Introduction and Objectives: Stented open pyeloplasty is widely used in pediatric urology practice. Our aim is to present our experience with stentless pyeloplasty in children. Materials and Methods: Between June 2009 to July 2012, 46 children had open Anderson-Hynes dismembered pyeloplasty using 2.5-3 cm flank incision. The children were prospectively randomized to 2 groups: stentless pyeloplasty (25 children) and stented pyeloplasty (21 children). Both groups were compared regards length of hospital stay, postoperative complications, success rates and number of surgical procedures needed to achieve success. Results: Both groups were comparable regards age (median 6 months each), sex, pre-operative hydronephrosis (HN) and split renal function. Median drain removal time and hospital stay were 2 days and 3 days in the stentless and stented groups, respectively (p0.001). Resolution or minimal residual HN was noticed postoperatively after median time of 4 months (range 2-12) for stentless group and after 4 months (range 2-14) in the stented group (p=0.568). Recurrent ureteropelvic junction obstruction developed in one patient in each group. Median number of surgical procedures needed to achieve success was 1 vs. 2 for the stentless and stented groups, respectively (p0.001). Conclusion: Open stentless pyeloplasty in children is feasible with shorter hospital stay and fewer surgical procedures.

Changing pattern of laryngeal tuberculosis

Changing pattern of laryngeal tuberculosis

Background: The principal sites of neonatal phototherapy (NNPT) action may localize not only in the skin but also in capillary circulation under the skin. Thus, the safety of phototherapy particularly in relation to hemodynamic control must be investigated. Since regional blood flow is affected by NO and ET, it is important to study the effect of phototherapy on circulating levels of both of them and to use the changes of vital signs as markers for hemodynamic stability . Aim of the work: This study aimed to evaluate the effect of phototherapy on blood ET and NO in hyperbilirubinemic newborn infants of different gestational ages with stable vital signs and to observe changes in vital signs in those newborn infants after 24 hours of phototherapy. Patients and Methods: This study included 50 newborn infants (29 preterm 37weeks and 21 full term ≥37 weeks) with stable vital signs who received phototherapy for high unconjugated bilirubinemia. Heart rate (HR), respiration rate (RR), mean arterial blood pressure (MABP), Serum endothelin-1 and nitric oxide level were detected before phototherapy subsequently monitored after 24 hours after phototherapy. Results: The present study revealed that after 24 hours of phototherapy there is a significant increase in NO and ET serum level, NO:ET ratio ,HR and a significant decrease in MABP in both full term and preterm newborns. There is no significant change in RR in both preterm and full term newborns. Conclusions: Phototherapy can disturb the dynamic balance between NO and ET, leading to a more prominent effect of NO. This effect may be not harmful in newborns with stable vital signs, but harmful effect may occur in newborns with septicaemia or decompensated vital signs. Careful observation of vital signs should be done in all newborns under the effect of Phototherapy. Also the safety of continuous phototherapy for more than 24 hours in newborn infants with different gestational ages and different birth weights must be verified.

Background: The principal sites of neonatal phototherapy (NNPT) action may localize not only in the skin but also in capillary circulation under the skin. Thus, the safety of phototherapy particularly in relation to hemodynamic control must be investigated. Since regional blood flow is affected by NO and ET, it is important to study the effect of phototherapy on circulating levels of both of them and to use the changes of vital signs as markers for hemodynamic stability . Aim of the work: This study aimed to evaluate the effect of phototherapy on blood ET and NO in hyperbilirubinemic newborn infants of different gestational ages with stable vital signs and to observe changes in vital signs in those newborn infants after 24 hours of phototherapy. Patients and Methods: This study included 50 newborn infants (29 preterm 37weeks and 21 full term ≥37 weeks) with stable vital signs who received phototherapy for high unconjugated bilirubinemia. Heart rate (HR), respiration rate (RR), mean arterial blood pressure (MABP), Serum endothelin-1 and nitric oxide level were detected before phototherapy subsequently monitored after 24 hours after phototherapy. Results: The present study revealed that after 24 hours of phototherapy there is a significant increase in NO and ET serum level, NO:ET ratio ,HR and a significant decrease in MABP in both full term and preterm newborns. There is no significant change in RR in both preterm and full term newborns. Conclusions: Phototherapy can disturb the dynamic balance between NO and ET, leading to a more prominent effect of NO. This effect may be not harmful in newborns with stable vital signs, but harmful effect may occur in newborns with septicaemia or decompensated vital signs. Careful observation of vital signs should be done in all newborns under the effect of Phototherapy. Also the safety of continuous phototherapy for more than 24 hours in newborn infants with different gestational ages and different birth weights must be verified.

Introduction: The association of Hirschsprung’s disease (HD) and anorectal malformation (ARM) is rare. The aim of this study is to highlight the frequency and co morbidity that may be related to this association. Patients and methods: over a period of ten years eight cases with ARM found to have HD association. All cases were diagnosed by complete clinical, radiological assessment and histopathological examination before correction. Results: Their age at presentation ranged from 3 days to 10 years. The diagnosis started early during neonatal period only in three cases while in the remaining five cases was delayed either because of atypical symptoms or unsuspected association. Fecal fistula after closure of stoma and wound dehiscence is evident associated co morbidity. Conclusions: routine rectal biopsy is important after ARM correction and before stoma closure.