Letters to the Editor
Dog bite injuries of genitalia and rabies immunisation Access this article online Quick Response Code:
Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.143183 PMID: ****
Sir, We read with interest the letter “Dog bite injuries of genitalia.”[1] We can understand the concern of the authors regarding the administration of immunoglobulin reported in our previous manuscripts.[2]
The real problems with postexposure prophylaxis are the cost of the vaccine and immunoglobulin as well as the availability of the immunoglobulin. For this reason, preexposure prophylaxis has played a role in decreasing the need for immunoglobulin injection, especially in developing countries where rabies is endemic.[5] We think that in all countries where rabies is endemic, preexposure prophylaxis should be advocated to avoid the need of post-exposure prophylaxis with or without immunoglobulins. Mirko Bertozzi, Antonino Appignani Department of Pediatric Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, S. Andrea delle Fratte, Perugia, Italy
We agree that the use of immunoglobulin should be based on the severity of the wound, but how can we measure the danger of a wound if a true exposure to rabies was defined as a bite or contamination of a person’s mucous membranes or open wounds with saliva from a laboratory-confirmed or clinically rabid animal? Of course, postexposure vaccination is not necessary in case of checked family dog.[3] In the case of need, human rabies can be prevented by postexposure vaccination with or without immunoglobulin injection even if a dramatic reduction of human rabies deaths in Thailand was achieved largely by the provision of expensive World Health Organisation standard postexposure treatment, utilising modern tissue culture vaccines and immunoglobulins.[4]
Address for correspondence: Dr. Mirko Bertozzi, S.C. Di Clinica Chirurgica Pediatrica, Università Degli, Studi Di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06100 Perugia, Italy. E-mail: [email protected]
REFERENCES 1. 2. 3.
4.
5.
Pokee N, Wiwanitkit V. Dog bite injuries of genitalia. Afr J Paediatr Surg 2014;11:200. Bertozzi M, Appignani A. The management of dog bite injuries of genitalia in paediatric age. Afr J Paediatr Surg 2013;10:205-10. Bertozzi M, Prestipino M, Nardi N, Falcone F, Appignani A. Scrotal dog bite: Unusual case and review of pediatric literature. Urology 2009;74:595-7. Sriaroon C, Sriaroon P, Daviratanasilpa S, Khawplod P, Wilde H. Retrospective: Animal attacks and rabies exposures in Thai children. Travel Med Infect Dis 2006;4:270-4. Permpalung N, Wongrakpanich S, Korpaisarn S, Tanratana P, Angsanakul J. Trend of human rabies prophylaxis in developing countries: Toward optimal rabies immunization. Vaccine 2013;31:4079-83.
Is it a Palomo’s operation? Access this article online Quick Response Code:
Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.143188 PMID: *****
African Journal of Paediatric Surgery
Sir, We have read the article ‘Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques’ by Marte et al.[1] with interest. We congratulate the authors for this nice comparative study that reaffirms the benefits of minimal invasive surgery in the management of this common ailment. Though a October-December 2014 / Vol 11 / Issue 4
371
wide array of surgical modalities are available for the treatment of varicocele, it is the advent of minimally invasive techniques (laparoscopic varicocelectomy) that had resulted in larger acceptance of surgical means as the treatment of choice. Single incision laparoscopic surgery (SILS) represents a further advance in minimally invasive technique. The indications of SILS are rapidly expanding with the availability of better instruments and surgical expertise. The authors had compared conventional three-trocar laparoscopic varicocelectomy and SILS Palomo varicocelectomy. Both the procedures follow the same technique except for the mode of trocar placement. We notice that there is a disparity in the terms used for describing the procedures in the title of the article and the patients and methods section. There is wide spread confusion regarding the exact technical details of Palomo procedure.[2] The original article by Palomo depicts that the procedure was carried out under local anaesthesia. Entry into the retroperitoneum was gained through a 4 cm longitudinal incision, 3 cm above the deep ring and parallel to the poupart ligament. The procedure was completed with ligation and excision of segments of both the testicular artery and vein. While Palomo procedure was completely confined to the extraperitoneal space, laparoscopic approaches necessitate initial entry into the peritoneal space followed by the entry to the extraperitoneal space. This is in contradiction to the original Palomo procedure that had eliminated the risk of intraperitoneal
mishaps during the intervention. In the light of the above facts, laparoscopic varicocelectomy should be a more appropriate terminology rather than laparoscopic Palomo varicocelectomy for describing the minimal invasive intervention for varicocele management. Though varicocele is more common, on the left side, 7-10% of patients can have bilateral varicocele. The authors have not mentioned of the side of varicocele in the operated patients. It is also necessary to mention about the number of bilateral cases in this series as the operating time for a bilateral varicocele is expected to be longer as compared to a unilateral varicocele. This factor can induce bias in the interpretation of the results. Mention of the duration of follow-up period is also missing in this article. Nitinkumar Borkar, Nitin K. Kashyap, Debajyoti Mohanty1 Departments of Trauma and Emergency and 1General Surgery, AIIMS, Raipur, Chhattisgarh, India Address for correspondence: Dr. Nitinkumar Borkar, 402, Type 4 A, AIIMS Residential Complex, Kabir Nagar, Raipur - 492 001, Chhattisgarh, India. E-mail: [email protected]
REFERENCES 1.
2.
Marte A, Pintozzi L, Cavaiuolo S, Parmeggiani P. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques. Afr J Paediatr Surg 2014;11:201-5. Palomo A. Radical cure of varicocele by a new technique; preliminary report. J Urol 1949;61:604-7.
Transanal protrusion of intussusceptions Access this article online Quick Response Code:
Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.143190 PMID: *****
Sir, The report on “transanal protrusion of intussusceptions” is very interesting.[1] Obiora et al. noted “transanal protrusion occurred more in females and is associated with late presentation, older age, high bowel resection rate, and high mortality.” [1] In fact, this report confirms the previous report by 372
October-December 2014 / Vol 11 / Issue 4
Ameh and Mshelbwala [2] Similar epidemiological pattern can be seen. Ameh and Mshelbwala noted “the risk of morbidity and mortality in anal protruding intussusception is high” [2] and also mentioned for necessity of early detection and management. [2] This condition can be easily misdiagnosed as rectal prolapsed and can be neglected.[3] The use of radiological approach might be useful for helping differential diagnosis.[4] Beuy Joob, Viroj Wiwanitkit1,2,3,4 Sanitation 1 Medical Academic Center, Bangkok, Thailand, 1Hainan Medical University, China, 2 Faculty of Medicine, University of Nis, Serbia, 3Joseph Ayobabalola University, Nigeria, 4Dr DY Patil Medical University, Mumbai, Maharashtra, India African Journal of Paediatric Surgery
Copyright of African Journal of Paediatric Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Dog bite injuries of genitalia and rabies immunisation Access this article online Quick Response Code:
Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.143183 PMID: ****
Sir, We read with interest the letter “Dog bite injuries of genitalia.”[1] We can understand the concern of the authors regarding the administration of immunoglobulin reported in our previous manuscripts.[2]
The real problems with postexposure prophylaxis are the cost of the vaccine and immunoglobulin as well as the availability of the immunoglobulin. For this reason, preexposure prophylaxis has played a role in decreasing the need for immunoglobulin injection, especially in developing countries where rabies is endemic.[5] We think that in all countries where rabies is endemic, preexposure prophylaxis should be advocated to avoid the need of post-exposure prophylaxis with or without immunoglobulins. Mirko Bertozzi, Antonino Appignani Department of Pediatric Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, S. Andrea delle Fratte, Perugia, Italy
We agree that the use of immunoglobulin should be based on the severity of the wound, but how can we measure the danger of a wound if a true exposure to rabies was defined as a bite or contamination of a person’s mucous membranes or open wounds with saliva from a laboratory-confirmed or clinically rabid animal? Of course, postexposure vaccination is not necessary in case of checked family dog.[3] In the case of need, human rabies can be prevented by postexposure vaccination with or without immunoglobulin injection even if a dramatic reduction of human rabies deaths in Thailand was achieved largely by the provision of expensive World Health Organisation standard postexposure treatment, utilising modern tissue culture vaccines and immunoglobulins.[4]
Address for correspondence: Dr. Mirko Bertozzi, S.C. Di Clinica Chirurgica Pediatrica, Università Degli, Studi Di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06100 Perugia, Italy. E-mail: [email protected]
REFERENCES 1. 2. 3.
4.
5.
Pokee N, Wiwanitkit V. Dog bite injuries of genitalia. Afr J Paediatr Surg 2014;11:200. Bertozzi M, Appignani A. The management of dog bite injuries of genitalia in paediatric age. Afr J Paediatr Surg 2013;10:205-10. Bertozzi M, Prestipino M, Nardi N, Falcone F, Appignani A. Scrotal dog bite: Unusual case and review of pediatric literature. Urology 2009;74:595-7. Sriaroon C, Sriaroon P, Daviratanasilpa S, Khawplod P, Wilde H. Retrospective: Animal attacks and rabies exposures in Thai children. Travel Med Infect Dis 2006;4:270-4. Permpalung N, Wongrakpanich S, Korpaisarn S, Tanratana P, Angsanakul J. Trend of human rabies prophylaxis in developing countries: Toward optimal rabies immunization. Vaccine 2013;31:4079-83.
Is it a Palomo’s operation? Access this article online Quick Response Code:
Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.143188 PMID: *****
African Journal of Paediatric Surgery
Sir, We have read the article ‘Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques’ by Marte et al.[1] with interest. We congratulate the authors for this nice comparative study that reaffirms the benefits of minimal invasive surgery in the management of this common ailment. Though a October-December 2014 / Vol 11 / Issue 4
371
wide array of surgical modalities are available for the treatment of varicocele, it is the advent of minimally invasive techniques (laparoscopic varicocelectomy) that had resulted in larger acceptance of surgical means as the treatment of choice. Single incision laparoscopic surgery (SILS) represents a further advance in minimally invasive technique. The indications of SILS are rapidly expanding with the availability of better instruments and surgical expertise. The authors had compared conventional three-trocar laparoscopic varicocelectomy and SILS Palomo varicocelectomy. Both the procedures follow the same technique except for the mode of trocar placement. We notice that there is a disparity in the terms used for describing the procedures in the title of the article and the patients and methods section. There is wide spread confusion regarding the exact technical details of Palomo procedure.[2] The original article by Palomo depicts that the procedure was carried out under local anaesthesia. Entry into the retroperitoneum was gained through a 4 cm longitudinal incision, 3 cm above the deep ring and parallel to the poupart ligament. The procedure was completed with ligation and excision of segments of both the testicular artery and vein. While Palomo procedure was completely confined to the extraperitoneal space, laparoscopic approaches necessitate initial entry into the peritoneal space followed by the entry to the extraperitoneal space. This is in contradiction to the original Palomo procedure that had eliminated the risk of intraperitoneal
mishaps during the intervention. In the light of the above facts, laparoscopic varicocelectomy should be a more appropriate terminology rather than laparoscopic Palomo varicocelectomy for describing the minimal invasive intervention for varicocele management. Though varicocele is more common, on the left side, 7-10% of patients can have bilateral varicocele. The authors have not mentioned of the side of varicocele in the operated patients. It is also necessary to mention about the number of bilateral cases in this series as the operating time for a bilateral varicocele is expected to be longer as compared to a unilateral varicocele. This factor can induce bias in the interpretation of the results. Mention of the duration of follow-up period is also missing in this article. Nitinkumar Borkar, Nitin K. Kashyap, Debajyoti Mohanty1 Departments of Trauma and Emergency and 1General Surgery, AIIMS, Raipur, Chhattisgarh, India Address for correspondence: Dr. Nitinkumar Borkar, 402, Type 4 A, AIIMS Residential Complex, Kabir Nagar, Raipur - 492 001, Chhattisgarh, India. E-mail: [email protected]
REFERENCES 1.
2.
Marte A, Pintozzi L, Cavaiuolo S, Parmeggiani P. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques. Afr J Paediatr Surg 2014;11:201-5. Palomo A. Radical cure of varicocele by a new technique; preliminary report. J Urol 1949;61:604-7.
Transanal protrusion of intussusceptions Access this article online Quick Response Code:
Website: www.afrjpaedsurg.org DOI: 10.4103/0189-6725.143190 PMID: *****
Sir, The report on “transanal protrusion of intussusceptions” is very interesting.[1] Obiora et al. noted “transanal protrusion occurred more in females and is associated with late presentation, older age, high bowel resection rate, and high mortality.” [1] In fact, this report confirms the previous report by 372
October-December 2014 / Vol 11 / Issue 4
Ameh and Mshelbwala [2] Similar epidemiological pattern can be seen. Ameh and Mshelbwala noted “the risk of morbidity and mortality in anal protruding intussusception is high” [2] and also mentioned for necessity of early detection and management. [2] This condition can be easily misdiagnosed as rectal prolapsed and can be neglected.[3] The use of radiological approach might be useful for helping differential diagnosis.[4] Beuy Joob, Viroj Wiwanitkit1,2,3,4 Sanitation 1 Medical Academic Center, Bangkok, Thailand, 1Hainan Medical University, China, 2 Faculty of Medicine, University of Nis, Serbia, 3Joseph Ayobabalola University, Nigeria, 4Dr DY Patil Medical University, Mumbai, Maharashtra, India African Journal of Paediatric Surgery
Copyright of African Journal of Paediatric Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
