic proceduresChest computed tomographic images of patients aged 8 years and younger were measured for external diameter (ED) (AP distance from skin to skin) and internal diameter (AP distance between internal surface of anterior chest wall and anterior surface of vertebral body) at the midway of the lower half of the sternum. Compressible depth was defined as 1 cm short of internal diameter. We determined that up to a 10% estimated risk of overcompression is acceptable and approximated a quantile regression line for the 10th percentile of compressible depth on ED. After rounding coefficients, we used its equation as a new indicator. Main findingsA total of 426 images were analyzed. The new indicator had a slope of 0.5 and an intercept of −1.9 cm (1 fingerbreadth). Compared to one-third ED, the new indicator would provide deeper CC with average difference of 1.9 mm (95% confidence interval, 1.6-2.2 mm) without increasing the risk of overcompression (both 4.9%). Chest compression of 4/5 cm would provide deeper CC compared to the new indicator (difference, 3.5 mm; 95% confidence interval, 2.7-4.1 mm); however, its overcompression risk was too high (31.5%). Principal conclusionChest compression of one-half ED minus 1 fingerbreadth maximizes CC depth without increasing overcompression in pediatric population.

An Analysis of Reliability and Accuracy of Muscle Thickness Ultrasonography in Critically Ill Children and Adults.

Muscle wasting starts already within the first week in critically patients and is strongly related to poor outcome. Nevertheless, the early detection of muscle wasting is difficult. Therefore, we investigated the reliability and accuracy of ultrasonography to evaluate skeletal muscle wasting in critically ill children and adults. This prospective observational study enrolled 30 sedated critically ill children and 14 critically ill adults. Two independent investigators made 210 ultrasonographical assessments of muscle thigh thickness. Inter- and intraobserver reliability and cutoff levels were calculated as a function of muscle thickness and the expected reduction in muscle size (predefined at 20% and 30%). Mean ± SD muscle thickness was 1.67 ± 0.55 cm in the pediatric and 2.10 ± 0.85 cm in the adult population. The median absolute interobserver variability was 0.07 cm (interquartile range [IQR], 0.04-0.20 cm) in the pediatric population and 0.05 cm (IQR, 0.03-0.09 cm) in the adult population. However, the absolute intraobserver accuracy had a 95% confidence interval of 0.43 cm in children and 0.22 cm in adults. Only a 30% decrease (0.50 cm) in muscle thickness can be detected in critically ill children. Although the interobserver variability is acceptable in the pediatric population, the intraobserver variability is too large with respect to the expected reduction in muscle thickness. In adults, ultrasonography may be a reliable tool for early detection of muscle mass wasting.

Right Ventricular Outflow Tract Velocity Time Integral Determination in 570 Healthy Children and in 52 Pediatric Atrial Septal Defect Patients.

Determination of the right ventricular outflow tract velocity time integral (RVOT VTI) is an important part of the noninvasive investigation of pulmonary blood flow in adults; however, age-related pediatric reference data are lacking. We examined growth-related changes of RVOT VTI values in children and the predictive value of RVOT VTI values in identifying enhanced pulmonary blood flow in children with secundum type atrial septal defect (ASD). A prospective study was conducted in a group of 570 healthy children and 52 children with a moderate-sized to large ASD. We determined the effects of age, body length (BL), body weight (BW), and body surface area (BSA) on RVOT VTI values. The predictive value of normal values stratified for age, BW, BL, and BSA was tested in our 52 ASD children. RVOT VTI values ranged from mean 9.7±1.2cm in neonates to 23.3±2.7cm in children with 18years of age and showed a positive correlation with age, BL, BSA, and BW. In our population, RVOT VTI z-scores showed a high specificity for detecting ASD patients (>97%) with sensitivity up to 71%. We provide normal ranges and calculated z-scores of pediatric RVOT VTI values. Normal RVOT VTI z-scores might be additional predictors in identifying increased pulmonary blood flow in patients with ASD.

A Single Center Experience Comparing Miniperc and Shockwave Lithotripsy for Treatment of Radiopaque 1-2 cm Lower Caliceal Renal Calculi in Children: A Prospective Randomized Study.

A prospective randomized study was performed comparing miniperc and shockwave lithotripsy (SWL) for treatment of radiopaque 1 to 2 cm lower caliceal renal calculi in children to evaluate safety and efficacy of these procedures. Pediatric patients (<15 years) with a single radiopaque lower caliceal renal stone 1 to 2 cm undergoing treatment between March 2012 and September 2013 in our department were randomized into two groups-group A, miniperc; group B, SWL. The two groups were compared statistically regarding patient demographic profile, 3-month stone-free rate (SFR), re-treatment rates, auxiliary procedures, and complications. There were 106 patients enrolled in each group. The mean age (10.3 years vs 10.7 years, P=0.57) and stone size (12.7 mm vs 12.9 mm, P=0.31) were similar between group A and B patients. The re-treatment rate and auxiliary procedure rate were significantly greater in group B compared with group A (41.5% vs 2.8% and 14.2% vs 5.6%, respectively; P<0.001). The overall 3-month SFR was 94.3% for group A vs 83% for group B (P=0.03). The complication rate (20.7% vs 3.7%; P=0.01) and hospital stay (3.7 days vs 7.1 hours; P=0.01) was significantly higher in group A compared with group B. Blood transfusion was given in 10.3% patients in group A vs none in group B (P=0.01). Miniperc is more efficacious than SWL for treatment of radiopaque lower caliceal renal calculi 1 to 2 cm in children in terms of higher SFR and lesser auxiliary and re-treatment rates. Miniperc, however, resulted in more complication, operative time, radiation exposure, and hospital stay.

Laparoscopic Ovarian Surgery in Children and Adolescents

Background and Objectives:Although laparoscopy is widely used in gynecologic surgery in adults, few studies have been undertaken to examine its use in young and adolescent patients. This study was conducted to investigate the safety and feasibility of laparoscopic surgery for the treatment of benign ovarian disease in children and adolescents.Methods:A retrospective chart review was conducted on 106 patients (age, <20 years) who underwent laparoscopic surgery at Kangnam Sacred Heart Hospital from 2006 through 2012.Results:The mean patient age was 17.1 years, and the youngest one was 8. Pathologic analyses revealed that 32 (30.2%) patients had dermoid cyst, 30 (28.3%) had simple cyst, and 15 (14.2%) had endometrioma. Conservative procedures, such as cystectomy (48.1%), aspiration (5.7%), fulguration (4.7%), and detorsion (3.8%), were performed in 65.1% of all cases. A subanalysis revealed that the surgical outcomes of children (age, ≤15 years), including operative time, estimated blood loss, postoperative hemoglobin decrease, and postoperative length of hospital stay, were comparable to those of adolescents (age, 16–19 years), despite significant differences in mean height between the 2 groups (156.1 ± 10.71 cm in children vs. 162.1 ± 5.14 cm in adolescents; P < .0001). (The age break between the study groups was set at 15 years, because most girls reach their adult height between the ages of 15 and 16 years.) No intra- or perioperative complications were noted. In a comparison study of surgical outcomes in 433 women (age, 20–50 years) and the 106 young and adolescent girls in our sample (age, <20 years), those in our patients were not inferior.Conclusion:In children and adolescents, laparoscopic surgery can be successfully performed with conventional instruments designed for use in adults.

Response of Indian growth hormone deficient children to growth hormone therapy: association with pituitary size.

To ascertain the impact of pituitary size as judged by Magnetic Resonance Imaging (MRI), on response to Growth Hormone (GH) therapy in GH deficient children. Thirty nine children (9.1 ± 2.7y, 22 boys) with non-acquired GH deficiency (21 Isolated GH deficiency and 18 Combined pituitary hormone deficiency) were consecutively recruited and followed up for oneyear. Clinical, radiological (bone age and MRI) and biochemical parameters were studied. Children with hypoplastic pituitary (pituitary height < 3mm) had more severe height deficit (height for age Z-score -6.0 vs. -5.0) and retardation of skeletal maturation (bone age chronological age ratio of 0.59 vs. 0.48) at baseline as compared to children with normal pituitary heights (p < 0.05 for both). After oneyear of GH therapy, height for age Z scores and percentage change in height for age Z scores were significantly higher in children with hypoplastic pituitaries (13.8 ± 3.6 and 28.7% vs. 11.2 ± 4.1 and 21.4%). Significant co-relation was observed between pituitary height and height for age Z-scores at baseline (r = 0.39, p < 0.05). The predicted adult height using Tanner Whitehouse-2 equations improved from 140.8 to 152.3cm in children with hypoplastic pituitary when compared to an increase from 145.8 to 153.5cm observed in children with normal pituitary height (p < 0.05). Indian growth hormone deficient children with hypoplastic pituitary respond better to therapy with GH in short term.

A clinical and economic evaluation of Control of Hyperglycaemia in Paediatric intensive care (CHiP): a randomised controlled trial.

Early research in adults admitted to intensive care suggested that tight control of blood glucose during acute illness can be associated with reductions in mortality, length of hospital stay and complications such as infection and renal failure. Prior to our study, it was unclear whether or not children could also benefit from tight control of blood glucose during critical illness. This study aimed to determine if controlling blood glucose using insulin in paediatric intensive care units (PICUs) reduces mortality and morbidity and is cost-effective, whether or not admission follows cardiac surgery. Randomised open two-arm parallel group superiority design with central randomisation with minimisation. Analysis was on an intention-to-treat basis. Following random allocation, care givers and outcome assessors were no longer blind to allocation. The setting was 13 English PICUs. Patients who met the following criteria were eligible for inclusion: ≥ 36 weeks corrected gestational age; ≤ 16 years; in the PICU following injury, following major surgery or with critical illness; anticipated treatment > 12 hours; arterial line; mechanical ventilation; and vasoactive drugs. Exclusion criteria were as follows: diabetes mellitus; inborn error of metabolism; treatment withdrawal considered; in the PICU > 5 consecutive days; and already in CHiP (Control of Hyperglycaemia in Paediatric intensive care). The intervention was tight glycaemic control (TGC): insulin by intravenous infusion titrated to maintain blood glucose between 4.0 and 7.0 mmol/l. This consisted of insulin by intravenous infusion only if blood glucose exceeded 12.0 mmol/l on two samples at least 30 minutes apart; insulin was stopped when blood glucose fell below 10.0 mmol/l. The primary outcome was the number of days alive and free from mechanical ventilation within 30 days of trial entry (VFD-30). The secondary outcomes comprised clinical and economic outcomes at 30 days and 12 months and lifetime cost-effectiveness, which included costs per quality-adjusted life-year. CHiP recruited from May 2008 to September 2011. In total, 19,924 children were screened and 1369 eligible patients were randomised (TGC, 694; CM, 675), 60% of whom were in the cardiac surgery stratum. The randomised groups were comparable at trial entry. More children in the TGC than in the CM arm received insulin (66% vs. 16%). The mean VFD-30 was 23 [mean difference 0.36; 95% confidence interval (CI) -0.42 to 1.14]. The effect did not differ among prespecified subgroups. Hypoglycaemia occurred significantly more often in the TGC than in the CM arm (moderate, 12.5% vs. 3.1%; severe, 7.3% vs. 1.5%). Mean 30-day costs were similar between arms, but mean 12-month costs were lower in the TGC than in CM arm (incremental costs -£3620, 95% CI -£7743 to £502). For the non-cardiac surgery stratum, mean costs were lower in the TGC than in the CM arm (incremental cost -£9865, 95% CI -£18,558 to -£1172), but, in the cardiac surgery stratum, the costs were similar between the arms (incremental cost £133, 95% CI -£3568 to £3833). Lifetime incremental net benefits were positive overall (£3346, 95% CI -£11,203 to £17,894), but close to zero for the cardiac surgery stratum (-£919, 95% CI -£16,661 to £14,823). For the non-cardiac surgery stratum, the incremental net benefits were high (£11,322, 95% CI -£15,791 to £38,615). The probability that TGC is cost-effective is relatively high for the non-cardiac surgery stratum, but, for the cardiac surgery subgroup, the probability that TGC is cost-effective is around 0.5. Sensitivity analyses showed that the results were robust to a range of alternative assumptions. CHiP found no differences in the clinical or cost-effectiveness of TGC compared with CM overall, or for prespecified subgroups. A higher proportion of the TGC arm had hypoglycaemia. This study did not provide any evidence to suggest that PICUs should stop providing CM for children admitted to PICUs following cardiac surgery. For the subgroup not admitted for cardiac surgery, TGC reduced average costs at 12 months and is likely to be cost-effective. Further research is required to refine the TGC protocol to minimise the risk of hypoglycaemic episodes and assess the long-term health benefits of TGC. Current Controlled Trials ISRCTN61735247. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 26. See the NIHR Journals Library website for further project information.

Ultrasound–Guided Left Brachiocephalic Vein Cannulation in Children With Underlying Bleeding Disorders

To evaluate the safety and effectiveness of ultrasound-guided left brachiocephalic vein cannulation in infants and children with underlying bleeding conditions. Retrospective cohort. PICU of a tertiary pediatric hospital. Thirty-four patients requiring central venous catheterization from January 2011 to January 2012. None. Two pediatric intensivists, experienced in ultrasound-guided vessel cannulation, performed the ultrasound catheterization of the left brachiocephalic vein. Ultrasound equipment consisted of a standard ultrasound monitor with a linear 6-13 MHz probe. The ultrasound monitor was set on a resolution with a depth of 1.8 cm for infants and 2.2 cm for children. The "in-plane" technique was used for all patients. Thirty-four catheterizations were performed. Patient median age was 12.5 months (5.75-63.5 mo) and median weight was 9.25 kg (7-16.25 kg). The population of infants and children analyzed was composed of 25 patients with hematologic disorder (73%) treated with hematopoietic stem cell transplantation, five patients (15%) supported with extracorporeal membrane oxygenation for viral pneumonias, and four patients (12%) with uremic hemolytic syndrome. A 4F catheter was used in 79% of cases. Left brachiocephalic vein cannulation was successful in all 34 patients. Median time needed for cannulation was 350 seconds (277.5-450 s). The overall complication rate was 9% (3 of 34) and consisted of difficulty in advancing the guidewire after having pierced the vein. The time required for catheter positioning and complications was not associated with both lower body weight and body surface area of the patients (p > 0.05). Mean central venous catheter duration was 32 ± 4 days. Data reported in this retrospective study confirm the safety and effectiveness of ultrasound-guided left brachiocephalic vein catheterization in infants and children with underlying bleeding disorders.

Gedeckte Perforation eines Meckel-Divertikels – eine seltene sonografische Diagnose bei älteren Erwachsenen mit akutem Abdomen

Meckel’s diverticulum is the result of an incomplete obliteration of the vitelline duct, which joins the yolk sac to the midgut lumen and is typically obliterated during the sixth week of gestation. It’s considered the most common congenital anomaly of the gastrointestinal tract, affecting 2 % of the general population. It is a true diverticulum, located in the distal ileum and consisting of all layers of the bowel wall. The distance between the diverticulum and the ileocecal valve changes with increasing age, from an average distance of 34 cm in children (< 2 years) to an average distance of 67 cm in adults. Only 4 % of people with Meckel’s diverticulum develop complications (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006). Most complications occur in patients under the age of 2. Further predisposing factors are male sex (male: female = 3:1), diverticulum length of more than 2 cm and ectopic tissue in the diverticulum wall. Heterotopic gastric mucosa is present in 50 % of all Meckel’s diverticula, pancreatic mucosa is encountered in approximately 5 % of diverticula, and colonic mucosa is present on rare occasions (Chandramohan K et al. Gastrointestinal stromal tumour in Meckel’s diverticulum; World Journal of Surgical Oncology 2007, 5: 50). The most common clinical presentations of the Meckel’s diverticulum in adults are intestinal obstruction (22–50 %) and diverticulitis (20 %).Bleeding is less common. In children the most frequent complication is hemorrhage (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006).

Meckel’s Diverticulum with Covered Perforation – A Rare Sonographic Diagnosis in Elderly Adults with Acute Abdomen

Meckel’s diverticulum is the result of an incomplete obliteration of the vitelline duct, which joins the yolk sac to the midgut lumen and is typically obliterated during the sixth week of gestation. It’s considered the most common congenital anomaly of the gastrointestinal tract, affecting 2 % of the general population. It is a true diverticulum, located in the distal ileum and consisting of all layers of the bowel wall. The distance between the diverticulum and the ileocecal valve changes with increasing age, from an average distance of 34 cm in children (< 2 years) to an average distance of 67 cm in adults. Only 4 % of people with Meckel’s diverticulum develop complications (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006). Most complications occur in patients under the age of 2. Further predisposing factors are male sex (male: female = 3:1), diverticulum length of more than 2 cm and ectopic tissue in the diverticulum wall. Heterotopic gastric mucosa is present in 50 % of all Meckel’s diverticula, pancreatic mucosa is encountered in approximately 5 % of diverticula, and colonic mucosa is present on rare occasions (Chandramohan K et al. Gastrointestinal stromal tumour in Meckel’s diverticulum; World Journal of Surgical Oncology 2007, 5: 50). The most common clinical presentations of the Meckel’s diverticulum in adults are intestinal obstruction (22–50 %) and diverticulitis (20 %).Bleeding is less common. In children the most frequent complication is hemorrhage (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006).

Latissimus dorsi flap harvest with a short incision

Latissimus dorsi (LD) flap is one of the most common options utilized in reconstructive armamentarium. In this report, we present our experience on harvest of the full LD muscle flap through a short incision. Twelve free and two pedicled full LD muscle flaps were raised in 14 patients (9 males and 5 females). In this technique, an oblique incision was placed 5-7 cm caudal to axillary apex, beginning from the posterior axillary line, so as to center the neurovascular hilus. The length of incision was 10 cm in adults and 8 cm in children. Mean dissection time was 45 min. All flaps survived totally. Seroma formation developed in two cases and treated with syringe aspiration and compressive dressing. In late postoperative period, donor site scars became inconspicuous and patient satisfaction was high. Short incision technique may be a good option to overcome scar problems in donor site of the LD flap. The technique reduces the dissection time and does not require sophisticated surgical devices and skill, when compared to endoscopic LD flap harvesting from the literature.

Full sternotomy with limited skin incision for surgical treatment of atrial septal defect

Background:­In this study, we report our experience with repair of atrial septal defects utilizing a minimally invasive surgical approach. Methods: A full median sternotomy with mini skin incision was used in 29 patients (24 females, 5 males; median age 8 years; range 4 to 19 years) between November 2008 and August 2010. A midline chest incision was typically terminated at or near the nipple line, measuring approximately 6 cm in children and 7.5 cm in adolescents. Atrial septal defect was successfully treated through a mini skin incision in 27 patients. Skin incision was unavoidably enlarged in two patients due to technical challenges.