Day 2 :
Keynote Forum
Andrew J A Holland
The University of Sydney, Australia
Keynote: Current management of undescended testes
Time : 10:00-10:40
Biography:
Andrew J A Holland graduated from London University in 1988 and obtained his FRCS in 1992. He is trained in London, Perth, Adelaide and Sydney, obtaining his FRACS. As a Surgeon Scientist Scholar of the Royal Australasian College of Surgeons, he was awarded a PhD from the University of Sydney. He became a Senior Lecturer at the university in the same year and a consultant Paediatric Surgeon at The Children’s Hospital at Westmead. He was given a Personal Chair in Paediatric Surgery at The University of Sydney in 2010 and has over 200 publication in the scientific literature.
Abstract:
Undescended testes (UDT) remain common, with increasing evidence that acquired UDT or the ascending testis syndrome should be considered part of the spectrum in this pathology. Between 0.5 to 9% of boys may be affected depending on the quality of ascertainment, reporting, geographic location and age at presentation. There appears limited value for the use of ultrasound in the diagnosis, although it remains widely used and does not reliably differentiate between UDT and retractile testes. Prompt diagnosis and early referral for surgical evaluation and treatment would seem most likely to result in an optimal functional and cosmetic outcome as well as reducing the risks of torsion and faciltating diagnosis of any subsequent malignancy. Hormonal treatment, rather than orchidopexy, remains popular in some centers despite lack of good evidence to support its efficacy, although it may have an important adjunct role in optimizing fertility. Debate continues over the optimal surgical approach while performing an orchidopexy, whether initially laparoscopic, single or staged, a traditional inguinal open approach or via a parascrotal incision. The testis, rather than quiescent, appears biologically active in the male infant with increasing evidence of an adverse impact on future spermatogenesis and fertility in males with an UDT. Whilst not definitive, there would seem to be an increasing consenus on the value, in terms of future fertility, of earlier orchidopexy before 12 months of age. The need for earlier surgery has to be balanced against the potential risks of operative intervention and general anasethesia.
Keynote Forum
Howard I Pryor II
Johns Hopkins University School of Medicine, USA
Keynote: Mucous fistula refeeding decreases parenteral nutrition exposure in post-surgical premature neonates
Time : 10:40-11:20
Biography:
Howard I Pryor II has completed his MD and General Surgery Residency at the George Washington University; a Research Fellowship at the Massachusetts General Hospital and Pediatric Surgery Fellowship at Johns Hopkins Hospital. He is an Instructor of Pediatric Surgery at Johns Hopkins School of Medicine and an Assistant Professor of Surgery at The Uniformed Services University of Health Sciences. He has published more than 20 journal articles and chapters and serves as a reviewer of the Journal of Pediatric Surgery.
Abstract:
Premature neonates occasionally require emergent bowel resection. They are frequently left with discontinuous bowel and one or more ostomies. Further, these children are at risk for short gut syndrome and parenteral nutrition (PN) dependence. PN exposure causes hepatotoxicity and requires central venous access; therefore, maximizing enteral nutrition is desirable. One technique is via mucous fistula refeeding. Refeeding involves collecting endostomy output and introducing it into the lumen of a mucous fistula; increasing bowel absorption. We hypothesized that refed children would have decreased exposure to PN and reach goal enteral feeds earlier than non-refed children. We conducted a retrospective review of neonatal patients who underwent bowel resection and ostomy formation with our without mucous fistula creation at our institution between July 2012 and July 2014. Patients who underwent refeeding were compared to those who did not. Twenty-eight cases were identified: 13 in the refeeding group and 15 in the ostomy group. We observed that refed children required significantly shorter times to reach goal enteral feeds when compared to the ostomy group. Refed children also reached goal enteral feeds and permanently discontinued PN at an earlier time point following restoration of bowel continuity. None of the differences appear related to confounding variables as no differences were identified between the 2 groups. These findings suggest that a prospective multi-center trial of refeeding is warranted, with the goal of more clearly defining the benefits and potential side effects of mucous fistula refeeding in post-surgical premature neonates.
Keynote Forum
Minu Bajpai
All India Institute of Medical Sciences, India
Keynote: Management of children with high grade bilateral vesicoureteric reflux and nephropathy
Biography:
Dr Minu bajpai,is a Professor of Paediatric Surgeon at All India Institute of Medical Sciences, New Delhi, India. He is Fulbright scholar (Johns Hopkins, Baltimore). He is Executive Editor of Journal of Progress in Paediatric Urology. He is President of Indian Association of Paediatric Surgeons(I.A.P.S.) from 2014-2015. He Received ICMR National awards twice- 1995-Dr. Kamla Menon award in Paediatrics & 2009-Kunti Omprakash Gold Medal in Paediatrics. He Founded the Indian Society for Paediatric Urology & Asian Society for Paediatric Urology in 1998. He Publish 201 journals in Peer Reviewed.
Abstract:
Background: Vesicoureteric reflux (VUR) is one of the most common urological problems faced by pediatric surgeons. Antibiotics are helpful for short periods and in lower grades of VUR. Continuing VUR can cause renal damage by activating the Renin Angiotensin System (RAS). Subsequently severe bilateral VUR leads to nephropathy. Antibiotic treatment, followed by endoscopic management is the answer to managing such cases till 18 months of age. If bilateral VUR still persists, surgery is the key.
Aim: To study the short term and the long-term results of anti-reflux surgery in children with severe grade bilateral VUR and nephropathy.
Methods: A prospective study conducted from July 2009 onwards at our institute and data pertaining to epidemiological, clinical (including blood pressure), biochemical markers (PRA), urine microalbuminuria, glomerular filtration rate, DMSA scan were recoded and compared in patients with severe grade bilateral VUR before & after anti-reflux surgery and after initiation of Angiotensin converting enzyme-1 inhibitors (ACE-I) therapy.
Results: A total of 26 children with severe VUR who underwent bilateral Cohen’s re-implantation were included. It was seen that 81% patients (21/26) had >20% improvement in their GFR while only 19% (5/26) showed <20% improvement in their GFR after anti-reflux surgery. There was also significant improvement in the markers of renal damage after surgery (PRA, urinary microalbuminuria, GFR, blood pressure, DMSA scan) in both the groups.
Conclusion: In patients with severe VUR, anti-reflux surgery leads to improvement in GFR and other markers of renal damage. In the long term, once the surgical effect plateaued out, the use of ACE-I also proved beneficial in such patients.
- Neonatology | Pediatric Endocrine Surgery | Pediatrics Oncology and Haematology
Chair
Andrew J A Holland
The University of Sydney, Australia
Co-Chair
Howard I Pryor II
Johns Hopkins University School of Medicine, USA
Session Introduction
Chrysoula Papachristou
General Hospital of Trikala, Greece
Title: Breastfeeding in infants born in the maternity clinic hospital of Trikala Greece in 2015-2016
Time : 12:20-12:50
Biography:
Chrysoula Papachristou is an Attending Physician of Pediatrics at General Hospital of Trikala. She finished Medical School of Ioannina Greece and Pediatric Residencyat University of Larissa Greece. She has participated at the International Child Mental Health Training Program at Childrens Boston Hospital in 2008.
Abstract:
Breast milk is the best food for the baby, especially during the first months of life. Exclusive breastfeeding is difficult to achieve. The purpose of this retrospective study is to record the frequency of breastfeeding the first 2, 6 and 12 months of life, and the factors that contribute to the establishment and continuation of this. We performed a retrospective study using a telephone questionnaire to all mothers who gave birth in the obstetrics clinic of Trikala Hospital in 2015-2016. Data were collected from 300 mothers. Approximately 70% of mothers begun to nurse in the first month. 30% of mothers were not breastfed at all, almost half of mothers (48.4%) continued with exclusive or mixed feeding up to 2 months, while 32% continue at 6 months. The percentage drops at 22% in the first year of life. Mothers who adopted lactation even for 40 days say they had been very well informed about the process, especially from obstetric and medical staff of the hospital. Finally, over 60% said they did not have help at home to support the choice of breastfeeding. The breastfeeding rate in Hospital of Trikalais rather satisfactory for Greece, still better rates can be achieved. It appears that on the part of mothers, there is intense interest in the initiation and establishment of breastfeeding, and the approach of obstetric and pediatric care contributes positively towards it.
Ingegerd Ivanov Ofverholm
Karolinska University Hospital, Sweden
Title: Overexpression of tyrosine kinase and chromatin remodeling genes in the iAMP21 subtype of pediatric acute lymphoblastic leukemia
Biography:
Ingegerd Ivanov Öfverholm is an MD at the Karolinska University Hospital in Sweden. She will complete her PhD in March 2017, at the age of 34 years. Her research is focused on novel genetic risk-markers in childhood ALL; she has 6 publications on this subject.
Abstract:
Intrachromosomal amplification of chromosome 21 (iAMP21) is a cytogenetic subtype associated with relapse and poor prognosis in pediatric B-cell precursor acute lymphoblastic leukemia, however, the biological cause of the high relapse risk is still unknown. The only genetic alteration consistently present in all iAMP21 cases is additional copies of the region of amplification, and the minimal region of amplification (MRA) has been determined to a 5,1 Mb region on 21q22.3. The MRA encompasses several protein coding genes, including RUNX1, however, no causative oncogene or tumor suppressor has thus far been identified in the region. In this study, we used massively parallel sequencing in an integrated approach to investigate the structure and transcriptional effects of the iAMP21 rearrangement, with focus on the MRA, and we show that the iAMP21 subtype has several unique and recurrent alterations of genes involved in cell cycle and chromatin remodeling that could possibly explain the relapse tendency for this subtype.
Ulf Schubert
Karolinska University Hospital, Sweden
Title: Early detection of cardiac dysfunction after preterm birth by speckle-tracking echocardiography
Biography:
Dr Ulf Schubert he is an assistant professor affiliated from Karolinska University Hospital, Stockholm and belongs to the department Cardiology, Internal Medicine (General Medicine), Cardiothoracic Surgery and he published 10 research articles in the research gate, his skills and expertise in cardiac function, Cardiovascular, Aorta, Echocardiography, and Carotid Arteries. His research interests mainly focus on cardiology, internal medicine, cardiothoracic surgery and congenital heart disease.
Abstract:
Background: Preterm infants are at higher risk to suffer from adverse cardiovascular events later in life. However, data on cardiac function and possible interventions is scarce. Therefore, we undertook a sequential analysis of cardiac function after preterm birth by speckle-tracking echocardiography (STE) and compared the results to a healthy control group.
Methods: Evaluation of cardiac function of 25 very preterm infants (GA 26-30 weeks) at birth, term and 3 months of corrected age by STE and comparison to 30 healthy term children (1st investigation intrauterine), using longitudinal strain (%), strain rate (1/sec) and tissue velocities (cm/s) in both ventricles in systole and diastole for myocardial performance, and comparison to conventional echocardiography.
Results: Very preterm infants exhibited significantly lower left ventricular (LV) strain values (19.9 vs. 22.0%), systolic (5.8 vs. 6.4 cm/s) and diastolic (7.8 vs. 10.6 cm/s) tissue velocities and early diastolic strain-rate values (3.9/s vs. 4.7/s) at 3 months of corrected age compared to healthy controls. There was a trend of lower values even in the right ventricle- though not statistically significant.
Conclusion: LV systolic and diastolic dysfunction is present 6 months after very preterm birth and can be identified by STE while conventional echocardiography is not able to detect abnormal myocardial performance at this age. Dysfunction might occur because of premature adaption towards higher systemic afterload and re-modelling of the LV early in life. Therefore, we recommend using STE in early routine follow-up of preterm infants.
Toshio Chiba
Kairos Corporation, Japan
Title: 8K Ultra-high Definition (UHD) Endoscope: A probable game-changing eye for pediatric surgery
Biography:
1975 Toshio Chiba graduated from Tohoku University School of Medicine. 1978 Research Fellow, Institute for Protein Research, Osaka University. 1986 Visiting Assistant Professor/Clinical Fellow, Division of Pediatric Surgery, University of Pittsburgh. 1992 Lecturer/Associate Professor, Division of Pediatric Surgery, Tohoku University Hospital. 1997 Visiting Assistant Professor/Visiting Professor/Senior Scientist, Fetal Treatment Center/Department of Surgery, UCSF. 2001 Director, Department of Strategic Medicine, National Center for Child Health and Development. 2012 Chairman, Medical Imaging Consortium. 2013 Professor, The University of Tokyo. 2015 Professor, Nihon University. 2017 CEO, Kairos Corporation. His research interests include fetal surgery and pediatric surgery.
Abstract:
We could successfully develop a handy 8K ultra-high definition (UHD) camera which was combined with an optically advanced rigid endoscope and an 85-inch 8K UHD display. For the past 3 years, we have clinically performed endoscopic cholecystectomy uneventfully in a total of 6 adult patients having symptomatic gallstone disease. The 8K UHD imaging could give us a visual acuity of 4.27 and a 16-fold higher resolution (33,000,000 pixels) as compared with that of a currently employed 2K high definition (HD) imaging (2,000,000 pixels). In our clinical practice, the 8K UHD endoscope offered surgeons an outstanding quality of vision with a sense of presence as well as a feeling of real solid things with detailed pin-sharp, true-to-life, and 3-D like images. Importantly enough, these imaging qualities are sure to enable us much more sharp accurate procedures including dissection or anastomosis of minute blood vessels or nerve fibers. We should emphasize here that these capabilities are required most to accomplish surgical intervention for susceptible fragile tissues of small pediatric patients. There are still a couple of problems to be overcome, the 8K UHD endoscope is sure to be quite promising technology for general along with pediatric surgery which should be safer, faster, and less expensive.
Nadav Friedel
Tel Aviv University, Israel
Title: Are we over-treating insect bite related periorbital cellulitis in children? The experience of a large, tertiary care pediatric hospital
Biography:
Nadav Friedel has completed his MD at Semmelweis University, Budapest, Hungary in 2011. Since then, he is working at Dana-Dwek Children Hospital, Tel Aviv, Israel as a Medical Doctor.
Abstract:
Introduction: Preseptal (periorbital) and orbital cellulitis are potentially catastrophic infections near the eye. Preseptal cellulitis is far more common, and although classically reported to be associated with dacryocystitis, sinusitis/upper respiratory infection, trauma/surgery, or infection from contiguous areas, it can also be associated with insect bites. The objective of this study was to determine the prevalence of insect bite-associated preseptal cellulitis and to compare clinical findings and outcomes of these patients with those having other causes for the condition.
Methods: Retrospective chart review was done on children with a final discharge diagnosis of periorbital cellulitis from January 2009 to December 2014 at a tertiary care children’s hospital.
Results: 213 children were diagnosed with preseptal cellulitis during the 5-year study period, of whom 60 (28%) were associated with insect bites. Patients in the non-insect bite group more commonly had fever at presentation (p <0.001), with increased WBC and CRP values (both p <0.001). No patient with insect bite-associated preseptal cellulitis presented with fever, and none underwent radiographic testing or computerized tomography; their mean age was also lower (p <0.001) and length of stay was significantly shorter.
Conclusions: This study suggests that children with preseptal cellulitis associated with insect bites could be candidates for oral antibiotic therapy with outpatient follow-up by.
Kakali Roy
All India Institute of Medical Sciences, India
Title: Blood lead level in children of Kolkata
Time : 16:10-16:40
Biography:
Dr. Kakali Roy has completed her M.B.B.S. at the age of 24 years from West Bengal University of Health Sciences and postgraduation in Pediatric Medicene from Institute of Child Health,Kolkata.She is now working as Senior Resident at India’s premier Institute, All India Institute of Medical Sciences,Delhi. She has published 3 papers in reputed journals and has presented paper at International Conference of Emmerging Infectious Disease, Georgia, USA.
Abstract:
Background: Lead toxicity accounts for about 0.6% of the global burden of disease (WHO 2009). A published draft report on Site Assessment of Lead Pollution at an area of Kolkata (having lead smelters) on July 2006, stated high lead level in water, soil, solid waste and air particle. We conducted a health check up camp for children of that area in 2015 and collected blood samples. In our hospital, we also got 2 sporadic cases of lead toxicity with frank features of poisoning including lead lines in x-ray.
Aims & Objectives: To conduct a field study to evaluate blood lead level in children residing in contaminated area of Kolkata and to look for effect of BLL on hematological parameters.
Materials & Methods: This was a cross sectional observational study on 50 children of age group 1-12 years, who attended the camp. BLL was estimated by Atomic Absorption Spectroscopy (AAS) using graphite furnace atomic absorption spectrometer.
Results: The median age of the population was 8 years with higher proportion of males (58%). Median BLL was 4.55 µg/dl and 24% (n=12) of these children had BLL above the CDC recommended cut off value of 5 µg/dl. However, none of the children had BLL >10 µg/dl or anemia (mean hemoglobin of 12.3 g% with normal RBC indices). This is expected as previous studies have clearly shown the association of lead and anemia is only at BLL >10µg/dl though hemoglobin level showed a negative linear dose-response relation with lead level using scatter plot.
Conclusion: In our study even at known contaminated area, none had BLL exceeding the CDC intervention level. This may be due to lead free gasoline, a principle source of lead exposure, is not in use for more than 15 years. This indicates a positive impact of measures taken regarding lead poisoning. But both the sporadic cases were from households engaged in hazardous occupation at home settings, where children had direct daily exposure and these children are more vulnerable to poisoning. These ‘HOT SPOTS’ or ‘POCKETS’ are needed to be identified and further research is justified.
Biniam Ayele
Bahir Dar University, Ethiopia
Title: Double intussusception (ileocolocolic) with mobile cecum and ascending colon
Biography:
Biniam Ayele Berkie is graduated from University of Gondar as a Medical Doctor. Currently, he is working as a Physician and Lecturer at Felegehiwot Referral hospital and Bahir Dar University respectively. He is a 4th year Surgical Resident at Bahir Dar University.
Abstract:
Intussusception refers to telescoping of one portion of proximal gut to another distal part with further motion of the intussusception into the intussusceptions by ongoing peristalsis. The commonest intussusception being ileocolic is about 85 to 90%. Rarely caecocaceo-colic, jejuno-jejunal or even ileo-ileo-colic occurs in a double or three-fold manner. Colo-colic is found more often in parasitic diseases. As far as aetiology is concerned, a mobile ascending colon, malrotation or non-rotation facilitates intussusception. Here we presented a case report of double intussusception of five month old female infant after she is presented with abdominal distension and vomiting of ingested matter of three days, the infant has also intermittent crying since birth especially after breastfeeding. For this, the neonate was admitted and diagnosis is made by abdominal ultrasound and for that the neonate was prepared and explored. The intraoperative finding concluded that baby was having gangrenous ileocolocolic intussusception with transverse colon perforation and about 5 cm of distal ileum, the lumen was extremely narrow when compared with the proximal one with the leading point. And the cecum and ascending colon was mobile. For this we have done end to end ileoascending anastomosis with end to end colocolic anastomosis of the transverse colon and biopsy was sent for histopathology. The patient was followed in the ICU for a week and discharged after improved conditions, so that the details of double intussusception and details of the intraoperative finding can be discussed.