Red Cross Children's Hospital Research Articles

Fast magnetic resonance imaging for diagnosing pulmonary tuberculosis in children: the sub-10-min unenhanced scan.

In this study, we aimed to report the feasibility and quality of fast (unenhanced < 10-min duration) magnetic resonance imaging (MRI) for the detection of lymphadenopathy in non-sedated children with suspected tuberculosis (TB). This was a prospective study that involved children (< 13years of age) hospitalised at Red Cross Children's Hospital with suspected pulmonary TB who were referred for a fast MRI of the chest. The limited short-duration MRI protocol included coronal short tau inversion recovery (STIR) and axial diffusion-weighted imaging (DWI) sequences with additional axial STIR and axial and coronal T2 sequences if the patient was compliant. The scan time was capped at 10min and a study was considered successfully completed when DWI and STIR images were obtained in axial planes. MRI quality was recorded as 'acceptable quality'; 'poor quality, but readable'; and 'non-diagnostic'. Of the 192 fast MRI protocol scans, 166 (86%) were successfully completed within the 10-min allotted scan period. There was no age or sex difference between successful and unsuccessful studies. The mean duration of successful scans was 6.5min (standard deviation = 1.5min, range = 4-10min). Fast (sub-10-min scan) MRI is feasible for diagnosis of lymphadenopathy in non-sedated children in the setting of suspected TB, including those below 6years of age.

Conjoined twins with a single heart with complex disease

Conjoined twins are a rare presentation with an estimated incidence of 1: 50000 pregnancies. They occur due to a random event, not related to heredity, maternal age or delivery conditions. This article is a case-report of a pair of female thoraco-omphalopagus conjoined twins, who were diagnosed during prenatal period through a morphological ultrasound. After a 24-week gestation period, the female newborns had a total weight of 1100g, and were born of a cesarean section. Both fetuses scored 3 in the Apgar scale in the first minute, getting down to a score of 1 in the fifth minute. Soon after birth, the newborns were referred to the Intensive Care Unit, where supportive measures were taken and transthoracic Doppler echocardiography was performed for diagnostic confirmation. The echocardiogram showed that there was only one heart for both newborns with a complex heart disease. In 75% of the cases of thoraco-omphalopagus conjoined twins, structural heart disfigurements are found in at least one of the fetuses. Besides, in approximately 80-90% of the cases, the cardiac abnormalities in the heart junction are far too complex, making it impossible to surgically separate the fetuses. This way, a structural and functional analysis of the heart is considerably more efficient post-birth, and it’s shown to be more accurately done through an echocardiography. This reveals that cardiac changes are a crucial factor in the fetal and postnatal evaluations of conjoined twins. Such procedures are a way of providing adequate medical recommendations, which may always be honest and based on scientific evidence.Descriptors: Diseases in Twins; Twins, Conjoined; Heart Diseases.ReferencesMcMahon CJ, Spencer R. Congenital heart defects in conjoined twins: outcome after surgical separation of thoracopagus. Pediatr Cardiol. 2006;27(1):1-12Rode H, Fieggen AG, Brown RA, Cywes S, Davies MRQ, Hewitson JP et al. Four decades of conjoined twins at Red Cross Children's Hospital--lessons learned. S Afr Med J. 2006; 96(9Pt2):931-40.Barth RA, Filly RA, Goldberg JD, Moore P, Silverman NH. Conjoined twins: prenatal diagnosis and assessment of associated malformations [published correction appears in Radiology 1991 Jan;178(1):287]. Radiology. 1990;177(1):201-7.Spencer R. Anatomic description of conjoined twins: a plea for standardized terminology. J Pediatr Surg. 1996;31(7):941-944.Andrews RE, Yates RW, Sullivan ID. The management of conjoined twins: Cardiology assessment. Semin Pediatr Surg. 2015;24(5):217-20.Andrews RE, McMahon CJ, Yates RW, et al. Echocardiographic assessment of conjoined twins. Heart. 2006;92(3):382-87.Lopes LM, Brizot ML, Schultz R, Liao AW, Krebs VLJ, Francisco RPV et al. Twenty-five years of fetal echocardiography in conjoined twins: lessons learned. J Am Soc Echocardiogr. 2013;26(5):530-538.Brooks R. Ian McEwan attacks church over right to die. Sunday may 18 2014. The Sunday Times https://www.thetimes.co.uk/article/mcewan-attacks-church-over-right-to-die-gq8nwtbhqjb.Sih DA, Bimerew M, Modeste RRM. Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town. Curationis. 2019;42(1):e1-8.Albuquerque S, Pereira M, Fonseca A, Canavarro MC. Impacto familiar e ajustamento de pais de crianças com diagnóstico de anomalia congênita: influência dos determinantes da criança. Rev psiquiatr clín. 2012;39(4):136-41.Pereira PK, Lima LA, Legay LF, Santos JFC, Lovisi GM. Congenital malformation of the baby and risk of maternal mental disorders during the pregnancy-puerperal period: a systematic review. Cad Saúde Colet (Rio de Janeiro). 2011;19(1):2-10.

Vitamin D status of children with moderate to severe chronic Kidney Disease at a Tertiary Pediatric Center in Cape Town.

The prevalence of suboptimal Vitamin D levels is higher in patients with chronic kidney disease (CKD) than in the general population. Recent findings suggest that progression of CKD is linked to a suboptimal Vitamin D level. A high percentage of CKD patients have severe Vitamin D deficiency. These patients also have a low level of 25-hydroxy-vitamin D [25(OH)D] and consequently, a reduced ability to form active 1,25-dihydroxyvitamin D. Various factors underlie the low level of 25(OH)D, including a sedentary lifestyle, decreased intake of Vitamin D due to CKD-related dietary restrictions, and decreased synthesis of Vitamin D in skin due to uremia. All these factors may be particularly influential in patients with progressively worsening CKD, including those receiving chronic dialysis. The objective of our study is to determine the prevalence of Vitamin D deficiency in children with CKD stages three to five and those receiving chronic dialysis, to ascertain whether there is a relationship between Vitamin D deficiency and the stage of CKD, and to identify any clinical correlates associated with the Vitamin D status. A single-center, retrospective review was conducted of 46 children (younger than 18 years) with CKD stages 3-5D who attended the renal clinic of the Red Cross Children's Hospital between October 2013 and November 2014. In total, 73.9% of the study population had suboptimal Vitamin D levels (43.5% and 30.4% had Vitamin D deficiency and insufficiency, respectively). The prevalence of Vitamin D deficiency was significantly higher in older children (≥10 years of age) than in younger children (P = 0.000) but did not significantly differ between males and females (P = 0.693). In total, 12 of 15 black children (80%), 19 of 26 colored children (73.1%), two of four white children (50%), and one Asian child (100%) had suboptimal Vitamin D levels. Neither white nor Asian child had Vitamin D deficiency. In addition, 90% of patients undergoing chronic dialysis, 80% of whom were receiving peritoneal dialysis, had suboptimal Vitamin D levels. Age, weight, height, and the albumin concentration were significantly associated with the Vitamin D level. There was a positive linear relationship between the Vitamin D level and the serum albumin concentration (Spearman's rho correlation coefficient = 0.397, P = 0.007). In total, 87.5% of patients with nephrotic-range proteinuria had suboptimal Vitamin D levels, and 80% were Vitamin D deficient (P = 0.004). A higher percentage of Vitamin D deficiency/insufficiency cases was documented during the winter (24/34, 70.6%) than during the summer (10/34, 29.4%); however, this difference was not statistically significant (P = 0.685). Sub-optimal Vitamin D is high among children with moderate to severe CKD and significantly higher in those undergoing chronic dialysis. The emerging evidence of the role of Vitamin D in slowing progression of CKD highlights the need for monitoring and correction of Vitamin D levels in predialysis children.

The Effect of Electrical Load Shedding on Pediatric Hospital Admissions in South Africa.

South Africa faced repeated episodes of temporary power shutdowns, or load shedding, in 2014/2015. The effect of load shedding on children's health is unknown. We determined periods of load shedding using Twitter, Facebook, and data from the City of Cape Town. We obtained the number of unscheduled hospital admissions between June 2014 and May 2015 from Red Cross Children's Hospital, Cape Town, and weather data from the South African Weather Service. We used quasi-Poisson regression models to explore the relationship between number of hospital admissions and load shedding, adjusted for season, weather, and past admissions. Based on assumptions about the causal process leading to hospital admissions, we estimated the average treatment effect, that is, the difference in expected number of admissions per day had there been load shedding each day or on any of the preceding 2 days compared with if there had not been any load shedding. We found a 10% increase (95% confidence interval: 4%, 15%) in hospital admissions for days where load shedding was experienced on the same day, or no more than 2 days prior, compared with when there was no load shedding in the past 2 days. The increase was more pronounced during weekdays (12% [7%, 18%] vs. 1% [-9%, 11%]), and for specific diagnoses (e.g., respiratory system: 14% [2%, 26%]). The average treatment effect was estimated as 6.50 (5.12, 7.87) highlighting that about 6 additional admissions a day could be attributed to load shedding. The association we measured is consistent with our hypothesis that failures of the power infrastructure increase risk to children's health. See video abstract at, http://links.lww.com/EDE/B409.

Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

PURPOSE OF STUDY: Prolonged bracing following injury in patients with Spinal Cord Injury without Radiographic Abnormality (SCIWORA) remains controversial. Some authors claim that there is occult instability and a risk of recurrent injury whereas others propose that the spinal column will deform elastically, but will return to its baseline stability by elastic recoil. We aim to assess the presence of ligamentous injury on MRI and the incidence of recurrent instability following SCIWORA in order to determine the need for prolonged bracing. METHODS: A retrospective chart review was performed for a series of 12 patients with documented SCIWORA that presented to Red Cross Children's Hospital over the past 8 years. Details regarding mode of injury, age at presentation, neurological deficit at presentation, MRI findings and long-term prognosis were documented. RESULTS: There were nine males and three females. The median age was 4.35 years. All patients were victims of high energy motor vehicle accidents. In two patients there was disruption of the ligamentum flavum at the level of the injury. There were no episodes of recurrent instability or neurological compromise in those patients that had recovered. None of our patients had rigid bracing following the diagnosis of SCIWORA. CONCLUSION: Infrequently observed disruption of isolated stabilising structures in SCIWORA did not lead to early or delayed instability in our patients. We did not find evidence to support the practice of prolonged rigid bracing to prevent recurrence following SCIWORA. LEVEL OF EVIDENCE: Prognostic case study, level IV.

Focus on the Top Ten Diagnoses Could Reduce Pediatric Dermatology Referrals.

There is a sense that many patients seen at referral centers could be managed at a primary health care level. The objective of the current study was to examine the range of diagnoses among consultations at the Red Cross Children's Hospital in Cape Town, South Africa, to help develop a strategy for targeted education of primary health care personnel. This was a retrospective review of data for children seen at a pediatric dermatology clinic from 2005 to 2010, recorded according to International Classification of Diseases coding and compared with published data from similar clinical settings. There were 13,253 clinic visits, with 4,789 patients seen (median age 4.8 yrs, range 2 days to 18.6 yrs). The top 10 diagnoses accounted for 88.5% of consultations (59.5% atopic eczema [AE], 7.1% seborrheic dermatitis [SD], 4.2% superficial mycoses, 3.1% molluscum contagiosum, 2.8% vitiligo, 2.7% viral warts, 2.4% prurigo or scabies, 2.3% psoriasis, 2.3% hemangioma, 2.1% impetigo). Disease prevalence was somewhat different during the first year of life (AE 43.7%, SD 18.6%, hemangiomas 13.4%). Inflammatory dermatoses (76.6%) were more prevalent than infections and infestations (14.5%). The disease spectrum was similar to that in developed countries, although AE prevalence was higher in this study (followed by London 36%, Greece 35%, and Hong Kong 33%) than in 19 published studies. The top 10 diagnoses accounted for more than 70% of diagnoses in 12 studies. The retrospective nature and setting at a specialist clinic increased bias and limited generalizability. Focused education on the optimal care of common diseases, especially AE, could reduce referrals, improve access, and allow specialists at tertiary centers more time to manage complex and uncommon dermatoses.

P102 – 2305: Long-term neurodevelopmental and behavioural outcomes of acute organophosphate poisoning in South African children

Objective Organophosphate poisoning (OPP) is a significant cause of mortality in resource-poor countries, especially in economies such as that of South Africa where agricultural activity remains an important contributor to the economy. Long-term neurobehavioural sequelae of OPP have been reported in adults, but little is known about the neurodevelopmental outcomes of children who survive acute organophosphate pesticide poisoning, including that from domestic exposure. This study aimed to determine the performance of South African children surviving acute episodes of OPP on a standardized neurobehavioural battery compared to a control group of children previously admitted to hospital with paraffin poisoning. Methods Children were included who were 3–12 years with a previous admission for OPP to the Red Cross Children's Hospital, Cape Town. The control group comprised children admitted for paraffin poisoning and were matched to the index group for age, gender, home language, admission date and illness severity. All children were assessed for neurodevelopmental function. Caregivers were administered a questionnaire-based behavior rating scale, Achenbach System of Empirically Based Assessment. The neurodevelopmental performance and behaviour of OPP children was compared to that of the controls. Results A total of 91 children were tested, 46 OPP and 45 control children. No between group differences were found on any measures. Conclusion Although there were no significant differences between the children with OPP and those with acute paraffin exposure on preliminary analysis, possible explanations for this include sample size too small to detect subtle differences, exclusion from the study of children who had severe neurodisability or who had died due to OPP. Between group effects of these children may also have been masked by high prevalence risk factors in South Africa for poor development such as low socio-economic status, HIV exposure, maternal alcohol and smoking during pregnancy and poor maternal mental health.

Temporomandibular Joint Ankylosis In Children

Temporomandibular joint (TMJ) ankylosis is defined as osseous or fibrous fusion of the condyle of the mandible and the mandibular fossa of temporal bone (Nitzan et. al. 1998).It is a debilitating disease that renders the afflicted person unable to use their oral cavity well. Clinical presentation depends on the age at which ankylosis occurs and whether ankylosis is unilateral or bilateral. Surgery and postoperative physiotherapy are regarded as the mainstay treatment for TMJ ankylosis. The study reviews surgical outcomes of 13 children treated for temporomandibular joint (TMJ) ankylosis in the maxillofacial and oral surgery unit at Red Cross Children's Hospital. Nine patients were treated by gap arthroplasty, while four patients had previous reconstruction with costochondral graft. One patient treated by gap arthroplasty reankylosed. The study showed a positive correlation between intraoperative MIO and the outcome, and between age and the outcome. Mouth opening was improved by 15mm, with postoperative change of -4mm.

‘We didn't do anything wrong, we tried our best, but they just died … we tried, we really tried’: Child Deaths in the Paediatric Intensive Care Unit, Red Cross Children's Hospital, Cape Town, South Africa

This article argues that child deaths in the Paediatric Intensive Care Unit (PICU) generate profound moral struggle amongst caregivers. In it I deconstruct how caregivers manage the messy and at times problematic circumstances that clinical necessity requires from them in order to save children's lives. One result of this is that on many occasions they care for them at their time of death. When deaths are well managed compassion is engendered into the child's dying and the death becomes restorative for the family and unit. In this, consultants – who are intensive-care specialists – play a critical role as they take responsibility for the clinical management of child deaths. In doing so, they inform a team-based deliberation process to consider the child's clinical assessment in the context of other ethical and moral issues. In addition, consultants must take part in the social negotiation of these events with family and caregivers. Nurses in contrast are more intimately involved in child deaths and are shown to be more affected by the emotional, psychological and social consequences of deaths. The discussion further proposes that the nature of moral struggle is confounded by a complex of related factors that arise in a South African landscape, critical among which are the past inequities brought by apartheid and this makes the deaths of children particularly sensitive. These inequities are now inherent in a geographical context influencing the demographic and epidemiological profile of disease that children suffer from and thereby, their chances of survival on admission to the hospital and the deaths that occur.

Pathways to child and adolescent psychiatric care in the division of child and adolescent psychiatry at Red Cross children's hospital

Pathways to child and adolescent psychiatric care in the division of child and adolescent psychiatry at Red Cross children's hospital

Laparoscopic repair of anorectal malformations at the Red Cross War Memorial Children's Hospital: taking stock

BackgroundThe current standard repair for anorectal malformations in children is a posterior sagittal anorectoplasty. Recently, laparoscopic-assisted anorectoplasty (LAARP) was performed at the Red Cross Children's Hospital. MethodsA detailed case note review was conducted. Patient outcome was prospectively evaluated by colorectal nurse specialists using the Krickenbeck standardized questionnaire. Comparison among patients undergoing posterior sagittal anorectoplasty was performed. ResultsBetween September 2005 and June 2009, 24 children underwent LAARP. Sixteen had associated anomalies, including 7 children with renal and 4 children with cardiac abnormalities. Median age at surgery was 7.5 months (range, 2.6-15.0 months). Subtypes of anorectal malformation were as follows: vestibular, 2; bulbar, 9; prostatic, 7; vesical, 3; and with no fistula, 3. There was a 16% early complication rate. Redo-anoplasty was required in 9 patients. Eleven children had difficulties with follow-up. Thirteen children had regular follow-up and were analyzed further. Toilet training had been completed in 7 children (median age, 4.3 years; range, 3.5-6 years). Six children developed voluntary bowel motions. Six children are awaiting toilet training or are unable to train because of incontinence. ConclusionsAnal stenosis was the most common complication post-LAARP. Etiology appeared to be multifactorial, but poor compliance with dilatations was a leading cause.

Urinary tract infection following kidney transplantation: frequency, risk factors and graft function

The aim of this study was to determine the proportion of children who develop urinary tract infection (UTI) after kidney transplantation (KTx) and to identify the factors associated with UTI and its impact on graft function. To this end, we undertook a chart review of children who underwent KTx at Red Cross Children's Hospital between January 2003 and December 2009 and were followed-up for at least 6 months after transplantation. Sixty-two children (53.2% males) were followed-up for a mean (standard deviation) period of 36.9 (19.7) months. Mean age at transplantation was 10.0 (4.6) years. Twenty-five (40.3%) children had 89 UTI episodes during the study period, equivalent to 0.94 UTI episodes per one patient-year of follow-up. Acute pyelonephritis occurred in 17 (27.4%) children; another 17 (27.4%) had multiple post-KTx UTI. Klebsiella (40.0%) and Escherichia (28.0%) were the commonest organisms. Those with post-KTx UTI were, at transplantation, younger (8.3 vs. 11.2 years; p = 0.017), had lower urinary tract abnormality (LUTA) (13 vs. 1; p = 0.000) and had pre-KTx UTI (13 vs. 5; p = 0.001). Multivariate analysis revealed that only age <5 years at transplantation and LUTA remained significant and that UTI KTx was not associated with worsening graft function. UTI is common after post-KTx. Among our patient cohort, younger age and LUTA were risk factors, but UTI did not affect graft function.

Therapeutic impact of routine electrolyte testing in childhood diarrhoea

To report on the management of plasma sodium and potassium disturbances, identified by routine electrolyte testing in children. A prospective cohort study of patients admitted to the Diarrhoea Rehydration Unit of Red Cross Children's Hospital, Cape Town, South Africa. The patients were 530 children aged 6 weeks to 2 years with a primary diagnosis of diarrhoea. For plasma sodium levels <125 mmol/L (3.4%, 95% CI 2.0-0 5.3), 48 patients (95% CI 30-116) needed testing for one to receive a change of management. For plasma potassium levels <3 mmol/L (31.6%, 95% CI 27.6-35.6), fewer patients (6, 95% CI 5-7) needed testing for one to receive a change of management. Electrolyte abnormalities were detected and clinical management changed, but large numbers of patients needed to be tested for each change of management.

Child safety: a neglected priority

During the fi rst week of 2009 a number of children were treated in the Trauma Unit at the Red Cross War Memorial Children's Hospital in Cape Town. A 2-year-old girl visiting from the province fell in front of a bus while her mother was being robbed of a cell phone in one of the suburbs. The bus could not avoid the little girl, crushed her and killed her. A 6-yearold girl travelling back from the city to her home with her family was severely injured when someone threw a brick at the front windscreen of the car, breaking it and instantly killing the driver, after which the car left the road and all the passengers were seriously injured. Three children were electrocuted when their homes, which were disconnected by the municipality because of nonpayment, and were illegally rewired, leaving live wires exposed and killing the children. Another 6-year-old girl was hit by a stray bullet in a gang fight. Although all these deaths are quite different in nature, a similar pattern is recognizable. Adults, in active chase for their own gratifi cation are injuring children lethally in the process. It is unlikely that in any of these cases the children were directly targeted, however, they died while adults were pursuing their own criminal interests. A study performed a few years ago at the Red Cross Children's Hospital indicated that of all children presenting with head injuries after abuse, almost 50% of them were injured when adults were fi ghting with each other.

A profile of hospital-admitted paediatric burns patients in South Africa

BackgroundInjuries and deaths from burns are a serious, yet preventable health problem globally. This paper describes burns in a cohort of children admitted to the Red Cross Children's Hospital, in Cape Town, South Africa.This six month retrospective case note review looked at a sample of consecutively admitted patients from the 1 st April 2007 to the 30 th September 2007. Information was collected using a project-specific data capture sheet. Descriptive statistics (percentages, medians, means and standard deviations) were calculated, and data was compared between age groups. Spearman's correlation co-efficient was employed to look at the association between the total body surface area and the length of stay in hospital.FindingsDuring the study period, 294 children were admitted (f= 115 (39.1%), m= 179 (60.9%)). Hot liquids caused 83.0% of the burns and 36.0% of these occurred in children aged two years or younger. Children over the age of five were equally susceptible to hot liquid burns, but the mechanism differed from that which caused burns in the younger child.ConclusionIn South Africa, most hospitalised burnt children came from informal settlements where home safety is a low priority. Black babies and toddlers are most at risk for sustaining severe burns when their environment is disorganized with respect to safety. Burns injuries can be prevented by improving the home environment and socio-economic living conditions through the health, social welfare, education and housing departments.

Functional Status of Patients With Cerebral Palsy According to the International Classification of Functioning, Disability and Health Model: A 20-Year Follow-Up Study After Selective Dorsal Rhizotomy

Langerak NG, Lamberts RP, Fieggen AG, Peter JC, Peacock WJ, Vaughan CL. Functional status of patients with cerebral palsy according to the International Classification of Functioning, Disability and Health Model: a 20-year follow-up study after selective dorsal rhizotomy. Objective To determine functional status of patients with cerebral palsy 20 years after they received selective dorsal rhizotomy (SDR). Design A prospective 20-year follow-up study. Setting Red Cross Children's Hospital (SDR operation and 1-year follow-up assessment) and at institutional or private locations nearby patients' homes (20-year follow-up assessment). Participants Referred sample of 14 patients with spastic diplegia (6 women, 8 men; mean age, 27y; range, 22–33y) who were preoperatively ambulant and fulfilled strict selection criteria for SDR operation in 1985. Interventions Patients were assessed before and 1 and 20 years after SDR. Main Outcome Measures Standardized assessments of function according to 2 dimensions of the International Classification of Functioning, Disability and Health (ICF) model: (1) body structure and function (muscle tone, joint stiffness, voluntary movement) and (2) activity (rolling, sitting, kneeling, crawling, standing, walking, transitions) were obtained. In addition, based on assessments and questionnaires, Gross Motor Function Classification System (GMFCS) levels were determined before and at 1 year after SDR retrospectively and currently at 20 years after SDR. Results One year after SDR, functional outcomes based on the 2 dimensions of the ICF model improved significantly, and these improvements were maintained at 20 years after surgery. Patients showed a shift in their GMFCS levels 1 and 20 years after SDR. Conclusions In line with our 20-year follow-up study with gait parameters as outcome measures, patients with spastic diplegia still show improvements in their functional status 20 years after SDR. We acknowledge the presence of possible confounding factors and a small sample size, but we argue that the improvements found in this study were caused mainly by SDR. Finally, changes in GMFCS levels suggest a possible role for this tool to detect changes after an intervention.

Kaposi sarcoma in children with HIV: a clinical series from Red Cross Children's Hospital

Aim The study aimed to assess the clinical presentation, diagnosis, and treatment of Kaposi sarcoma in our HIV-positive paediatric population; analyse the increase in Kaposi sarcoma with the HIV epidemic; and look at unique surgical presentations and their implications for gastrointestinal surveillance. The incidence of Kaposi sarcoma, a herpesvirus 8–associated neoplasm of endothelial cells, has increased with the onset of the HIV epidemic. Surgical interest was prompted by a case of Kaposi sarcoma presenting with intussusception. Methods All HIV-positive children with Kaposi sarcoma from 2003 to 2007 were included in the study. A retrospective analysis of clinical data was performed. Main Results There were 9 children who ranged in age from 1 to 10 years (median, 7.1 years). Clinical presentations included oropalatal and laryngeal disease (5), pleural effusion (2), inguinoscrotal and skin disease (4), lymph node involvement (3), and gastrointestinal disease with haemorrhage (2), including one as a result of intussusception. Most patients presented with more than one clinical area involved. CD4 counts ranged from 14 to 2105. Two patients developed Kaposi sarcoma on antiretroviral treatment (ART); the remaining patients were started on antiretroviral treatment at presentation. Two patients died from overwhelming disseminated disease and one patient was lost to follow-up. Chemotherapy was required to achieve remission in the remaining 6. Before the HIV epidemic, this hospital treated one patient with Kaposi sarcoma every 4 years; the incidence has now increased to 2 patients per year. Conclusion Kaposi sarcoma is an increasingly important paediatric cancer in the era of the HIV epidemic. The clinical presentation in children is commonly oropalatal and inguinoscrotal disease. Gastrointestinal involvement was highlighted by a presentation with intussusception. The surgeon's role in diagnosis and management includes clinical recognition, biopsy, and definitive treatment.

Endoscopy Findings in HIV-Infected Children from Sub-Saharan Africa

The causes of persistent gastro-intestinal symptoms in HIV-infected children from sub-Saharan Africa remain poorly documented. The clinical, radiological and endoscopic findings of all HIV-infected children who underwent upper GI endoscopy at Red Cross Children's Hospital, Cape Town, South Africa, from February 2003 to October 2005 were documented. Twenty-six HIV-infected children underwent endoscopy; median age 1 year (range: 0.17-10.9 years). The majority had advanced HIV disease; 18 (69%) were WHO Stage 4; median CD4 10.7% (range: 1-39.8%). Presenting symptoms included persistent vomiting (18), dysphagia (4) and GIT bleed (6). Observational and histological findings showed poor correlation. Pathogens were identified in 10 children: cytomegalovirus infection in seven (two with cryptosporidium co-infection), Candida in two, Helicobacter pylori in one. Age and CD4 count were not associated with the pathogens. Endoscopy findings influenced clinical management in 21 (81%) cases. Upper-GI endoscopy identified a diverse spectrum of disease and provided information that would be clinically relevant to most HIV-infected children with upper gastro-intestinal symptoms.

Laparoscopic Insertion with Tip Suturing, Omentectomy, and Ovariopexy Improves Lifespan of Peritoneal Dialysis Catheters in Children

Over the past two decades, chronic peritoneal dialysis (PD) has emerged as the first choice pediatric dialysis modality. A recent study visually identified the cause of malfunction of PD catheters at the Red Cross Children's Hospital in Cape Town. The reasons that could be found, lead to changed Tenckhoff insertion-techniques from open to laparoscopic. This included suturing of the tip, omentectomy and ovarian-pexy by laparoscopy. In the present paper we prospectively analyzed, if changed insertion technique lead to an improved outcome. 26 Patients required 36 laparoscopic Tenckhoff insertions during the period August of 2003 and July of 2006. Overall a total number of 222.5 catheter-months have been observed. Laparoscopic insertion technique required 3 port placements. The tip of the catheter was sutured to pelvic peritoneum, omentectomy performed through a port site and ovariopexy done when required. The mean lifespan of all Tenckhoff's was 6.4 +/- 6.3 months. The tip of the catheter was sutured 20 times, omentectomy done in 9 cases and 6 patients underwent ovarian pexy. In the group where the tip was sutured to the pelvic peritoneum catheter life was 8.4 months compared to the non-sutured group which was only 4.1. Omentectomy lead to an overall catheter survival of 8.0 months compared to the no omentectomy group, which had a survival of 5.8 months. The complication-rate concerning early problems and malfunctions in the sutured and omentectomy groups was also lower. Patients who underwent both, suturing of the tip and omentectomy had no malfunctions at all. Omentectomy and suturing the tip can lower the complication-rate and prolong catheter survival. Using these procedures could decrease costs and morbidity and prevent patients from having further operations.

A pilot study evaluating the “STATSCAN” digital X-ray machine in paediatric polytrauma

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fan-beam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiography (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.