Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold...Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis.Endolumenal functional lumen imaging probe(EndoFLIP)an emerging technology,uses impedance planimetry to measure hollow organs cross sectional area,distensibility and compliance.It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters,oesophageal body,the pylorus and the anal canal.In this article,we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice.The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing.EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.展开更多
There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhoo...There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal(GI)diseases.Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess,and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes.Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region.Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion,with the emergence of inflammatory bowel disease(IBD)and eosinophilic GI disease as increasingly common endoscopic diagnoses.Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed,with a declining incidence of GI bleeding.However,the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases.Helicobacter pylori infection,particularly that of multidrug-resistant strains,remains a highly prevalent problem in specific regions.Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres,hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms.GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies,intestinal polyposis or oesophageal strictures requiring dilation.Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers.Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction,particularly in East Asian centres,as invaluable diagnostic and therapeutic tools in the management of IBD,obscure GI bleeding and intestinal polyposis.State of the art endoscopic diagnostics and therapeutics,including the use of artificial intelligence-aided endoscopy algorithms,real-time confocal laser endomicroscopy and peroral endoscopic myotomy,are expected to gain more utility in paediatrics.As paediatric gastroenterology matures as a subspecialty in Asia,it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards,and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy.This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific,with the relevant clinical outcomes.展开更多
As children are prone to be more radiosensitive than adults, it is imperative to assess the Entrance Skin Doses (ESDs) for patients being examined by X-rays, in order to ensure the optimization of dose while consideri...As children are prone to be more radiosensitive than adults, it is imperative to assess the Entrance Skin Doses (ESDs) for patients being examined by X-rays, in order to ensure the optimization of dose while considering a number of other fickles. The ESD received by 50 paediatrics (aged 1-13 years) undergoing 8 types of X-ray examinations were measured at Federal Teaching Hospital, Ido-Ekiti, Ekiti, Nigeria, within a period of February 2019 to March 2020 using thermoluminescent dosimeters. The mean ± SD of ESDs were 0.85 ± 0.32, 2.04 ± 0.75, 0.60 ± 0.07, 0.62 ± 0.22, 0.57 ± 0.24, 1.75 ± 0.76, 0.93 ± 0.31 and 0.63 ± 0.06 mGy for Chest, Skull, Hand, Forearm, Knee, Abdomen, Leg and Feet, respectively. The mean ESDs were found to be within the recommended reference dose in all examinations, except for the Chest examination which was higher. The data obtained in this study will serve as existing data in Nigeria for future research works, as it would assist in optimizing dose to patients, especially the paediatrics.展开更多
All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other excl...All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.展开更多
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic ...The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.展开更多
Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of pae...Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of paediatric brain tumors, and up to 33% of brain tumors in children under the age of three. Hydrocephalus is one of the complications, and it can be identified as progressive macrocephaly or increasing head circumference crossing percentiles, nausea, vomiting, poor appetite, irritability, and regression of developmental milestones.展开更多
Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon...Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon in older children. The most common pathogen is Coxsackie virus B. The offending agent instigates an immune response, which causes myocardial oedema with eventual systolic and diastolic dysfunction. Cardioembolic stroke can occur secondary to an intra-mural thrombus in a dysfunctional atrium or ventricle. We describe the case of an adolescent male with acute myocarditis complicated by a thromboembolic stroke. After initial management of acute pulmonary oedema and heart failure with restricted ejection fraction (HFrEF), the child developed seizure-like symptoms on the 10th day of hospitalization, prompting urgent neuro-radio diagnosis, which revealed acute infarcts in the cerebellum and frontal lobe of the cerebrum. We believe this case to be of clinical relevance because;1) The diagnosis of an acute stroke in children is often delayed due to the atypical clinical presentation and often the absence of traditional stroke-like symptoms, and 2) There is a lack of sufficient high-quality evidence regarding the predictors and the immediate management of stroke in paediatric heart disease, as well as inadequate data on prevalence and incidence in paediatric cardioembolic strokes.展开更多
BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding...BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration.AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview.METHODS This was a single-centre retrospective study.Twenty-four patients were enrolled between January 2017 and January 2023.Medical records of patients aged below 18 years who were admitted to authors’affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital’s database to Microsoft Excel 2019.Data were analysed using MedCalc Statistical Software.RESULTS Patient ages varied from 9 months to 11 years.The median age was 23.5 months,95%confidence interval(CI)19.49-44.77.We observed age clustering in children with foreign body aspiration at our institution with three age subgroups:(1)0-25 months;(2)40-60 months;and(3)120-140 months.We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together(odds ratio=10.0,95%CI:1.44-29.26,P=0.0197).Successful foreign body extraction was performed in all cases.Conversion to a rigid bronchoscope was not required in any of the cases.No major complications(massive bleeding,tracheobronchial tree perforation,or asphyxia)were observed.CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.展开更多
文摘Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis.Endolumenal functional lumen imaging probe(EndoFLIP)an emerging technology,uses impedance planimetry to measure hollow organs cross sectional area,distensibility and compliance.It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters,oesophageal body,the pylorus and the anal canal.In this article,we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice.The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing.EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.
文摘There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal(GI)diseases.Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess,and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes.Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region.Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion,with the emergence of inflammatory bowel disease(IBD)and eosinophilic GI disease as increasingly common endoscopic diagnoses.Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed,with a declining incidence of GI bleeding.However,the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases.Helicobacter pylori infection,particularly that of multidrug-resistant strains,remains a highly prevalent problem in specific regions.Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres,hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms.GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies,intestinal polyposis or oesophageal strictures requiring dilation.Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers.Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction,particularly in East Asian centres,as invaluable diagnostic and therapeutic tools in the management of IBD,obscure GI bleeding and intestinal polyposis.State of the art endoscopic diagnostics and therapeutics,including the use of artificial intelligence-aided endoscopy algorithms,real-time confocal laser endomicroscopy and peroral endoscopic myotomy,are expected to gain more utility in paediatrics.As paediatric gastroenterology matures as a subspecialty in Asia,it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards,and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy.This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific,with the relevant clinical outcomes.
文摘As children are prone to be more radiosensitive than adults, it is imperative to assess the Entrance Skin Doses (ESDs) for patients being examined by X-rays, in order to ensure the optimization of dose while considering a number of other fickles. The ESD received by 50 paediatrics (aged 1-13 years) undergoing 8 types of X-ray examinations were measured at Federal Teaching Hospital, Ido-Ekiti, Ekiti, Nigeria, within a period of February 2019 to March 2020 using thermoluminescent dosimeters. The mean ± SD of ESDs were 0.85 ± 0.32, 2.04 ± 0.75, 0.60 ± 0.07, 0.62 ± 0.22, 0.57 ± 0.24, 1.75 ± 0.76, 0.93 ± 0.31 and 0.63 ± 0.06 mGy for Chest, Skull, Hand, Forearm, Knee, Abdomen, Leg and Feet, respectively. The mean ESDs were found to be within the recommended reference dose in all examinations, except for the Chest examination which was higher. The data obtained in this study will serve as existing data in Nigeria for future research works, as it would assist in optimizing dose to patients, especially the paediatrics.
文摘All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.
文摘The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.
文摘Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of paediatric brain tumors, and up to 33% of brain tumors in children under the age of three. Hydrocephalus is one of the complications, and it can be identified as progressive macrocephaly or increasing head circumference crossing percentiles, nausea, vomiting, poor appetite, irritability, and regression of developmental milestones.
文摘Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon in older children. The most common pathogen is Coxsackie virus B. The offending agent instigates an immune response, which causes myocardial oedema with eventual systolic and diastolic dysfunction. Cardioembolic stroke can occur secondary to an intra-mural thrombus in a dysfunctional atrium or ventricle. We describe the case of an adolescent male with acute myocarditis complicated by a thromboembolic stroke. After initial management of acute pulmonary oedema and heart failure with restricted ejection fraction (HFrEF), the child developed seizure-like symptoms on the 10th day of hospitalization, prompting urgent neuro-radio diagnosis, which revealed acute infarcts in the cerebellum and frontal lobe of the cerebrum. We believe this case to be of clinical relevance because;1) The diagnosis of an acute stroke in children is often delayed due to the atypical clinical presentation and often the absence of traditional stroke-like symptoms, and 2) There is a lack of sufficient high-quality evidence regarding the predictors and the immediate management of stroke in paediatric heart disease, as well as inadequate data on prevalence and incidence in paediatric cardioembolic strokes.
文摘BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration.AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview.METHODS This was a single-centre retrospective study.Twenty-four patients were enrolled between January 2017 and January 2023.Medical records of patients aged below 18 years who were admitted to authors’affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital’s database to Microsoft Excel 2019.Data were analysed using MedCalc Statistical Software.RESULTS Patient ages varied from 9 months to 11 years.The median age was 23.5 months,95%confidence interval(CI)19.49-44.77.We observed age clustering in children with foreign body aspiration at our institution with three age subgroups:(1)0-25 months;(2)40-60 months;and(3)120-140 months.We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together(odds ratio=10.0,95%CI:1.44-29.26,P=0.0197).Successful foreign body extraction was performed in all cases.Conversion to a rigid bronchoscope was not required in any of the cases.No major complications(massive bleeding,tracheobronchial tree perforation,or asphyxia)were observed.CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.
