Variations in preoperative decision making for antireflux procedures in pediatric gastroesophageal reflux disease: a survey of pediatric surgeons

Background/Purpose

The purpose of the study was to identify influential factors contributing to the variation with which antireflux procedures (ARPs) are performed at freestanding children's hospitals in the United States.

Methods

We conducted an online survey of pediatric surgeons working in Child Health Corporation of America (CHCA) member hospitals in which we examined decision making for ARPs.

Results

Thirty-six percent (n = 121) of contacted surgeons responded. Eighty percent reported requiring preoperative upper gastrointestinal series before ARPs, and 13% require a pH probe study. Although surgeons ranked their own opinion as the most important in preoperative decision making, parents and referring physicians played significant roles in hypothetical scenarios. In children with negative/equivocal objective studies, more than half of surgeons reported offering ARP when the referring specialist felt that ARP was indicated. Despite equivocal studies, 20% of the surgeons reported offering ARP when the parents were convinced that ARP would help. In a patient with both a positive pH probe and upper gastrointestinal series, 46% of surgeons reported declining ARP if parents were hesitant.

Conclusions

These data suggest that a surgeon's final decision to perform ARP may be just as influenced by nonobjective factors, such as referring physician and parental opinions, as it is by objective studies. Our survey reinforces the need for further examination of specific factors in preoperative decision making for ARPs in the pediatric population.     

Physiological determinants of residual cerebral arterial pulsatility on best medical treatment after TIA or minor stroke

Cerebral arterial pulsatility is strongly associated with cerebral small vessel disease and lacunar stroke yet its dependence on central versus local haemodynamic processes is unclear. In a population-based study of patients on best medical managment, 4–6 weeks after a TIA or non-disabling stroke, arterial stiffness and aortic systolic, diastolic and pulse pressures were measured (Sphygmocor). Middle cerebral artery peak and trough flow velocities and Gosling’s pulsatility index were measured by transcranial ultrasound. In 981 participants, aortic and cerebral pulsatility rose strongly with age in both sexes, but aortic diastolic pressure fell more with age in men whilst cerebral trough velocity fell more in women. There was no significant association between aortic systolic or diastolic blood pressure with cerebral peak or trough flow velocity but aortic pulse pressure explained 37% of the variance in cerebral arterial pulsatility, before adjustment, whilst 49% of the variance was explained by aortic pulse pressure, arterial stiffness, age, gender and cardiovascular risk factors. Furthermore, arterial stiffness partially mediated the relationship between aortic and cerebral pulsatility. Overall, absolute aortic pressures and cerebral blood flow velocity were poorly correlated but aortic and cerebral pulsatility were strongly related, suggesting a key role for transmission of aortic pulsatility to the brain.     

四川省自贡市儿童1型糖尿病发病率研究

为摸清我省儿童１型糖尿病的发病情况,按ＷＨＯ儿童糖尿病多国研究计划方案,我们在自贡市（四区,两县）对１９８９～１９９６年儿童１型糖尿病发病率进行了调查研究。１　材料与方法１．１　病例来源　第一来源：自贡市３０个县区级有１型糖尿病诊断能力的医院。第二来...     

First rotavirus vaccine licensed: Is there really a need?

The first rotavirus vaccine was licensed in the United States on 31 August 1998 for the prevention of severe rotavius diarrhea in children. Despite this landmark in new vaccines, many pediatricians and public health professionals in Europe are uncertain of the need for this vaccine for the routine immunization of infants. In Europe, ample evidence suggests that rotavirus is the most common cause of hospitalizations for severe diarrhea among children, but proper studies documenting the disease burden of rotavirus or th cost-effectiveness of a rotavirus immunization program have only been conducted in the United Kingdom following epidemiologic models used in the United States. All children are infected with rotavirus during their first few years of life, 30-50% of diarrheal hospitalizations among children <5 years are due to this agent, and, by the age of 5 years, between 1 in 40 and 1 in 77 children in Europe and the United States may be hospitalized for rotavirus. The first vaccine is a live, oral preparation combining four different serotypes of rotavirus and administered in three doses with other childhood immunizations. The good efficacy against severe rotavirus diarrhea, the low risk of adverse side effects and the positive costeffectiveness equation have led the two major immunization advisory groups in the U.S. to recommend this vaccine for routine use in American infants. European physicians and policymakers should re-examine the epidemiology and disease burden of rotavirus diarrhea now that an effective method of prevention is at hand. □ Childhood immunization, diseases, rotavirus, vaccination .     

COMPARISON OF CLINICAL CHARACTERISTICS AND HIGH-RISK FACTORS IN AUSTRALIAN ABORIGINAL AND NON-ABORIGINAL NEONATES WITH NECROTISING ENTEROCOLITIS

In a five-year retrospective data analysis, incidence of >stage II necrotising enterocolitis (NEC) was four times higher in aboriginal (18/125) than non-aboriginal (11/306) neonates, all ≤32 weeks' gestation. Stage III NEC occurred more frequently (10/18 vs 3/11) and related mortality was higher (44.4% vs 0%) in aboriginal than non-aboriginal neonates. Risk factors for NEC-prolonged rupture of membranes (50% vs 9.1%, p=0.01), prematurity (median [range] gestational age: 25 (24–28.5) vs 30 [27–33]) weeks, p=0.02), birth weight (<1 kg 13 [72%] vs 2 [18%], p=0.007) and intrauterine growth retardation (50% vs 0%, p=0.01) occurred more frequently in aboriginal neonates. Though feed type and increments per day were similar, aboriginal neonates received higher volume of feeds/kg/day (median [range]: 154 [145–189] vs 106 [103–134] ml, p< 0.05). Condition at delivery and respiratory status before development of NEC were not significantly different.     

Composites based on carbon fibers and liquid crystalline epoxy resins, 1 Monomer synthesis and matrix curing

The synthesis and physical characterization of a novel liquid crystalline epoxy resin, used as a matrix for carbon fiber‐reinforced composites is presented in this paper. The curing reaction was monitored by means of calorimetric and rheological measurements. Calorimetric analysis indicates that the presence of carbon fibers does not affect the reaction rate. A conventional isotropic epoxy resin is used as a model compound in the rheological analysis. According to the patent literature, two different formulations of the model compound were used, characterized by a stoichiometric ratio of epoxy and an epoxy excess, respectively, with respect to the curing agent.     

A pilot study of the association between cariogenic oral bacteria and preterm birth*

Objectives: We examined the associations between preterm birth and low birth weight and maternal caries history, maternal periodontal status, and salivary levels of mutans streptococci and Lactobacilli. Design: This study was a matched case–control study in women during their pregnancy or up to 8 weeks after delivery. Subjects and methods: Thirty‐four women delivering before 37 weeks gestation were recruited along with 73 term controls matched for age and race/ethnicity. Demographic and obstetric information was collected from questionnaires and medical records and oral examinations along with commercial salivary tests were completed within the study groups. Main outcome measures: The main outcome variables were the preterm birth and low birth weight status. The independent variables measured were the salivary levels of Lactobacilli and mutans streptococci and the caries and periodontal status of the subjects. Results: The odds ratio comparing low levels of bacteria in preterm mothers and controls was statistically significant for Lactobacilli (odds ratio (OR) = 3.45, 95% confidence interval (CI) = 1.27 to 10.00) and almost significant for mutans streptococci (OR = 2.63, 95% CI = 0.95 to 8.33). Clinical caries and periodontal disease measures did not differ significantly between groups. Conclusion: Within the limitation of our study, low levels of Lactobacilli in saliva were found to be associated with preterm birth.