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Matthew T. Harting Austin Wheeler Todd Ponsky Benedict Nwomeh Chuck L. Snyder Nicholas E. Bruns Aaron Lesher Samir Pandya Belinda Dickie Sohail R. Shah 《Journal of pediatric surgery》2019,54(3):587-594
Importance
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction.Objective
To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery.Design
Review and opinion design.Setting
n/a.Participants
n/a.Main outcomes and measures
n/a.Results
n/a.Conclusions and relevance
Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services.Brief Abstract
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program.Type of Study
Review.Level of Evidence
Level V. 相似文献3.
Adegboyega Timothy Adewale Steven M. Rowe George M. Solomon 《Journal of cystic fibrosis》2019,18(2):e11-e13
Purpose
To raise awareness of colocolonic intussusception as a gastrointestinal complication of CF mimicking distal intestinal obstruction syndrome (DIOS) and discuss risk of recurrence.Case summary
A 33-year-old Caucasian male with cystic fibrosis presented with an acute abdomen diagnosed via imaging as colocolonic intussusception. He was managed with fluid replacement therapy and polyethylene glycol. He was re-admitted due to recurrence likely secondary to recurrent constipation and development of a fecalith. Surgery was contraindicated due to absence of tissue ischemia or necrosis.Discussion
Several possible etiological factors have been described, especially some that tend to occur within the context of CF disease, such as DIOS and PERT, and symptoms of colocolonic intussusception are similar to those of other causes of an acute abdomen but distinguishable by advanced imaging modalities. Due to risk of recurrence, an etiology of intussusception should be sought.Conclusion
Colo-colonic intussusception is a rare cause of an acute abdomen in the adult Cystic Fibrosis (CF) patient and may be associated with underlying constipation or presence of a fecalith. 相似文献4.
Binyu Lu Li Li Molly Schneider Craig A. Hodges Calvin U. Cotton James D. Burgess Thomas J. Kelley 《Journal of cystic fibrosis》2019,18(2):175-181
Background
Previous studies have demonstrated that CF epithelial cells exhibit increased cholesterol content at the plasma membrane compared to wild type controls as measured by electrochemical methods. Microtubule dysregulation that impacts intracellular transport has also been identified in CF cells and is reversible with histone deacetylase 6 (HDAC6) inhibition, a regulator of tubulin acetylation. The hypothesis of this study is that increased membrane cholesterol content in CF cells is dependent on HDAC6 regulation.Methods
Electrochemical measurement of membrane cholesterol in mouse trachea and in primary human CF bronchial epithelial cells is used to monitor CFTR correction and manipulation of cholesterol processing by HDAC6 inhibition.Results
Data demonstrate that induction of Cftr expression in an inducible CF mouse model restores tubulin acetylation levels and normalizes membrane cholesterol content. To test the relationship between tubulin acetylation, membrane cholesterol levels were measured in a CF mouse model depleted of Hdac6 expression (CF/HDA). CF/HDA mouse trachea have WT membrane cholesterol levels while CF mice have approximately two-fold increase in membrane cholesterol compared to WT consistent with previous studies. Pharmacological inhibition of HDAC6 in primary human CF bronchial epithelial cells also reduces membrane cholesterol levels.Conclusions
This study demonstrates that elevated membrane cholesterol in CF epithelium is regulated by HDAC6 function and that the electrochemical measure of membrane cholesterol correlates with both genetic and pharmacological CFTR correction. 相似文献5.
6.
Alexander Becker Kobi Peleg Joseph Dubose Yaakov Daskal Adi Givon Boris Kessel 《Journal of pediatric surgery》2019,54(4):780-782
Background
Penetrating stab wounds in children are relatively rare and no clear recommendations for the optimal evaluation have been devised. An acceptable traditional approach to the patient with an abdominal stab wound who does not require urgent surgery is selective nonoperative management and serial exams. The use of routine computed tomography remains an actively utilized investigation for these patients at many institutions.Purpose
We hypothesize that the approach to pediatric stab wound victims should be distinctly different than that of adult counterparts in order to minimize radiation exposure.Methods
A retrospective cohort study involving abdominal stab wounds among pediatric trauma patients (age < 14) compared with adults between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry.Results
A total of 92 children and 4444 adults were identified from the registry for inclusion. Among the children 20 (21.7%) patients had intraabdominal injury compared to 1730 (38.9%) among adult counterparts. Four children were hemodynamically unstable, two of them were referred directly to operating room and two others were treated without surgery. Among the remaining 88 children there was no observed mortality.Conclusions
The majority of pediatric stab wounds trauma victims have minor abdominal injuries. We do not recommend the routine utilization of abdominal CT scan in the evaluation of abdominal stab wounds. Observation with serial exams and minimization of radiation exposure from CT are warranted in this unique population.Type of study
Retrospective comparative study.Level of evidence
3. 相似文献7.
Laurence Delhaes Kada Touati Odile Faure-Cognet Muriel Cornet Françoise Botterel Eric Dannaoui Florent Morio Patrice Le Pape Fréderic Grenouillet Loic Favennec Solène Le Gal Gilles Nevez Alain Duhamel Andrew Borman Veroniek Saegeman Katrien Lagrou Elia Gomez Maiz-Luis Carro Jean-Philippe Bouchara 《Journal of cystic fibrosis》2019,18(2):212-220
Background
Fungi are increasingly recognized for their potential role in contributing to pulmonary damage in Cystic Fibrosis (CF). We therefore designed a prospective international study aimed at (i) determining the prevalence of fungi isolated from sputum samples collected from a large CF population, (ii) comparing the performance of different media used for fungal culture, and (iii) proposing a standardized protocol suitable for CF routine microbiology.Methods
An international, consensually designed prospective study was set up (https://www.ecfs.eu/special-projects/mucofong-international-project). All centers worked according to the same protocol approved by Lille Ethical Committee. CF sputa were inoculated onto eight semi-selective media incubated at 37?°C or 25?°C–30?°C for 15?days, and inspected twice weekly for fungal growth.Results
A total of 469 sputa were collected from patients at 18 European and one Australian CF centers. Positive cultures for fungal growth were significantly associated with patient ages. Aspergillus fumigatus was the most frequently isolated mold. We identified a growing European North-to-South gradient of Scedosporium prevalence, while yeasts, Aspergillus section Fumigati, Cladosporium and Penicillium were significantly more prevalent in the Northern regions.Conclusions
According to the CHi-squared Automatic Interaction Detector method, we propose a consensual protocol based on two media (YPDA or Sabouraud medium, and B(+) medium) to detect the main opportunistic molds in CF context; the use of an additional medium being recommended according to the patient's clinical status. This standardized protocol allows us to have an accurate overview of the respiratory mycobiome on the culturomic side in CF. 相似文献8.
Wael Elzeneini Ramy Waly David Marshall Alan Bailie 《Journal of pediatric surgery》2019,54(2):322-325
Purpose
We instituted early clean intermittent catheterization (CIC) in 1997 for all newborn infants with spina bifida (SB). We compared this group to a historical group managed expectantly to see if early catheterization was associated with a reduction in renal scar rate as determined by DMSA scanning.Methods
Data were studied retrospectively on all infants with SB over a recent 13-year period who were treated with early universal CIC in a regional pediatric urology department. These were compared to our previously published outcomes in a historical group (1985–1994) that was managed expectantly [Brown et al. Chronic pyelonephritis in association with neuropathic bladder. Eur J Pediatr Surg 1999;9 Suppl 1:29–30.]Results
114 infants were born with SB from 1997 to 2010, of which 13 were excluded from this analysis. Mean follow-up was 11.4?years. In the historical cohort there were 126 infants born from 1985 to 1994, with 26 exclusions; follow-up then ranged from 4 to 13?years. DMSA scan showed renal scarring in 19/101 (18.8%) of the recent cohort versus 39/100 (39%) of the previous group (P?=?0.002). Renal scarring at a later age also appeared to be a feature of the recent group, with first detection occuring by 4?years in only 9/19 (47%) in the latest cohort compared to 28/39 (72%) in the historical cohort.Conclusion
Based on these renal protective data, we recommend indwelling and then intermittent catheterization from birth in all patients with SB.Level of evidence
Level III.Type of study
Retrospective, cohort comparison study. 相似文献9.
Elizabeth J. Renaud Stig Sømme Saleem Islam Danielle B. Cameron Robert L. Gates Regan F Williams Tim Jancelewicz Tolulope A Oyetunji Julia Grabowski Karen A. Diefenbach Robert Baird Meghan A. Arnold Dave R. Lal Julia Shelton Yigit S. Guner Ankush Gosain Akemi L Kawaguchi Robert L. Ricca Roshni Dasgupta 《Journal of pediatric surgery》2019,54(3):369-377
Background
The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy.Methods
The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review.Results
Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence.Conclusions
Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature.Type of study
Systematic review of level 1–4 studies.Level of evidence
Level 1–4 (mainly 3–4). 相似文献10.
Yasmine Yousef Etienne St-Louis Robert Baird Emily R. Smith Elena Guadagno Dickens St-Vil Dan Poenaru 《Journal of pediatric surgery》2019,54(4):831-837
Background
The Lancet Commission on Global Surgery highlighted global surgical need but offered little insight into the specific surgical challenges of children in low-resource settings. Efforts to strengthen the quality of global pediatric surgical care have resulted in a proliferation of partnerships between low-and middle-income countries (LMICs) and high-income countries (HICs). Standardized tools able to reliably measure gaps in delivery and quality of care are important aids for these partnerships. We undertook a systematic review (SR) of capacity assessment tools (CATs) focused on needs assessment in pediatric surgery.Methods
A comprehensive search strategy of multiple electronic databases was conducted per PRISMA guidelines without linguistic or temporal restrictions. CATs were selected according to pre-defined inclusion criteria. Articles were assessed by two independent reviewers. Methodological quality of studies was appraised using the COSMIN checklist with 4-point scale.Results
The search strategy generated 16,641 original publications, of which three CATs were deemed eligible. Eligible tools were either excessively detailed or oversimplified. None used weighted scores to identify finer granularity between institutions. No CATs comprehensively included measures of resources, outcomes, accessibility/impact and training.Discussion
The results of this study identify the need for a CAT capable of objectively measuring key aspects of surgical capacity and performance in a weighted tool designed for pediatric surgical centers in LMICs.Type of Study
Systematic Review.Level of Evidence
II. 相似文献11.
Ranjani Somayaji Michael D. Parkins Anand Shah Stacey L. Martiniano Michael M. Tunney Jennifer S. Kahle Valerie J. Waters J. Stuart Elborn Scott C. Bell Patrick A. Flume Donald R. VanDevanter 《Journal of cystic fibrosis》2019,18(2):236-243
Background
Antimicrobial susceptibility testing (AST) is a cornerstone of infection management. Cystic fibrosis (CF) treatment guidelines recommend AST to select antimicrobial treatments for CF airway infection but its utility in this setting has never been objectively demonstrated.Methods
We conducted a systematic review of primary published articles designed to address two PICO (patient, intervention, comparator, outcome) questions: 1) “For individuals with CF, is clinical response to antimicrobial treatment of bacterial airways infection predictable from AST results available at treatment initiation?” and 2) “For individuals with CF, is clinical response to antimicrobial treatment of bacterial airways infection affected by the method used to guide antimicrobial selection?” Relationships between AST results and clinical response (changes in pulmonary function, weight, signs and symptoms of respiratory tract infection, and time to next event) were assessed for each article and results were compared across articles when possible.Results
Twenty-five articles describing the results of 20 separate studies, most of which described Pseudomonas aeruginosa treatment, were identified. Thirteen studies described pulmonary exacerbation (PEx) treatment and seven described ‘maintenance’ of chronic bacterial airways infection. In only three of 16 studies addressing PICO question #1 was there a suggestion that baseline bacterial isolate antimicrobial susceptibility was associated with clinical response to treatment. None of the four studies addressing PICO question #2 suggested that antimicrobial selection methods influenced clinical outcomes.Conclusions
There is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment, suggesting a need for careful consideration of current AST use by the CF community. 相似文献12.
Benjamin D. Carr Christa N. Grant Richard E. Overman Samir K. Gadepalli James D. Geiger 《Journal of pediatric surgery》2019,54(3):604-607
Background
Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases.Methods
Patients aged 0 to 12?months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum.Results
All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29?days postoperatively and were discharged from hospital at a median of 42?days postoperatively.Conclusions
Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches.Study type
Therapeutic.Level of evidence
IV 相似文献13.
Mark A. Underwood 《Journal of pediatric surgery》2019,54(3):405-412
Background
Immaturity of the host immune system and alterations in the intestinal microbiome appear to be key factors in the pathogenesis of necrotizing enterocolitis (NEC). The aim of this paper is to weigh the evidence for the use of probiotics to prevent NEC in premature infants.Methods
Animal studies, randomized controlled trials, observational cohort studies and meta-analyses involving administration of probiotic products for the prevention of NEC were reviewed. This review of the evidence summarizes the available preclinical and clinical data.Results
In animal models probiotic microbes alter the intestinal microbiome, decrease inflammation and intestinal permeability and decrease the incidence and severity of experimental NEC. In randomized, placebo-controlled trials and cohort studies of premature infants, probiotic microbes decrease the risk of NEC, death and sepsis.Conclusion
Evidence is strong for the prevention of NEC with the use of combination probiotics in premature infants who receive breast milk. The potential risks and benefits of probiotic administration to premature infants should be carefully reviewed with parents.Type of study
Therapeutic.Level of evidence
I. 相似文献14.
Ghazi M. Al Edwan Hammam H. Mansi Omar Nabeeh M. Atta Mohammad M. Shaath Rawand Al Adwan Waleed Mahafza Kameel M. Afram Omar Ababneh Deema Al Adwan Muheilan M. Muheilan 《Journal of pediatric surgery》2019,54(3):595-599
Objective
The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment.Materials and methods
The study was designed as an open-label uncontrolled therapeutic clinical trial. The eligible patients who underwent Intravesical botulinum toxin injection were evaluated before treatment. The evaluation included a 7-day paper bladder diary to assess OAB symptoms (frequency, urgency urinary incontinence (UUI) and nocturnal enuresis (NE)), filling the Arabic International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI short form), and conducting urodynamic study. The Urodynamic parameters obtained were the maximum filling detrusor pressure, cystometric bladder capacity, and compliance. After 12?weeks of the intravesical injection, the patients were revaluated and the results were compared using paired samples t-test.Results
The study enrolled 75 patients. And of those, statistical analysis was done on 46 patients who did follow the study protocols. The mean age was 8.9?years and male to female ratio was 1:4. There was a statistically significant improvement in overactive bladder symptoms and urodynamic parameters in the patient injected with botulinum toxin with minimal side effects.Conclusion
The evidence in this study would support the safety and efficacy of Intravesical botulinum toxin injection in children with refractory idiopathic OAB with significant improvement of symptoms, quality of life, as well as urodynamic parameters.Type of Study
Open-label uncontrolled therapeutic clinical trial.Level of Evidence
III 相似文献15.
Tatjana Stadil Antti Koivusalo Mikko Pakarinen Audun Mikkelsen Ragnhild Emblem Jan F. Svensson Henrik Ehrén Linus Jönsson Jakob Bäckstrand Helene Engstrand Lilja Felipe Donoso Jørgen Mogens Thorup Thorstein Sæter Lars Rasmussen Rikke Neess Pedersen Pernilla Stenström Einar Arnbjörnsson Kristján Óskarsson Niels Qvist 《Journal of pediatric surgery》2019,54(3):423-428
Background
Several surgical procedures have been described in the reconstruction of long-gap esophageal atresia (LGEA). We reviewed the surgical methods used in children with LGEA in the Nordic countries over a 15-year period and the postoperative complications within the first postoperative year.Methods
Retrospective multicenter medical record review of all children born with Gross type A or B esophageal atresia between 01/01/2000 and 12/31/2014 reconstructed within their first year of life.Results
We included 71 children; 56 had Gross type A and 15 type B LGEA. Delayed primary anastomosis (DPA) was performed in 52.1% and an esophageal replacement procedure in 47.9%. Gastric pull-up (GPU) was the most frequent procedure (25.4%). The frequency of chromosomal abnormalities, congenital heart defects and other anomalies was significantly higher in patients who had a replacement procedure. The frequency of gastroesophageal reflux (GER) was significantly higher after DPA compared to esophageal replacement (p?=?0.013). At 1-year follow-up the mean body weight was higher after DPA than after organ interposition (p?=?0.043).Conclusion
DPA and esophageal replacement procedures were equally applied. Postoperative complications and follow-up were similar except for the development of GER and the body weight at 1-year follow-up. Long-term results should be investigated.Type of study
Treatment study.Level of evidence
Level III. 相似文献16.
John Jayman Ali Tourchi Zhaoyong Feng Bruce J. Trock Mahir Maruf Karl Benz Matthew Kasprenski Timothy Baumgartner Daniel Friedlander Paul Sponseller John Gearhart 《Journal of pediatric surgery》2019,54(3):491-494
Purpose
To investigate the factors affecting primary bladder closure in cloacal exstrophy (CE). A successful primary closure is important for optimizing reconstructive outcomes, and it is a critical first-step in the reconstruction of CE. The authors' hypothesize that a smaller diastasis and use of an osteotomy are independent predictors of a successful closure.Methods
A prospectively maintained database of 1332 exstrophy-epispadias complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. Univariate and multivariable analyses were performed to identify significant factors associated with CE primary bladder closure.Results
Of 143?CE patients identified, 99 patients met inclusion criteria. Median follow-up time was 8.82 [IQR 5.43–14.26] years. In the multivariable model, the odds of having a successful closure are about 4 times greater for the staged cloacal approach compared to the 1-stage approach (OR, 3.7; 95% CI 1.2–11.5; p-value?=?0.023). Also, having an osteotomy increases the chance of a successful closure by almost six-fold (OR, 5.8; 95% CI 1.7–19.6; p-value?=?0.004).Conclusions
Using the staged approach with a pelvic osteotomy is paramount to a successful primary closure in CE. The authors strongly recommend using the staged approach and osteotomy as these factors independently increase the chance for a successful primary bladder closure.Study Type
Therapeutic study.Level of Evidence
Level III, Retrospective comparative study. 相似文献17.
Benjamin R. White Chong Zhang Angela P. Presson Kim Friddle Robert DiGeronimo 《Journal of pediatric surgery》2019,54(3):465-470
Objective
To describe the prevalence and outcome of assisted home feeding (AHF) in medically complex neonatal intensive care unit (NICU) patients, and to identify variables associated with AHF in this population.Study Design
1223 infants who survived to discharge from 2013 to 2015 were identified in our single-center, retrospective cohort study at a large tertiary referral NICU. Demographic and selected disease-specific variables were compared between infants discharged on full oral feeding (PO) versus AHF.Result
404 (33%) infants were discharged on AHF (NG?=?201, GT?=?186, NJ?=?17). AHF neonates were born at an earlier gestational age, lower birth weight, had longer hospital admission, greater post-menstrual age at discharge, and had more associated co-morbidities compared to the PO group.Conclusion
AHF was a frequently used and safe intervention in our large cohort of infants.Level of Evidence
Treatment Study Level III. 相似文献18.
Ivo P. van de Peppel Marcela Doktorova Gitte Berkers Hugo R. de Jonge Roderick H.J. Houwen Henkjan J. Verkade Johan W. Jonker Frank A.J.A. Bodewes 《Journal of cystic fibrosis》2019,18(2):286-293
Objective
Disruption of the enterohepatic circulation of bile acids (BAs) is part of the gastrointestinal phenotype of cystic fibrosis (CF). Ivacaftor (VX-770), a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, improves pulmonary function in CF patients with class III gating mutations. We studied the effect of ivacaftor on the enterohepatic circulation by assessing markers of BA homeostasis and their changes in CF patients.Methods
In CF patients with an S1251N mutation (N?=?16; age 9–35?years S125N study/NTR4873) or a G551D mutation (N?=?101; age 10–24?years; GOAL study/ NCT01521338) we analyzed plasma fibroblast growth factor 19 (FGF19) and 7α-hydroxy-4-cholesten-3-one (C4) levels, surrogate markers for intestinal BA absorption and hepatic synthesis, respectively, before and after treatment with ivacaftor.Results
At baseline, median FGF19 was lower (52% and 53%, P?<?.001) and median C4 higher (350% and 364%, P?<?.001), respectively, for the S1251?N and G551D mutation patient groups compared to healthy controls. Treatment with ivacaftor significantly increased FGF19 and reduced C4 levels towards normalization in both cohorts but this did not correlate with CFTR function in other organs, as measured by sweat chloride levels or pulmonary function.Conclusions
We demonstrate that patients with CFTR gating mutations display interruption of the enterohepatic circulation of BAs reflected by lower FGF19 and elevated C4 levels. Treatment with ivacaftor partially restored this disruption of BA homeostasis. The improvement did not correlate with established outcome measures of CF, suggesting involvement of modulating factors of CFTR correction in different organs. 相似文献19.
Marc G Schlatter Long V Nguyen Maria Tecos Elle L Kalbfell Omar Gonzalez-Vega Tedi Vlahu 《Journal of pediatric surgery》2019,54(4):663-669