more case!!

CONJOINED TWINS

Conjoined twinning is one of the most fascinating human malformations and has also been reported in other animals—mammals, fishes, birds, reptiles, and amphibians.Treating conjoined twins can be a daunting challenge for the surgeon. Furthermore, these cases often raise religious,moral, ethical, and legal issues.

Approximately 75% of conjoined twins are female, and 70% are fused at the thorax (thoracopagus) or abdomen (omphalopagus). The union can be in the frontal, transverse, or sagittal plane. The 2 main categories are symmetrical or equal conjoined twins (ie, 2 well-developed babies) and asymmetrical or unequal conjoined twins (ie, a small part of the body is duplicated, or an incomplete twin is attached to a fully developed twin). In broad terms, conjoined twins may be regarded as a doubling anomaly. The later the incomplete embryologic separation occurs, the higher the likelihood of a complicated fusion. 

read more at Conjoined Twins

Tunica vaginalis: An aid in hypospadias fistula repair: Our experience of 14 cases

Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. The correction of such fistula is associated with a failure rate of 10 to 40%. The step in successful repair of a fistula is separation of the suture lines in the urethra and skin using well vascularized elastic tissue. We report our experience of using the tunica vaginalis flap as a layer between the neourethra and skin suture line in repair of recurrent urethrocutaneous fistula. 

Patients and Methods: We have used the tunica vaginalis flap for the repair of recurrent urethrocutaneous fistula in 14 children with a mean age of 6.5 years (range 3-14 years). All patients had undergone previous hypospadias repair and at least one previous attempt to close the fistula had failed. Surgery was initiated by injecting a povidone solution via urethral meatus to identify all fistulae. The fistulae were closed primarily and urethral suture line was covered with a flap of tunica vaginalis which was harvested either through a small scrotal incision and mobilized via a subcutaneous tunnel into the penile shaft (8/14) or by the same incision as for fistula closure (6/14). The testis was fixed to the scrotum. A urethral catheter was kept for urinary diversion for 10 days. 

Results: The repair was successful in all but one patient in whom there was leak from the fistula site. One patient in whom tunica vaginalis fascia was tunnelled into neourethra developed scrotal haematoma which needed drainage. Penile cosmesis was acceptable without any significant postoperative testicular complication in 13/14 patients. 

Conclusion: Repair of recurrent urethrocutaneous fistula with a tunica vaginalis flap is highly effective regardless of fistula location. This flap is easy to mobilize and provide effective coverage of urethral suture line. Putting a glove drain should be considered into scrotal wound if perfect haemostasis is doubtful.

read more on this at Tunica vaginalis: An aid in hypospadias fistula repair: Our experience of 14 cases

Malaysian Experiences on Paediatric Surgery.

    Malaysia have had many experiences that involve paediatric surgeries. However, amongst them, the one that catches our attention was the history made by UKM Medical Centre after the success of the ‘minimally invasive’ surgery on a 14 day-old baby to remove 95 per cent of his pancreas. 

keyhole

     Thus, the surgery (pancreatectomy) was done for the first time of its kind in the world for patients below 30 days old. The surgery was done to protect the newborn from brain damage. The patient was suffering from a rare case of Persistent Hyperinsulinemic Hypoglycemia of Infancy (PHHI) where the pancreas produces excessive insulin. This can lead to brain damage because it induces hypoglycemia by reducing the glucose level in the blood. 

Dr Dayang

    The physician who performed the surgery was Dr Dayang Anita Abdul Aziz, Consultant Pediatric Surgeon & Head of UKM Paediatric Surgery Unit. She said, “the treatment is to remove nearly the entire pancreas. But extra care had to be taken because if we over do it, the child will become diabetic when old. The removal has to be just right. We call it near total pancreatectomy.” The surgery was done by using a laparoscopic camera inserted through the navel so that the pancreas can be viewed on a high definition (HD) screen without having to cut the infant's abdomen open. Then Dr Dayang inserted surgical instruments through a small incision which was less than 3mm in length at each side of the abdomen. With guided by the magnified images of the pancreas on the HD screen, she cut the pancreas into small pieces and taking it out one piece at a time. The whole process took nearly two and a half hours. 

    Keyhole surgery is quite common and is done in both public and private hospitals all over Malaysia. But what makes UKMMC different is the facilities and expertise to do keyhole surgery in infants and newborns which entailed more complex procedures. 

Keyhole surgery

Read more about the news by clicking the following link, UKM Made History with Keyhole Surgery on a 14 Day Old Baby

Professional Association of Paediatric Surgery.

1.       American Pediatric Surgical Association (APSA)

The mission of the American Pediatric Surgical Association is to ensure optimal pediatric surgical care of patients and their families, to promote excellence in the field, and to foster a vibrant and viable community of pediatric surgeons.

They achieve their missions by

·         Developing and advocating for standards of care for infants and children and influencing public policy around the surgical care of children.

·         Encouraging discovery, innovation and improvement of care

·         Providing rich user friendly venues for the dissemination of up-to-date knowledge

·         Offering high quality continuing education to members

·         Creating identity and community among pediatric surgeons

·         Promoting a supportive health care environment for patients, staff, and surgeons and ensuring that it is sustained by economic health

2.       British Association of Paediatric Surgeons (BAPS) 

The primary aim of BAPS is to set the standards of care of paediatric surgical practice in the UK and Ireland.The Strategic Aims are based on the objectives of the Association which are:-

·         The support of Paediatric Surgical Practice

·         The advancement of study, practice and research in Paediatric Surgery

·         To maintain links with Sub-specialist Societies and other groups within Paediatric Surgery

·         Liaison with the Surgical and other Royal Colleges, the Professions allied to medicine, other relevant Professional bodies and Government

·         Fostering of professional relations with Paediatric Surgeons overseas 6. The proper and prudent management of the resources of BAPS as a registered UK Charity in line with the requirements of the Charity Commissioners

3.       Indian Association of Pediatric Surgeons

Their mission is to

·         propound, to practice, to promote, to project and to propagate the specialty of Pediatric surgery, to render high quality Pediatric surgical care

·         foster fraternity and familial feelings amongst the members

·         pursue professional practice with ethics and empathy

·         stay away from a milieu muddled with mundane materialism

4.       World Federation of Associations of Pediatric Surgeons

The objective of the Federation shall be the improvement and maintenance of the standards of pediatric surgery throughout the world for the common good by any non-profit making means and in particular, but without prejudice to the generality of the foregoing words, by all or any of the following means:

·         The promotion and integration of pediatric surgery throughout the world.

·         The maintenance of a centre for cooperation and interchange of information among pediatric surgical associations, societies and organizations approved by the Federation.

·         The encouragement of the development and maintenance of high standards of care, education, training and research in pediatric surgery and its allied sciences throughout the world.

·         The encouragement of clinical and scientific congresses of pediatric surgical associations, societies and organizations approved by the Federation.

Not to forget, Malaysia has its very own Paediatric association...

5.       Malaysian Paediatric Association (MPA)

The aims and objects of the Association shall be:

·         To advance the knowledge and practice of paediatrics.

·         To promote child health.

·         To promote research in Malaysia in the field of paediatrics and child health.

·         To bring together periodically medical practitioners for scientific discussion and practical demonstration on paediatric subjects.

·         To acquire, establish, print and publish books, magazines, periodicals, leaflets or other literary or scientific works that the Association may think desirable for the promotion of its objects with the approval of the authorities concerned.

·         To do all such acts and things incidental or subsidiary to all or any of the above objects.

Paediatric Surgeon-Degree requirement

Do you have what it takes to become a paediatric surgeon? Then, wonder no more as we reveal the steps and requirements to be one.

Paediatric surgeon is for individuals with an interest in medicine as well as children. A career in paediatric surgery offers the opportunity to specialize in the surgical treatment of children's disorders, including neonatal and prenatal surgery, child trauma and child oncology.

What are the skills necessary to become a Paediatric Surgeon?

Together with certification and proper training, the Pediatric surgeon qualifications are these following skills:

1. the Paediatric Surgeon must have a genuine interest and concern for newborns and children’s needs.
2. It is essential that the Paediatric surgeon has a clear understanding of pharmacology and child physiology because their work involves treating their patients in different levels of development
3. Must be highly sensitive when interacting with the families and their patients

Steps to be a Paediatric Surgeon :

Step 1 Earn a Bachelor's Degree

Step 2 Apply to Medical School

Step 3 Earn a Medical Degree

Step 4 Complete Residency

Step 5 Become Licensed

Step 6 Become Board Certified in General Surgery

Step 7 Become Board Certified in Paediatric Surgery

However, the procedures to become a paediatric surgeon in Malaysia differs from the United State.

To learn more, just click here ----> Pediatric Surgeon: Career Roadmap

Other references:

Pediatric Surgeons: Job Description and Info for Students Considering a Career in Paediatric Surgery

Pediatric surgery

More on Paediatric Surgery!

Undeniably, anything has made easier than ever with a mere click of the mouse. There are plenty of articles, forums and websites that can provide aspiring paediatric surgeons with useful information about the field. One of the websites that we had found rather useful would be DoctorsHangout.com.

This website discusses on investigations for congenital megacolon and treatment options for paediatrics surgery. Many specialists opted for rectal biopsy as the procedure of choice. Other procedure that can also be done include anorectal manometry, barium enema and abdomen x-ray. As for the treatment, anorretomiectomy and colostomy are the usual surgical procedures.

A CHANCE to live, a HOPE to heal.

Meet Low Yong Xuan or Baby, as she is affectionately known. She is an active, bubbly 3 year-old girl. Nothing puts a smile on her face as much as when she is watching her favourite Tom and Jerry cartoons and when she is mingling with her friends at the nursery.

Low, however, does not have a regular childhood like any other healthy children. At the tender age of 6 months, she was diagnosed with Bilateral Wilms Tumour. It was a type of cancer which is found in the kidney that may further complicate her condition if the tumour spreads to the lungs, liver or nearby lymph nodea. The disease is apparently common in children who are under the age of five.

All a child ever needed is to feel great about oneself and live a happy, healthy life. 

Based on this true story which was adapted from MAKNA, we were inspired to create a blog on Paediatric surgery. 

Nature of Work – Paediatric Surgeon

What is an average day like?

·         Working routine varies every day with its own challenges.

• This includes carrying out ward rounds, working in the outpatient clinics, attending theatre sessions and teaching during a typical day.

• Paediatric surgeons work within a multidisciplinary team of fellow paediatrics, radiologists, histologists and oncologists.

• Patients are exceptionally varied, with only the age range in common. However, within this age range paediatric surgeons treat a great variety – from babies through to teenagers.

• The most common challenge that paediatric surgeons face would be counselling the parents and children through difficult times.

Malaysia requirement

Degree requirement :

1.            Undergraduate – STPM, Matriculation, Foundation or A-Level

2.       Doctor of medicine (M.D.) – Malaysia or Doctor of osteopathic medicine (D.O.) – other country

Paediatric surgery specialist :

·    

• Paediatric cardiothoracic (surgery on the child's heart and/or lungs, including heart and/or lung transplantation)
• Paediatric nephrological surgery (surgery on the child's kidneys and ureters, including renal, or kidney, transplantation)
• Paediatric neurosurgery (surgery on the child's brain, central nervous system, spinal cord, and peripheral nerves)
• Paediatric urological surgery (surgery on the child's urinary bladder and other structures below the kidney necessary for urination)
• Paediatric emergency surgery, surgery involving fetuses or embryos (overlapping with obstetric/gynecological surgery, neonatology, and maternal-fetal medicine) surgery involving adolescents or young adults,
• Paediatric hepatological (liver) and gastrointestinal (stomach and intestines) surgery (including liver and intestinal transplantation in children)
• Paediatric orthopedic surgery (muscle and bone surgery in children)
• Paediatric plastic and reconstructive surgery (such as for burns, or for congenital defects like cleft palate not involving the major organs)
• Paediatric oncological (childhood cancer) surgery.

Stepping in the World of Paediatric Surgery.

Paediatrics surgery is a specialized field of surgery in treating conditions that can be surgically corrected in a baby, child or adolescent. The definition is taken from surgery encyclopedia.

A paediatric surgeon works to correct and improve congenital conditions, traumatic injuries, or diseases which are faced by paediatric patients. There are many sub-specialties within this field such as paediatric general surgery, paediatric orthopedic (bone) surgery, paediatric otolaryngology (ear, nose, and throat) and paediatric ophthalmology (eye).

According to Malaysian Association of Paediatric Surgeons (MAPS), there are several  clinical practice guidelines for paediatric surgeons. A general surgeon for instance, who is interested in obtaining the basic knowledge of paediatric surgery in his practice should spend at least 6 months in a recognized centre. A paediatric surgeon have to cooperate with highly skilled people in anaesthesia, radiology and nursing staffs in order to provide appropriate paediatric services.