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1.
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2.
Verena Ellerkamp Andreas Schmid Gunnar Blumenstock Georg Hrivatakis Wolfgang Astfalk Steffan Loff Joerg Fuchs Sabine Zundel 《Journal of pediatric surgery》2018,53(11):2219-2224
Background
Early orchidopexy (OP) around the age of 1 year is recommended in boys with congenital undescended testis (UDT) worldwide since decades. Former retrospectives studies did not distinguish congenital from acquired UDT with a consecutive negative bias concerning the age at surgery.Methods
In a retrospective analysis, data of all boys who underwent OP in eight pediatric surgery institutions from 2009 to 2015 were analyzed. Congenital or acquired UDT were differentiated. Patients were categorized into 3 groups of age at surgery: (1) < 12?months, (2) 12–24?months, (3) > 24?months. Data of one institution were analyzed in detail: exact age of first referral, exact age at surgery, intraoperative findings.Results
Out of 4448 boys, 3270 boys had congenital UDT. In 81% (2656 cases) surgery was performed beyond the age of 1 year, in 54.4% (1780) beyond the age of 2 years. chi-Square statistics showed a higher rate of early operations in hospitals compared to outpatient services and in Germany compared to Switzerland. In 694 congenital detailed cases, median age at referral was 13?months [range 0–196], median age at surgery was 15?months [range 0–202].Conclusion
Delayed referral is the main reason for guideline non-conform delayed surgery in UDT.Type of Study
Clinical Research paper.Level of evidence
Level III: Treatment Study. 相似文献3.
Tamer E. Helmy Wael Ghanem Hesham Orban Helmy Omar Mahmoud El-Kenawy Ashraf T. Hafez Mohammed Dawaba 《Journal of pediatric surgery》2018,53(8):1461-1463
Objective
To detect whether grafting the incised plate during Snodgrass repair would improve outcome.Materials and methods
Sixty patients with primary distal hypospadias were included. Patients were equally randomized using closed envelop method to either Snodgrass or grafted tubularized incised plate repair (GTIP). All operations were performed by a single surgeon. All intaroperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.Results
All 60 patients were evaluated at 1 year of follow-up. Mean age at surgery was 40 ± 15 months. Both groups were comparable as regard to patients' age, meatus location, length and width and depth of urethral plate and glans width. Success was documented in 29/30 patients (96.7%) in the Snodgrass group. The only complication was meatal stenosis in one patient, whereas success was documented in 28/30 patients (93.3%) in the GTIP group. The two failures were secondary to partial glans dehiscence. Success rate was not statistically different. Flow rate data at 1 year showed insignificant difference between both groups as regards Q-max and voiding time. The only statistically significant difference between both groups was a longer operative time 106 ± 12 min in the GTIP group compared to only 77 ± 9 for the Snodgrass group (p = 0.005).Conclusions
Snodgrass and GTIP techniques for primary distal hypospadias repair have similar outcome. With a significantly shorter operative time, Snodgrass repair remains the first choice for primary distal hypospadias repair.Type of the study
Prospective randomized study.Level of evidence
Level I. 相似文献4.
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5.
Scott S. Short Brian T. Bucher Douglas C. Barnhart Nadia Van Der Watt Sarah Zobell Ashley Allen Michael D. Rollins 《Journal of pediatric surgery》2018,53(11):2174-2177
Purpose
We sought to examine the short-term outcomes following single-stage repair of rectoperineal and rectovestibular fistulae in infants and identify risk factors for wound complication.Methods
Patients with a rectoperineal or rectovestibular fistula treated with a single-stage repair beyond the neonatal period (> 30 days of age) at a pediatric colorectal center (2011–2016) were reviewed.Results
36 patients with a rectoperineal and 7 patients with a rectovestibular fistula were repaired using the Posterior Sagittal Anorectoplasty (PSARP) approach. Median follow-up was 31 months. The median age and weight at the time of repair were 166 days and 6.5 kg. Four patients (11%) suffered a wound complication (3 rectoperineal, 1 rectovestibular). Two required a diverting colostomy to allow wound healing. Two patients suffered skin separation managed with local wound care. All 4 patients experienced satisfactory wound healing without anoplasty stricture. Two different patients developed a stricture of the neo-anus. Age and weight at time of repair, gender, and presence of a genitourinary anomaly were not associated with wound complications.Conclusion
Delayed single-stage repair of rectoperineal and rectovestibular fistulae can be performed safely in infants beyond the newborn period. With attentive treatment, satisfactory healing can be anticipated if a wound complication is encountered.Level of Evidence
Retrospective Comparative Study, Level III. 相似文献6.
In Geol Ho Kyong Ihn Eun-Jung Koo Eun Young Chang Jung-Tak Oh 《Journal of pediatric surgery》2018,53(10):2008-2012
Purpose
This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).Methods
We retrospectively analyzed the clinical data of 465 infants treated for inguinal hernia from January 2006 to December 2015. Among them, 124 underwent LR and 341 underwent OR.Results
In the OR group, 16.1% (55/341) primarily underwent bilateral inguinal hernia repair and 13.6% (42/308) subsequently developed metachronous contralateral inguinal hernia during follow-up. In the LR group, 75.8% (94/124) underwent primary bilateral inguinal hernia repair and only 1.6% (2/123) developed metachronous contralateral inguinal hernia. The mean operation times of unilateral inguinal hernia repair showed no statistical differences between LR and OR. However, the mean operation times of bilateral inguinal hernia repair were shorter in LR (39.8 ± 10.4 vs. 51.1 ± 14.4 min, p < 0.001). Postoperative recurrence and wound infection showed no statistical differences between the groups, but postoperative scrotal swelling was more common in OR (0.0% vs. 4.0%, p = 0.006).Conclusion
LR in infants showed a lower incidence of metachronous hernia, shorter operation times, and better postoperative course than OR. LR could be considered the primary operation method in infants with inguinal hernia.Levels of Evidence
Prognosis Study, Retrospective Study, Level III. 相似文献7.
Robert J. Obermeyer Nina S. Cohen Sheema Gaffar Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson 《Journal of pediatric surgery》2018,53(6):1226-1229
Background/Purpose
Our previously published data suggested several risk factors for infection after the Nuss procedure. We aimed to further elucidate these findings.Methods
An IRB-approved (14–03-WC-0034), single institution, retrospective review was performed to evaluate the incidence of postoperative Nuss bar infections associated with seven variables. These were subjected to bivariate and multivariable analyses. A broad definition of infection was used including cellulitis, superficial infection with drainage, or deep infection occurring at any time postoperatively.Results
Over 7 years (4/1/2009–7/31/2016), 25 (3.2%) of 781 patients developed a postoperative infection after primary Nuss repair. Multivariable analyses demonstrated an increased risk of infection with perioperative clindamycin versus cefazolin for all infections (AOR 3.72, p = .017), and specifically deep infections (AOR 5.72, p = .004). The risk of a superficial infection was increased when antibiotic infusion completed > 60 min prior to incision (AOR 10.4, p = .044) and with the use of peri-incisional subcutaneous catheters (OR 8.98, p = .008).Conclusion
Following primary Nuss repair, the rate of deep bar infection increased with the use of perioperative clindamycin rather than cefazolin. The rate of superficial infection increased when perioperative antibiotic infusion was completed more than 60 min prior to incision and with the use of peri-incisional subcutaneous catheters. Further studies are needed to better understand these findings.Type of study
Retrospective chart review.Level of evidence
Level III treatment study. 相似文献8.
Kibileri Williams Lauren Baumann Fizan Abdullah Shawn D. St. Peter Tolulope A. Oyetunji 《Journal of pediatric surgery》2018,53(1):48-51
Purpose
The role of prophylactic antibiotics for elective laparoscopic cholecystectomy has been questioned over the last decade. Although gradually being discontinued in the adult population, the practice among pediatric surgeons remains unknown. Our aim was to investigate the use of perioperative antibiotics in children undergoing elective laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis and biliary dyskinesia.Methods
We retrospectively reviewed the Pediatric Health Information System (PHIS) database for 2015 and selected all patients 18 years old or younger who underwent LC for cholelithiasis (without cholecystitis) or biliary dyskinesia. Demographic and hospital data were extracted as well as antibiotics administered and surgical complications.Results
A total of 1112 patients from 44 hospitals were identified with a median age of 15 years (IQR 13–16 years). Eight out of every 10 hospitals routinely give prophylactic antibiotics in more than 50% of patients. In 37 hospitals that performed more than 5 LC per year, 19 to 100% of patients were given antibiotics. No surgical complications were identified in those who did not get antibiotics.Conclusion
There is significant inter-hospital variation in prophylactic antibiotic administration for elective LC in children. Perioperative antibiotic administration should be tracked as a quality metric in the current push for better stewardship.Level of evidence
III.Type of study
Retrospective. 相似文献9.
Etienne St-Louis Annie Chabot Hayden Stagg Robert Baird 《Journal of pediatric surgery》2018,53(5):968-972
Background
Subcutaneous endoscopically-assisted ligation (SEAL) for pediatric inguinal hernia repair has gained in popularity although variations in techniques exist. Peritoneal scarring by thermal injury has been described as an adjunct. We explored the hypothesized inverse-correlation between peritoneal scarring and recurrence after SEAL.Methods
We conducted a single-center retrospective review of all patients < 18 years old undergoing SEAL between 2010 and 2016 (REB-20172727). Demographics and outcomes were investigated. Univariate and multivariable logistic regressions were performed to evaluate the association between peritoneal scarring and recurrence.Results
We identified 272 patients. Median age was 3 years, 35% were female, and 19% were born premature. Median follow-up was 30 months, ≥ 1 visit/patient. Bilaterality was noted in 35%. There were no reported cases of metachronous hernia, vas injury, testicular atrophy or chronic pain, and recurrence rate was 4.6%. Prematurity, unilateral repair, incarceration, and suture-type (Ti-Cron® vs. Ethibond®) had significant correlation with recurrence on univariate analysis (p < 0.25). Surgeon experience did not. Peritoneal scarring, performed in 195 cases (72%), was not predictive of recurrence (adjusted OR = 0.87, p = 0.830) on multivariable analysis.Conclusion
The rate of complications with SEAL compares favorably to published data. Thermal injury was not associated with improved recurrence rates. The benefits of peritoneal scarring may not outweigh the risks.Level of Evidence
III – Retrospective Case–Control Study. 相似文献10.
Steven S. Rothenberg 《Journal of pediatric surgery》2018,53(1):121-125
Purpose
This study evaluates the results of thoracoscopic management of complex, non-type C, EA and TEF in infants.Methods
From March 2000 to February 2017, 23 patients were treated for Type A N = 13, Type B N = 4, and Type E N = 6. Patients diagnosed with EA had G-tube feeds for a period of 4–9 weeks. All procedures were performed thoracoscopically. EA gaps were between 4 and 7 1/2 vertebral bodies.Results
All surgeries were completed thoracoscopically. Average operative time was 95 min for Type A, 115 min for Type B, and 50 min for Type E. Two patients with long gaps had small leaks which resolved with conservative management. One patient with an H-type was re-intubated causing a partial disruption of the tracheal repair. This required thoracoscopic re-exploration with repair and placement of an intercostal muscle flap. No patient has any clinical evidence of fused ribs, chest wall asymmetry, shoulder girdle weakness, or winged scapula.Conclusion
Thoracoscopic repair of complex EA and TEF is safe and effective. The excellent visualization of the thoracic inlet allows for extensive mobilization creating sufficient length for long gaps and safely managing high fistulas. This may limit injury to adjacent structures and avoid a neck incision and chest wall deformity.Level of evidence
IV. 相似文献11.
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12.
Keisuke Suzuki Makoto Komura Kan Terawaki Tetsuro Kodaka Takumi Gohara Hiroko Komura Yasuhide Nakayama 《Journal of pediatric surgery》2018,53(2):330-334
Background
Prosthetic patches can be used to repair large congenital diaphragmatic hernia defects but may be associated with infection, recurrence, and thoracic deformity. Biosheets (collagenous connective tissue membranes) have been used in regenerative medicine. We evaluated the efficacy of Biosheets in a rabbit model.Methods
Biosheets were prepared by embedding silicone plates in dorsal subcutaneous pouches of rabbits for 4 weeks. In group 1 (n = 11), Gore-Tex® sheets (1.8 × 1.8 cm) were implanted into a diaphragmatic defect. In group 2 (n = 11), Seamdura®, a bioabsorbable artificial dural substitute, was implanted in the same manner. In group 3 (n = 14), biosheets were autologously transplanted into the diaphragmatic defects. All rabbits were euthanized 3 months after transplantation to evaluate their graft status.Results
Herniation of liver was observed in 5 rabbits (45%) in group 1, 8 (73%) in group 2, and 3 (21%) in group 3. A significant difference was noted between groups 2 and 3 (P = 0.017). Biosheets had equivalent burst strength and modulus of elasticity as native diaphragm. Muscular tissue regeneration in transplanted biosheets in group 3 was confirmed histologically.Conclusion
Biosheets may be applied to diaphragmatic repair and replacement of diaphragmatic muscular tissue.Level of evidence
Level III. 相似文献13.
Jason O. Robertson Cory N. Criss Lily B. Hsieh Niki Matsuko Josh S. Gish Rodrigo A. Mon Kevin N. Johnson Ronald B. Hirschl George B. Mychaliska Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(4):629-634
Purpose
For the last seven years, our institution has repaired infants with CDH that require ECMO early after cannulation. Prior to that, we attempted to decannulate before repair, but repaired on ECMO if we were unable to wean after two weeks. This study compares those strategies.Methods
From 2002 to 2016, 65 infants with CDH required ECMO. 67.7% were repaired on ECMO, and 27.7% were repaired after decannulation. Data were compared between patients repaired ≤ 5 days after cannulation (“early protocol”, n = 30) and > 5 days after cannulation or after de-cannulation (“late protocol”, n = 35). We used Cox regression to assess differences in outcomes between groups.Results
Survival for the early and late protocol groups was 43.3% and 68.8%, respectively (p = 0.0485). For patients that were successfully decannulated before repair, survival was 94.4%. Moreover, the early repair protocol was associated with prolongation of ECMO (16.8 ± 7.4 vs. 12.6 ± 6.8 days, p = 0.0216).After multivariate regression, the early repair protocol was an independent predictor of both mortality (HR = 3.48, 95% CI = 1.28–9.45, p = 0.015) and days on ECMO (IRR = 1.39, 95% CI = 1.07–1.79, p = 0.012). All bleeding occurred in patients repaired on ECMO (29.5%, 13/44).Conclusions
Our data suggest that protocolized CDH repair early after ECMO cannulation may be associated with increased mortality and prolongation of ECMO. However, early repair is not necessarily harmful for those patients who would otherwise be unable to wean from ECMO before repair. Further work is needed to better move towards individualized patient care.Type of study
Treatment Study.Level of evidence
Level 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.
Yew-Wei Tan Debasish Banerjee Kate M. Cross Paolo De Coppi Simon C. Blackburn Clare M. Rees Stefano Giuliani Joe I. Curry Simon Eaton 《Journal of pediatric surgery》2018,53(10):1883-1889
Background/Purpose
Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch.Methods
We retrospectively reviewed all cases of MH who underwent first-time repair in 2012-2017 in our institution to determine recurrence and complication rate. A MEDLINE search related to minimally invasive surgery (MIS) and patch repair of MH was conducted for systematic review. Eligible articles published from 1997-2017 with follow-up data available were included. Primary outcomes measured were recurrence and complication. Meta-analysis to compare open versus MIS and primary versus patch repair in the MIS group were performed in comparative cohorts. Continuous data were presented as median (range), and statistical significance was P < 0.05.Results
In our institution, 12 consecutive patients aged 17-month-old (22 days-7 years), underwent laparoscopic patch repair of MH, with one conversion to laparotomy. No recurrence or significant complication occurred over a follow-up period of 8 months (1-48 months).Thirty-six articles were included from literature review and were combined with the current series. All were retrospective case reports or series, of which 6 were comparative cohorts with both MIS and open repairs. A total of 296 patients from 37 series were ultimately used for analysis: 80 had open repair (4 patch) and 216 had MIS repair (32 patch), with a patch rate of 12%. There were 13 recurrences (4%): no difference between open and MIS repairs (4/80 vs 9/216, p = 0.75); recurrence rate following primary repair was 13/260 (5%), but no recurrence occurred with 36 patch repairs. Meta-analysis showed no difference in recurrence between open and MIS repair (p = 0.83), whereas patch repair was associated with 14% less recurrence compared with primary repair, although it did not reach statistical significance (p = 0.12). There were 13 complications (5%): no difference between open and MIS repairs (5/80 vs 8/216, p = 0.35). One small bowel obstruction occurred in a patient who had laparoscopic patch repair.Conclusion
In MH, recurrence and complication rates are comparable between MIS and open repairs. Use of patch appeared to confer additional benefit in reducing recurrence.Type of Study
Systematic reviewLevel of Evidence
3A 相似文献16.
Khalid Alzahrani Julien Lejeune Walid Lakhal Baptiste Morel Ann-Rose Cook Karim Braïk Hubert Lardy Aurelien Binet 《Journal of pediatric surgery》2018,53(7):1417-1419
Background
Port-a-cath (PAC) is an essential device in the management of the patients of chronic illness, but despite theirs benefits there are many complications either at the time of insertion or at time of removal. Our aim of this study is to evaluate the fracture rate of the catheter at removal time in comparison with catheter type either polyurethane or silicone.Methods
A retrospective monocentric study of all PACs which were removed at our university pediatric hospital between 1 January 2006 and 31 December 2016. Two groups were compared: polyurethane group and silicone group.Results
Total of 216 central lines were removed, the mean age at the time of extraction was 9.7 ± 4.9 years and the mean time for both catheter was 2.7 ± 1.6 years, fracture occurred in 11 catheter of the polyurethane group (n = 119), with no fracture of silicone group (n = 86), in the polyurethane group, the risk of catheter fracture is significantly related to the duration of the PAC in place.Conclusion
We found that the polyurethane-based catheters are more vulnerable for rupture and retained fragment in the blood vessels, especially if left in place for long time, for this reason we have switched to silicone-based catheter and all catheters should be remove within duration maximal of 2 years.Type of study
Prognosis study.Level of evidence
Level II. 相似文献17.
Tiffany J. Zens Andrew P. Rogers Erica L. Riedesel Charles M. Leys Daniel J. Ostlie Michael A. Woods Kara G. Gill 《Journal of pediatric surgery》2018,53(6):1168-1174
Introduction
Contrast-enhanced CT remains the first-line imaging for evaluating postoperative abscess (POA) after appendicitis. Given concerns of ionizing radiation use in children, we began utilizing quick MRI to evaluate POA and summarize our findings in this study.Materials and Methods
Children imaged with quick MRI from 2015 to 2017 were compared to children evaluated with CT from 2012 to 2014 using an age and weight matched case–control model. Radiation exposure, size and number of abscesses, length of exam, drain placement, and patient outcomes were compared.Results
There was no difference in age or weight (p > 0.60) between children evaluated with quick MRI (n = 16) and CT (n = 16). Mean imaging time was longer (18.2 ± 8.5 min) for MRI (p < 0.001), but there was no difference in time from imaging order to drain placement (p = 0.969). No children required sedation or had non-diagnostic imaging. There were no differences in abscess volume (p = 0.346) or drain placement (p = 0.332). Thirty-day follow-up showed no difference in readmissions (p = 0.551) and no missed abscesses. Quick MRI reduced imaging charges to $1871 from $5650 with CT.Conclusion
Quick MRI demonstrated equivalent outcomes to CT in terms of POA detection, drain placement, and 30-day complications suggesting that MRI provides an equally effective, less expensive, and non-radiation modality for the identification of POA.Type of Study
Retrospective Case–Control Study.Level of Evidence
Level III. 相似文献18.
Dani O. Gonzalez Jennifer N. Cooper Shawn D. St. Peter Peter C. Minneci Katherine J. Deans 《Journal of pediatric surgery》2018,53(3):513-520
Background
In patients undergoing gastroschisis closure, the effects of timing of closure and patient and hospital-level characteristics on length of stay (LOS) and time to enteral autonomy are unknown.Study design
Using the Pediatric Health Information System, we compared neonates who underwent early (within 1 day of birth) versus delayed (> 1 day after birth) gastroschisis closure from 2005 to 2013. We evaluated the relationship between time to closure and both LOS and days on total parenteral nutrition (TPN).Results
Of 4459 neonates with gastroschisis, 43.9% underwent early closure and 56.1% underwent delayed closure. Delayed closure, complicated gastroschisis, government insurance, lower birth weight, older age at closure, and complex chronic conditions were associated with longer LOS and days on TPN (all p < 0.05). There was significant inter-hospital variability in both outcomes, after adjusting for patient- and hospital-level characteristics, including hospitals' gastroschisis and neonatal volumes, median age at closure, and percentages of complicated and delayed gastroschisis patients, (p < 0.01).Conclusion
Delayed gastroschisis closure is associated with longer LOS and duration of TPN, even after excluding complicated cases. Furthermore, after controlling for hospital volume, rate of complicated gastroschisis, and timing of closure, the persistent inter-hospital variability suggests that practice variability is partially responsible for these differences.Type of study
Retrospective study.Level of evidence
III 相似文献19.
Abdullah Alshehri Kourosh Afshar Julie Bedford Graeme Hintz Erik D Skarsgard 《Journal of pediatric surgery》2018,53(5):1046-1051
Introduction
Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <?2) and obesity (BMI Z-scores > + 2) with 30-day postoperative outcomes.Methods
We queried the Pediatric NSQIP Participant Use File and extracted data on patients’ age 29 days to 18 years who underwent abdominal or thoracic procedures. Normalized anthropometric measures were calculated, including weight-for-height for < 2 years, BMI for ages ≥ 2 years, and height for age. Logistic regression models were developed to assess nutritional outlier status as an independent predictor of postoperative outcome.Results
23,714 children (88% ≥ 2y) were evaluated. 4272 (18%) were obese, while 2640 (11.1%) and 904 (3.8%) were stunted and wasted, respectively, after controlling for gender, ASA/procedure/wound classification, preoperative steroid use, need for preoperative nutritional support, and obese children had higher odds of SSIs (OR 1.29, 95% CI 1.1–1.5, p = 0.001), while stunted children were at increased risk of any 30-day postoperative complication (OR 1.16, 95% CI 1.0–1.3, p = 0.036).Conclusion
Children who are stunted or obese are at increased risk of adverse outcome after abdominal or thoracic surgery.Level of Evidence
III 相似文献20.
Kathryn Taylor Kristin A. Sonderman Lindsey L. Wolf Wei Jiang Lindsey B. Armstrong Tracey P. Koehlmoos Brent R. Weil Robert L. Ricca Christopher B. Weldon Adil H. Haider Samuel E. Rice-Townsend 《Journal of pediatric surgery》2018,53(11):2214-2218