Potential predictors of the onset of focal intestinal perforation in extremely low birth weight infants based on an analysis of coagulation and fibrinolysis markers at birth: A case-control study based on ten years of experience at a single institution

Purpose: We aimed to investigate potential predictors of focal intestinal perforation (FIP) in extremely low birth weight infants (ELBWIs) among coagulation and fibrinolysis markers at birth.Methods: We reviewed the medical records of FIP patients and their coagulation and fibrinolysis markers at birth between 2010 and 2019, and matched patients according to gestational age. FIP was diagnosed based on macroscopic intestinal perforation with a punched-out lesion without necrosis. Patient characteristics and blood test results, including coagulation and fibrinolysis marker levels, were compared between the groups.Results: Two hundred forty ELBWIs were enrolled in this study (FIP, n = 18; controls, n = 222). In the FIP group, the gestational age at birth was significantly younger (p = 0.023) and the birth weight was significantly lower (p = 0.007) in comparison to the control group. Furthermore, the FIP group showed significantly lower levels of fibrinogen (p = 0.027) and factor XIII (F-XIII) (p = 0.007). The receiver operating characteristics curves for fibrinogen and F-XIII revealed that the 95% confidence intervals of fibrinogen and F-XIII were 0.530–0.783 (p = 0.027), and 0.574–0.822 (p = 0.007), respectively.Conclusions: This is the first report focusing on coagulation and fibrinolysis markers in FIP patients at birth. The fibrinogen and F-XIII values at birth are potential predictors of FIP in ELBWIs.Type of Study: Study of Diagnostic Test (Case Control Study)Level of Evidence: Level IV     

Diaphragmatic eventration resulting from phrenicectomy treated with surgical method; report of a case

The case was a 59-year-old man who has a history of left mediastinal tumor resection with left phrenicectomy. The elevated diaphragm revealed by chest X-ray 7 years after the operation led to diagnosis of diaphragmatic eventration. Since any symptom was seen in the early period, "wait and watch" strategy was done for management. Both the abdominal enlarged feeling and the dyspnea on effort were appeared 10 years after the operation. Under the speculation of these symptoms related to the elevated abdominal organs came up with diaphragmatic eventration, surgical method the plication of the diaphragm was performed. The diaphragm was plicated by interrupted suture as opening the diaphragm to avoid injury the abdominal organs, and reinforced with the Marlex mesh. We used artificial mesh to reinforce the thin diaphragm with exceptation of prevent the postoperative recurrence, because a result of the etiological process of the case was considered as disuse atrophy of diaphragm after phrenicectomy.     

Group A streptococcal brain abscess: a case report and a review of the literature since 1988

Brain abscesses caused by group A Streptococcus (GAS) are rare infectious diseases. In this report we present a case of brain abscess due to GAS infection occurring after milk tooth extraction in a healthy child. A literature review of previously reported cases is presented.     

A comparison of the characteristics and precision of needle driving for right-handed pediatric surgeons between right and left driving using a model of infant laparoscopic diaphragmatic hernia repair

Purpose

We compared the characteristics and precision of right and left needle driving for right-handed pediatric surgeons using a laparoscopic diaphragmatic repair model.

Methods

Eighteen right-handed pediatric surgeons performed three needle driving maneuvers using both hands. We evaluated the required time and conducted an image analysis. The total path length, velocity, and acceleration of the needle driving were also evaluated.

Results

Obtained results show the findings for the required time (s, Rt 310.78 ± 148.93 vs. Lt 308.61 ± 122.53, p = 0.93), sum of needle driving balances (mm, Rt 5.23 ± 2.44 vs. Lt 5.05 ± 3.17, p = 0.83), the gap of the needle driving interval (Rt 1.2 ± 0.93 vs. Lt 2.17 ± 1.67, p = 0.04), total path length (mm, Rt 594.03 ± 205.29 vs. Lt 1641.07 ± 670.68, p < 0.01), and average velocity (mm/s, Rt 1.92 ± 0.54 vs. Lt 5.3 ± 1.39, p < 0.01).

Conclusion

For right-handed pediatric surgeons, left needle driving showed almost same quality of right needle driving as regarding the precision. But left needle driving also showed too fast but not economical movement unfortunately, implying rough and risky forceps manipulation. Non-dominant hand training is necessary to avoid organ injury.

     

Noninvasive quantitative evaluation of the patency of internal mammary artery grafts to the left anterior descending coronary artery by transthoracic Doppler echocardiography

OBJECTIVES: Evaluation of left anterior descending coronary artery (LAD) flow by transthoracic Doppler echocardiography (TTDE) may allow assessment of anastomosis of the internal mammary artery (IMA) grafted to the LAD. This study tested the feasibility of TTDE to evaluate anastomotic stenosis of the IMA grafted to the LAD. METHODS: TTDE was performed in 66 patients (48 men and 18 women, mean age 67 +/- 10 years) with left or right IMA grafts to the LAD. The distal IMA flow at the anastomosis was visualized and the percentage stenosis was evaluated by the continuity equation using the anastomotic and pre-anastomotic flow velocity measured by TTDE as well as by angiography. If the anastomotic flow was not visualized by TTDE, the absence of augmented diastolic flow of the proximal IMA, by using the supraclavicular approach, with diastolic to systolic mean velocity ratio < 0.25 was considered as anastomotic occlusion. RESULTS: Anastomotic flow was visualized and the percentage stenosis was obtained by the continuity equation in 50 patients. In 4 of the remaining 16 patients, the proximal IMA flow by TTDE showed the occlusion pattern. In these 54 (82%) patients, the percentage stenosis by TTDE showed a significant correlation with that by angiography (r2 = 0.86, p < 0.0001). In all the remaining 12 patients with the patent proximal IMA pattern but without visualized anastomotic flow, the patency was confirmed by angiography. CONCLUSIONS: TTDE enables direct visualization and quantitative evaluation of the anastomotic patency in patients with IMA graft to the LAD.     

Thoracoscopic repair of neonatal left diaphragmatic hernia with sac combined with both extralobar pulmonary sequestration and congenital pulmonary airway malformation

Intradiaphragmatic extralobar pulmonary sequestration (IDEPS) is considered to be very rare among extralobar pulmonary sequestration (EPS), and IDEPS combined with congenital diaphragmatic hernia (CDH) with sac is extremely rare. The patient was a neonatal girl. Left-sided CDH with a hernia sac was diagnosed based on computed tomography (CT). Thoracoscopic repair was planned for the 5th day after birth. Left CDH with sac was recognized on the posterolateral side and isolated EPS was recognized on the sac. The hernia sac, including the EPS, was resected, and the diaphragm defect was closed. The resected specimen consisted of fibrous connective tissue and pulmonary sequestration (PS) connected with the sac. It was diagnosed as the hybrid form, with features of both type 2 congenital pulmonary airway malformation (CPAM) and EPS. The postoperative course was uneventful. At 1 year and 9 mo after the operation, no recurrence of herniation or laterality of the diaphragm was recognized.     

A comparison of Tc-99m HMPAO brain SPECT images of young and aged normal individuals

The purpose of this study was to examine the normal distribution patterns of^99mTc-HMPAO (HMPAO) in young and aged normal individuals and to clarify differences between the distribution patterns of the two groups by means of an anatomical standardization technique. The tracer distribution was measured with HMPAO and SPECT in 18 normal subjects; age range 20–81 yrs. SPECT images were globally normalized by averaging whole brain radioactivity counts to 100 counts/voxel. The SPECT images for each subject were transformed into the standard brain anatomy by means of a computerized brain atlas, together with each subject’s CT images. Mean and SD images for young (28.8 ± 6.4 yrs) and aged groups (62.3 ± 10.2 yrs) were then calculated on a voxel-by-voxel basis. Statistically significant differences between young and aged groups were observed in the relative tracer distribution patterns. In the aged group, relative decreases were found in the cortical areas of the frontal and temporal lobes, limbic areas and basal ganglia regions. The results, as visualized changes in tracer distribution patterns with aging, may contribute to more accurate clinical diagnosis.