A novel technique to measure severity of pediatric pectus excavatum using white light scanning.

Background/purpose

Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.

Infants with esophageal atresia and right aortic arch: Characteristics and outcomes from the Midwest Pediatric Surgery Consortium

Purpose

Right sided aortic arch (RAA) is a rare anatomic finding in infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF). In the presence of RAA, significant controversy exists regarding optimal side for thoracotomy in repair of the EA/TEF. The purpose of this study was to characterize the incidence, demographics, surgical approach, and outcomes of patients with RAA and EA/TEF.

Procedural burden experienced by children with cancer during their terminal hospital admission

Background

Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA).

Morphologic changes in the canine urinary tract after ureteral reconstruction with the tunica albuginea (experimental study)*

Objectives: The problem of ureteral reconstruction has not been fully solved, despite dramatic developments in surgical methods. Many attempts to repair a ureteral damage with autologous or homologous organ grafts, or with organic substitutes have not really been satisfactory. Also, attempts to use alloplastic and heteroplastic prostheses made of synthetic materials have been equally disappointing. Experimental studies, particularly in dogs, indicate great regenerative abilities of ureters when appropriate surgical techniques are used. Materials and methods: In our experimental study, suitability of the tunica albuginea for reconstruction of the middle part of the ureter was investigated in 20 dogs. The dogs were divided into two groups according to a type of ureteral damage: partial (a patch graft) or complete (a tube graft). The ureteral damage was 2–3 cm long in 10 dogs and 3–3.5 cm long in the subsequent 10 dogs. Each dog underwent two operations. The first operation involved a fenestrating incision in the ureter, 23.5 cm long, so as to preserve the ureteral continuity, and then the produced injury was repaired with a patch of the tunica albuginea, with the 4 Charr catheter being inserted in the ureter. The second operation involved a complete excision of ureteral segments, 2–3.5 cm long, on the contralateral side. The excised length of the ureter was substituted with a tube graft of the tunica albuginea, also using the 4 Charr catheter. Thus, in 21 cases, a partial damage of the ureteral wall was repaired with a patch graft of the tunica albuginea. In 19 cases, a complete damage of the ureter was repaired with a tube graft of the tunica albuginea. Results: Four dogs died after the tube-graft implantation due to urinary infiltration and/or purulent inflammatory changes in the kidneys. Autopsies were performed in all the dogs after they had been put to sleep. Definitely poor results were obtained in case of the complete reconstruction of the ureteral loss with a tube graft of the tunica albuginea, 3–3.5 cm long. Within the graft area, we observed inflammatory infiltrates of varied intensity, fibrosis, cicatricial strictures or ureteral obstruction. Occasionally, necrotic foci, degenerative changes or hydronephrosis were found. In case of the reconstruction with a shorter tube graft, i.e. 2–3 cm long, similar changes were observed, however, they were less intense. Satisfactory results were obtained following the partial reconstruction of the ureteral loss with a patch graft of the tunica albuginea. In this case, we observed generally normal regeneration not only of the transitional epithelium but the muscular layer and ureteral structure as well, with full patency of the ureter preserved. The findings obtained in our study are compatible with the findings of other authors. Conclusions: (1) The success of reconstructive procedures in the ureters can be achieved if the continuity of the ureter is preserved and the catheter is removed after 14 days. (2) The substitution of a complete ureteral loss with a tube-graft of the tunica albuginea results in necrosis of the graft and restenosis. *Printed in part at the postdoctoral thesis of Tyloch Ferdynand MD: “An experimental study on the use of tunica albuginea for supplying at westage of ureters” (Badania doswiadczalne nad przydatnoscia blony bialawej jadra w operacjach plastycznych moczowodu) University School of Medical Sciences Bydgoszcz 1994.     

HLA class I-restricted responses to vaccinia recognize a broad array of proteins mainly involved in virulence and viral gene regulation

We have analyzed by ex vivo ELISPOT the anti-vaccinia cytotoxic T lymphocyte responses of peripheral blood mononuclear cells from humans vaccinated with Dryvax vaccine. More than 6,000 peptides from 258 putative vaccinia ORFs predicted to bind the common molecules of the HLA A1, A2, A3, A24, B7, and B44 supertypes were screened with peripheral blood mononuclear cells of 31 vaccinees. A total of 48 epitopes derived from 35 different vaccinia antigens were identified, some of which (B8R, D1R, D5R, C10L, C19L, C7L, F12, and O1L) were recognized by multiple donors and contain multiple epitopes recognized in the context of different HLA types. The antigens recognized tend to be >100 residues in length and are expressed predominantly in the early phases of infection, although some late antigens were also recognized. Viral genome regulation and virulence factor were recognized most frequently, whereas few structural proteins were immunogenic. Finally, most epitopes were highly conserved among vaccinia virus Western Reserve, variola major and modified vaccinia Ankara, supporting their potential use in vaccine and diagnostic applications.     

Regulation of adaptive immunity by natural killer cells

Natural killer (NK) cells are well recognized as cytolytic effector cells of the innate immune system. In the past several years, the structure and function of NK cell receptors for the major histocompatibility complex (MHC) class I molecules and other ligands have been the subject of extensive studies. These studies have focused largely on the mechanisms of target cell recognition for lysis. Another aspect of NK cell function that seems to be underappreciated is their role in immune regulation. Since NK cells produce a number of immunologically relevant cytokines, it has been suggested that these cells may modulate the development of the adaptive immune response. But, is it the only mechanism by which NK cells interact with cells involved in the induction of antigen-specific responses? This article reviews some older and more recent studies and attempts to place NK cells in the context of potent immune regulators of T cell responses.     

Early lymphocyte recovery after intensive timed sequential chemotherapy for acute myelogenous leukemia: peripheral oligoclonal expansion of regulatory T cells

Few published studies characterize early lymphocyte recovery after intensive chemotherapy for acute myelogenous leukemia (AML). To test the hypothesis that lymphocyte recovery mirrors ontogeny, we characterized early lymphocyte recovery in 20 consecutive patients undergoing induction timed sequential chemotherapy for newly diagnosed AML. Recovering T lymphocytes were predominantly CD4(+) and included a greatly expanded population of CD3(+)CD4(+)CD25(+)Foxp3(+) T cells. Recovering CD3(+)CD4(+)CD25(+)Foxp3(+) T cells were phenotypically activated regulatory T cells and showed suppressive activity on cytokine production in a mixed lymphocyte reaction. Despite an initial burst of thymopoiesis, most recovering regulatory T cells were peripherally derived. Furthermore, regulatory T cells showed marked oligoclonal skewing, suggesting that their peripheral expansion was antigen-driven. Overall, lymphocyte recovery after chemotherapy differs from ontogeny, specifically identifying a peripherally expanded oligoclonal population of activated regulatory T lymphocytes. These differences suggest a stereotyped immunologic recovery shared by patients with newly diagnosed AML after induction timed sequential chemotherapy. Further insight into this oligoclonal regulatory T-cell population will be fundamental toward developing effective immunomodulatory techniques to improve survival for patients with AML.     

New osteotomies for midface advancement in patients with Crouzon syndrome

In some patients with Crouzon's syndrome the typical midface advancement can produce an excessive nasal protrusion which calls for subsequent rhinoplasty. Proposed modification of classical Le Fort III procedure consists in midface osteotomy and external distraction without median orbital walls and nasal component. Limited surgical approach through vestibular incision and split lower eyelids makes the operation quite easy and less extensive. So far, three adult patients were successfully treated according to described modality.     

Prevention of hypergranulation tissue after gastrostomy tube placement: A randomised controlled trial of hydrocolloid dressings

Hypergranulation tissue formation is a common complication after gastrostomy tube (G‐tube) placement, occurring in 44%–68% of children. Hydrocolloid dressings are often used in the treatment of hypergranulation tissue but have not been studied for the prevention of postoperative hypergranulation tissue. An institutional review board (IRB)‐approved, prospective, randomised study was performed in paediatric patients who underwent G‐tube placement at a single, large children's hospital from January 2011 to November 2016. After placement, patients were randomly assigned to (1) standard postoperative G‐tube care, (2) standard hydrocolloid G‐tube dressing, or (3) silver‐impregnated hydrocolloid G‐tube dressing, and the incidences of postoperative hypergranulation tissue formation, tube dislodgement, infection, and emergency department use were compared. A total of 171 patients were enrolled; 128 patients (75%) had at least 4 months of follow up and were included in the analyses. Eighty‐nine patients (69.5%) developed hypergranulation tissue during the postoperative period, with no significant differences in incidence among the three treatment arms. Of those who developed hypergranulation tissue, 46 (56%) visited the emergency department, compared with 6 of the 39 patients (19%) who did not develop hypergranulation tissue. Hydrocolloid dressings (standard or silver‐impregnated) do not prevent the development of hypergranulation tissue or other complications after G‐tube placement in paediatric patients.     

Shear Wave Elastography in the Evaluation of the Urethral Sphincter Complex after Radical Prostatectomy

Post-prostatectomy pelvic floor muscle rehabilitation has a significant impact on urinary continence recovery. The aim of our study was the evaluation of urethral sphincter complex using shear wave elastography in patients after radical prostatectomy, with and without postsurgical pelvic floor muscle rehabilitation. Thirty-three patients were included in the study. The severity of urinary incontinence after radical prostatectomy was evaluated. Transrectal ultrasound examination was performed in all patients with shear wave elastography to visualize the urethral sphincter complex and estimate its length. Statistical analysis revealed that higher than average urethral sphincter complex stiffness correlates with a smaller number of pads used per day (p < 0,05) and better urine continence based on scales: subjective 0–10 (p < 0.05) and International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) (p < 0.05). The post-prostatectomy pelvic floor muscle rehabilitation group had statistically significant higher stiffness of the urethral sphincter complex compared with the group without rehabilitation (p < 0.05). The study found that shear wave elastography is a valuable method in evaluation of the urethral sphincter complex.