bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful Thoracoscopic Excision of Complex Supracardiac Middle Mediastinal Bronchogenic Cyst in an Infant
Authors: Raut Amit , Parakh Sushil , Parakh Akanksha , Mukhi Neha 
Published: May 2024

Introduction:
We report the first case of complex supracardiac middle mediastinal foregut duplication lesion compressing and adherent to the heart, managed successfully thoracoscopically in an infant, in an innovative way.

Materials and Surgical Technique:
A 1-year-old girl was diagnosed as having supracardiac middle mediastinal foregut duplication lesion. It was completely overlying and adherent to her heart giving transmitted pulsations to the lesion, causing indentation over the left atrium and surrounded by all vital structures such as aorta, pulmonary artery, bronchi and phrenic nerve. After proper counselling of parents and relatives, the patient was posted for surgery. After proper positioning, thoracoscopic access was gained, difficulty here was neither bulge nor surface marking of the lesion was seen in thoracic cavity anywhere, considering the anatomical relations. The mediastinal pleura was opened, through a very narrow window for accessing the lesion, which was surrounded by vital structures in the middle mediastinum. A gentle dissection of the lesion was done to relieve it from adjacent adhered thoracic vitals structures successfully. Histopathological examination confirmed it as a bronchogenic cyst.

Discussion:
Foregut duplication cyst, especially bronchogenic cysts, have been reported at various locations, however, supracardiac middle mediastinal bronchogenic cyst completely sitting on the heart, adherent to it causing compression of the left atrium and left bronchus and surrounded completely by the aorta, pulmonary artery and bronchus, has not been reported till date. Also, successful thoracoscopic excision of such rarely located lesion moving with heart, in a 1-year-old girl, has not been reported yet.
A Wave-Like Anastomosis, a New Technique of Anastomosis to Prevent Stricture after Oesophageal Atresia Repair
Authors: Saiad Mohamed Oulad 
Published: May 2024

Background:
Anastomotic stricture still a frequent postoperative complication. Its development is multifactorial, nonetheless by improving some factors we can prevent the stricture. Anastomotic technique is among the factors that can be improved to prevent this complication.

Aims and Objectives:
Our aim is to report a new technique of anastomosis with a multiple plain suture, wave-like anastomosis and large low traction zone to prevent stricture after esophageal atresia repair. Furthermore this is a self-patient's anatomy dependant technique.

Materials and Methods:
A retrospective study reported forty nine esophageal atresia survivals without significant difference in weight and gap length. They were divided in two groups A and B with respectively eighteen and thirty one patients. The wave-like anastomosis technique is used in group A but in the group B an end to end anastomosis was used.

Results:
After a mean follow-up of 3 years no patient of the group A presented with anastomotic stricture and eight patients in the group B presented with stricture (p=0,046) so there was a significant difference between the two groups.

Conclusion:
This is a technique providing a multiple plain anastomosis, increasing the lumen in the anastomotic site and helping to prevent anastomotic stricture.
Paediatric Neck Masses in Zaria
Authors: Shuaibu Iliyasu Yunusa , Sholadoye Tunde Talib , Ajiya Abdulrazak , Usman Mohammed Aminu , Aliyu Halima Oziohu 
Published: May 2024

Background:
A neck mass is any abnormal lesion in the neck that can be seen, palpated, or identified on imaging. It is one of the most common reasons for presentation to the surgical clinics.

Aim:
the aim is to analyse the clinical presentation and treatment outcome in children who were diagnosed and managed for neck masses in a tertiary centre in Northwestern Nigeria.

Materials and Methods:
The records of patients managed for neck masses over 7 years between January 2013 and December 2019 were reviewed. Demographic and clinical data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA).

Results:
A total of 99 cases were reviewed and there were 52 (52.5%) males and 47 (47.5%) females with male-to-female ratio of 1.1:1, and mean age ± standard deviation of 4.4 ± 3.9 years, the primary complaints of all the patients were neck swellings. The anterior triangle was the most common region involved in 86 (86.9%) patients. The majority of the neck masses were congenital, accounting for 71 (71.8%) patients. Ultrasound scanning was the most commonly requested radiological investigation done in 87 (87.8%) patients. Thyroglossal duct cyst was the most common paediatric neck mass seen in 41 (41.4%) patients. The majority of the patients 68 (68.7%) had an excisional biopsy of the lesion. Surgical site infection was the most common complication noted in 7.1% of the study population.

Conclusion:
Most of the neck masses were congenital and were managed surgically. Prompt diagnosis with appropriate treatment may result in a good outcome.
Are Online Discussion forums Useful Platforms for Paediatric Surgeons to Seek Advice Regarding Patient Management? A review of the Queries Posted on the World Federation of Association of Pediatric Surgeons Facebook group (The Pediatric Surgeon's Lounge)
Authors: Anand Sachit , Sharma Shilpa , Shehata Sameh 
Published: May 2024

Background:
Social media platforms are popular places for discussing difficult cases amongst the surgeons. Paediatric Surgeon's Lounge (PSL) is a closed Facebook group for the interaction of paediatric surgeons from different parts of the world. We aim to assess the safety and utility of the responses given by the members of the PSL group to the queries about the management of paediatric surgical cases.

Methods:
All posts on PSL between January and July 2021 were retrospectively screened to select the patient management-related queries. For each included query, all the responses were scrutinised for their utility and safety. The utility was categorised as helpful or not helpful, and the safety of these responses was categorised as safe or unsafe. A note was also made whether any unsafe response was rectified in the subsequent responses or not. The proportion of each response category was calculated.

Results:
Twenty-two queries with a total of 353 responses were assessed. The median (range) number of responses per query was 10 (2–45). The proportion of helpful, safe and rectified unsafe responses was 91.5% (307/353), 96.8% (342/353) and 36% (4/11), respectively.

Conclusions:
PSL is a safe and helpful platform for taking advice regarding the management of paediatric surgical cases.
Byar's Flaps in the Management of Congenital Megaprepuce
Authors: Alsamahy Omar , Gad Dalia , Othman Doaa , Fahiem-ul-Hassan Mir 
Published: May 2024

Introduction:
Early management of congenital megaprepuce (CMP) is necessary to address recurrent urinary tract infections and parental concerns. Different procedures, mostly using the inner preputial skin to cover the phallus, have been described. However, cosmetic appearance with the inner preputial covering of the penis is suboptimal. Owing to this, we conducted this study using outer preputial skin in the form of Byar's flaps to cover the penile shaft and analysed the results.

Patients and Methods:
This prospective study included 19 patients with CMP operated by a single surgeon using the Byar's flap technique. Following surgery patients were assessed on the 4th post-operative day, at 3 months and 1-year post-operative for cosmetic and functional outcomes. Parental satisfaction about cosmetic results was evaluated using a subjective score. Data were collected and analysed.

Results:
Nineteen patients with CMP were studied with a mean age of 6.3 months. Nineteen patients (100%) patients presented with buried penis and preputial ballooning, malodorous infected urine in 15 (78.9%) patients, thin stream of urine in 17 (89.4%) and dysuria in 12 (63%) patients. One of the patients had associated glanular hypospadias and the other two had isolated chordee. There were no significant complications except for one patient who developed meatal stenosis which was later managed by a meatoplasty. All patients had satisfactory cosmetic appearance.

Conclusion:
CMP is an uncommon but easily identifiable condition. Early surgical correction is recommended to prevent complications. Byar's flap technique yields very good functional and cosmetic results in the management of CMP.
Religious Circumcision (Khatna) and Circumcision Mishaps in Kashmiri Children
Authors: Hassan Yaqoob , Rasool Humayoon , Rather Ajaz Ahmad , Ahmad Younis , Rasool Insha 
Published: May 2024

Background:
Male circumcision is recommended practice in Muslim tradition and one of the oldest operations performed all over the world. Male circumcision is universal in our Muslim-dominated valley of Kashmir for religious reasons. It can be performed by different techniques such as the conventional open methods, the device methods and sutureless methods. The objective of this study was to report our practice of male circumcision amongst children and compare the different common surgical techniques and highlight the circumcision mishaps conducted by quacks in the Kashmir Valley.

Materials and Methods:
This was a comparative observational study conducted at SKIMS Medical College and Hospital, from 2017 to 2021. Children who presented for primary circumcision were subjected to one of two different surgical techniques; the dorsal slit or Guillotine method. The prospective analysis of children managed for circumcision mishaps conducted by non-professionals was also included in the study. Circumcisions done after 2 years of age were defined as delayed. The data were collected analysed using SPSS software (SPSS version 22, IBM, Armonk, NY, USA).

Results:
Total of 689 Kashmiri Muslim male children between 1 day and 10 years of age over a period of 5 years were studied. Six hundred and fifty-five children for primary circumcision and 34 children managed for circumcision mishaps were included in the study. Amongst the subjects for primary circumcision, the most number of children were between 1 and 2 years of age (33.28%). One hundred and fourteen (25.73%) hospital-delivered babies and 201 (94.81%) home-delivered babies had delayed circumcision that is after 2 years of age (P = 0.00001). Religious requirement was the only indication for circumcision in this study. Three hundred and ninety-six (60.46%) children were circumcised with dorsal slit and 259 (39.54%) with guillotine method using computer-generated random numbers. Complications were found 8.08% of subjects in dorsal slit method as compared to 16.60% in guillotine technique (P = 0.008). Out of 34 children managed for circumcision mishaps, 11 (32.35%) presented with massive bleeding after primary circumcision by half doctors, 18 (52.94%) had incomplete circumcision, 3 (8.82%) had multiple skin bridges and 2 (5.88%) had incomplete circumcision with glans injury. All the patients with circumcision mishaps were treated with good outcome. There was no mortality.

Conclusion:
Circumcision occurs at a wide range of ages and male circumcision is universal in our Muslim-dominated valley for religious reasons. Circumcision by quacks and the associated complications are still prevalent in our society. The procedure is safe and free of any major complications when conducted by trained medical personnel under aseptic conditions of the operation theatre and hence should be encouraged.
Congenital Heart Defects in Orofacial Cleft
Authors: Erinoso Olufemi A. , James Olutayo , Sokunbi Ogochukwu J , Adamson Olawale O. , Adekunle Adeola A. , Agbogidi Olusola F. , Ogunlewe Ajoke O. , Ekure Ekanem N. , Adeyemo Wasiu L. , Ladeinde Akinola L. , Ogunlewe Olugbemiga M. 
Published: May 2024

Background:
Congenital heart defects (CHDs) are one of the most common associated anomalies in patients with an orofacial cleft (OFC). However, few studies have shown the association between cleft type and CHDs in our population. This study aimed to assess the prevalence of CHDs in a cohort of OFC patients at a tertiary health facility in Nigeria, as well as assess the risk of CHD by OFC type.

Materials and Methods:
This was a prospective study design. Patients with an OFC were consecutively enrolled at a single OFC treatment facility. All subjects were assessed by a paediatric cardiologist and had echocardiography done. They were categorised based on the presence of CHDs, as well as the OFC phenotypic type (cleft lip and/or alveolus, cleft lip and palate and cleft palate only). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was set at P < 0.05.

Results:
A total of 150 subjects enrolled in the study over a period of 2 years (2018–2020). The median age of subjects was 6 months (interquartile range: 2–24), and 54.7% were female. The prevalence of CHDs in the subjects reviewed was 30.7%. Based on the severity of CHDs, the majority presented with simple defects (95.6%). Overall, the most common presentation was patent foramen ovale (12.7%), followed by septal defects (8.0%). There was no significant association between cleft type and the odds of a CHD.

Conclusion:
The study reports a relatively high prevalence of CHDs in patients with OFC; however, there was no association between the risk of CHD by cleft type. Although a majority of CHDs may pose a low operative risk, cardiac evaluation is recommended for all cases of OFC to aid the identification of potentially high-risk cases.
Laparoscopic-assisted Transanal Pull-through for Hirschsprung's Children Older than 3 Years
Authors: Arafa Ahmed , Mohamed Wesam , Taher Heba , Ragab Moutaz , Abouelfadl Mohamed Hamed 
Published: May 2024

Context:
Hirschsprung's disease (HD) is a congenital anomaly affecting the enteric nervous system commonly the rectosigmoid region. Treatment is surgical where the aganglionic segment is resected, and bowel continuity is restored by a coloanal anastomosis. In 1999, Georgeson et al. proposed a new technique of primary laparoscopic-assisted pull-through for HD as a new gold standard.

Aim:
The aim of the study was to evaluate the outcome of the laparoscopic-aided transanal pull-through procedure for the management of HD in children older than 3 years of age.

Methods:
This study was conducted on 15 consecutive patients presented to a university hospital, diagnosed as having HD relying on their clinical features, barium enema study and rectal biopsy. In all cases, laparoscopic-assisted transanal pull-through was attempted. The laparoscopic part included transition zone identification, seromuscular biopsy for fresh frozen histopathology and sigmoid and rectal mobilisation as much as possible down the peritoneal reflection. The transanal part included mobilisation of the rectal lower segment by 2–3 cm, resection till the ganglionic segment, and full-thickness two-layer coloanal anastomosis was done.

Results:
Early complications occurred in eight cases: enterocolitis in four cases and perianal excoriation occurred in four cases. There were no cases of anastomotic leak. Late complications occurred in seven patients: four cases developed stricture at the site of coloanal anastomosis and three cases experienced enterocolitis at 6 and 9 months postoperatively.

Conclusion:
Laparoscopic-aided transanal pull-through procedure is a safe, feasible modality for the management of HD in children more than 3 years.
External and Internal Parasitic Conjoined Twinning
Authors: Menon Prema , Solanki Shailesh , Samujh Ram , Kakkar Nandita , Bhatia Anmol , Mohanty Suravi , N. Rao K. L. 
Published: May 2024

Background:
Parasitic conjoined twin is a rare but well-known entity with unclear embryopathogenesis. Abnormal conjoined twinning can result in an externally attached parasitic twin (PT), an enclosed foetus in foetu, or a mature teratoma. The treatment requires complete excision and reconstruction of local anatomy which is not always straightforward.

Materials and Methods:
PT cases presenting over 12 years were analysed. Patients with complete data, histopathological diagnosis and follow-up were included in the study. During follow-up, specific complications and related investigations were considered.

Results:
A total of five patients at four different sites were identified: two retroperitoneal foetus in foetu and three externally attached PTs which were located in the lumbar region, sacrococcygeal area and on the lower anterior abdominal wall. All patients underwent complete surgical excision. In foetus in foetu cases, the blood supply was directly from the aorta with a short stump while the three externally located ones required meticulous and careful dissection with the reconstruction of local anatomy.

Conclusion:
Parasitic conjoined twinning can present at different sites and surgical challenges vary accordingly. For surface lesions, reconstruction may be as complicated as excision. Prognosis can be affected by the excellence of anatomical restoration. Long-term follow-up is essential to address problems specific to the site of lesion and method of surgical reconstruction.
Posterior Urethral Polyp in Children
Authors: Aballa Najoua , Saiad Mohamed Oulad 
Published: May 2024

Background:
Polyps of the urethra is a rare cause of obstruction of the lower urinary tract. The clinical presentation is not specific; the symptoms vary and may be isolated or associated, including acute retention of urine, dysuria, and hematuria. Ultrasound and voiding urethrocystography guide the diagnosis. Urethrocystoscopy confirms the diagnosis and allow the treatment. Our aim is to bring to light this rare condition and report our experience in the management of posterior urethral polyps.

Subject and Methods:
A retrospective study of posterior urethral polyp presented from 2008 to 2019 was performed. Charts were evaluated for clinical presentation, management, pathology findings, and long term follow-up.

Results:
Six patients were recorded. Dysuria and hematuria are the most reported features. Ultrasonography and voiding cystourethrogram made the diagnosis in 4 patients out of 6. Urethrocystoscopy made the diagnosis and transurethral resection in all our patients.

Conclusions:
Posterior urethral polyp is a rare benign tumor in children. Urethrocystscopy allow both diagnostic and therapeutic.
A Prospective Observational Study to Evaluate the Change in Inhibin-B as a Marker of Sertoli Cell Function in Children Subjected to Surgical Correction for Undescended Testes
Authors: Raman V Shankar , Khanna Sanath , Verma Vishesh 
Published: May 2024

Background and Objectives:
Undescended testes (UDT) or cryptorchidism is a common congenital disability characterised by the absence of at least one testicle from the scrotum. The primary aim of surgical correction is to preserve fertility potential and prevent complications including trauma, malignancy, hernia and torsion. Often, children, especially in developing countries, present late with UDT. The effect of surgical correction in the recovery of Sertoli cell function in children aged more than 2 years is not apparent. The present study was conducted to study the change in inhibin-B level as a marker of Sertoli cell function in surgically corrected UDT in a heterogeneous population.

Materials and Methods:
A prospective observational study conducted over a 3-year period at a tertiary care paediatric surgery centre recruited 76 children with UDT undergoing surgical correction. Inhibin-B as a marker for Sertoli cell function was studied preoperatively and postoperatively. Continuous variables were summarised by calculating mean, standard deviation, median and interquartile range (IQR). Quantile versus quantile plotting was done to assess the distribution of the data. Data were analysed in two groups, with participants aged <2 years (Group A) and more than 2 years (Group B). Wilcoxon signed-rank test was used to compare the pre-operative and post-operative value.

Results:
In Group A (n =39), the median (IQR) of pre-operative inhibin-B was 181 pg/ml (148–254) and post-operative inhibin-B was 230 pg/ml (176–296). In Group B, the median (IQR) of pre-operative inhibin was 70 pg/ml (44–104) and post-operative inhibin was 102 pg/ml (46–176). There was a significant increase in post-operative inhibin when compared to the pre-operative inhibin (P = 0.015 and 0.012, respectively, in Group A and B). Luteinizing hormone (LH) showed a significant decrease (P = 0.002) in Group A following surgery but bordering on significance in Group B (P = 0.43). On the other hand, follicle-stimulating hormone showed a significant decrease (P < 0.01) in Group B following surgery but not in Group A (P = 0.87).

Conclusion:
The mean post-operative inhibin-B levels were increased significantly as compared to the pre-operative levels indicating either a successful orchiopexy/adequate germ cell number or both. The benefit of orchiopexy may extend even to children presenting late for evaluation.
A study on serum ferritin, C-reactive protein, and its correlation with HBA1c in type 2 diabetes mellitus
Authors: Rangappa Nikitha , Bentoor Sanjeevkumar Neelakantappa 
Published: May 2024

Abstract

Introduction:
Diabetes mellitus is a multifaceted metabolic disorder with impaired glucose status in the human body relative to insulin deficiency. Resistance to its action causes impaired glucose tolerance and hyperglycemia. Serum ferritin and C-reactive protein (CRP) are acute-phase reactants correlated with glycated haemoglobin (HBA1c) in a diagnosed diabetic patient as chronic inflammatory markers.

Aim:
The study aimed to study the relationship between HBA1c in diabetes patients and inflammatory markers such as serum ferritin and CRP.

Materials and Methods:
The study group comprised 106 subjects who met the criteria of type 2 diabetes mellitus, an age group between 30 and 90, involving both genders; inclusion and exclusion criteria were added to the study group. Fasting blood sugar, postprandial blood sugar, HBA1c, urine routine, lipid profile, serum ferritin, and CRP were assessed in all study subjects. Data were statistically analyzed and compared the relationship among HBA1c, serum ferritin, and CRP.

Results:
In this study, 31.1% constituted the age group between 50 and 60. A total of 51.9% were males. A total of 64.2% were on oral hypoglycaemics, and 18% had urine albumin on examination. On Spearman’s rho correlation between serum ferritin and HbA1c, the r value is 0.011, and the P value is 0.911 having a positive correlation. On Spearman’s rho correlation between CRP and HbA1c, the r value is 0.017, and the P value is 0.865 showing a positive correlation.

Conclusion:
In this study, inflammatory indicators, including serum ferritin and CRP levels, have a positive correlation with HbA1c values, though statistically not significant, showing higher HbA1c values with elevated serum ferritin and CRP levels. Raised inflammatory markers suggest a chronic inflammatory process in a condition or disease such as diabetes mellitus. By measuring these parameters, we can discover essential aspects of screening, the course of diabetes, its complications, and prevention.