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Abstract Ts Present Ted at the Surgical Annals of Pediatric Surgery Vol. 6, No 1, January 2010, PP 447-71 EPSA 2009 Abstracts Abstracts Presented at the 25th Annual International Meeting of Egyptian Pediatric Surgical Association (EPSA) December 8-12, 2009, Luxor, Egypt Memorial and Guest Lectures EPSA 2009 - Honorary Membership Lecture standards, particularly amongst women, limited health care resources and a constant brain drain of health care Effects of Arabic- Turkish Medicine on Development of professionals. Africa bears 24% of the global burden of Paediatric Surgery; Children’s Rights and Ethical disease but only 3% of the health care work force and only Issues in Paediatric Surgical Procedures During 1% of its financial resources are designated for health. Ottoman Period. Thirty-six of the 57 countries do not meet basic standards S.N. Cenk Buyukunal for health care. There is also the added burden of the Department of P. Surgery, Section of P Urology , HIV/AIDS epidemic and internecine strife. Despite this, Cerrahpasa Medical Facultyty, University of Istanbul, Turkey Africa’s population is estimated to increase by 1 billion in the next 45 years. Children constitute more than half this Almost all medical historians believe that Abu-Kasım-ul- population. Surgical disease in Africa will increase with Zahravi (Albucassis) was the most important founding surgical infections, trauma and congenital abnormalities surgeon as far as pediatric surgery is concerned.With his being the major demand areas with 85% of children surgical textbook(Cordoba,Endulucia)he was almost the first requiring a surgical treatment before the age of 15yrs. Late one who showed the pictures of instruments and even some presentation and advanced pathology is the rule. Those pediatric surgical techniques.A 15th century surgeon from health care workers that are trained, frequently leave for Anatolia,Turkey, Sabuncuoglu Serafeddin(1460) was the greener pastures or are overwhelmed by the gargantuan first one who presented colourful pictures of the operations task before them. Despite this enormous task paediatric and also surgical instruments. He was highly effected by surgeons in Africa are beginning to mobilize, communicate Zahravi ;however he made some additional ,important and move forward as a group. Training is becoming better contributions to his book. defined and paediatric surgeons are making inroads into the During Ottoman reign childrens’rights in health issues was surgical care of children by first setting standards of care. very important , and every effort was made by the There are clearly problems with serving rural areas as >90% community to preserve pediatric patients’ rights. In this of paediatric surgeons practice in urban areas. Nursing, lecture some informed consents about the pediatric general surgical and anaesthetic services need to be operations from 15th, 16th century will be presented. expanded. Training of paediatric surgeons should take place Besides there will be a comparison of so called “children in Africa. Practical steps to improve care are better rights” between East and European civilisation. education in the early recognition of disease, improvement During this short presentation, the remarkable contribution in communication and transport, bedside emergency of Arabic and Turkish-Ottoman medicine to pediatric management of neonates, enteral tube feeding, staged surgical field will be presented in details. surgical procedures, anaesthesia which avoids intubation and strong support to general surgeons who for the EPSA 2009 - Kaddah Memorial Lecture foreseeable future will be doing most of the surgery for children. We live in the hope of progress Challenges for Paediatric Surgery in Africa Alastair J. W. Millar Professor of Paediatric Surgery, Red Cross War Memorial EPSA 2009 - Bahnassy Memorial Lecture Children’s Hospital. Rondebosch, Cape Town, South Africa Ex Utero Intrapartum Treatment (EXIT): Outcomes and Most African countries struggle with problems of high birth Lessons Learned rate, high rates of infant mortality, poverty, poor educational Richard G. Azizkhan EPSA 25th congress abstracts. Cincinnati Children’s Hospital Medical Center, Cincinnati, Routine evaluation and harvesting of DNA, chromosomes USA and cell lines forms the base of the transition of knowledge The lessons learned from fetal surgical treatment of in humans to animal models. congenital diaphragmatic hernia led to the development of In the past mainly teratogenic models have been used for a the Ex Utero Intrapartum Treatment (EXIT) procedure. number of so-called index diagnoses with a questionable Recently there has been a significant expansion of this significance for our understanding of the ethiology and technique to a number of clinical conditions, especially pathogenesis of these anomalies. those with fetuses with perinatal airway compromise. EXIT The integration of basic concepts of organ development and strategy is being employed for patients with Congenital High the respective effects of both genes and transcription factors Airway Obstruction (CHAOS), large neck masses, severe has resulted in new insights in anomalies like congenital micrognathia, high risk CDH, and hypoplastic left heart diaphragmatic hernia (CDH) and trachea-oesophageal syndrome with restrictive atrial anatomy. The airway is fistula (TOF). established under controlled environment in these high risk Our approach in these specific anomalies will be highlighted patients. However, these maneuvers are only possible while as a model for a fundamental change of thoughts towards utero-placental gas exchange is preserved by maintaining major congenital anomalies. Apart from a mono-specialistic uterine relaxation and optimizing maternal and fetal approach pediatric surgeons should integrate their research hemodynamics. It is important to preserve uterine volume in departments of cell biology and/or genetics as financial using a rapid amniotic infuser to minimize abruption and to restrictions will otherwise be the limiting factor for prevent cord compression. Vigorous intraoperative approaches like genome wide analysis and gene cloning. monitoring is employed continuously to treat potential Collaboration both on a national as well as an international problems that may lead to abrupt termination of the intended level is a pre-requisite for future success given the relative procedures. The EXIT team composed of multiple low incidence of many of the anomalies treated primarily by disciplines must be prepared for the unexpected to ensure pediatric surgeons. maternal safety and to minimize fetal complications. During EXIT to airway procedures, the head and neck and the EPSA 2009 - Guest Lecture – II upper torso of the fetus is externalized from the hysterotomy, the airway is assessed using multiple Advances in Molecular Genetics of Cryptorchidism. modalities. These may consist of direct laryngoscopy and Hadziselimovic Faruk, bronchoscopy. If endotracheal intubation is unsuccessful, a Kindertagesklinik, Liestal, Switzerland tracheotomy with retrograde intubation or tracheostomy should be performed. In some instances, mass resection Cryptorchidism affects 1-3% of boys and is the most has to be performed before a secure airway can be common endocrine disease in childhood. Cryptorchid testis achieved. has a typical histology; depletion of germ cells and impaired Conclusion, the EXIT procedure successfully ensures maturation of gonocytes accompanied by intestinal fibrosis prolonged utero-placental gas exchange and fetal and Leydig cell atrophy. Endocrine and primary endorgan hemodynamic stability. The EXIT procedure can be used to failures are the two etiological factors most frequently held secure difficult fetal airways, and allows for a variety of other responsible for the increased incidence of infertility in procedures to be performed to ensure successful transition unilateral and bilateral cryptorchidism. The ultimate aim of to the postnatal environment. But most importantly, it all therapeutic approaches to cryptorchidism is to have both converts a possible catastrophic emergency into a testes in the scrotum and achieve normal fertility potential. controlled planned procedure. 70% of cryptorchid patients have a hypo-gonadotropic hypogonadism. In boys with unilateral cryptorchidism, EPSA 2009 - Guest Lecture – I testicular pathology caused by hormonal imbalance was bilateral; 71 % of scrotal testes had a reduced number of Major congenital anomalies, do you understand. A germ cells and 75 % had impaired gonocytes transformation translational approach. into Ad spermatogonia. D. Tibboel Evidence of a relative postpubertal gonadotropin deficiency Erasmus MC Sophia Children’s Hospital Rotterdam, The became even clearer when LH plasma values were Netherlands correlated to the presence of Ad spermatogonia. While both high infertility risk and intermediate infertility risk groups had Pediatric surgeons are the main players in the treatment normal basal LH levels, the low infertility risk group had LH and consequently understanding of major congenital levels in the hypogonadotropic range. In our long term, anomalies. prospective follow-up study, hormonal analyses confirmed Giving the developments in developmental biology and previous observations of an inverse correlation between clinical and molecular genetics new approaches enable us FSH and sperm count . Furthermore, we confirmed that to understand both normal and abnormal development of a patients with bilateral cryptorchidism had higher FSH variety of organ systems. plasma
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