Success Rate Of Reduction Research Articles

Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study.

BackgroundIntussusception is a common cause of small intestinal obstruction in children under two years of age. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop a conservative management protocol for acute ileocaecal intussusception in children under two years of age.MethodsThis prospective study was carried out in 118 consecutive patients under two years of age. Patients presented with symptoms and signs of acute intestinal obstruction and a diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation.ResultsThere were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%), and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs for less than 24 hours accounted for 80.5% of the cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool, and presenting with the classic triad of symptoms of intussusception were found as the factors that correlated to the surgical management outcome. All patients recovered well without any complications. The median of postoperative hospital stay of two days for the pneumatic reduction group and six days for the operation group.ConclusionThe early diagnosis of intussusception contributes to the success of pneumatic reduction and reduces the requirement of surgical intervention.

Lower scores in pharmacokinetics than in pharmacodynamics assessment among students in a health and life sciences curriculum

In pharmacology teaching, pharmacokinetics (PK) and pharmacodynamics (PD) may be defined as part of the ‘general pharmacology’ domain, whereas effects of drugs on the autonomic nervous system and clinical trial design might be defined as part of the ‘medical’ and ‘clinical’ pharmacology domain, respectively. We recently designed a pharmacology course covering these domains for second year Health and Life Sciences students at the Vrije Universiteit Amsterdam (VU). We used a combination of lectures, problem-based learning and practicals to transfer knowledge to students in order for them to acquire sufficient knowledge and insight to solve real-world pharmacological problems. To evaluate whether we 1) successfully aligned our course objectives with both our teaching strategy and assessment, and 2) to identify topics in our course that would benefit from improvement in teaching strategy and/or effort, we determined success rate of the exam questions in above-defined pharmacology domains. We analyzed 3 consecutive second year cohorts (n = 377) of students enrolled in our course, and found a statistically significant reduction in success rate in exam questions of the general pharmacology domain (especially in PK), compared to domains covering ‘medical’ and ‘clinical’ pharmacology. In addition, we found lower success rates for ‘knows how’ questions compared to ‘knows’ questions in the combined PK/PD domain. Our data show that we overall succeeded in aligning our course objectives with both our teaching strategy and assessment, but that outcomes on the PK domain might benefit from additional attention.

Effectiveness of ultrasound-guided hydrostatic reduction of intussusception in children

Aim: To review the effectiveness of ultrasound- guided hydrostatic reduction of intussusception in children.
 Methods: This prospective interventional study was done during one year period from January 2014 to December 2014 in the department of Radiology and Imaging of Dhaka Medical College and Hospital, Dhaka and included 30 children clinically and radiologically diagnosed as intussusception with symptoms d” 48 hours. They underwent ultrasound-guided hydrostatic reduction using normal saline and the effectiveness of this technique was reviewed.
 Results: Majority of the study population were in the age group of 7-24 months with mean age of 9.04± 2.48 months. 100% patients who presented within 24 hours of their symptoms achieved successful reduction whereas success rate of reduction were 95% and 0% respectively in patients presented within 24-36 hours and after 36 hours of their symptoms. 60% cases required 5-10 minutes for successful reduction, 20% cases required 3-5 minutes and 10% patients needed > 10 minutes. Within 3 attempts, reduction happened in 90% cases whereas 10% cases failed to reduce. No case was tried for reduction after 3 attempts in consideration of the bowel pathology and complications. Only 10% patients developed negligible complications. No case showed recurrence.
 Conclusion: Ultrasound guided hydrostatic reduction of intussusception is an effective nonoperative treatment of intussusception in children because of its high success rate, less complications and recurrence rate.
 J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 134-140

Nghiên cứu các yếu tố xác định tháo lồng bằng phẫu thuật ở trẻ em dưới 2 tuổi bị lồng ruột cấp

FACTORS DETERMINING OF OPERATIVE REDUCTION IN ACUTE INTUSSUSCETION OF CHILDREN Background: Intussusception is the common cause of small intestinal obstruction in children under two years old. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop the conservative management protocol for acute ileocaecal intussusception in children undertwo years old. Methods: This prospective study was carried out in 118 consecutive patients under two years old. Patients presented with symptoms and signs of acute intestinal obstruction and diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation. Results: There were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%) and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs less than 24 hours were accounted for 80.5% of cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool and presenting with the classic triad of symptoms of intussusception were found as the factors which correlated to the surgical management outcome. All patients were well recovery without any complication. The median of postoperative hospital stay was two days for pneumatic reduction group and six days for operation group. Conclusion: Early diagnosis of intussusception contributes the success of pneumatic reduction and reduces the requires of surgical intervention. Key words: intussusception, pneumatic reduction, surgical intervention.

Effect of Midazolam Alone Versus Midazolam with Maternal Presence on Pain and Anxiety of Lumbar Puncture in 6 to 24-Month-Old Children.

Midazolam at a dosage of 0.5 mg/kg induces anxiolytic effects in 90% of children. This study was performed to elucidate whether intravenous midazolam with maternal presence is more efficient than intravenous midazolam alone in the reduction of pain and anxiety of lumbar puncture (LP) in 6 to 24-month-old children. In this not-blinded clinical trial, we included 60 children aged 6 to 24 months old undergoing LP in the Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran, from September 2014 to March 2015. The participants were randomly assigned to two groups, and all of them received painless injection of 0.5 mg/kg midazolam five minutes before LP. In group I, LP was performed with maternal presence and in group II, the mothers were absent. The primary outcomes included anxiety and pain scores before LP and during needle insertion to the skin for LP. The secondary outcomes comprised of success rates in the reduction of anxiety (anxiety score of four and more) and pain (pain score of less than three) when the needle was inserted to the skin for LP. Twenty-eight girls and 32 boys were evaluated in the two groups. Maternal presence was found to be effective in the reduction of anxiety (2.7±0.65 vs. 3.83±0.87; P=0.001) and pain scores (3.8±1.75 vs. 6.1±1.63, P=0.001). In the maternal presence group, success rate in anxiety (76.7% vs. 16.6%; P=0.0001) and pain reduction (63.3 % vs. 6.7%; P=0.0001) was higher than in the midazolam alone group. Maternal presence during lumbar puncture can reduce pain and anxiety among 6 to 24-month-old children.

Effect of manipulative reduction combined with air enema on intestinal mucosal immune function in children with intussusception.

Objective:To explore the effect of manipulative reduction combined with air enema on intestinal mucosal immune function in children with intussusception.Methods:This is a prospective randomized controlled study in which 60 children with primary intussusception admitted to Hebei Children’s Hospital from October 2018 to October 2019 were selected for this study. They were randomly divided into two groups. The 30 patients in the experimental group underwent manipulative reduction and air enema reduction, and 30 patients in the control group underwent only air enema reduction. Pain scores and pressure during enema were recorded and analyzed. Fasting blood of children in the experimental group were drawn to test the serum T lymphocyte subsets CD3+, CD4+, CD8+ levels, B lymphocyte subsets CD19+ level, and NK cell subsets CD56+ levels before reduction. Among them, fasting blood of 28 children with successful reduction were drawn again in the morning after reduction, and the indicators of each immune cell subgroup before and after reduction were analyzed. Two children with unsuccessful reduction were no longer tested for these indicators.Results:Twenty-Eight children in the experimental group had successful reduction, and two children with unsuccessful reduction were changed to open surgery (28/30). Twenty five Children in the control group had successful reduction, and five were changed to open surgery (25/30). There was no significant difference in the success rate of reduction between two groups (p>0.05). Close observation for 12~24h after reduction found that none of the children had signs of peritonitis. The pain score and reduction pressure of the observation group were lower than those of the control group, and the difference was statistically significant (p<0.05). The levels of serum CD3+, CD4+, and CD8+ after reduction in the experimental group were significantly higher than before reduction, and the difference was statistically significant (p<0.05). CD19+ level was significantly lower than before reduction, and the difference was statistically significant (p<0.05). There was no significant difference in changes of other indicators.Conclusions:Manipulative reduction combined with air enema reduction can relieve pain and air injection pressure during enema, reduce reperfusion injury caused by intestinal ischemia, and protect intestinal mucosal immune function, which is a favored treatment.

Incarcerated and strangulated inguinal hernias in children: A 10-year retrospective analysis

Abstract Background: In pediatric inguinal hernia, the most feared complication is incarceration, which can lead to catastrophic consequences if not resolved expeditiously. Aims: This study assessed the usefulness of manual reduction of complicated inguinal hernia in children. Settings and Design: This study was designed to study the age at presentation, gestation age at birth, duration of symptoms, success rate of manual reduction of incarcerated inguinal hernia, subsequent treatment, operative findings, and outcome of strangulated cases in pediatric patients. Materials and Methods: This is a retrospective study involving 56 children under 15 years of age with a diagnosis of complicated inguinal hernia managed between January 2009 and December 2018 at a tertiary care hospital in Nigeria. Demographic characteristics, clinical presentations, management, and outcome were retrieved. Data were analyzed using SPSS software version 22 (IBM Corp., NY, USA). The results were presented as frequencies and percentages. Categorical variables were analyzed using Chi-square test. P &lt; 0.05 was deemed statistically significant. Results: The age of patients ranged between 8 days and 14 years, with a median of 2 months; 79% were infants. Males outnumbered females by a ratio of 27:1, and the rate of incarceration was 5.0%. Majority (89.3%) had no previous hospital visits. Those who had successful manual reduction was 80%. Time of presentation was a statistically significant factor for successful reduction, P &lt; 0.05. One patient experienced en masse reduction, and there was no mortality. Conclusion: Majority of those with incarcerated inguinal hernias were infants, and manual reduction was associated with early presentation.

Radial head subluxation in pediatric clinics and emergency departments in China

PurposeTo investigate the characteristics of the onset and treatment of radial head subluxation (RHS) in pediatric clinics and emergency departments. MethodsA retrospective study was performed on 11, 404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018. The patients who with history of trauma and fracture of the affected limb were excluded. The following factors were examined: the mechanisms of RHS, the type of manual reduction, the attending physician's clinical background (emergency surgeon, junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon), and the epidemiological features (gender, age, climate and location) of the injury. ResultsThe mean age of the patients was 27.93 ± 17.94 months (range 0.93–214.53 months), with a peak incidence of 10.73–44.53 months. Approximately two-thirds of RHS cases occurred in cold weather from January to March and from September to December. Females accounted for 53.81% (n = 6137) of the cases, and left injuries were predominant (56.87%, n = 6485) in all cases. Mechanisms of injury were classified as “pull” (90.57%, n = 10, 339), “fall” (1.56%, n = 178), “hit” (0.75%, n = 86) and “unknown” (7.02%, n = 801). The overall success rate of manual reduction was 99.47%, and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons (p < 0.05). However, there was still a recurrence rate of 12.16% in the 9827 patients. ConclusionYounger children are predisposed to RHS, and there is a possibility of recurrence. Trained emergency doctors can handle it well, but it is essential to refer patients to specialists when manual reduction failed.

Management of recurrent ileocolic intussusception

PurposeThe aims of this study were to evaluate the need for surgical intervention for patients with recurrent ileocolic intussusception (RICI), especially for multiple recurrences, and to investigate whether early and late recurrence patterns were associated with surgery. MethodsPatients with ileocolic intussusception (ICI) during the years 2007–2019 were included. Demographic data, recurrences, and outcomes were analyzed. Early RICI was defined as recurrence within 48 h. ResultsOverall, 604 episodes of ICI were confirmed in 491 patients. The recurrence rate was 13.8%, with 113 episodes in 68 patients. There were no statistically significant differences in age, reduction success rate, operation, or pathological lead points (PLPs) between the recurrence and non-recurrence groups. There was no significant association between the number of recurrences and the presence of a PLP or between the number of recurrences and whether the recurrences were early or late. The presence of PLPs was not significantly associated with age or recurrence, but the reduction success rate was significantly lower (P < 0.001). ConclusionsEach recurrence should be managed as a first episode, regardless of early or late recurrence. Operative reduction should be considered when nonoperative reduction fails, a PLP is suspected, or there are signs of peritonitis.Type of Study: Treatment Study.Level of Evidence: Level III.

Selection of Pneumatic Reduction in Invagination Treatment and the Factors Affecting the Success of This Method.

ObjectiveTo retrospectively evaluate the success rates of fluoroscopy-guided pneumatic reduction in children with intussusception and to determine the risk factors and patient characteristics affecting the success of this method.Materials and methodsRetrospective evaluation was made of a total of 183 children diagnosed with ultrasonography (USG) and treated in the pediatric surgery clinic between August 2010 and December 2017. Data related to gender, age (month), date of presentation, invaginated segment localizations and treatment modalities were retrieved from the patient files.In children who underwent pneumatic reduction, surgical success was determined as the visualization of air flow through the small intestine on fluoroscopy and patients who received reduction were followed up in our clinic. No progress of the air given or failure to see the air flow to the small intestine despite some progression of the air was evaluated as failure and surgical procedure was started in 39 patients. All patients were followed up at the hospital for at least 24 to 48 hours after the procedures.Patients with perforation, peritonitis, vital instability, or general condition disorder during presentation at our clinic (n = 29) were directly admitted for surgery.ResultsThe study included a total of 183 children, comprising 116 (63.4%) males and 67 (36.6%) females with a mean age of 61.3 ± 34.3 months. While mesenteric lymphadenitis (n = 7) was determined as the most common lesion in cases where a pathologic lead point was detected (7.6%), Meckel’s diverticulum was observed in four patients, polyps in two patients, and an involvement associated with Henoch Schönlein Vasculitis in one patient. Pneumatic reduction procedure was applied in 154 (84.1%) patients and successful results were obtained in 115 (74.7%) patients, while surgical intervention was required in 39 (25.3%) patients.While frequency of admission to direct surgery following the failure of pneumatic reduction in children under the age of two years was determined to be higher than the frequency of healing, the successful pneumatic reduction and admission to direct surgery rates in children between the ages of 0-4 years was found to be significantly higher than those in other age groups (p < 0.001). The pneumatic reduction success rate was determined to decrease significantly in children aged ≥6 years (p < 0.001). The mean hospitalization duration of the patients who underwent surgery after pneumatic reduction (five days) was determined to be significantly longer compared to that of the patients who underwent direct surgery and for whom a successful pneumatic reduction was ensured (p = 0.001 and p = 0.008, respectively).ConclusionFluoroscopy-guided pneumatic reduction has a high success rate and is still one of the first option methods in the treatment of idiopathic intussusception. The application of the method under operating room conditions is more appropriate for patient safety. It is considered that the non-operative reduction success may increase with the detailed evaluation of intussusception cases determined to have pathologic lead points in children aged <2 years and >6 years.

Intussusception: A 14-year experience at a UK tertiary referral centre

AimsIntussusception is the most common cause of acute intestinal obstruction in infants. First line management in uncomplicated cases at our centre is fluoroscopy guided air enema reduction. This study reports a 14 year UK single centre experience highlighting management and outcomes of intussusception in children. MethodsAll cases of intussusception (ICD 10-code K56.1) at a single tertiary referral centre from 2004 to 2017 were analyzed. Data evaluated included patient demographics, clinical presentation, treatment modality(s), complications and outcome(s). ResultsTwo hundred ninety confirmed cases (69% male) of intussusception were identified during the study period. The median age at presentation was 9.5 months (range 4 days–15 years). One hundred eighty-six (64%) cases occurred in children who were transferred to Alder Hey from peripheral district hospitals. One hundred ninety-six cases (68%) proceeded directly to air enema reduction and successful reduction was achieved in 129 cases (66%). A single case (0.5%) of attempted air enema reduction was complicated by perforation. Early recurrence rate following air enema reduction was 9%. Operative management was indicated in 140 (48%) cases of which 66 required bowel resection (47%). There were no deaths. ConclusionsWe highlight one of the largest single centre UK studies defining practice outcomes for intussusception across the British Isles. Our centre has achieved a 66% success rate of non-operative reduction over 14 years in line with the British Society Pediatric Radiology (BSPR) recommendations and within 5% of the national median metric (71%). Moreover these outcomes were achieved with a very low complication rate (0.5%) from air enema reduction and no mortality in the series. Type of studyRetrospective study. Level of evidenceIII

Clinical effect of different methods for endoscopic precut sphincterotomy in difficult intubation during endoscopic retrograde cholangiopancreatography: A comparative analysis

Objective To investigate the clinical characteristics of different methods for endoscopic precut sphincterotomy in difficult intubation during endoscopic retrograde cholangiopancreatography (ERCP) . Methods A retrospective analysis was performed for the clinical data of 185 patients who underwent ERCP and precut sphincterotomy in The Second Affiliated Hospital of Kunming Medical University from May2015 to December 2018. According to the method for endoscopic precut sphincterotomy, these patients were divided into needle-knife precut sphincterotomy (NKP) group with 73 patients, needle-knife fenestration (NKF) group with 24 patients, transpancreatic precut sphincterotomy (TPS) group with 30 patients, and arch-knife precut sphincterotomy group (Erlangen group) with 58 patients. These four precut methods were analyzed in terms of advantages and disadvantages, influence on the success rate of intubation, and increase or reduction in complications. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for comparison within each group; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Nemenyi method was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between multiple groups, and a logistic regression analysis was used to determine risk factors and perform a multivariate analysis. Results The NKF and TPS groups had a significantly higher success rate of intubation than the NKP group (both P 57 years (OR = 0. 094, 95% CI: 0. 028-0. 316, P 57 years (OR = 0. 065, 95% CI: 0. 017-0. 256, P < 0. 001) was an independent protective factor against the risk of PEP, while total time of operation (OR = 1. 040, 95% CI: 1. 007-1. 074, P = 0. 016) was an independent risk factor for PEP. Conclusion TPS may be safer and more effective than NKP and Erlangen under certain conditions. Age and total time of operation may influence the incidence rate of complications.

Does Mentoring by Orthopedic Surgeons Improve Forearm Fracture Reduction Outcomes by Pediatric Emergency Physicians? Evaluation of a Process Improvement Intervention Program.

Forearm fractures are among the most frequently encountered orthopedic injuries in children. The maintenance of satisfactory alignment can be problematic and postreduction displacement with resultant malunion can occur. The objective of the study was to evaluate pediatric emergency medicine (PEM) physicians' performance on forearm fracture reduction to determine the impact of a Process Improvement Intervention Program (PIIP) on postreduction displacement rates after initial reduction. The PIIP was designed to improve our PEM physicians' skills and knowledge in how to properly apply and mold casts to better maintain the alignment of reduced forearm fractures. A PIIP was implemented during 2015-2016 when orthopedic surgeons mentored postfellowship-trained PEM physicians. Patient cohorts from pre- and post-PIIP implementation were investigated and compared to evaluate the impact of the PIIP on PEM physicians' initial fracture reduction success rates and postreduction displacement rates. Descriptive and analytical statistics including univariate and multivariate models were tested to understand changes in physicians' performance. Pre- and postcohorts had similar demographic and clinical characteristics and similarly high initial reduction success rates. When distal and midshaft fracture types were combined, there was no significant difference in postreduction displacement rates between the 2 cohorts, but when stratified based on fracture type, the distal radius postcohort showed a statistically significant improvement in postreduction maintenance. A PIIP by pediatric orthopedic surgeons did not change the PEM physicians' initial fracture reduction success rate, but it did result in a statistically significant improvement in maintenance of reduction rates.

Using positive behavioural support (PBS) for STOMP medication challenge

PurposeThe purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication.Design/methodology/approachA two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge.FindingsThere was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication.Practical implicationsThis study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams.Originality/valueThis is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging.

Imaging Intussusception in Children’s Hospitals in the United States: Trends, Outcomes, and Costs

ObjectiveTo describe imaging utilization, outcomes, and cost in the management of intussusception between 2010 and 2017 in pediatric hospitals in the United States. MethodsAll children (under 18 years of age) with a primary diagnosis of intussusception in a large administrative database were identified. Demographics, imaging, and costs were described. ResultsThere were 17,032 children (63.3% boys, 36.7% girls, mean age: 3.2 years) that had 20,655 hospital encounters for intussusception, and 88.5% were <5 years of age. The average length of stay was 2.8 days (median: 1 day), with rates of intensive care unit admission, 3.7%; 90-day readmission, 10.5%; and mortality, 0.2%. The surgical rate was 19.6%, and 93.5% (n = 19,301) of patients underwent imaging: 87.2% (n = 16,822) received ultrasound, 69.1% (n = 13,329) had fluoroscopy, 59% (n = 11,380) had abdominal radiographs, and 8.8% (n = 1,696) had CT. The reduction success rate for fluoroscopy was 77.9%. Surgery was more common in rural patients (26.8% versus 18.7% in urban patients, P < .001). Median encounter costs were $2,675 (interquartile range: $1,637-$5,465). Imaging cost represented a quarter (median $680, interquartile range: $372-1,069) of all costs. Higher costs (median) were associated with longer length of stay (<3 days: $858 versus >3 days: $5,342; use of CT ($4,168 versus $943 in patients without a CT), and surgery ($4,434 versus $860 without surgery). ConclusionThe management of intussusception is mainly nonsurgical, most frequently involving imaging with ultrasound and fluoroscopy, and resulting in excellent outcomes in the great majority of the cases. Despite playing a central role for diagnosis and management, imaging only represents a fraction of total cost.

Ultrasonic evaluation of the effect of cartilage acetabular, glenoid labrum and acetabular tissue on closed reduction of developmental dysplasia of hip

Objective To investigate the effect of cartilage acetabular, glenoid labrum and acetabular tissue on closed reduction of developmental dysplasia of hip (DDH) by analyzing the outcomes of the ultrasound measurement on DDH before and after Pavik Harness treatment. Methods Graf method was used in ultrasound measurement before the treatment. Position of cartilaginous acetabulum and glenoid labrum and displacement direction of femoral head in 31 patients with hip dislocations (type D, type Ⅲ, type Ⅳ, 36 hips) were recorded. The follow-up testing with ultrasound measurement on the inside of the hip were performed after 1-2 weeks of Pavik Harness treatment. Mediolateral dimension, anteroposterior dimension and the area of maximum section of acetabular tissue were measured. Reduction effects were evaluated. Results The success rate of reduction of dislocation hips with cartilaginous acetabulum on the head orientation was obviously higher than that on the foot orientation(P<0.000 1). The success rate of reduction of dislocation hips with glenoid labrum on the head orientation was obviously higher than that on the foot orientation(P=0.001 6). There was a statistically significant difference in the success rate of different types of hip dislocation (type D, type Ⅲ, type Ⅳ) (P=0.002 7). There were statistically significant differences in mediolateral dimension, anteroposterior dimension and the area of maximum section of acetabular tissue between the reduction group and the group without dislocation, the irreducible group and the group without dislocation, the irreducible group and the reduction group (P<0.01). Conclusions Ultrasonography is of great significance in the diagnosis and treatment of children with DDH. The position of hip cartilaginous acetabulum and glenoid labrum, types of hip dislocation and the volume of acetabular tissue have important effects on the success of the closed reduction. Key words: Ultrasonography; Hip dislacation; Acetabulum; Closed reduction; Glenoid labrum; Acetabular tissue

Clinical Characteristics of Intussusception with Surgical Reduction: a Single-Center Experience with 568 Cases

BackgroundIntussusception is among the most common acute abdominal emergencies in infancy, but only some cases need surgical reduction. This study assessed the clinical characteristics of patients undergoing surgical reduction of intussusception. MethodsThis retrospective study reviewed 568 pediatric patients who failed air-enema reduction and underwent surgical reduction for intussusception in our department between 2008 and 2017. ResultsThe series comprised 376 boys and 192 girls (2.0:1, male:female ratio) and most of the intussusceptions were primary, which is typical before the age of 1 year. The success rate of air-enema reduction in our hospital was 94.2%. Patients over 3 years old had the highest rate of surgical reduction (ca. 11.8%). The probabilities of primary and secondary intussusception were equal above 2 years old. Intussusception caused by intestinal malignant lymphoma was diagnosed above 2 years of age with atypical symptoms. Gender was irrelevant regarding the presence of bloody stools (P = 0.594), but the younger patients and children with complex/compound intussusception had a higher proportion of bloody stools (n = 148, 40.0%, P = 0.000) and intestinal necrosis (n = 44, 42.3%, P = 0.024). The occurrence time of bloody stools (OTBS) in complex/compound intussusception was shorter than for other types. ConclusionsThis retrospective study analyzed the clinical features of patients undergoing surgical reduction for intussusception and summarized the characteristics and management of complex/compound intussusception.

Soft Set Based Parameter Value Reduction for Decision Making Application

The soft set theory is a completely new mathematical tool for modeling vagueness and uncertainty, which can be applied to decision making. However, in the process of making decision, there are some unnecessary and superfluous information which should be reduced. Normal parameter reduction is a good way to reduce superfluous information, which keeps the entire decision ability. However, the algorithm has a low redundant degree, which involves a great amount of computation. It is not certain that normal parameter reduction has the solution, that is, it has a low success rate of finding reduction. Parameterization value reduction is another reduction method, which improves redundant degree, amount of computation, and success rate of finding reduction. However, this method only considers the best choice, but it does not concern the suboptimal choice, the sequence of choice, and added parameter, that is, it loses some part of decision ability. In order to settle these problems, in this paper, we introduce the parameter value reduction which keeps the entire decision ability while having a very high redundant degree and success rate of finding reduction and low amount of computation. Maximal parameter value reduction is defined as the special cases of parameter value reduction and the related heuristic algorithms are presented, which reaches an extreme degree to reduce the redundant information. The comparison result among maximal parameter value reduction, parameterization value reduction, and normal parameter reduction on 30 datasets shows that the proposed algorithm outperforms parameterization value reduction and normal parameter reduction.

A Novel Approach to Parameter Reduction of Fuzzy Soft Set

The fuzzy soft set (FSS) that combines soft set theory with fuzzy set theory has been introduced to deal with uncertainty in many practical decision-making problems. However, there exist some less important and superfluous information in the decision-making process which should be removed. In order to settle these problems, different methods have been developed for parameter reduction of FSS which are based on different decision criteria. In this paper, the problem of parameter reduction of FSS is studied based on choice value criteria. Initially, some previous reduction approaches such as; normal parameter reduction (NPR), proximate normal parameter reduction (PNPR) and distance-based parameter reduction (DBPR) of FSS are analyzed and their inherent difficulties are discussed. Then, a new method for parameter reduction of FSS is proposed and its heuristic algorithm is given. The proposed algorithm is compared with NPR, PNPR and DBPR algorithms from the aspects of success rate of finding reduction, reduction ratio and decision ability, respectively. The comparison results show that the proposed algorithm has much higher applicability and efficiency as compared to rest of the three algorithms. Finally, an application of our proposed algorithm is discussed in a real life decision-making problem.

A new enema for treatment of intussusception with hydrostatic reduction: Olive oil

Objectives:Intussusception is routinely treated using ultrasound-guided hydrostatic reduction (USGHR) with normal saline in our paediatric surgery department. With this study, olive oil was added to normal saline in ultrasound-guided reduction of intussusception.Materials and Methods:Forty patients who were diagnosed and treated for intussusception in Van Yuzuncu Yıl University Faculty of Medicine Pediatric Surgery Department from March 2017 to May 2017 were included in the study. During this retrospective study, randomly chosen 20 patients that treated with USGHR using normal saline were marked as Group 1. Moreover, 20 patients that treated with USGHR using a mixture of olive oil and saline (10% olive oil 90% normal saline) were marked as Group 2. Patients' age, gender, symptoms, treatment techniques, complications and hospitalisation periods were retrospectively noted.Results:Forty patients were included in the study. In Group 1, 14 patients were treated in the first session, 4 patients were treated in the second session and 2 patients required laparotomy. Mean reduction time in this group was 15 min mean fluid volume used in each reduction was 80 ml/kg and mean hospitalisation period was 38 h. In Group 2, 19 patients were treated in the first session, and only 1 patient required a second session. Mean reduction time was 12 min, used fluid volume was 58 ml/kg for each reduction and hospitalisation period was 24 h.Conclusion:The average volume of fluid used for reduction, average reduction time, numbers of recurrent reductions and hospitalisation were less when a mixture of olive oil and normal saline were used in comparison with when normal saline was used alone to reduction the intussusception under ultrasound guidance. Using olive oil mixed with normal saline as a new enema fluid is likely to increase the success rate of ultrasound-guided reduction of intussusception.