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1.
Yi-ting Yeh Niang-cheng Lin Yi-chen Yeh Hsin-lin Tsai Cheng-yen Chen Chia-pei Liu Chinsu Liu 《Journal of pediatric surgery》2018,53(12):2416-2422
Background
Antifibrosis therapy may prevent progressive liver fibrosis after successful Kasai portoenterostomy (KPE) in biliary atresia (BA) patients. The aim of this study is to evaluate the efficacy of antifibrosis therapy in a rat model of BA and KPE.Methods
BA model was created on three-week-old Sprague–Dawley rats by intrabiliary alcohol injection as previously described, and KPE was performed at postoperative week (POW) 5 by cystoenterostomy. Liver biopsies were performed at the time of BA creation, during KPE, POW 9, and at sacrifice (POW 17). Prednisolone (0.1?mg/100?g/day, group 1, n?=?20), Vitamin A (0.5?mg/100?g/day, group 2, n?=?20), and ursodeoxycholic acid (UDCA, 1.5?mg/100?g/day, group 3, n?=?20) were respectively given to three groups after KPE and continued daily until sacrifice. Histological evaluation of fibrosis and immunohistochemistry stains for 8 fibrosis markers were compared to the control group (without medication, n?=?10).Results
Among the four markers, namely ɑ-smooth muscle actin (ɑ-SMA), glial fibrillary acidic protein (GFAP), tumor growth factor β1 (TGFβ1) receptors 1 and 2, which showed persistently high expression after successful KPE in the examined 8 markers, only the expression of ɑ-SMA was significantly reduced in all treatment groups at POW17. However, the fibrosis grade at POW 17 was only significantly reduced in group 2 in comparison with the control group (Vitamin A vs. control group, Ishak score 3 vs. 1.8, p?<?0.05).Conclusion
In our rat model of BA with KPE, Vitamin A was effective in reducing liver fibrosis, and the mechanisms deserve further study.Level of evidence
Basic science. 相似文献2.
Patrick Ho Yu Chung Paul Kwong Hang Tam Kenneth Kak Yuen Wong 《Journal of pediatric surgery》2018,53(12):2409-2411
Purpose
This study compared the bacteriology and clinical outcomes between simple (SC) and intractable cholangitis (IC) after Kasai operation.Methods
Post-Kasai patients (n?=?192) from 1980 to 2015 were retrospectively reviewed. The results of blood culture and clinical outcomes between the patients with SC and IC were compared.Main results
A total of 102 cholangitic episodes in 68 patients were analyzed (SC vs IC?=?76 vs 26). There were more IC episodes within the first year of Kasai operation (SC vs IC?=?36.8% vs 61.5%, p?=?0.022). The most common bacteria identified in SC and IC groups were Escherichia Coli and Staphylococcus aureus. Until the latest follow up, the native liver survival rates in patients with SC and IC were 75.0% and 50.0% (p?=?0.89). Among the patients with IC, the native liver survival rate was significantly better in those with a positive culture (100% vs 20%, p?=?0.001).Conclusion
Intractable cholangitis is a common complication within the first year of Kasai operation and may be caused by a different spectrum of organisms. The identification of the bacteria by blood culturing may result in a better treatment outcome.Level of evidence
Level III. 相似文献3.
Toshiharu Matsuura Yusuke Yanagi Makoto Hayashida Yoshiaki Takahashi Koichiro Yoshimaru Tomoaki Taguchi 《Journal of pediatric surgery》2018,53(4):671-675
Background
No protocol has been established for the diagnosis and management of chylous ascites after liver transplantation (LT). In this study, we retrospectively reviewed our cases of posttransplant chylous ascites (PTCA) and aimed to propose a diagnostic and management protocol.Patients and methods
We retrospectively reviewed the clinical records of 96 LT recipients who underwent LT at our department. The incidence of PTCA and the associated risk factors were analyzed and our protocol for chylous ascites was evaluated.Results
PTCA occurred in 6 (6.3%) patients (mean age: 10.7 ± 11.0 years) at a mean of 10.8 ± 3.6 days after LT. The primary disease in all of PTCA cases was biliary atresia (BA). The periportal lymphadnopathy was an independent risk factor for PTCA. In all cases PTCA successfully resolved according to our protocol. Octreotide was administered in 4 of our 6 PTCA cases. The mean postoperative hospital stay was 40.2 ± 8.4 days, which was similar to that of cases without PTCA.Conclusions
The incidence of PTCA in LT patients, especially in those with BA, is relatively high. Our diagnostic criteria and our management protocol were helpful for patients with refractory ascites after LT.Type of study
Diagnostic test: Level II. Treatment study: Level III. 相似文献4.
Masaki Nio Motoshi Wada Hideyuki Sasaki Hiromu Tanaka Megumi Nakamura Hironori Kudo 《Journal of pediatric surgery》2018,53(12):2412-2415
Background
We evaluated the clinical significance of follow-up data, including 99mTc-DTPA galactosyl human serum albumin (99mTc-GSA) liver scintigraphy data, as prognostic indicators for jaundice-free patients with biliary atresia (BA).Methods
Of 87 patients who underwent Kasai portoenterostomy (KP) between 1991 and 2012, 45 jaundice-free patients aged 1–2?years underwent 99mTc-GSA scintigraphy and were classified into 2 groups: those who survived with a native liver (Group A, n?=?34) and those who required liver transplantation (LTx) (Group B, n?=?11). We compared 99mTc-GSA scintigraphy data (HH15, LHL15, and HH15/LHL15 [H/L15]) and liver function test (LFT) results between the groups. The patients underwent a second 99mTc-GSA scintigraphy at approximately 5?years of age.Results
All patients survived. HH15, H/L15, total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, and alanine transaminase levels were higher in Group B than in Group A (p < 0.05). Total and direct bilirubin levels were associated with H/L15 (p < 0.05). There were no significant changes in results between the first and second 99mTc-GSA scintigraphy in Group A.Conclusions
Mid- and long-term prognoses may be predicted using 99mTc-GSA scintigraphy data and LFTs in patients aged 1–2?years. We recommend regular monitoring of postoperative data following KP, even in jaundice-free patients.Level of evidence
III. 相似文献5.
Toshihiko Watanabe Michinobu Ohno Kazunori Tahara Kotaro Tomonaga Yasushi Fuchimoto Akihiro Fujino Tomoro Hishiki Keiko Tsukamoto Yushi Ito Rika Sugibayashi Seiji Wada Haruhiko Sago Masataka Higuchi Kazuteru Kawasaki Takako Yoshioka Yutaka Kanamori 《Journal of pediatric surgery》2018,53(12):2390-2393
Background/Purpose
Differences in clinical features between congenital pulmonary airway malformation (CPAM) and bronchial atresia (BA) have not yet been clearly described.Methods
We retrospectively reviewed 112 patients with a pathological diagnosis of CPAM or BA. The clinical parameters were statistically analyzed between these diseases.Results
Seventy-one patients received prenatal diagnosis and 41 received postnatal diagnosis. The percentage of prenatal diagnosis was significantly higher in CPAM patients (84% vs 50%, p?<?0.001). Among patients with prenatal diagnosis, the backgrounds were not different between the two diseases except for the number of Caesarean sections (81% vs 9%, p?<?0.0001). The numbers of patients that underwent fetal interventions and emergent neonatal surgery were higher in CPAM (51% vs 15%, p?<?0.01 and 76% vs 12%, p?<?0.0001), although there was no statistical difference in survival rate (86% vs 97%, p?=?0.2). In patients receiving postnatal diagnosis, pneumonia was the primary symptom in most BA patients, whereas respiratory distress was the major symptom in patients with CPAM. Age at presentation of the primary symptom was significantly older in BA patients (4.2?years vs 1.2?years, p?<?0.005).Conclusion
CPAM and BA have distinct clinical features in terms of therapeutic and natural history. Careful imaging evaluation and pathological analysis can lead to an accurate diagnosis of BA.Type of study
Prognostic study.Level of evidence
Level II.This study is categorized as a “Prognostic Study” with LEVEL III of Evidence. 相似文献6.
Yoshiaki Takahashi Toshiharu Matsuura Koichiro Yoshimaru Yusuke Yanagi Makoto Hayashida Tomoaki Taguchi 《Journal of pediatric surgery》2018,53(11):2245-2249
Background/Purpose
Intracranial hemorrhage (ICH) is a severe complication of biliary atresia (BA). We aimed to compare the clinical data of BA patients with and without ICH.Methods
Sixty-three BA patients who underwent Kasai portoenterostomy were included in this study. We retrospectively reviewed their clinical records, and compared the ICH and non-ICH groups.Results
ICH occurred in seven patients (11.1%). The patients with ICH were significantly older at the time of Kasai portoenterostomy (median age: 90.0 vs 65.5?days). The hepatobiliary enzyme levels of the patients with ICH were significantly lower in comparison to the patients without ICH (T-Bil 6.7 vs 9.8?mg/dl; AST 95 vs 194?U/L; ALT 44 vs 114?U/L). On the other hand, the coagulation test values of the patients with ICH were significantly higher in comparison to the patients without ICH (PT 50.0 vs 12.4?s; APTT 200.0 vs 36.9?s). Although the survival rates did not differ to a statistically significant extent, persistent neurological sequelae occurred in two patients in the ICH group.Conclusions
The hepatobiliary enzyme levels of the patients with ICH were significantly lower than those without ICH. However, coagulopathy was found to be significantly more progressive in patients with ICH.Levels of Evidence
Level III. 相似文献7.
Background
The concept of brain death is still not acceptable nor implemented in Egypt. Donor safety in liver transplantation is on the top of our priorities.Purpose
The purpose of this study is to evaluate the effectiveness of using IJV distensibility as a reliable method for intraoperative assessment of fluid responsiveness.Methods
A prospective observational study was conducted in Ain Shams university specialized hospitals. 40 donor candidates for right lobe hepatectomy for living donor liver transplantation were enrolled. During period of hypovolemia (T0) left IJV scanned and measured. After a given fluid bolus in the form of ringer acetate 5?ml/kg. ultrasonic and hemodynamic measurements were reassessed 10?min (T 10) after the fluid resuscitation.Results
Highly significant changes in MABP, HR, and CVP (p?<?0.01) were detected after fluid resuscitation, regarding the IJV distensibility it showed a highly significant reduction from baseline (T0) to post-resuscitation expansion (P?=?0.0001). Baseline (T0) measurements showed no significant correlation between IJV distensibility and hemodynamic parameters (P?≥?0.05). Post-resuscitation values (T10) showed no significance correlation between HR and IJV distensibility (P?=?0.772). On the other side it showed a highly significance negative correlation between MABP, CVP and IJV distensibility (r?=??0.390, P?=?0.013) and (r?=??0.3321, p?=?0.036) respectively. The correlation between the percentages of change of IJV distensibility and hemodynamic parameters showed highly significant negative correlation between IJV distensibility and MABP (r?=??0.359, P?=?0.023) also with CVP (r?=??0.464, P?=?0.017). No difference was found regarding the HR (P?=?0.336).Conclusion
Organ transplantation centers with experience, CVP monitoring may not be necessary in highly selective patient population. IJV distensibility, a non-invasive and safe method can be used to guide fluid replacement in healthy donor. 相似文献8.
Emma C. Hamilton Julius Balogh Duc T. Nguyen Edward A. Graviss Andras A. Heczey Mary T. Austin 《Journal of pediatric surgery》2018,53(1):163-168
Background/purpose
The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies.Methods
The United Network for Organ Sharing (UNOS) database was queried for all patients < 18 years old who received an OLT with a primary malignant liver tumor between 1987 and 2012 (n = 544). Five-year patient and graft survival were determined using Kaplan–Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model.Results
The majority of patients were diagnosed with hepatoblastoma (HB) (n = 376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant.Conclusions
In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types.Type of study
Case series with no comparison group.Level of evidence
IV. 相似文献9.
Xiaolong Xie Yang Wu Qi Wang Yiyang Zhao Bo Xiang 《Journal of pediatric surgery》2018,53(11):2307-2311
Objectives
The aim of this study was to explore the risk factors associated with recurrence of intussusception after operative or nonoperative reduction in children.Methods
Between January 2004 and December 2012, patients with intussusception treated with nonoperative and operative reduction were retrospectively analyzed. We included the patients who were diagnosed with intussusception from the age of 0?year to 18?years who received nonoperative and operative reduction as an initial treatment. The data collected included demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), investigations (ultrasound findings) and the method of reduction.Results
The risk factors for recurrence of idiopathic intussusception were analyzed by the univariable analysis and multivariable analysis. In the univariable model, the significant risk factors for recurrence of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, poor prognosis signs on ultrasound scans, location of mass, and pathological lead point. After multivariable analysis was done, we found that the significant risk factors for recurrence of intussusception were age?≥?2?years (OR?=?5.597, P?=?0.044), duration of symptoms ≥ 48?h (OR?=?91.664, P?<?0.001), rectal bleeding (OR?=?4.758, P?=?0.009), location of mass (left over right side) (OR?=?0.038, P?<?0.001), pathological lead point (OR?=?0.002, P?<?0.001).Conclusion
Our study found that age?≥?2?years, duration of symptoms ≥ 48?h, rectal bleeding, location of mass (left over right side) and pathological lead point were risk factors for recurrence of intussusception.Level of evidence
Prognosis study.Type of study
Retrospective study. 相似文献10.
Takahashi A Masuda N Suzuki M Shimura T Nomoto K Suzuki N Asao T Tsuchida Y Kuwano H 《Journal of pediatric surgery》2004,39(1):1-5
Background
The result of hepatic portoenterostomy for biliary atresia (BA) has improved, but there are some patients who experience worsened liver function in the long term after one decrease in jaundice owing to portoenterostomy. However, the cause of the liver dysfunction in the long term has not been clearly ascertained.Methods
Five patients (5 to 28 years of age) with BA underwent liver transplantation (LT) because of liver dysfunction after successful portoenterostomy. To clarify the cause of liver dysfunction occurring in the long term, the authors performed a cholangiogram, hepatic venogram, and macroscopic/microscopic examination of the liver just after LT.Results
(1) Macroscopically, the liver could be divided into 3 areas, the hypertrophic, atrophic, and intermediate, with findings between those of the hypertrophic and atrophic areas. (2) The divided areas clearly corresponded to the liver segments. Segment IV was the hypertrophic area in all patients, but segments VI and VII were the atrophic areas in 4 of the 5 patients. (3) Based on the cholangiographic and microscopic findings, the hypertrophic area had near-normal structure with bile ducts. The atrophic area had severe fibrosis and contained only a few bile ducts in the intralobular spaces of liver.Conclusions
It seems that segmental bile drainage must have been established by hepatic portoenterostomy in some patients and that some postoperative patients might have worsened liver function in the long-term follow-up period accompanied with progression of fibrosis and impaired bile drainage. These pathologic changes occur in each liver segment. 相似文献11.
Dor Yoeli Ruth L Ackah Rohini R Sigireddi Michael L Kueht N Thao N Galvan Ronald T Cotton Abbas Rana Christine A O&#x;Mahony John A Goss 《Journal of pediatric surgery》2018,53(11):2240-2244
Background
The aim of this study is to describe the incidence and impact of reoperation following pediatric liver transplantation, as well as the indications and risk factors for these complications.Methods
All primary pediatric liver transplants performed at our institution between January 2012 and September 2016 were reviewed. A reoperative complication was defined as a complication requiring return to the operating room within 30?days or the same hospital admission as the transplant operation, excluding retransplantation.Results
Among the 144 pediatric liver transplants performed during the study period, 9% of the recipients required reoperation. The most common indications for reoperation were bleeding and bowel complications. There was no significant difference in the graft survival of patients with a reoperation and those without a reoperation (p?=?0.780), but patients with a reoperation had a significantly longer hospital length of stay (median of 39?days vs. 11?days, p?=?0.001). Variant donor arterial anatomy, transplant operative time, intraoperative blood loss, transfusion volume of packed red blood cells or cell saver per weight, and transfusion with fresh frozen plasma, platelets, or cryoprecipitate were significantly associated with reoperation upon univariable logistic regression, but none of these risk factors remained statistically significant upon multivariable regression.Conclusion
At our institution, reoperation did not significantly impact graft survival. We identified variant donor arterial anatomy, transplant operative time, intraoperative blood loss, transfusion volume of packed red blood cells or cell saver per weight, and transfusion with fresh frozen plasma, platelets, or cryoprecipitate as risk factors for reoperation, although none of these risk factors demonstrated independent association with reoperation in a multivariable model.Type of study
Prognosis Study.Level of evidence
Level III. 相似文献12.
Takanori Ochi Hiroki Nakamura Momoko Wada Tsuyoshi Tamura Hiroyuki Koga Tadaharu Okazaki Masahiko Urao Yoichi Ishizaki Seiji Kawasaki Mureo Kasahara Koichi Mizuta Geoffrey J. Lane Atsuyuki Yamataka 《Journal of pediatric surgery》2018,53(2):277-280
Purpose
We reviewed our post-Kasai portoenterostomy biliary atresia (BA) patients who required liver transplantation (LTx) for deterioration in native liver (NL) function to investigate mortality in relation to age at LTx.Methods
BA patients indicated for LTx when less than 18 years old (U18; n = 17) and when 18 or older (18 +; n = 13) were compared. All achieved jaundice clearance postoperatively (TBil ≤ 1.2 mg/dL (≈ 20 μmol/L)).Results
In U18, living-donor (LD) LTxs were performed at a median of 6.1 years (range: 0.5–16.7; n = 14) and cadaveric (CD) LTxs at a median of 1.3 years (1.1–1.5; n = 3). In 18 +, LDLTxs were performed at a median of 28 years (18–37; n = 8), and 1 case died from graft versus host disease. CDLTxs were indicated in 5, but 4 died at a median of 30 years (26–32), a mean of 1.4 years (0.7–1.8) after NL deterioration commenced. One case is awaiting CDLTx. At the time of review, all U18 and 7 LDLTx cases in 18 + were clinically stable. Mortality rates were 0% in U18 and 38% in 18 + (P = .006).Conclusion
Our results highlight the extremely grave prognosis for long-term BA patients requiring LTx when 18 or older because of poor donor availability in Japan.Level of evidence
Level III. 相似文献13.
Yasushi Fuchimoto Toshihiko Watanabe Akihiro Fujino Yutaka Kanamori Yushi Itoh Seiji Wada Haruhiko Sago Takako Yoshioka 《Journal of pediatric surgery》2018,53(12):2386-2389
Purpose
The purpose of this study was to clarify the relationship between congenital pulmonary airway malformation volume ratio (CVR) of bronchial atresia (BA), CVR of congenital cystic adenomatoid malformations (CCAM), and time of surgery after birth.Method
We retrospectively analyzed data of 36 BA and CCAM cases, prenatally diagnosed as CPAM from 2009 through 2014.Results
Within 2?h after birth, 12 neonatal patients underwent emergent (EMG) lobectomy. Five cases of lobectomy were performed urgently (UG) from 12 to 48?h after birth. Four cases of lobectomy were required within 30?days after birth (early?=?EAG). We performed lobectomy in 15 other patients at 11?months after birth (late?=?LG). Of the EMG cases, 11 were macrotype CCAM (maximal CVR > 2.0), and 4 of 5 UG cases were microtype CCAM (CVR > 2.0). Of the EAG cases, 3 of 4 were macrotype CCAM with CVR of < 1.5. Of 15 LG, 13 were BA and showed a CVR of 0.13–3.0 (median, 0.78). The CVR of the cases operated on within 48?h after birth was significantly larger than that of the cases operated on after 2?weeks (p?=?0.001).Conclusion
EMG or UG lobectomy was usually required after birth in CCAM, indicating maximal CVR > 2.0. By contrast, elective surgery was performed in most BA cases.Level of evidence
IV. 相似文献14.
Emma Fehmel Warwick J. Teague Di Simpson Elizabeth McLeod John M. Hutson Jeremy Rosenbaum Mark Oliver George Alex Sebastian K. King 《Journal of pediatric surgery》2018,53(12):2440-2443
Background
Pediatric inflammatory bowel disease (IBD) may be associated with a higher burden of surgery and postoperative complications. This study aimed to measure the burden in pediatric IBD over a 20-year period in a large tertiary referral center.Methods
A retrospective review was conducted of children diagnosed with IBD between 1996 and 2015, with a focus upon operative intervention (excluding endoscopy) and postoperative outcomes.Results
Of 786 IBD patients, 121/581 (20.8%) with Crohn's disease (CD) and 22/205 (10.7%) with ulcerative colitis (UC) underwent surgery during the study period. When comparing 10-year epochs for CD, median time from diagnosis to intervention decreased from 34?months to 3?months (P?<?0.0001). Postoperative complications occurred in 16/121 (13%) CD patients (bowel obstruction: 10, anastomotic stricture: 4, stomal issues: 4, anastomotic leak: 1). Within the UC cohort, the median time from diagnosis to intervention decreased from 62?months to 6?months (P?=?0.0019). Postoperative complications occurred in 9/22 (41%) UC patients (bowel obstruction: 7, stomal issues: 3, anastomotic stricture: 1). Compared with CD, complications were more frequent in UC patients (P?=?0.004).Conclusion
Surgery and postoperative complications are common in pediatric IBD. The timing of intervention has trended towards earlier operations in both CD and UC.Level of evidence
Treatment study—level III (retrospective comparative study). 相似文献15.
Paul D. Robinson Sooky Lum Courtney Moore Kate M. Hardaker Nick Benseler Paul Aurora Peter Cooper Dominic Fitzgerald Renee Jensen Reginald McDonald Hiran Selvadurai Felix Ratjen Sanja Stanojevic 《Journal of cystic fibrosis》2018,17(4):511-517
Background
Different interfaces (mouthpiece/nose clip vs. facemask) are used during multiple breath washout (MBW) tests in young children.Methods
We investigated the effect of interface choice and breathing modalities on MBW outcomes in healthy adults and preschool children.Results
In adults (n?=?26) facemask breathing significantly increased LCI, compared to mouthpiece use (mean difference (95% CI) 0.4 (0.2; 0.6)), with results generalizable across sites and different equipment. Exclusively nasal breathing within the facemask increased LCI, as compared to oral breathing. In preschoolers (2–6?years, n?=?46), no significant inter-test difference was observed across interfaces for LCI or FRC. Feasibility and breathing stability were significantly greater with facemask (incorporating dead space volume minimization), vs. mouthpiece. This was more pronounced in subjects <4?years of age.Conclusion
Both nasal vs. oral breathing and mouthpiece vs. facemask affect LCI measurements in adults. This effect was minimal in preschool children, where switching between interfaces is most likely to occur. 相似文献16.
Yangyang R. Yu Richard Sola Somala Mohammed Joshua T. Lackey Sheena John Eric Rosenfeld Wei Zhang Shawn D. St. Peter Sohail R. Shah 《Journal of pediatric surgery》2018,53(10):2032-2035
Background
Patient-controlled analgesia (PCA) is often used in children with perforated appendicitis. To prevent urinary retention, some providers also routinely place Foley catheters.This study examines the necessity of this practice.Methods
We retrospectively reviewed all children (≤ 18?years old) with perforated appendicitis and postoperative PCA from 7/2015 to 6/2016 at two academic children's hospitals. Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley catheter.Results
Of 313 patients who underwent appendectomy for perforated appendicitis (Hospital 1: 175, Hospital 2: 138), 129 patients received an intraoperative Foley (Hospital 1: 22 [13%], Hospital 2: 107 [78%], p?<?0.001). Age, gender, and BMI were similar between those with an intraoperative Foley and those without. There were no urinary tract infections in either group.Urinary retention rate in patients with an intraoperative Foley following removal on the inpatient unit (n?=?3, 2%) and patients without an intraoperative Foley (n?=?10, 5%) did not reach significance (p?=?0.25). On univariate analysis, demographics, intraoperative findings, PCA specifics, postoperative abscess formation, and postoperative length of stay, were not significant risk factors for urinary retention.Conclusions
The risk of urinary retention in this population is low despite the use of PCA. Children with perforated appendicitis do not require routine Foley catheter placement to prevent urinary retention.Level of evidence
II 相似文献17.
Background
Biliary atresia (BA) is typically treated by Kasai portoenterostomy (KPE), and there is a relationship between age at surgery and outcome. We hypothesize that previous abdominal surgery (PAS) for associated congenital intestinal conditions could be used to identify BA earlier, perhaps improving prognosis.Methods
A retrospective case note review was performed of all BA patients at a single centre from 1999 to 2016. Demographics and clinical outcome data were collected. Additional data on laparotomy, parenteral nutrition, and referral were collected from patients who underwent PAS. Data are median (range).Main results
Two-hundred-and-fifty-seven children were reviewed. Of these, 16 (6.2%) underwent PAS on day 3 (0–23), during which 5 atretic gallbladders were noted. Gallbladder appearance was not referenced in the operation notes of 8 infants. Jaundice and acholic stools were noted at 4 (0–56) days and 21 (0–60) days, respectively. Age at KPE was comparable between PAS and the other patients (50 vs. 51 days; P = 0.78), but native liver survival was significantly lower after PAS (p < 0.0001). Mortality rate was higher in PAS patients (25% vs. 4.5%; P = 0.0007). Survival was unaffected by early referral of patients on finding an atretic gallbladder at surgery.Conclusion
About 6% of infants have already undergone abdominal surgery for biliary atresia associated intestinal anomalies. Routine gallbladder examination at time of laparotomy could have aided earlier diagnosis and treatment of biliary atresia in up to 80% of patients in this cohort. However, our data suggest that clinical outcome is poorer in biliary patients who undergo prior abdominal surgery and is not improved by earlier referral.Level of evidence
Prognostic study: Level III. 相似文献18.
Background/purpose
The role of serum gamma-glutamyl transpeptidase (GGT) levels in predicting clinical outcomes after Kasai portoenterostomy (KPE) is unknown. This study analyzed whether postoperative GGT along with the aspartate aminotransferase-to-platelet ratio index (APRi) predicted prognosis of biliary atresia (BA).Methods
Data were retrospectively reviewed for 169 BA patients categorized into jaundice-free (JF) (total bilirubin < 2.0 mg/dL ≤ 6 months post-KPE) and persistent jaundice (PJ) groups (total bilirubin ≥ 2.0 mg/dL ≤ 6 months post-KPE). Serum biochemical markers, including GGT levels, were measured monthly after KPE, and mean GGT levels and APRi were compared between groups. Factors predicting native liver survival (NLS) were determined using a Cox regression analysis.Results
GGT concentrations > 550 IU/L at month 5 (hazard ratio: 1.74, P < 0.05), an APRi > 0.605 at month 4 (hazard ratio: 3.78, P = 0.001), and being jaundice-free at 6 months (hazard ratio: 5.49, P < 0.001) were independent risk factors for decreased NLS.Conclusions
Serum GGT concentrations > 550 IU/L at month 5 and an APRi > 0.605 at month 4 post-KPE were associated with significantly lower NLS rates. Among JF patients, those with GGT concentrations > 550 IU/L at month 5 and APRi > 0.605 at month 4 showed poorer outcomes.Type of study
Retrospective comparative studyLevel of evidence
Level III. 相似文献19.
Mitchell R. Ladd Alejandro V. Garcia Ira L. Leeds Courtney Haney Maria M. Oliva-Hemker Samuel Alaish Emily Boss Daniel S. Rhee 《Journal of pediatric surgery》2018,53(11):2336-2345
Background
Pediatric patients with Crohn disease (CD) are frequently malnourished, yet how this affects surgical outcomes has not been evaluated. This study aims to determine the effects of malnourishment in children with CD on 30-day outcomes after surgery.Study design
The ACS NSQIP-Pediatric database from 2012 to 2015 was used to select children aged 5–18 with CD who underwent bowel surgery. BMI-for-age Z-scores were calculated based on CDC growth charts and 2015 guidelines of pediatric malnutrition were applied to categorize severity of malnutrition into none, mild, moderate, or severe. Malnutrition's effects on 30-day complications. Propensity weighted multivariable regression was used to determine the effect of malnutrition on complications were evaluated.Results
516 patients were included: 349 (67.6%) without malnutrition, 97 (18.8%) with mild, 49 (9.5%) with moderate, and 21 (4.1%) with severe malnutrition. There were no differences in demographics, ASA class, or elective/urgent case type. Overall complication rate was 13.6% with malnutrition correlating to higher rates: none 9.7%, mild 18.6%, moderate 20.4%, and severe 28.6% (p?<?0.01). In propensity-matched, multivariable analysis, malnutrition corresponded with increased odds of complications in mild and severely malnourished patients (mild OR?=?2.1 [p?=?0.04], severe OR 3.26 [p?=?0.03]).Conclusion
Worsening degrees of malnutrition directly correlate with increasing risk of 30-day complications in children with CD undergoing major bowel surgery. These findings support BMI for-age z scores as an important screening tool for preoperatively identifying pediatric CD patients at increased risk for postoperative complications. Moreover, these scores can guide nutritional optimization efforts prior to elective surgery.Level of Evidence
IV. 相似文献20.
Scott S. Short Stephen J. Fenton Eric R. Scaife Brian T. Bucher 《Journal of pediatric surgery》2018,53(3):545-547