共查询到20条相似文献，搜索用时 93 毫秒
1.
Kibileri Williams Lauren Baumann Adil Shah Fizan Abdullah Emilie K. Johnson Tolulope A. Oyetunji 《Journal of pediatric surgery》2018,53(1):86-89
Purpose
Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18 months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level.Methods
We retrospectively reviewed both the State Ambulatory Surgery Database (SASD) in 2012 and the Pediatric Health Information System (PHIS) for 2015. All patients aged 18 years or less with a diagnosis of UDT who underwent orchiopexy were included. Demographic data including age at repair as well as surgical subspecialty and payer status were extracted.Results
Analysis of the 2012 SASD for New Jersey, Florida, and Maryland yielded 1654 patients. The majority were white, 791 (48.3%), with a median age at repair of 4 years (IQR 1–8). Most patients, 1048 (64%), had orchiopexy later than age 2. A total of 844 males were identified from the PHIS database. Of these, 63% were white. The median age at repair was 5 years (IQR 1–9). There were 577 (68%) patients older than 2 years at orchiopexy.Conclusion
Almost 70% of boys with undescended testes in the United States are undergoing orchiopexy at least 6 months later than the recommended age.Type of study
Retrospective.Level of evidence
III. 相似文献2.
Background
In congenital undescended testis (UDT) in humans, thermal insult damages early germ cell development during mini-puberty (3–6 months) causing increased risk of both cancer and infertility. In rodents however, UDT causes infertility but not cancer. In the TS rat with congenital UDT we hypothesized that early germ cell development would be normal as UDT only becomes manifest at 3–4 weeks (and the germ cells only become sensitive to thermal injury) after minipuberty is complete at 1 week.Methods
Normal testis and potential UDT from unilateral cryptorchid TS rats were collected at week 1 and 4 and processed into paraffin sections labeled for Sertoli cells (AMH), early germ cells (MVH) and spermatogonial stem cells (PLZF). Confocal microscopic images and Fiji Image J were used to count cells in testicular tubules with paired T-test statistical analysis.Results
Total germ cells/tubule, basement membrane-bound germ cells/tubule, and Sertoli cells/tubule were unchanged between normally descending and future UDT at 1–4 weeks old (P > 0.05) Total germ cells/tubule and spermatogonial stem cells/tubule increased dramatically between weeks 1 and 4.Conclusion
Rat gonocyte transformation is normal in both normally descending and future UDT. This suggests that congenitally cryptorchid rats may not develop testicular cancer because gonocytes (the putative origin of malignant degeneration) normally transform into spermatogonial stem cells before UDT occurs and the risk of thermal injury develops. This suggests the TS rat may be a good model for acquired UDT in human where the abnormal testicular position develops after gonocyte transformation is completed in the first year. 相似文献3.
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4.
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5.
Jin K. Kim Michael E. Chua Jessica M. Ming Joana Dos Santos Elke Zani-Ruttenstock Alanna Marson Mark Bayley Martin A. Koyle 《Journal of pediatric surgery》2018,53(10):2041-2047
Background/purpose
Limited efforts have been made in assessing the qualities of clinical practice guidelines (CPGs) on cryptorchidism (UDT). This appraisal aims to determine the quality of recent CPGs on the management of UDT.Methods
After systematic literature search, all English-based CPGs providing recommendations for the management of UDT from 2012 to 2017 were reviewed. Using the AGREE II (Appraisal of Guidelines and Research Evaluation) instrument, eligible CPGs were independently appraised by 5 reviewers. Domain scores were calculated and summarized. Intraclass coefficient (ICC) was used to assess for interrater reliability.Results
Five CPGs from Agency for Healthcare Research and Quality (AHRQ), American Urological Association (AUA), British Association of Pediatric Surgeons/British Association of Urologic Surgeons (BAPS/BAUS), Canadian Urological Association (CUA), and European Association of Urology/European Society for Pediatric Urology (EAU/ESPU) were assessed. There was a solid agreement (ICC: 0.749) among the 5 reviewers (p < 0.001). Most recommendations for diagnostic and treatment approaches were consistent across CPGs. For most guidelines, the domains of ‘clarity of presentation,’ ‘scope and purpose,’ ‘stakeholder involvement,’ and ‘rigor of development’ were high, while ‘applicability’ was low.Conclusion
Most guidelines on UDT score high in the AGREE II domains and have consistent recommendations. To improve the ‘applicability’ domain, future guidelines should improve on aspects that facilitate implementation of the recommendations.Type of study
Systematic review.Level of evidence
V (based on the lowest level of evidence utilized by the assessed guidelines). 相似文献6.
Jake D Foster Nigel J Hall S Charles Keys David M Burge 《Journal of pediatric surgery》2018,53(11):2331-2335
Background
Many pediatric surgeons have limited experience of esophageal replacement. This study reports outcomes of esophageal replacement by gastric transposition performed by a single UK-based pediatric surgeon.Methods
Consecutive patients were identified who underwent esophageal replacement by gastric transposition over a 28?year period. Clinical and demographic data were collected. Weight-for-age Z-scores were calculated for esophageal atresia patients.Results
Nineteen patients were identified. Indication in the majority was long-gap esophageal atresia (n?=?17; 10 with tracheoesophageal fistula). At surgery, median age was 8.5?months (range 2–55); median weight was 7.4?kg (range 4.0–17.4?kg). A right-sided thoracotomy or transhiatal approach was used. Median postoperative length of stay was 17.5?days (range 7–130); median intensive care stay was three days (range 1–63). There were no deaths. Anastomotic leak rate at 30?days was 10.5% (n?=?2). One patient required early stricture dilatation. Median weight-for-age Z-score increased from ? 2.17 at one year of age to ? 1.86, ? 1.70 and ? 1.93 at 5, 10 and 15?years.Conclusions
Esophageal replacement by gastric transposition offers a potentially life-changing treatment; however, it is associated with significant morbidity. The majority of patients eventually achieve full oral feeding and maintenance of weight gain trajectory. A right-sided approach to the esophagus is feasible.Type of Study
Treatment Study.Level of Evidence
IV. 相似文献7.
James K. Wall Tiffany J. Sinclair William Kethman Christina Williams Craig Albanese Karl G. Sylvester Matias Bruzoni 《Journal of pediatric surgery》2018,53(3):503-507
Background
Minimal access surgery (MAS) has gained popularity in infants less than 5 kg, however, significant challenges still arise in very low weight infants.Study design
A retrospective chart review was performed to identify all infants weighing less than 3 kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts.Results
A total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p = 0.003). There were no deaths within 30 days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort.Conclusion
Advanced MAS may be performed in infants weighing less than 3 kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures.Type of study
Prognosis study.Level of evidence
Level III. 相似文献8.
Jennifer G. Michlitsch Rodrigo L.P. Romao Joseph M. Gleason Luis H. Braga Lisa Allen Abha Gupta Armando J. Lorenzo 《Journal of pediatric surgery》2018,53(7):1374-1380
Purpose
Localized vaginal rhabdomyosarcoma (RMS) is associated with a favorable prognosis, but strategies for local control remain controversial. The use of radiotherapy (RT) can have important long-term sequelae, while traditional resection involves major reconstructive surgery. We describe a new surgical approach employing a minimally-invasive resection and immediate reconstruction.Materials and methods
Records from 4 consecutive patients with localized vaginal RMS managed in 4 major pediatric referral centers were reviewed. All cases were performed with a standardized technique.Results
Patients were diagnosed at a median age of 24 months. Each underwent a total/subtotal vaginectomy with autologous buccal graft vaginal replacement. Final margins were focally positive in one patient and negative in three. None received radiotherapy. To date, all patients have patent buccal neovaginas, enjoy a favorable aesthetic result, and remain disease-free at a median follow-up of 35 months.Conclusions
We report 4 cases of localized vaginal RMS successfully treated with a minimally invasive surgical approach. All patients have avoided radiation and remain disease-free. Our initial data suggest that surgical local control and immediate reconstruction are feasible and can spare these patients the long-term complications of RT. Longer follow-up is critical to ensure disease-free survival with a functional, successfully reconstructed neovagina.Type of study
Case series.Level of evidence
Level IV. 相似文献9.
Cristine S. Velazco Brenna S. Fullerton Charles R. Hong Kate A. Morrow Erika M. Edwards Roger F. Soll Tom Jaksic Jeffrey D. Horbar Biren P. Modi 《Journal of pediatric surgery》2018,53(1):108-112
Background
Necrotizing enterocolitis (NEC) is classically a disease of prematurity, with less reported regarding morbidity and mortality of this disease among other infants.Methods
Data were prospectively collected from 2009 to 2015 at 252 Vermont Oxford Network member centers on neonates with birth weight > 2500 g admitted to a participating NICU within 28 days of birth.Results
Of 1629 neonates with NEC, gestational age was 37 (36, 39) weeks, and 45% had major congenital anomalies, most commonly gastrointestinal defects (20%), congenital heart defects (18%), and chromosomal anomalies (7%). For the 23% of infants who had surgery for NEC, mortality and length of stay were 23% and 63 (36, 94) days versus 8% and 34 (22, 61) days in medical NEC. Independent predictors of mortality were congenital heart defects (p < 0.0001), chromosomal abnormalities (p < 0.05), other congenital malformations (p < 0.001), surgical NEC (p < 0.0001), and sepsis (p < 0.05). All of these in addition to gastrointestinal defects were independent predictors of increased length of stay. Nutritional morbidity at discharge included 6% receiving no enteral feeds and 27% who were < 10th percentile weight-for-age.Conclusions
Major congenital anomalies are present in nearly half of > 2500 g birth weight infants diagnosed with necrotizing enterocolitis. Morbidity and mortality increase with sepsis, surgical disease, and congenital anomalies.Type of study
Prognosis Study.Level of evidence
Level II. 相似文献10.
Vinicius Menezes Jesus Francisco Buriti Rodrigo Lessa Maria Betânia Toralles Luciana Barros Oliveira Ubirajara Barroso 《Journal of pediatric surgery》2018,53(4):808-812
Introduction
Genital ambiguity is a very common phenomenon in disorders of sex development (DSD). According to the Chicago Consensus 2006, feminizing genitoplasty, when indicated, should be performed in the most virilized cases (Prader III to V). Advances in the knowledge of genital anatomy in DSD have enabled the development and improvement of various surgical techniques. Mobilization of the urogenital sinus (MUS), first described by Peña, has become incorporated by most surgeons. However, the proximity of the urethral sphincter prompts concern over urinary incontinence, especially for full mobilization of the urogenital sinus.Objective
To retrospectively evaluate the short-term surgical results of feminizing genitoplasty with total mobilization of the urogenital sinus in patients with DSD.Methods
Review of medical records of all patients undergoing feminizing genitoplasty with mobilization of the urogenital sinus. We evaluated the rates of complications from surgery and of urinary incontinence, as well as cosmetic results, according to the opinion of the surgeon and the family.Results
A total of 8 patients were included in the study. The mean age at surgery was 51 months. Congenital adrenal hyperplasia (CAH) was diagnosed in six patients, and gonadal dysgenesis in the other two. The vagina was separated from the urethra, with suitable distance in all cases. No patient had urinary incontinence after surgery. The mean follow-up of patients was.20 months (3–56 months). In all cases, surgeons recorded being satisfied with the aesthetic result of post-surgical genitalia. The family was recorded as satisfied with the aesthetic result of the genitalia after surgery. In every case, there was no need for a second surgical procedure.Conclusion
The total mobilization of the urogenital sinus is a feasible and safe technique. The technique permits good cosmetic results, and urinary incontinence is absent.Type of study
Therapeutic study.Level of evidence
Level III. 相似文献11.
Suna Sun Weihua Pan Wenjie Wu Yiming Gong Jia Shi Jun Wang 《Journal of pediatric surgery》2018,53(8):1584-1587
Objectives
The treatment of long gap esophageal atresia (LGEA) is one of the most challenging congenital malformations in neonatal surgery. A preoperative bougienage stretching technique for elongation of the two segments of esophagus is applied to achieve utilizing the native esophagus to establish esophageal continuity by open or thoracoscopic approach.Methods
From January 2015 to May 2017, 12 neonates who suffered from LGEA were admitted to our department. They were divided into 2 groups (A and B) according to their admission time. They all accepted bougienage stretching technique before esophageal anastomosis.Results
Initially the lengths of esophageal gap in 12 infants ranged from 4 to 7.5 vertebral bodies (M = 5.8 ± 1.1). The gap lengths became –1 to 2.5 vertebral bodies after bougienage stretching technique and tension-free anastomosis were performed successfully for all 12 cases: Group A (n = 5) by thoracotomy and group B (n = 7) by thoracoscopic approach. 12 cases have been followed up for 1–25 months (M = 12.4 ± 8.5) after definitive surgery.Conclusions
Bougienage stretching technique for LGEA is feasible with satisfactory clinical results. Thoracoscopic approach is a good choice for primary anastomosis in LGEA.Levels of evidence
Treatment Study Level IV 相似文献12.
David I. Chu Jonathan M. Tan Peter Mattei Allan F. Simpao Andrew T. Costarino Aseem R. Shukla Joseph W. Rossano Gregory E. Tasian 《Journal of pediatric surgery》2018,53(10):1980-1988
Background
Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.Methods
We performed a retrospective cohort study using the 2013–2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children < 18 years old who underwent laparoscopic surgery to 45,012 children who underwent open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay.Results
Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15–0.79]), inhospital mortality (OR 0.42 [0.22–0.81]) and 30-day morbidity (OR 0.61 [0.50–0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend = 0.01) and in-hospital mortality (ptrend = 0.05), but not for 30-day mortality (ptrend = 0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children.Conclusions
Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD.Level-of-evidence
Level III: Treatment Study. 相似文献13.
Colin Muncie Michael Morris Barry Berch David Sawaya Christopher Blewett 《Journal of pediatric surgery》2018,53(1):126-129
Purpose
The safety and effectiveness of a stapled intestinal anastomosis in adults, children, and infants is well documented. However, in neonates it is not well validated. We hypothesized that premature infants who received a stapled bowel anastomosis utilizing endoscopic staplers had similar outcomes compared to patients with a handsewn anastomosis.Methods
A retrospective study was performed reviewing premature infants who underwent an intestinal anastomosis over a 4-year period. Patients greater than 36 weeks gestational age at birth or a weight greater than 5 kg at surgery were excluded. Patient demographics, type of intestinal anastomosis, and anastomotic related complications within 3 months were collected and analyzed.Results
Sixty-five patients underwent 71 operations involving an intestinal anastomosis: 33 cases were handsewn, and 38 cases were stapled. Groups were noted to have differences in age, weight, and diagnosis. Complications including leak and anastomotic stricture did not differ between groups. Reports of blood per rectum after surgery were more common in the stapled group (24% versus 6%, p = 0.0522), but this did not reach statistical significance.Conclusion
There were no significant differences in anastomotic complications when comparing the handsewn and stapled intestinal anastomosis techniques in premature infants weighting less than 5 kg.Type of study
Treatment Study.Level of evidence
III. 相似文献14.
Chenghao Chen Qi Zeng Zhongzhi Li Na Zhang Jie Yu 《Journal of pediatric surgery》2018,53(9):1855-1857
Objective
To measure the force required for correcting pectus carinatum to the desired position and investigate the correlations of the required force with patients’ gender, age, deformity type, severity and body mass index (BMI).Methods
A total of 125 patients with pectus carinatum were enrolled in the study from August 2013 to August 2016. Their gender, age, deformity type, severity and BMI were recorded. A chest wall compressor was used to measure the force required for correcting the chest wall deformity. Multivariate linear regression was used for data analysis.Results
Among the 125 patients, 112 were males and 13 were females. Their mean age was 13.7 ± 1.5 years old, mean Haller index was 2.1 ± 0.2, and mean BMI was 17.4 ± 1.8 kg/m2. Multivariate linear regression analysis showed that the desirable force for correcting chest wall deformity was not correlated with gender and deformity type, but positively correlated with age and BMI and negatively correlated with Haller index.Conclusions
The desirable force measured for correcting chest wall deformities of patients with pectus carinatum positively correlates with age and BMI and negatively correlates with Haller index. The study provides valuable information for future improvement of implanted bar, bar fixation technique, and personalized surgery.Type of study
Retrospective study.Level of evidence
Level 3–4. 相似文献15.
Vaibhavi Umesh Rebecca H Sussman Janeen Smith Christine Whyte 《Journal of pediatric surgery》2018,53(2):295-297
Purpose
The purpose of this study was to assess whether adolescent patients who heal their pilonidal sinus disease with the Bascom cleft lift have a sustained result, or if younger age puts them at increased risk of relapse.Methods
Twenty-two consecutive patients (18 male, median age 16 years at surgery) who underwent Bascom procedures were contacted regarding long term outcomes following surgery. Additional clinical data were collected from the medical records of the subjects.Results
Seventeen of 22 (77%) patients studied were completely healed at median 27 (range 9–268) days after a single procedure. Three of 22 (14%) required a second procedure during follow up. Of these, all three healed fully after the second procedure. Based on intention to treat, 20 of 22 (91%) patients had complete healing documented at a median of 31 days after initial surgery. Half of the patients were fully healed and back to normal activities by one month and 68% by two months. Two patients (9%) failed surgery and had ongoing pilonidal disease. Fifteen of 22 (68%) patients completed a follow-up survey at a median of 44 months elapsed from surgery. All responders were fully healed, and none reported relapse or further surgeries.Conclusions
Excision of pilonidal sinus disease by the Bascom procedure resulted in lasting cure for most adolescent patients studied. A small proportion of patients failed to heal in the first year and had ongoing pilonidal disease. No late failures occurred.Level of evidence
Level III, nonexperimental observational study. 相似文献16.
Huseyin Murat Mutus Burhan Aksu Ersan Uzun Neslihan Gulcin Gonca Gercel Erdem Ozatman Cigdem Ulukaya Durakbasa Hamit Okur 《Journal of pediatric surgery》2018,53(2):293-294
Background/purpose
Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic.Methods
PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6 months ago were done for the long-term results, including coherence to regional hair care.Results
There were 268 patients with a median age of 16 years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3 months (7 days–49 months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6–63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences.Conclusions
Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences.Type of study
Treatment study.Level of evidence
Level IV (Retrospective case series with no comparison group). 相似文献17.
Inna N. Lobeck Amir M. Alhajjat Phylicia Dupree John M. Racadio Mark M. Mitsnefes Rebekah Karns Greg M. Tiao Jaimie D. Nathan 《Journal of pediatric surgery》2018,53(9):1825-1831
Introduction
Renal artery occlusive disease is poorly characterized in children; treatments include medications, endovascular techniques, and surgery. We aimed to describe the course of renovascular hypertension (RVH), its treatments and outcomes.Methods
We performed literature review and retrospective review (1993–2014) of children with renovascular hypertension at our institution. Response to treatment was defined by National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents at most-recent follow-up.Results
We identified 39 patients with RVH. 54% (n = 21) were male, with mean age of 6.93 ± 5.27 years. Most underwent endovascular treatment (n = 17), with medication alone (n = 12) and surgery (n = 10) less commonly utilized. Endovascular treatment resulted in 18% cure, 65% improvement and 18% failure; surgery resulted in 30% cure, 50% improvement and 20% failure. Medication alone resulted in 0% cure, 75% improvement and 25% failure. 24% with endovascular treatment required secondary endovascular intervention; 18% required secondary surgery. 20% of patients who underwent initial surgery required reoperation for re-stenosis. Mean follow-up was 52.2 ± 58.4 months.Conclusions
RVH treatment in children includes medications, surgical or endovascular approaches, with all resulting in combined 79% improvement in or cure rates. A multidisciplinary approach and individualized patient management are critical to optimize outcomes.Type of Study
Retrospective comparative studyLevel of evidence
Level III 相似文献18.
Mercedes Pilkington Martin Situma Andrea Winthrop Dan Poenaru 《Journal of pediatric surgery》2018,53(5):1073-1079
Purpose
Favorable surgical outcomes depend on timely access to care. This study quantifies these delays and explores caregiver barriers to access in a Ugandan facility.Methods
An interviewer-facilitated survey was administered over 8 months to consecutive pediatric surgical families at Mbarara Regional Referral Hospital (MRRH). Delays were classified using the Three Delays Model: care-seeking, arrival at health facility, and from surgical consultation to surgery. Barriers at each stage were explored with caregivers.Results
The survey included 174 patients. Family members were first to recognize disease in 90%, but only 14% sought medical attention immediately. Delays in seeking care predominated (median 30 days), mostly attributed to home treatments (51%) and other responsibilities (28%). After referral decision, 80% of caregivers brought their child to MRRH immediately (median time to arrival < 24 h). Upon MRRH arrival, 57% of patients were assessed the same day, and time to surgery was relatively short (median 4 days). Despite free under-5 care, out-of-pocket payments (between $1–42 USD) were reported by 64%.Conclusions
Care-seeking delays dominate access to pediatric surgical care in Uganda, and cost remains a significant barrier. Primary provider education and advocacy for increased resources would be useful interventions to improve timeliness of pediatric surgical care.Level of Evidence
Level II. 相似文献19.
Brenna S. Fullerton Charles R. Hong Cristine S. Velazco Charles E. Mercier Kate A. Morrow Erika M. Edwards Karla R. Ferrelli Roger F. Soll Biren P. Modi Jeffrey D. Horbar Tom Jaksic 《Journal of pediatric surgery》2018,53(1):101-107
Purpose
This study characterizes neurodevelopmental outcomes and healthcare needs of extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to ELBW infants without NEC.Methods
Data were collected prospectively on neonates born 22–27 weeks’ gestation or 401–1000 g at 47 Vermont Oxford Network member centers from 1999 to 2012. Detailed neurodevelopmental evaluations were conducted at 18–24 months corrected age. Information regarding rehospitalizations, postdischarge surgeries, and feeding was also collected. “Severe neurodevelopmental disability” was defined as: bilateral blindness, hearing impairment requiring amplification, inability to walk 10 steps with support, cerebral palsy, and/or Bayley Mental or Psychomotor Developmental Index < 70. Diagnosis of NEC required both clinical and radiographic findings.Results
There were 9063 children without NEC, 417 with medical NEC, and 449 with surgical NEC evaluated. Significantly higher rates of morbidity were observed among infants with a history of NEC. Those with surgical NEC were more frequently affected across all outcome measures at 18–24 months corrected age: 38% demonstrated severe neurodevelopmental disability, nearly half underwent postdischarge operations, and a quarter required tube feeding at home.Conclusion
At 18–24 months, extremely low birth weight survivors of necrotizing enterocolitis were at markedly increased risk (p < 0.001) for severe neurodevelopmental disability, postdischarge surgery, and tube feeding.Level of evidence
II (prospective cohort study with < 80% follow-up rate). 相似文献20.
Federica Pederiva Alberto Sgrò Riccardo Coletta Basem Khalil Antonino Morabito 《Journal of pediatric surgery》2018,53(7):1345-1350