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1.
Andrea Soria Gondek Lucia Riaza Daniel Cuadras Xavier Tarrado Castellarnau Lucal Krauel 《Journal of pediatric surgery》2018,53(4):599-604
Background/purpose
To identify factors that dim the efficacy of ultrasound guided saline enema (USGSE) and to design a mathematical model for predicting the probability of success of USGSE.Methods
Retrospective review of patients admitted with the diagnosis of ileocolic intussusception from 2009 to 2014. Demographics, clinical and sonographic data were reviewed.Results
116 first episodes of ileocolic intussusceptions. 109 USGSE attempts were analyzed. Composite reduction rate was 77%. A significant relationship was found between initial location of the intussusception, free peritoneal fluid (OR = 0.329, 95% CI: 0.124–0.875), negative Doppler signal and sonographic signs of intestinal occlusion and unsuccessful USGSE. Initial location beyond the splenic angle was an independent risk factor for USGSE failure (OR = 0.053, 95% CI: 0.005–0.534). A predictive model based on onset of symptoms, free peritoneal fluid and intussusception location was a reliable tool for prediction (AUC 0.63, 95% CI: 0.53–0.817). Assuming that a patient with less than 75.3% chance of USGSE success is going to fail, we would identify more than 80.9% of the real failures.Conclusions
This predictive model could be a filter selection for the patients at risk of USGSE failure and therefore candidates to further imaging investigations or referral to a surgical unit.Level of evidence
III. 相似文献2.
Kohei Otake Keiichi Uchida Michiko Kubo Akira Yamamoto Yuka Nagano Ryo Uratani Kiyoshi Hashimoto Kohei Matsushita Mikihiro Inoue Hirofumi Sawada Masato Kusunoki 《Journal of pediatric surgery》2018,53(3):499-502
Background/purpose
The purpose of this study was to explore clinical characteristics and primary surgical diagnoses associated with in-hospital death in pediatric surgical patients admitted to the neonatal intensive care unit (NICU) of a tertiary hospital.Methods
This retrospective study includes all patients admitted to our NICU for pediatric surgical diseases between January 2001 and December 2015. Univariate and multivariate binary logistic regression were performed to assess independent factors associated with in-hospital death.Results
A total of 440 cases were included and 334 (83.5%) patients underwent one or more surgeries. Thirty six patients (8.2%) died while hospitalized in the NICU. The 5 most common surgical diagnoses were intestinal atresia/stenosis, anorectal malformation, congenital diaphragmatic hernia (CDH), esophageal atresia, and urinary system disorder. Necrotizing enterocolitis (NEC) had the highest mortality rate. Using logistic regression, in-hospital death was predicted by extremely low birth weight (ELBW) (odds ratio (OR) = 6.594; P = 0.006), CDH (OR = 13.954; P < 0.001), and NEC (OR = 8.991; P = 0.049).Conclusions
This study describes CDH, NEC, and ELBW are independent predictive factors associated with in-hospital death of pediatric surgical patients in our NICU. Novel approaches for those conditions are required to improve the survival.Type of study
PrognosticLevels of evidence
II. 相似文献3.
Michael Joseph Emma C. Hamilton Andrea Hayes-Jordan Winston W. Huh Mary T. Austin 《Journal of pediatric surgery》2018,53(1):169-173
Purpose
The purpose of this study was to determine whether racial/ethnic disparities exist in disease presentation, treatment, and survival among children and adolescents with extremity sarcoma.Methods
The Surveillance, Epidemiology, and End Results (SEER) data were analyzed for patients < 20 years old with soft-tissue extremity sarcomas from 1973 to 2013. Multivariate logistic regression was performed to determine the association between race/ethnicity and disease stage at presentation and likelihood of surgical resection. Overall survival (OS) was evaluated using hazard ratios with 95% confidence intervals.Results
1261 cases were identified: 650 (52%) non-Hispanic whites (NHW), 313 (25%) Hispanics, 182 (14%) non-Hispanic blacks (NHB), and 116 (9%) other race/ethnicity. Logistic regression results showed that Hispanics and NHB were 51% and 44%, respectively, less likely to undergo surgical resection compared to NHW (OR = 0.49, 95% CI: 0.30–0.80; OR = 0.56, 95% CI: 0.32–0.98, respectively). Factors associated with failure to undergo surgical resection included histology, lower extremity site, tumor size, and distant metastases. OS based on race/ethnicity significantly differed using the log-rank test, with NHB having the worst survival (p < 0.05).Conclusions
We conclude that NHB, Hispanics, and other race/ethnicity were less likely to undergo surgical resection for extremity sarcoma. Further work is needed to better characterize and eliminate disparities in the management and outcomes of children with extremity sarcomas.Type of study
Prognosis study.Level of evidence
IV 相似文献4.
Robert J. Obermeyer Sheema Gaffar Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson Cynthia S. Kelly 《Journal of pediatric surgery》2018,53(2):260-264
Aim of the study
The aim of the study was to determine the role of patch metal allergy testing to select bar material for the Nuss procedure.Methods
An IRB-approved (11–04-WC-0098) single institution retrospective, cohort study comparing selective versus routine patch metal allergy testing to select stainless steel or titanium bars for Nuss repair was performed. In Cohort A (9/2004–1/2011), selective patch testing was performed based on clinical risk factors. In Cohort B (2/2011–9/2014), all patients were patch tested. The cohorts were compared for incidence of bar allergy and resultant premature bar loss. Risk factors for stainless steel allergy or positive patch test were evaluated.Main results
Cohort A had 628 patients with 63 (10.0%) selected for patch testing, while all 304 patients in Cohort B were tested. Over 10 years, 15 (1.8%) of the 842 stainless steel Nuss repairs resulted in a bar allergy, and 5 had a negative preoperative patch test. The incidence of stainless steel bar allergy (1.8% vs 1.7%, p = 0.57) and resultant bar loss (0.5% vs 1.3%, p = 0.23) was not statistically different between cohorts. An allergic reaction to a stainless steel bar or a positive patch test was more common in females (OR = 2.3, p < 0.001) and patients with a personal (OR = 24.8, p < 0.001) or family history (OR = 3.1, p < 0.001) of metal sensitivity.Conclusion
Stainless steel bar allergies occur at a low incidence with either routine or selective patch metal allergy testing. If selective testing is performed, it is advisable in females and patients with a personal or family history of metal sensitivity. A negative preoperative patch metal allergy test does not preclude the possibility of a postoperative stainless steel bar allergy.Level of evidence
Level III Treatment Study and Study of Diagnostic Test. 相似文献5.
Sona Sehgal Anthony D. Sandler A Alfred Chahine Parvati Mohan Clarivet Torres 《Journal of pediatric surgery》2018,53(10):1989-1995
Introduction
Despite medical and surgical management, a subset of children with short bowel syndrome (SBS) who have discrepancy between proximal small bowel and distal colon have persistent feeding intolerance. We propose the use of an Ostomy in Continuity (OIC) (Bishop-Koop or Santulli) as a salvage procedure to decompress the proximal bowel while still maintaining maximal intestinal length, in these patients.Methods
A retrospective chart review of 104 SBS patients identified sixteen patients who underwent an OIC. Measures of reliance on parenteral nutrition (PN), growth, intestinal failure associated liver disease, the rate of central venous catheter infections and enterocolitis were collected. These parameters were compared before and after the placement of OIC in the same patients at a median follow-up period of 24 months (range 3–52 months). Outcome measures include intestinal autonomy and survival without intestinal and liver transplant.Results
All 16 patients showed significant improvement in their enteral tolerance after OIC. The mean PN caloric requirement decreased from 95% to 21% (p = 0.0001). The median weight Z score improved from ? 1.18 to 0.20 (p = 0.0006) and the median height Z score improved from ? 2.74 to ? 1 (p = 0.0001). The mean conjugated bilirubin decreased from 10.3 mg/dl to 0.3 mg/dl (p = 0.0001) in nine patients with hyperbilirubinemia. There was no decrease in central venous catheter infections (CVCI) but there was a decrease in the rate of enterocolitis. None of the patients required intestinal or liver transplant. There was one minor skin excoriation complication in one patient with a Bishop-Koop stoma.Conclusions
The application of an ostomy in continuity within a comprehensive intestinal rehabilitation program is a novel approach in the treatment of refractory short bowel syndrome that improves intestinal autonomy and decreases the rate of enterocolitis.Type of Study
Case Series.Level of evidence
IV (Cohort Study). 相似文献6.
Hiromu Miyake Bo Li Carol Lee Yuhki Koike Yong Chen Shogo Seo Agostino Pierro 《Journal of pediatric surgery》2018,53(5):909-913
Background
Necrotizing enterocolitis (NEC) is a disease known to cause injury to multiple organs including the liver. Liver regeneration is essential for the recovery after NEC-induced liver injury. Our aim was to investigate hepatic proliferation and progenitor cell marker expression in experimental NEC.Methods
Following ethical approval (#32238), NEC was induced in mice by hypoxia, gavage feeding of hyperosmolar formula, and lipopolysaccharide. Breastfed pups were used as control. We analyzed serum ALT level, liver inflammatory cytokines, liver proliferation markers, and progenitor cell marker expression. Comparison was made between NEC and controls.Results
Serum ALT level was higher in NEC (p < 0.05). The mRNA expression of inflammatory cytokines in the liver was also higher in NEC (IL6: p < 0.05, TNF-α: p < 0.01). Conversely, mRNA expression of proliferation markers in the liver was lower in NEC (Ki67; p < 0.01, PCNA: p < 0.01). LGR5 expression was also significantly decreased in NEC as demonstrated by mRNA (p < 0.05) and protein (p < 0.01) levels.Conclusions
Inflammatory injury was present in the liver during experimental NEC. Proliferation and LGR5 expression were impaired in the NEC liver. Modulation of progenitor cell expressing LGR5 may result in stimulation of liver regeneration in NEC-induced liver injury and improved clinical outcome.Level of evidence
Level IV. 相似文献7.
Background
Recently, perioperative transfusions were demonstrated to be associated with higher rate of surgical site infections (SSIs) in neonates. We sought to examine whether a similar relationship exists between perioperative blood transfusions and SSI among non-neonatal pediatric general surgical patients.Methods
We conducted an IRB-approved retrospective study reviewing non-neonatal patients (age greater than 28 days and less than 18 years) who underwent a general or thoracic surgical procedure in 2012, 2013, 2014, in the American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files. We used Chi-square analyses to perform a bivariate analysis comparing proportions of SSI's between patients who received blood transfusion to those who did not. Multiple logistic regression analyses compared the odds of SSIs in transfused versus nontransfused patients controlling for organ failure, steroid use, nutritional status, current infection, American Society of Anesthesiologists (ASA) Physical Status classification, and wound classification.Results
There were 55,133 patients with 1779 patients who received blood transfusion (≥ 25 ml/kg body weight) during or within 72 h of surgery. Bivariate analysis showed at least twice the rate of infection in transfused patients compared to nontransfused patients (p < 0.01): superficial SSI 3.5% vs 1.5%; deep SSI 0.8% vs 0.2%, organ space SSI 3.8% vs 1.6%; deep dehiscence 2% vs 0.3%. Total wound infections and dehiscence for transfused patients were 10.5% vs 3.8% in nontransfused patients (p < 0.01). Multiple regression analysis showed that nutritional issue, current infection, and wounds not classified as “clean” have statistically significant correlation with SSI. Although there was significant interaction between ASA and transfusion (p < 0.0001), we found statistically significant associations between transfusions and SSI for ASA class 1–2 (OR = 5.51, 95% CI 3.47–7.52), ASA class 3 (OR = 2.06, 95% CI 1.63–2.61), and ASA class 4–5 (OR = 1.67, 95% CI 1.15–2.42).Conclusion
In non-newborn pediatric general and thoracic surgery patients, transfusions were associated with higher risk of SSI or wound dehiscence. Although there was a significant interaction between ASA and transfusion, OR for SSI was stronger for lower ASA classes.Type of Study
Retrospective Review.Level of Evidence
II 相似文献8.
Anastasia Mentessidou Ioanna Loukou Georgios Kampouroglou Anastasia Livani Ioannis Georgopoulos Petros Mirilas 《Journal of pediatric surgery》2018,53(8):1504-1508
Background/purpose
In the few studies on intestinal complications and growth of cystic fibrosis (CF) patients with a history of meconium ileus (MI), operated MI has not been investigated separately. We aimed to investigate the incidence of long-term intestinal obstruction sequelae [constipation, distal intestinal obstruction syndrome (DIOS)] and growth in CF patients operated for MI.Methods
Retrospective study (1989–2016) including operative diagnoses and procedures, constipation and DIOS events, yearly Body Mass Index (BMI) measurements. Outcomes were examined in subgroups operated for MI only and for MI with atresia and/or volvulus.Results
Of 49 patients followed-up for 15 (mean) years, 5 (10.2%) developed constipation and 14 (28.6%) DIOS. BMI was within normal percentiles in 53 patients over a 10-year follow-up. MI only and MI with atresia and/or volvulus did not differ in constipation and/or DIOS incidence (11/34 vs. 7/15, p = 0.39) or in BMI (p = 0.47). Cases with ileocecal valve resection (ICV-R) showed lower constipation and/or DIOS incidence than those without ICV-R (0/6 vs. 11/28, p = 0.02) and no different BMI (p > 0.05).Conclusions
CF patients operated for MI were in long-term risk for constipation/DIOS; their growth was normal. Interestingly, underlying atresia/volvulus neither increased constipation/DIOS risk nor affected growth. Strikingly, ICV-R showed no constipation/DIOS risk and no impact on growth.Type of study
Retrospective comparative study.Level of evidence
III. 相似文献9.
Robert J. Obermeyer Nina S. Cohen Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson 《Journal of pediatric surgery》2018,53(6):1221-1225
Purpose
The purpose of this study was to determine variables predictive of an excellent correction using vacuum bell therapy for nonoperative treatment of pectus excavatum.Methods
A single institution, retrospective evaluation (IRB 15-01-WC-0024) of variables associated with an excellent outcome in pectus excavatum patients treated with vacuum bell therapy was performed. An excellent correction was defined as a chest wall depth equal to the mean depth of a reference group of 30 male children without pectus excavatum.Results
Over 4 years (11/2012–11/2016) there were 180 patients enrolled with 115 available for analysis in the treatment group. The reference group had a mean chest wall depth of 0.51 cm. An excellent correction (depth ≤ 0.51 cm) was achieved in 23 (20%) patients. Patient characteristics predictive of an excellent outcome included initial age ≤ 11 years (OR = 3.3,p = .013), initial chest wall depth ≤ 1.5 cm (OR = 4.6,p = .003), and chest wall flexibility (OR = 14.8,p < .001). Patients that used the vacuum bell over 12 consecutive months were more likely to achieve an excellent correction (OR = 3.1,p = .030). Follow-up was 4 months to 4 years (median 12 months).Conclusion
Nonoperative management of pectus excavatum with vacuum bell therapy results in an excellent correction in a small percentage of patients. Variables predictive of an excellent outcome include age ≤ 11 years, chest wall depth ≤ 1.5 cm, chest wall flexibility, and vacuum bell use over 12 consecutive months.Type of study
Retrospective chart review.Level of evidence
Level III treatment study. 相似文献10.
Craig C. Teerlink Ryan Bernhisel Lisa A. Cannon-Albright Michael D. Rollins 《Journal of pediatric surgery》2018,53(7):1355-1359
Background
Familial recurrence of Hirschsprung disease (HSCR) is well documented, and risk estimates for relatives have been reported from various populations. We describe the familial clustering of HSCR cases using well-established unbiased familial aggregation techniques within the context of a population genealogy.Methods
Patients included 264 HSCR cases identified using ICD-9 diagnosis coding from the two largest healthcare providers in Utah who also had linked genealogy data. The GIF statistic was used to identify excess familial clustering by comparing average relatedness of cases to matched controls. In addition, relative risks (RRs) of HSCR in relatives of cases were estimated using age-, sex- and birthplace-matched disease rates, and for several diseases frequently associated with HSCR (Down syndrome, multiple endocrine neoplasia IIa, central hypoventilation syndrome, Bardet–Biedl syndrome, ventricular and atrial septal defect).Results
Significant excess relatedness was observed for all HSCRs (p < 1e? 3). Significant RRs for HSCR were observed for first-, second-, and fourth-degree relatives of cases (RR = 12.0, 10.0, and 4.6, respectively). Significant elevated risks of Down syndrome, Bardet–Biedl syndrome, and atrial and ventricular septal defects were observed for HSCR cases.Conclusion
This population-based survey of HSCR provides confirmation of a genetic contribution to HSCR disease and presents unbiased risk estimates that may have clinical value in predicting recurrence.Level of evidence rating
Prognosis study, level II. 相似文献11.
Toshiharu Matsuura Yusuke Yanagi Makoto Hayashida Yoshiaki Takahashi Koichiro Yoshimaru Tomoaki Taguchi 《Journal of pediatric surgery》2018,53(4):671-675
Background
No protocol has been established for the diagnosis and management of chylous ascites after liver transplantation (LT). In this study, we retrospectively reviewed our cases of posttransplant chylous ascites (PTCA) and aimed to propose a diagnostic and management protocol.Patients and methods
We retrospectively reviewed the clinical records of 96 LT recipients who underwent LT at our department. The incidence of PTCA and the associated risk factors were analyzed and our protocol for chylous ascites was evaluated.Results
PTCA occurred in 6 (6.3%) patients (mean age: 10.7 ± 11.0 years) at a mean of 10.8 ± 3.6 days after LT. The primary disease in all of PTCA cases was biliary atresia (BA). The periportal lymphadnopathy was an independent risk factor for PTCA. In all cases PTCA successfully resolved according to our protocol. Octreotide was administered in 4 of our 6 PTCA cases. The mean postoperative hospital stay was 40.2 ± 8.4 days, which was similar to that of cases without PTCA.Conclusions
The incidence of PTCA in LT patients, especially in those with BA, is relatively high. Our diagnostic criteria and our management protocol were helpful for patients with refractory ascites after LT.Type of study
Diagnostic test: Level II. Treatment study: Level III. 相似文献12.
Objective
To compare treatment outcomes in children with Hirschsprung's disease who underwent treatment using the Duhamel or TERPT surgical procedures.Methods
Medline, Cochrane, EMBASE, and Google Scholar databases were searched through December 26, 2016. Search strings included Hirschsprung's disease, fecal incontinence, transanal endorectal pull-through, and Duhamel operation. Randomized controlled studies (RCTs) and retrospective studies that compared the treatment of Hirschsprung's disease in with TERPT or Duhamel surgical procedures in neonates, infants, or children were included.Results
The study included six studies with a total of 280 patients. The meta-analysis indicated that the Duhamel and TERPT interventions were similar with respect to rate of postoperative fecal incontinence (OR = 0.85, 95% CI = 0.37 to 1.92, P = 0.692) and operation time (difference in means = 46.68 min, 95% CI = ? 26.96 to 114.31, P = 0.226). The Duhamel procedure was associated with longer postoperative hospital stay (Difference in means = 3.14 days, 95% CI = 1.46 to 4.82, P < .001) and a lower rate of enterocolitis (OR = 0.21, 95% = 0.07 to 0.68, P = 0.009) compared with the TERPT procedure.Conclusions
The study found that Duhamel and TERPT procedures showed similar benefit in treating Hirschsprung's disease, although differences exist with respect to length of postoperative hospital stay and the incidence of enterocolitis.The type of study
Meta-analysis.Level of evidence
Level II. 相似文献13.
William Bonadio Syeda Shahid Lior Vardi Carly Buckingham Allison Kornblatt Chloe Free Peter Homel 《Journal of pediatric surgery》2018,53(3):441-445
Importance
Appendicitis is a common, potentially serious pediatric disease. An important factor in determining management strategy [whether/when to perform appendectomy, duration of antibiotic therapy/hospitalization, etc.] and predicting outcome is distinguishing whether perforation is present.Objective
The objective was to determine efficacy of commonly assessed pre-operative variables in stratifying perforation risk in children with appendicitis.Design
A retrospective analysis of consecutive cases was performed.Setting
The setting was a large urban hospital pediatric emergency department.Participants
Four hundred forty-eight consecutive cases of CT [computerized tomography]-confirmed pediatric appendicitis during a 6-year period in an urban pediatric ED [emergency department]: 162 with perforation and 286 non-perforated.Main outcome(s) and measure(s)
To determine efficacy of clinical and laboratory variables with distinguishing perforation outcome in children with appendicitis.Results
Regression analysis identified 3 independently significant variables associated with perforation outcome – and determined their ideal threshold values: duration of symptoms > 1 day; ED-measured fever [body temperature > 38.0 °C]; CBC WBC absolute neutrophil count > 13,000/mm3. The resulting multivariate ROC [receiver operating characteristic] curve after applying these threshold values gave an AUC [area under curve] of 89% for perforation outcome [p < 0.001]. Risk for perforation was additive with each additional predictive variable exceeding its threshold value, linearly increasing from 7% with no variable present to 85% when all 3 variables are present.Conclusions
A pre-operative scoring system comprised of 3 commonly assessed clinical/laboratory variables is useful in stratifying perforation risk in children with appendicitis.Physicians can utilize these factors to gauge pre-operative risk for perforation in children with appendicitis, which can potentially aid in planning subsequent management strategy.Level of evidence
III. 相似文献14.
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15.
Background/purpose
The role of serum gamma-glutamyl transpeptidase (GGT) levels in predicting clinical outcomes after Kasai portoenterostomy (KPE) is unknown. This study analyzed whether postoperative GGT along with the aspartate aminotransferase-to-platelet ratio index (APRi) predicted prognosis of biliary atresia (BA).Methods
Data were retrospectively reviewed for 169 BA patients categorized into jaundice-free (JF) (total bilirubin < 2.0 mg/dL ≤ 6 months post-KPE) and persistent jaundice (PJ) groups (total bilirubin ≥ 2.0 mg/dL ≤ 6 months post-KPE). Serum biochemical markers, including GGT levels, were measured monthly after KPE, and mean GGT levels and APRi were compared between groups. Factors predicting native liver survival (NLS) were determined using a Cox regression analysis.Results
GGT concentrations > 550 IU/L at month 5 (hazard ratio: 1.74, P < 0.05), an APRi > 0.605 at month 4 (hazard ratio: 3.78, P = 0.001), and being jaundice-free at 6 months (hazard ratio: 5.49, P < 0.001) were independent risk factors for decreased NLS.Conclusions
Serum GGT concentrations > 550 IU/L at month 5 and an APRi > 0.605 at month 4 post-KPE were associated with significantly lower NLS rates. Among JF patients, those with GGT concentrations > 550 IU/L at month 5 and APRi > 0.605 at month 4 showed poorer outcomes.Type of study
Retrospective comparative studyLevel of evidence
Level III. 相似文献16.
Celia D. Flores Yangyang R. Yu Tamir A. Miloh John Goss Mary L. Brandt 《Journal of pediatric surgery》2018,53(5):976-979
Background
Alagille Syndrome (AGS) and Progressive Familial Intrahepatic Cholestasis (PFIC) are rare pediatric biliary disorders that lead to progressive liver disease. This study reviews our experience with the surgical management of these disorders over the last 20 years.Methods
We retrospectively reviewed the records of children diagnosed with AGS or PFIC from January 1996 to December 2016. Data collected included demographics, surgical intervention (liver transplant or biliary diversion), and complications.Results
Of 37 patients identified with these disorders, 17 patients (8 AGS,9 PFIC) underwent surgical intervention. Mean postsurgical follow-up was 6.9 ± 4.7 years. Liver transplantation was the most common procedure (n = 14). Two patients who were initially thought to have biliary atresia underwent hepatoportoenterostomy, but were subsequently shown to have Alagille syndrome. Biliary diversion procedures were performed in 3 patients (external n = 1, internal n = 2). PFIC patients tended to be older at the time of liver transplant compared to AGS (4.3 ± 3.9 years vs. 2.4 ± 1.1 years, p = 0.25). The AGS patient with external diversion had resolution of symptoms and no complications (follow-up: 12.5 years). Both PFIC patients with internal diversion (conduit between gallbladder and transverse colon) had resolution of pruritus and no progression of liver disease (follow-up: 3.8 and 4.5 years).Conclusions
AGS and PFIC are rare biliary disorders in children which result in pruritus and progressive liver failure. Three patients in this series (8%) benefited from biliary diversion for control of pruritus and have not to date required transplantation for progressive liver disease. 38% underwent transplantation owing to pruritus and severe liver dysfunction.Level of Evidence
2b 相似文献17.
Ferdynand Hebal Hayley T. Sparks Karen L. Rychlik Meredith Bone Sifrance Tran Katherine A. Barsness 《Journal of pediatric surgery》2018,53(4):794-797
Background/purpose
Arterial catheter complications are a common problem in a pediatric critical care setting, but reported complication rates and risk factors associated with peripheral arterial catheter complications vary. We conducted a retrospective cohort study to identify risk factors in a pediatric patient population.Methods
We performed a detailed abstraction of provider notes in the electronic medical records of inpatients ≤ 18 years of age who underwent arterial line placement between January 1, 2008 and January 1, 2013 at a university-affiliated standalone pediatric hospital. Inpatient records were assessed for complications associated with arterial catheterization and risk factors inherent to arterial catheter insertion.Results
Two hundred twenty-eight children were identified, of whom 75 (33%) had a total of 106 arterial catheter complications. Complications included line malfunctions (59%, n = 63), bleeding (16%, n = 17), multiple complications (11%, n = 12), infiltration (8%, n = 9), and hematoma (4%, n = 4). Line malfunction was reported in all patients with multiple complications. Independent predictors of complications associated with arterial catheterization were the presence of more than one provider during the insertion (p = 0.007) and insertion attempts at multiple sites (p = 0.036).Conclusions
Our analysis suggests the need for a prospective study to comprehensively assess provider-related risk factors associated with arterial catheter complications in children.Level of evidence
IV 相似文献18.
Pedro Videira Reis Gabriela Sousa Ana Martins Lopes Ana Vera Costa Alice Santos Fernando José Abelha 《Brazilian Journal of Anesthesiology》2018,68(3):244-253
Background
Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non‐cardiac surgery.Methods
Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann–Whitney, Chi‐square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI).Results
4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high‐risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay.Conclusion
Some factors influenced both surgical intensive care unit and hospital mortality. 相似文献19.
20.
Etienne St-Louis Annie Chabot Hayden Stagg Robert Baird 《Journal of pediatric surgery》2018,53(5):968-972