Laparoscopy-assisted percutaneous endoscopic gastrostomy using a “Funada-kit II” device

We aimed at assessing the effect of using a "Funada-kit II" device during laparoscopy-assisted percutaneous endoscopic gastrostomy (Lap-PEG), by reviewing 29 cases of Lap-PEG we performed from 2001 to 2011. We started using the "Funada-kit II" (CREATE MEDIC CO., Kanagawa, Japan) device with two parallel needles to puncture the stomach and assist suturing the anterior gastric wall to the anterior abdominal wall during Lap-PEG in 2011 (F-PEG). By introducing a loop through the lumen of one needle which allows placement of a suture introduced through the lumen of the other needle. Once repeated, the stomach can be pexied at two points, approximately 2?cm apart. We compared Lap-PEG (n?=?23) with F-PEG (n?=?6) where the mean ages and weights at surgery and sex ratios were similar. All cases were uneventful without intraoperative complications, although one postoperative wound infection occurred in a Lap-PEG case. There were no differences in the duration of analgesia, time taken to commence tube feeding, and return to full feeding. However, mean operating time was significantly shorter in F-PEG (28.1?min) versus Lap-PEG (46.1?min) p?相似文献   

Is barium enema reduction safe and effective in patients with a long duration of intussusception?

The aim of this study was to determine whether barium enema reduction (BER) is safe and effective in patients with a long duration of intussusception. Over the last 17 years, 104 patients were admitted to our hospital with a diagnosis of intussusception. All except 1 with peritonitis underwent BER primarily. Of the 103 intussusceptions treated primarily by BER, 84 (82%) were reduced by the enema alone, whereas 19 (18%) underwent surgical reduction. There were no differences in mean duration of disease between the patients with successful and failed enema reduction (successful: 15 ± 14 h; failures: 14 ± 11 h, P = 0.6). The success rate of BER was 85% within 12 h of symptoms, 76% for 12–24 h, and 71% for more than 24 h. Of 8 cases with a second trial, 4 (50%) were reduced by repeated barium enema. There were no deaths and no intestinal perforations. The success rate of more than 70% even in patients with a long duration of intussusception suggests that BER is safe and effective regardless of the duration of the disease. Accepted: 4 September 1998     

Open reduction and internal fixation for angulated, unstable odontoid synchondrosis fractures in children: a safe alternative to halo fixation?

External orthosis is the accepted and historical management of odontoid synchondrosis fractures; however, this conservative therapy carries a significant complication and fracture nonunion rate among young children. The purpose of this study was to evaluate the authors' own experience in the context of the literature, to explore surgical fixation as a primary treatment for unstable fractures. The authors retrospectively reviewed 2 cases of unstable odontoid synchondrosis fractures treated at their institution; both showed radiographic progression of deformity and subsequently underwent an open surgical reduction and fusion. A literature review was conducted to compare the authors' management strategy with those in published data. External orthosis for treatment of odontoid synchondrosis fractures has a strong history of success. However, in the literature, patients treated with a halo orthosis had a 43.3% rate of complications and an 11.4% risk of nonunion. There are radiographic findings that suggest instability, such as severe angulation and displacement of the odontoid process. Both patients in the present report underwent successful fusion without complication, as documented on CT scans obtained 3 months after surgery. Given the high rate of fusion attained with conservative therapy, it is recommended for most synchondrosis fractures. However, there is a recognized subgroup of synchondrosis fractures with severe angulation (> 30°) and displacement suggestive of significant ligamentous injury. In these patients, surgical fixation may be a safe and efficacious alternative to halo orthosis as the primary treatment.     

Thoracoscopic repair of congenital diaphragmatic hernia by inflation-assisted bowel reduction, in a resuscitated neonate: a better access?

Elective endoscopic diaphragmatic hernia repairs have been reported. But endoscopic surgery was regarded unsuitable for emergency repair of diaphragmatic hernia in ventilated newborn children in bad general condition. We report a new method for inflation-assisted reduction and thoracoscopic repair of congenital diaphragmatic hernia diaphragmatic in a vitally endangered neonate. From three 2.7 mm to 5 mm accesses warmed low-pressure, low-volume CO₂ was inflated into the thorax at 100 ml/min and 2 mm mercury. This allowed spontaneous reduction of the thoracic viscera into the abdomen and diaphragmatic suture with minimal handling. The 65-min procedure was tolerated well without perioperative deterioration. The baby was weaned off the respirator and breast-fed within 2 days, mediastinal shift normalized in 6 days. In suitable infants thoracoscopic repair and inflation-assisted reduction of thoracic contents is a more physiological access to congenital diaphragmatic hernia than laparoscopy or laparotomy.     

Isolated “one and a half syndrome” with brainstem tuberculoma

A seldom reported causal association of two rare entities, an isolated brainstem tuberculoma and an isolated One and a half syndrome in a 12 year old girl is presented. MRI showed an isolated inflammatory granuloma in the brainstem which on empirical treatment with anti tubercular drugs resulted in complete restoration of ocular motility, along with resolution of the lesion on follow up MRI at 6 months. The diagnosis and management are discussed.     

How long to prosecute child sexual abuse for a community using a Children's Advocacy Center and two comparison communities?

This article explores the length of time between key events in the criminal prosecution of child sexual abuse cases (charging decision, case resolution process, and total case-processing time), which previous research suggests is related to victims' recovery. The sample included 160 cases in three communities served by the Dallas County District Attorney. Most cases (69%) took at least 60 days for the charging decision, with cases investigated at the Children's Advocacy Center having a quicker time than either comparison community. Only 20% of cases had a case resolution time within the 180-day target suggested by the American Bar Association standard for felonies. Controlling for case characteristics, one of the three communities and cases with an initial arrest had a significantly quicker case resolution time. Total case processing generally took more than 2 years. Implications include the need to better monitor and shorten case resolution time.     

Congenital hemihypertrophy and pheochromocytoma,not a coincidental combination?

We describe a 19-year-old female, known to have congenital hemihypertrophy, who presented with bilateral benign pheochromocytoma. This is the second time that this combination has been reported in the literature. We speculate that the combination of congenital hemihypertrophy and pheochromocytoma is not coincidental and could be part of the clinical spectrum of the Beckwith-Wiedemann syndrome. CONCLUSION: in patients with congenital hemihypertrophy, the physician should be aware of the symptoms of pheochromocytoma. Besides screening for abdominal tumours, analysis of plasma and/or urinary catecholamines and/or their metabolites should be considered.     

Detection of fetal malnutrition using “CAN score”

Objective

Use of clinical assessment of nutrition status (CAN) score to assess the prevalence of fetal malnutrition among term newborns and to compare other anthropometric criteria used to assess fetal growth.

Methods

Prospective study of 529 term healthy newborns assessed using CAN score. Complete anthropometric assessment and determination of weight for gestation was done. Using CAN score as a standard, the usefulness of birth weight, weight for gestation, length, head circumference (HC), mid arm circumference (MAC), MAC/HC ratio and Ponderal index to assess fetal nutrition was determined.

Results

With a cut off value of 25, CAN score identified 148 (27.97%) malnourished neonates. 4% of appropriate for gestational age neonate were malnourished and 42.9 % of small for gestational age neonates were well nourished. When CAN score was taken as a standard, weight for gestation and MAC/HC had the highest sensitivity to identify malnourished neonates (92.5% & 90.5%).

Conclusion

CAN score identifies malnourished neonates which can be missed by other methods and identifies well nourished neonates classified as growth retarded by other methods.     

Ingestion of unusual foreign bodies and malrotation: a “perfect storm”

Management of foreign body ingestion is usually nonsurgical unless atypical foreign bodies or anatomical variants are suspected. The present article illustrates a case of atypical foreign bodies ingestion in the presence of intestinal malrotation. The patient required surgical treatment and had an uneventful postoperative recovery. The article also reviews the cases reported in the literature of magnetic ingestion and the possible complications associated with it.     

The “circle sign”: a new sonographic sign of pneumatosis intestinalis – clinical, pathologic and experimental findings

Background. Pneumatosis intestinals (PI) represents gas in the bowel wall. The appearance of PI using high-resolution ultrasound (HRUS) has not been well described. Objective. The purpose of this report is to describe a new ultrasound sign of pneumatosis seen in three patients. This sign, called the “circle sign”, is indicative of bubbles of gas within the circumference of the bowel, producing an appearance of a continuous echogenic ring on ultrasound. Further studies of the sonographic characteristics of pneumatosis were performed with an in vitro model. Materials and methods. HRUS was performed prospectively in three patients demonstrating extensive PI radiographically. The appearance of the gas was characterized and the behavior of the intramural bubbles was studied when the bowel was compressed with the ultrasound transducer. Either CT scan or pathologic correlation was obtained in all patients. Experimental models of PI using air injected into the wall of sausage casing were developed. Results. The presence of echogenic gas bubbles within the circumference of the wall of the bowel seen with HRUS was shown to represent pneumatosis intestinalis at histologic examination or by CT scanning in the three study patients. In vitro studies confirmed the clinical impression that the use of compression is helpful in distinguishing intramural from intraluminal air. Conclusion. The presence of echogenic gas bubbles in the wall of the bowel, often seen as a circle within the circumference of the bowel, may be helpful in diagnosing PI on ultrasound using HRUS. Received: 21 September 1998 Accepted: 21 January 1999     

Commentary: Splitting and lumping brain and childhood adversity measures – a commentary on Gheorghe,Li, Gallacher,and Bauermeister (2020)

The article by Gheorghe, Li, Gallacher & Bauermeister (2020) reports a neuroimaging study of childhood adversity assessed retrospectively in persons aged, on average, 62 years. Severe child maltreatment has repeatedly been related to enduring alterations in brain structure. These studies are typically conducted in high-risk samples, often combining different forms of adversity that co-occur in one adversity score. The authors chose to separately analyse each of three adversity questions that tap into emotional abuse, neglect and physical abuse. In contrast, the brain structural measures are combined to several latent variables. In this commentary, I argue that this analytical strategy, which runs counter to the common practice, is a strength of the study. As such, it provides important evidence of long-term brain developmental consequences of early adversities. The results suggest that memories of emotional abuse, but not other common adversities, are associated with differences in the cerebellum and part of the striatum only.     

Pharmacodynamics and pharmacokinetics of esmolol,a short-acting β-blocking agent,in children

Summary Esmolol, a short-acting intravenous cardioselective -blocking agent, was evaluated for age-dependent pharmacodynamic and pharmacokinetic features in 17 young patients (6 months to 14 years). A loading dose (500 g/kg/min) alternating with a maintenance dose (25–200 g/kg/min, titrating by 25 g/kg/min every 4 min) was infused until the heart rate or mean arterial pressure decreased 10%. Cardiac index, left ventricular shortening fraction, and systemic vascular resistance were measured at baseline, peak esmolol effect, and recovery. Serum esmolol concentrations were obtained to determine the half-life and the elimination rate constant.Esmolol reduced the heart rate, blood pressure, shortening fraction, and cardiac index in all patients, but it did not change systemic vascular resistance. Maintenance esmolol dose was 118 ±49 g/kg/min, and the half-life was 2.88±2.67 min. Blood pressure and heart rate returned to normal within 2–16 min, but cardiac index and shortening fraction took longer to recover. There were no statistically significant age-dependent pharmacodynamic effects, but blood pressure decreased prior to heart rate and cardiac index took longer to recovery in patients who weighed15kg. The pharmacokinetic profile in young patients was similar to that of older patients, but the half-life was shorter. The only side effeect was transient nausea and vomiting in one patient. Esmolol is a safe and efficacious -blocking agent in young patients.