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PurposeSplenectomies though well-established in the successful management of several resistant haemoglobinopathies, have not been studied in detail in the paediatric population to assess the outcomes. We conducted this review to primarily assess the surgical and anaesthetic outcomes of paediatric splenectomies and secondarily highlight factors predictive for a high-risk splenectomy.MethodsA 5 year retrospective chart review was made, and patient follow-up was done jointly using the hospital electronic medical records and telephonic calls. A p value of ResultsAmong the 69 splenectomised children, 61% were male and the overall mean age was 10.2 years. The cohort consisted of thalassemia’s(46%), ITP’s(30%), haemolytic anemias(19%) and 1 child each with lymphoma, splenic cyst and Kassabach Meritt syndrome. Most(96%) were electively operated and 23% were performed laparoscopically. 61% received intravenous analgesia and the mean volume of fluid administered intra-operatively was 21ml/kg. There was no documented OPSI, and there was one mortality. The mean follow-up period was 43 months.ConclusionSplenectomy was associated with a promising overall outcome with a survival rate of 98.5%. A greater pre-operative transfusion requirement, a larger sized spleen and increased fluid administration intra-operatively, were associated with a worse outcome.

The authors compared a 1-time application of bovine collagen and human amniotic membrane (HAM) to treat children with superficial second-degree burns.A prospective, blinded, internally randomized trial of 43 children was conducted. Fresh HAM (prepared in-house at the Christian Medical College, Vellore) and bovine collagen were applied to different halves of each wound and dried naturally to form a hard, shell-like, so-called exoskeleton. The shell was shed as epithelialization occurred beneath it. Clinical examination and serial photographs were used to track progress until the wound healed completely, as well as at 3 and 6 months after the burn injury. Two burns surgeons blinded to the material used evaluated the resulting scars using the Vancouver Scar Scale.The 43 children presented 3 hours after burn injury on average. A 1-time application was successful in 40 children (93%). After the dressing dried, all parents reported that their child was pain free and the exoskeleton could be handled over the burned area. A total of 16 children (37%) with a low-grade fever at the time of application were treated with simple antipyretic agents. Eight children reported itching at the dressing site. The dressing did not take or was removed in 3 children (7%). Minor serous collections occurred in 8 children who subsequently underwent aspiration. The median time to healing was 10 days in both study arms, with no significant difference in scarring between the 2 materials. Children with earlier shedding of the shell had significantly better scar quality (P.001).Collagen and HAM are safe and provide a one-time ambulatory option for burn dressing with comparable time to healing and scarring. Earlier shedding of the dressing is predictive of better scar quality. Because HAM is inexpensive and simple to prepare and store, it is an excellent choice for use in economically disadvantaged areas where collagen may be unavailable.

Ultrasound-guided hydrostatic reduction (UGHR) is a well accepted and widely used method of paediatric intussusception reduction, with the saline drip technique being the most commonly employed.In this study we aimed to assess the outcomes of a novel technique of UGHR.Data was obtained from a 15 year retrospective chart review of paediatric intussusceptions. Following resuscitation, UGHR was performed for uncomplicated intussusceptions using a 50cc syringe to infuse saline into the colon. It was performed in the ultrasound suite without sedation and time taken was monitored. A maximum of 3 attempts were done to achieve reduction.UGHR was attempted in 66 of 93 intussusceptions. The commonest type of intussusception was ileo-colic(91%) and the commonest symptom was vomiting(70%). Surgery was performed only when there was shock, peritonitis or repeated failed reductions. The median time taken for reduction was 4.9 minutes. The overall success rate was 83% with 89% of these requiring only a single attempt. There were no deaths or procedure related complications.The syringe technique for intussusception reduction is a safe, effective, and time-saving technique. Additionally, it offers the advantages of simplicity and rapidity of reduction and in experienced hands may not require pressure monitoring.