Minimally Invasive Non-Endoscopic Correction for Sagittal Craniosynostosis in Children Aged Below 6 Months

AIM: Object of this study is to determine effectiveness of this procedure used in this study which is minimally invasive non endoscopic correction for sagittal craniosynostosis in children below 6 months. METHODS: A prospective study was done in Neurosurgery children unit, Abu Elreash Japanese children hospital, Cairo university, Egypt, for patients with non syndromatic sagittal craniosynostosis. The variables analyzed; OFD, BPD, CI pre. & postoperative, age of patients at time of surgery, sex, duration of surgery and length of hospital stay. RESULTS: Our results shows statistically significant difference between pre-operative with post-operative after 2 days, post-operative follow-up, and follow-up after 1 year for OFD, BPD and CI. CONCLUSIONS: Internal helmet technique used in correction of sagittal synostosis in children below 6 months old giving good cosmetic results with the following advantages, (1) short surgery time, (2) small wound, (3) no much blood loss, (4) immediate good cosmetic result, (5) no need to use external devices which reduces the cost, family load, and child suffering, and (6) no need for long-term follow-up.

Treatment of vesicoureteric reflux in children

Aim. To study the efficacy of endoscopic correction of vesicoureteric reflux in children using bulk synthetic material.Material and methods. From 2016 to 2020, we studied the results of treatment of 63 children with vesicoureteric reflux. The children ranged in age from 6 months to 17 years. The degree of vesicoureteral reflux was as follows: grade I was observed in 2 (3.1%) patients, grade II in 16 (25.3%), grade III in 30 (47.6%), grade IV in 13 (21.98%), and grade V in 2 (3.1%). Among 63 patients with CKD, grade I was found in 26 (41.3%), grade II - in 16 (25.4%); grade III - in 13 (20.6%); grade V - in 2 (3.1%). - III stage - 13 (20,6%); IV stage - 8 (12,7%); IV stage - 4 (12,6%). - (12,7%), and there were no patients with V stage of CKD were absent. Unilateral vesicoureteric reflux was noted in 45 (71.4%) children, bilateral - in 18 (28.5%) children. Endoscopic intravesical correction of vesicoureteral reflux was performed by suburethral injection of “Dam+”.Results and discussion. Summarizing the results of our study, it should be noted that positive results were achieved concerning the relief of urinary tract infection, elimination of urine outflow from the upper urinary tract, improvement of renal function after PMR correction using “Dam+”. Positive results of VUR correction amounted to 75,01%.Conclusions. Endoscopic correction of VUR is one of the effective and low-traumatic methods of treatment. Application of the biocompatible synthetic material “Dam+” in the correction of vesicoureteric reflux contributes to positive results.

ENDOSCOPIC CORRECTION OF IATROGENIC TRACHEA INJURIES IN SMALL PETS

Today, the veterinarian is increasingly in veterinary practice began to use new modern technologies for the treatment of small pets, using modern equipment for medical manipulations. At present, a modern operating room can no longer be imagined without a ventilator and a device for giving inhalation anesthesia. But, even new modern equipment and modern drugs for performing anesthesia cannot protect against medical errors. One of the most important manipulations is the ability to correctly place the endotracheal tube to perform resuscitation or give inhalation anesthesia. The percentage of iatrogenic injuries during this procedure reaches 2.5 % and is complicated by bleeding and blood aspiration, which requires emergency assistance, primarily with the use of endosoepic technologies.

SPECIFIC FEATURES OF ENDOSCOPIC CORRECTION TECHNIQUE OF VESICOURETERAL REFLUX IN CHILDREN

Vesicoureteral reflux (VUR) is one of the most frequent diseases in pediatric urology studied since the 19th century. It has an increased risk of infection of the urinary tract, sclerosis of the renal parenchyma and development of reflux-nephropathy with an outcome in renal failure. Several treatment options have been developed for patients with VUR. For 50 years, open ureteral reimplantation has been considered the «gold standard» of treatment, but over the past 20 years there has been a shift towards less invasive methods, primarily endoscopic administration of bulking agents. In order to increase the effectiveness of endoscopic treatment, several basic recommendations for the operation have been identified and many volume-forming drugs have been developed. The most important is the correct choice of one of the three main methods of drug administration and the hydrodilation of the ureteral orifice during injection. Performing of endoscopic correction in compliance with all the rules and the use of the latest generation of bulking agents ensure the frequency of elimination of VUR up to 90% after the first injection.

MODERN PRINCIPLES OF TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN

The article presents data on the tactics and methods of treatment of patients with vesicoureteral reflux (VUR). The article examines the most frequently used methods of treatment of VUR in children (surgical antireflux operations, neoimplantation of the ureter, endoscopic correction, methods of introducing bulk-forming substances) in detail, and analyzes the advantages and disadvantages of the described treatment methods.

Quantitative and qualitative comparison of morphometric outcomes after endoscopic and conventional correction of sagittal and metopic craniosynostosis versus control groups

OBJECTIVE Surgical correction for sagittal and metopic craniosynostosis (SCS and MCS) aims to alter the abnormal cranial shape to resemble that of the normal population. The achieved correction can be assessed by morphometric parameters. The purpose of the presented study was to compare craniometric parameters of control groups to those same parameters after endoscopic and conventional (open) correction. METHODS The authors identified 4 groups of children undergoing surgical treatment for either SCS or MCS, with either endoscopic (SCS, n = 17; MCS, n = 16) or conventional (SCS, n = 29; MCS, n = 18) correction. In addition, normal control groups of nonaffected children who were 6 (n = 30) and 24 (n = 18) months old were evaluated. For all groups, several craniometric indices calculated from 3D photographs were compared for quantitative analysis. For qualitative comparison, averages of all 3D photographs were generated for all groups and superimposed to visualize relative changes. RESULTS For children with SCS, the cephalic index and coronal circumference index significantly differed preoperatively from those of the 6-month normal controls. The respective postoperative values were similar to those of the 24-month normal controls after both endoscopic and conventional correction. Similarly, for children with MCS, indices for circumference and diagonal dimension that were significantly different preoperatively became nonsignificantly different from those of 24-month normal controls after both endoscopic and conventional correction. The qualitative evaluation of superimposed average 3D head shapes confirmed changes toward normal controls after both treatment modalities for SCS and MCS. However, in SCS, the volume gain, especially in the biparietal area, was more noticeable after endoscopic correction, while in MCS, relative volume gain of the bilateral forehead was more pronounced after conventional correction. The average 3D head shapes matched more homogeneously with the average of normal controls after endoscopic correction for SCS and after conventional correction for MCS. CONCLUSIONS This quantitative analysis confirms that the performed surgical techniques of endoscopic and conventional correction of SCS and MCS alter the head shape toward those of normal controls. However, in a qualitative evaluation, the average head shape after endoscopic technique for SCS and conventional correction for MCS appears to be closer to that of normal controls than after the alternative technique. This study reports on morphometric outcomes after craniosynostosis correction. Only an assessment of the whole multiplicity of outcome parameters based on multicenter data acquisition will allow conclusions of superiority of one surgical technique.