Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

Development in material engineering provide many kinds of suture materials to medical fields. The choice of utilization depends on the surgeons decision, the durability, absorbtion times, tensile strength of the suture, and operation site in means of organ and tissue. In this study we aimed to investigate 7 different suture materials in vivo and in vitro conditions to evaluate the properties and durability. Basal tensile strength (TS) values of all sutures were measured and 168 Wistar albino rats were utilised in vivo groups. The sutures were placed in the bladder, stomach, intestine and bile duct (after obstructive jaundice). Urine and bile of rat, pH 1 and pH 10 were used as in vitro conditions. Seven different suture materials (Maxon, Vicryl, Plain Catgut, Surgical Silk, Polypropylene, Caprosyn and Biosyn) were investigated in 9 different in vitro and in vivo conditions. All sutures were chosen to be in size 5/0. In the following 5th day the sutures were tested related to durability and stability. Results were compared stastically using the Mann-Whitney U test and p < 0.05 was considered as stastically significant. Among all the suture materials only polypropylene proved to preserve its stability in vivo and in vitro surveys. Cat-gut and caprosyn lost its TS in all medias. Silk and biosyn lost its TS in all conditions except the stomach and intestines. Maxon also lost its TS in all condition except urine. Utilisation of caprosyn and biosyn in urinary procedures reduces stone formation and infections. The suture of choice in biliary tract should be vicryl, maxon or biosyn since polypropylene preserves its stability that could result in stone formation. In intestinal operations polypropylene, vicryl, and silk could be preferred.

Aim: The aim of this study was to evaluate the data of our patients treated for congenital muscular torticollis (CMT) in the period between 1990 and 2004. Here we report our clinical experience with CMT and review the literature. Patients and Methods: We retrospectively evaluated the data of our patients in terms of age, sex, clinical presentation, additional deformities, localization of the lesion, history of previous treatment attempts, diagnostic tests, additional abnormalities, findings at operation and surgical procedures. Results: The mean age of the patients who were operated for CMT (25 females, 27 males) was 4.3 years (range: 5 months to 16 years). Most of the lesions were seen on the left aspect of the neck. There was only one case with bilateral CMT. Seventeen out of 52 patients with CMT (32%) were diagnosed in the newborn period. The most encountered complaint at application was restriction of neck motion (57%). Associated complaints such as head tilt (53%), fascial asymmetry (34%), deformity of the skull (9.6%) were seen. Sternocleidomastoid tumor accounted for only 11% of the patients’ complaints. All patients in this series were treated by surgical intervention. Apart from one recurrence no other postoperative complication was observed during the follow-up period. Conclusions: Patients whose pathology does not resolve after 12 months of physical therapy or who develop facial asymmetry or plagiocephaly during the follow-up period should be operated on in order to achieve the best cosmetic result. In delayed cases additional surgery may be needed for the best cosmetic and functional result.

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