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Pediatric Surgery jobs

All Pediatric Surgery jobs for Wed Feb 1 2012

Pediatric Surgery jobs in "Pediatrics Surgeon - North Carolina" - NC

100407-1020 Pediatrics Surgeon - North Carolina NC BC/BE pediatric surgeon for level 1 trauma center Excellent opportunity to get involved in further development of a growing program Ideal candidate

Pediatric Surgery jobs in "OK - Pediatric Surgery opportunity!" - OK

Our client is the leading provider of pediatric care in the region. This hospital operates a busy LifeFlight service, a pediatric emergency center and a busy level 2 trauma center. They are currently

Pediatric Surgery jobs in "Pediatric Surgeon - South Dakota" - SD

101023-1390 Pediatric Surgeon - South Dakota SD Seeking BC/BE pediatric surgeon to join two other pediatric surgeons in well-established, growing practice Group consists of 26 pediatric physicians

Pediatric Surgery jobs in "Pediatric Surgeon - North Dakota" - ND

101023-1382 Pediatric Surgeon - North Dakota ND Seeking BC/BE pediatric surgeon to establish new program H1Bs approved Employed position Candidate will join two other board certified surgeons

Pediatric Surgery jobs in "Pediatric Surgeon - Ohio" - OH

100623-1125 Pediatric Surgeon - Ohio OH Practice at level II pediatric trauma center covering broad range of surgical cases J1/H1B sponsorship available Academics environment 155-bed facility

Pediatric Surgery jobs in "Corpus Christi" - TX

Reference: 20681 Specialty: Pediatric Surgery Location: Texas, Southern Population: 130,000 Practice Type: Employee J1/H1B visa: Yes, H1B -- Only 90 min from

Pediatric Surgery jobs in "Greater Albany" - NY

We have a great opportunity for you to come join a dynamic multi-specialty group in Greater Albany area of NY as a Pediatric Surgeon. Board Certification is preferred but Board Eligible

Pediatric Surgery jobs in "PED/GS 157707" - IA

PEDIATRIC GENERAL SURGERY MIDWESTERN COLLEGE TOWN ACADEMIC APPOINTMENT IMMEDIATE NEED FOR A HIGHLY TRAINED, TEAM ORIENTED PEDIATRIC SURGEON TO JOIN A VERY WELL RESPECTED GROUP OF PEDIATRIC SPECIALISTS

Pediatric Surgery jobs in "BILLINGS AREA" - MT

EXCELLENT OPPORTUNITIES FOR BC/BE PEDIATRIC SURGEONS IN METRO MONTANA Award winning medical center in Montana actively seeking a well-trained, BC/BE compassionate physician for

Pediatric Surgery jobs in "Greenville" - NC

The Brody School of Medicine at East Carolina University (ECU) is seeking a third BC/BE Pediatric Surgeon to join our growing faculty. This is an outstanding opportunity for junior faculty to

Pediatric Surgery jobs in "Fort Wayne" - IN

A very well established practice in the Greater Fort Wayne area of Indiana seeks to recruit a BC/BE Pediatric Surgeon. This opportunity consists of high acuity, complex cases, and

Pediatric Surgery jobs in "Ft. Wayne" - IN

Lutheran Hospital of Indiana, located in Fort Wayne, Indiana, has an excellent opportunity to join one other PD/GS and a nurse practitioner. Call is 1:2 but limited. This position offers a competitive

Pediatric Surgery jobs in "Valparaiso" - IN

Pediatric Surgery jobs in "MD 204844" - OR

MEDICAL DIRECTOR OF PEDIATRIC SURGICAL SERVICES PACIFIC NORTHWEST ACADEMIC APPOINTMENT IMMEDIATE NEED FOR A HIGHLY TRAINED, TEAM ORIENTED PEDIATRIC SURGEON TO LEAD A VERY WELL RESPECTED

Pediatric Surgery jobs in "Baltimore" - MD

Reference: 20475 Specialty: Pediatric Surgery, Director Division of Pediatric Surgery Location: Maryland BALTIMORE, MARYLAND: Director, Division of Pediatric Surgery; Surgeon-in-Chief,

Pediatric Surgery jobs in "Bradenton" - TX

Employed Pediatric Surgeon - Southern Texas South Texas Health System is looking for a Pediatric Surgeon to join the beautiful communities of Edinburg and McAllen, TX. You will have the option of

Pediatric Surgery jobs in "Southern" - MT

Pediatric Search Partners is seeking a BC/BE Pediatric Surgeon for an excellent opportunity in Southern Montana. Established practice of 7 general, laparoscopic, vascular and thoracic surgeons

Pediatric Surgery jobs in "Spokane" - WA

Deaconess Medical Center is seeking an experienced pediatric surgeon needed to join an existing practice. Be part of an Integrated Delivery System with two hospitals and a multispecialty clinic with 200

Pediatric Surgery jobs in "Riyadh" - SA

Head Medical: Paediatric Surgeon required for the Gulf Region Ref Number: ANS0051 Excellent tax free remuneration packages including; Travel

Pediatric Surgery jobs in "East" - NC

Pediatric Surgeon to become part of a three physician team. The candidate should be Board Certified in Pediatric Surgery. Candidates must have excellent clinical skills and a commitment to education and/or

Pediatric Surgery jobs in "" - NH

Practice setting(s) HospitalTrauma level IIReason for coverageRecruiting

Three Texas Children's Hospital and Baylor College of Medicine Physicians ... - MarketWatch (press release)

Three Texas Children's Hospital and Baylor College of Medicine Physicians ...MarketWatch (press release)"To have one of our surgeons with such a prestigious appointment is a testament to our staff and places Texas Children's Department of Surgery as a leading pediatric surgical program nationally." More information about Bisset's, Cassady's and Brandt's ...and more »

Congenital heart surgery in infants: Effects of acute kidney injury on outcomes - The Journal of Thoracic and Cardiovascular Surgery

Congenital heart surgery in infants: Effects of acute kidney injury on outcomesThe Journal of Thoracic and Cardiovascular SurgeryMethods: We retrospectively studied 430 infants (<90 days) who underwent heart surgery for congenital defects. With a pediatric modified version of the Acute Kidney Injury Network classification, we performed statistical analyses to detect factors and ...

Bariatric surgery in adolescents improves obesity-related diseases within ... - Medical Xpress

Science CodexBariatric surgery in adolescents improves obesity-related diseases within ...Medical XpressDoctors at Nationwide Children's Hospital who perform weight loss surgery (bariatric surgery) on adolescents took a look at their patient population in a retrospective study published in the January 2012 print edition of Pediatric Blood & Cancer.Surgery Brings Blood Pressure Benefits For Obese TeensdailyRxall 4 news articles »

Weight-loss surgery improves teens' health, study finds - Columbus Dispatch

Science CodexWeight-loss surgery improves teens' health, study findsColumbus DispatchAn article on the study is published in the journal Pediatric Blood & Cancer. The study was small, like most research that's been published on pediatric weight-loss surgery, and it has other limitations, but it is encouraging, said Dr. Marc Michalsky, ...Bariatric Surgery in Adolescents Improves Obesity-Related Diseases Within ...Newswise (press release)all 6 news articles »

Dr. David Gurd Named Head of Pediatric Spinal Deformity Surgery at Cleveland ... - Becker's Orthopedic & Spine

Dr. David Gurd Named Head of Pediatric Spinal Deformity Surgery at Cleveland ...Becker's Orthopedic & SpineCleveland Clinic has named orthopedic surgeon David Gurd, MD, head of the Pediatric Spinal Deformity Surgery Program with the Center for Pediatric Orthopaedics, according to a Cleveland Clinic news release. Dr. Gurd joined Cleveland Clinic in 2006.

Waning hope, a 6-organ transplant, life anew - Boston.com

Boston.comWaning hope, a 6-organ transplant, life anewBoston.com... director of the hospital's Pediatric Transplant Center. Now, the sassy girl who religiously follows “The Bachelor'' on television and spouts comebacks to her grandmother's every statement is back on her feet. And today, 98 days after the surgery, ...9-Year-Old Girl Heads Home After 6 Organ Transplant At Children's HospitalCBS Localall 29 news articles »

LOMA LINDA: Heart valve repairs possible without surgery - Press-Enterprise

LOMA LINDA: Heart valve repairs possible without surgeryPress-EnterpriseA procedure that corrects a heart condition in children without the need for open-heart surgery has been introduced at Loma Linda University Medical Center, hospital officials said. Pediatric cardiologists at the medical center's International Heart ...and more »

Chiltern Welcomes Gastroenterology, Oncology and Pediatric Therapeutic Experts ... - Sacramento Bee

Chiltern Welcomes Gastroenterology, Oncology and Pediatric Therapeutic Experts ...Sacramento Bee... hematology, pediatrics and malaria R & D at a global level, including major clinical leadership activities in emerging markets in Asia and Africa. Dr. Piccirillo is board-certified in General Surgery from the Hospital Evita, Buenos Aires, ...and more »

Foundation offers free pediatric surgery - Sun.Star

Foundation offers free pediatric surgerySun.StarTHE Philippine Airlines Foundation, headed by an Ilongga, is now accepting applications for a free pediatric charity surgery for patients with burns, correctable orthopedic conditions and cranio-facial defects. Foundation Executive Director Carmen ...

UIHC seeks to purchase $2.2 million surgical robot - The Gazette: Eastern Iowa Breaking News and Headlines (blog)

UIHC seeks to purchase $2.2 million surgical robotThe Gazette: Eastern Iowa Breaking News and Headlines (blog)Dr. John Meehan, a pediatric surgeon with Children's Hospital of Iowa, sits with the Intuitive Surgical da Vinci robotic surgical system he used to perform surgery on Mason Allen, the smallest baby in the world to receive robotic surgery.and more »

Laparoscopic management of müllerian duct cysts in infants.

Laparoscopic management of müllerian duct cysts in infants. J Pediatr Surg. 2011 Sep;46(9):1859-64 Authors: Aminsharifi A, Afsar F, Pakbaz S Abstract PURPOSE: The aim of the study was to demonstrate the feasibility of laparoscopic excision of pelvic müllerian duct cysts (MDCs) in infants. PATIENTS AND METHODS: Three-month-old female and 13-month-old male infants presented with frequent episodes of urinary retention and were found to have large retrovesical cystic pelvic masses. Preoperative workup including abdominopelvic ultrasonography and computed tomographic scan showed bilateral hydroureteronephrosis in the baby girl and a single left anatomical kidney with hydroureteronephrosis in the baby boy, caused by the pressure effect of the mass. The pelvic mass in both infants was excised via transperitoneal laparoscopy via a retrovesical approach. RESULTS: The operative times were 140 minutes in case 1 and 160 minutes in case 2. Excellent laparoscopic visualization and magnification allowed meticulous dissection of the mass from the pelvic organs in both cases. In the female infant, a 5 × 5-cm collection located retrovesically was found 3 weeks after the operation. It contained serosanguinous fluid that was percutaneously aspirated under ultrasound guidance. Histopathologic examination showed the pelvic mass to be an MDC in both patients. Postoperative abdominopelvic sonography at 3 months showed no recurrence of the mass and resolution of hydroureteronephrosis. In the male infant, a urodynamic study 3 months after the operation showed normal bladder dynamics. No voiding difficulty was noted in regular follow-up visits at the time of this writing (7 months postoperatively). CONCLUSION: Laparoscopic excision of pelvic MDCs in infants is technically feasible. It is a demanding and rarely reported procedure that offers excellent surgical exposure. Longer follow-up is necessary to see if this procedure will offer less morbidity than the open techniques. PMID: 21930005 [PubMed - indexed for MEDLINE]

Giant pilomatricoma mimicking a malignant parotid mass.

Giant pilomatricoma mimicking a malignant parotid mass. J Pediatr Surg. 2011 Sep;46(9):1855-8 Authors: Cozzi DA, d'Ambrosio G, Cirigliano E, Negro V, Iacusso C, Totonelli G, Uccini S Abstract Pilomatricomas are benign neoplasms of the hair follicle occurring relatively often in the pediatric population. However, lesions attaining massive proportions are very rarely encountered. We describe such a case presenting in the parotid region and initially misdiagnosed as malignancy. Preoperative biopsy provided accurate diagnosis and allowed definitive surgical excision using a parotid-sparing approach. In children, giant pilomatricoma should be included into the differential diagnosis of noninflammatory masses of the salivary gland region. PMID: 21930004 [PubMed - indexed for MEDLINE]

Lower limb salvage in a 7-month-old infant using free tissue transfer.

Lower limb salvage in a 7-month-old infant using free tissue transfer. J Pediatr Surg. 2011 Sep;46(9):1852-4 Authors: Wechselberger G, Radauer W, Schimpl G, Kholosy H, Ensat F, Edelbauer M, Hladik M Abstract Free flap reconstruction in infants is extremely rare. A seven-and-a-half-month-old male infant sustained an extensive soft tissue defect on his left knee caused by extravasation of an intraosseous arterenol infusion. A free latissimus dorsi flap was successfully performed for soft tissue reconstruction. Indications, advantages, and outcome of the procedure are discussed. PMID: 21930003 [PubMed - indexed for MEDLINE]

Primary renal synovial sarcoma in a 13-year-old boy.

Primary renal synovial sarcoma in a 13-year-old boy. J Pediatr Surg. 2011 Sep;46(9):1849-51 Authors: Scarpato KR, Makari JH, Agaronov M, Balarezo F, Parikh N, Finck CM, Ferrer FA Abstract Primary renal synovial sarcoma is a rare entity with fewer than 40 cases reported in the literature. Its clinical presentation and radiographic features, namely, its often complex cystic appearance, make it difficult to differentiate from other benign or malignant renal lesions. Although there are certain consistent morphological and immunohistochemical features, diagnosis ultimately depends on molecular studies. Prognosis is poor, and there currently exists no defined treatment protocol. Herein, we describe the youngest reported case of primary renal synovial sarcoma in the literature. PMID: 21930002 [PubMed - indexed for MEDLINE]

Gigantic ureteral diverticulum or pelvic cyst?

Gigantic ureteral diverticulum or pelvic cyst? J Pediatr Surg. 2011 Sep;46(9):1846-8 Authors: Slavkovic A, Vacic N, Jovanovic Z, Zivkovic V Abstract Ureteral diverticulum is a rare anomaly, and very few reported cases concerning it can be found in literature. We report a 3.5-year-old boy who presented with urinary tract infection, rare voiding, and straining during voiding. Ultrasonography and magnetic resonance imaging showed a cystic pelvic mass. At surgical intervention, however, a massive ureteral cystic structure communicating both with the ureteropelvic and ureterovesical portion of the ureter was observed. Finding the presence of a smooth muscle layer, the pathologist confirmed this to be a true diverticulum. The fact that fenoterol (which was used for the prevention of preterm labor in the boy's mother) significantly decreases frequency and amplitude of upper urinary tract contractions suggests that fenoterol treatment might have influenced the occurrence of this abnormality. PMID: 21930001 [PubMed - indexed for MEDLINE]

Giant multilocular thymic cyst in an HIV-infected adolescent.

Giant multilocular thymic cyst in an HIV-infected adolescent. J Pediatr Surg. 2011 Sep;46(9):1842-5 Authors: Tamagno M, Bibas BJ, Bernardi F, Lian YC, Bammann RH, Fernandez A, Jatene FB Abstract A girl with vertically acquired HIV infection presented with a 6-month history of dyspnea and chest pain. Computed tomography of the thorax showed a heterogenous mass measuring 13 × 9 × 17 cm located in the anterior mediastinum. Complete surgical resection was accomplished with no complications. The final diagnosis was multilocular thymic cyst, a distinct pathologic entity that is morphologically distinguishable and unrelated to congenital thymic cyst. PMID: 21930000 [PubMed - indexed for MEDLINE]

Free fascia lata repair for a second recurrent congenital diaphragmatic hernia.

Free fascia lata repair for a second recurrent congenital diaphragmatic hernia. J Pediatr Surg. 2011 Sep;46(9):1838-41 Authors: Sugiyama A, Fukumoto K, Fukuzawa H, Watanabe K, Mitsunaga M, Park S, Urushihara N Abstract Repair of recurrent congenital diaphragmatic hernia (CDH) continues to be a difficult problem. Although several materials have been used to repair recurrent CDH, the ideal material has yet to be established. We report the successful use of an autologous free fascia lata graft to repair the diaphragm following a second recurrence of CHD. The fascia lata is one of the strongest fascia in the body and is easy to obtain without extremity functional loss even in children. This procedure is regarded as effective for the repair of recurrent CDH. PMID: 21929999 [PubMed - indexed for MEDLINE]

Hodgkin lymphoma presenting with chest wall involvement: a case series.

Hodgkin lymphoma presenting with chest wall involvement: a case series. J Pediatr Surg. 2011 Sep;46(9):1835-7 Authors: Rich BS, McEvoy MP, Honeyman JN, La Quaglia MP Abstract Chest wall tumors in the pediatric population can have a variety of etiologies, malignancy being the most worrisome. Hodgkin lymphoma (HL) rarely presents as a chest wall mass in the pediatric population. In this report, we describe 3 male pediatric patients, all of whom had chest wall masses present at the initial diagnosis of HL. We also discuss the literature on this topic. We conclude that malignancy and, more specifically, HL should always be considered when evaluating a pediatric patient who presents with a chest wall mass. PMID: 21929998 [PubMed - indexed for MEDLINE]

Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis.

Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis. J Pediatr Surg. 2011 Sep;46(9):1824-34 Authors: Yang C, Zhang H, Pu J, Mei H, Zheng L, Tong Q Abstract PURPOSE: Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH. METHODS: Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. RESULTS: Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = -11.14; 95% confidence interval [CI], -20.61 to -1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications. CONCLUSIONS: Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH. PMID: 21929997 [PubMed - indexed for MEDLINE]

Biochemical and histological investigation of famotidine effect on postischemic reperfusion injury in the rat ovary.

Biochemical and histological investigation of famotidine effect on postischemic reperfusion injury in the rat ovary. J Pediatr Surg. 2011 Sep;46(9):1817-23 Authors: Kurt A, Isaoglu U, Yilmaz M, Calik M, Polat B, Hakan H, Ingec M, Suleyman H Abstract BACKGROUND/PURPOSE: In this study, an investigation was performed on the ovarian tissue of rats subjected to ischemia-reperfusion for the effect of famotidine on certain parameters of oxidation-antioxidation, cell DNA damage, and histological appearance. METHODS: The effects of famotidine on certain parameters of oxidation-antioxidation (total glutathione [tGSH], superoxide dismutase [SOD], malondialdehyde) and cellular DNA injury in the ovarian tissue of rats subjected to ischemia-reperfusion were investigated and underwent histological examination. RESULTS: The results show levels of 5.2 ± 0.6 nmol/g protein for tGSH, 8.3 ± 0.8 U/g for SOD activity, and 7.7 ± 0.9 μmol/g protein for malondialdehyde (P < .0001 when compared with controls) in ovarian tissue subjected to ischemia-reperfusion following famotidine treatment. The tGSH levels in control rats and in a healthy animal group were, respectively, 1.76 ± 0.7 and 5.5 ± 0.3 nmol/g protein (P < .0001). The SOD activity was 3.2 ± 0.9 U/g in control and 9.2 ± 0.6 U/g in healthy animal tissues. The differences between the values in the treatment and the control group, and between the healthy animal group and the control group were both highly significant (P < .0001). It was also observed that famotidine prevented, to a significant extent, an increase in the level of 8-hydroxy-2-deoxyguanine/guanine, a DNA damage product, as compared with the control group. CONCLUSION: These biochemical and histological results show that famotidine protects the ovarian tissue from ischemia-reperfusion injury. PMID: 21929996 [PubMed - indexed for MEDLINE]

Laparoscopic repair of pediatric inguinal hernia--is vascularity of the testis at risk? A study of 125 testes.

Laparoscopic repair of pediatric inguinal hernia--is vascularity of the testis at risk? A study of 125 testes. J Pediatr Surg. 2011 Sep;46(9):1813-6 Authors: Parelkar SV, Oak S, Bachani MK, Sanghvi B, Prakash A, Patil R, Sahoo S, Patel J Abstract AIM: The aim of this study was to study the effects of laparoscopic inguinal hernia repair on testicular perfusion and size. MATERIALS AND METHODS: A prospective study concerning laparoscopic inguinal hernia repair was performed for an 18-month period to evaluate testicular perfusion and size in the preoperative, early postoperative (within 48 hours of surgery), and late postoperative periods (6 months after surgery) using Doppler ultrasound (DUS) (both duplex and power Doppler mode). Laparoscopic closure of the deep inguinal ring was accomplished with a purse string suture (Nylon 3-0) using standard 3-port technique. The testis units were divided in 2 groups: group 1 comprising testis units in which a resistive index (RI) could be calculated and group 2 with instances in which an RI could not be calculated but showed blood flow consistently on DUS. RESULTS: A total of 112 boys underwent laparoscopic inguinal hernia repair with 100 available for complete follow-up and data analysis. One hundred twenty-five inguinal (25 bilateral) hernia repairs were performed. Group 1 had 80 testis units. There was no significant difference in values of RI between preoperative, early postoperative, and late postoperative periods. Group 2 had 45 testis units. Resistive index could not be calculated. Seventy-five percent showed only systolic blood flow on spectral analysis; hence, RI, 1; and the rest showed the presence of blood flow on power Doppler scan. All testis units consistently showed blood flow in the early and late postoperative period. No testicular atrophy was found at 6-month follow-up examination on DUS. CONCLUSION: Laparoscopic repair of inguinal hernia in children does not affect testicular perfusion or growth. PMID: 21929995 [PubMed - indexed for MEDLINE]

Gubernacular development in the mouse is similar to the rat and suggests that the processus vaginalis is derived from the urogenital ridge and is different from the parietal peritoneum.

Gubernacular development in the mouse is similar to the rat and suggests that the processus vaginalis is derived from the urogenital ridge and is different from the parietal peritoneum. J Pediatr Surg. 2011 Sep;46(9):1804-12 Authors: Buraundi S, Balic A, Farmer PJ, Southwell BR, Hutson JM Abstract BACKGROUND: Gubernacular development and testicular descent have been studied most extensively in rat models, but new transgenic mouse models require a deep understanding of normal mouse development so that results can be extrapolated to the human. We aimed to compare gubernacular anatomy during development in the mouse with that of the rat. METHODS: Time-mated mice (C57BL/6) and Sprague-Dawley rats were used to collect male fetuses at embryonic (E) days E13, E14, E15, E17, E18, and E19 and neonates at postnatal (P) days P0 and P2. Fetuses and newborn were processed for serial sections (sagittal, transverse, and coronal) and stained with hematoxylin and eosin, muscle markers (embryonic myosin, desmin), a neuronal marker (Tuj1), a mitotic marker (Ki67), and keratin marker to label epithelium. RESULTS: Early development of cremaster in the mouse was related to transversus abdominis muscle, but not internal oblique muscle (as in rats), and forms a monolaminar cremaster layer. There is close association between the regressing inguinal mammary bud and the gubernaculum in the mouse at E13. The peritoneal surface of the processus vaginalis (PV) covering the gubernaculum and epididymis was morphologically distinct from the remaining parietal peritoneum throughout development. CONCLUSIONS: Gubernacular development in mouse is similar to that in the rat except for certain structures, such as cremaster muscle. The PV seems to be derived from the surface of the urogenital ridge, separate from the remaining parietal peritoneum. This study suggests that the PV has evolved to aid testicular descent in this species, rather than a nondescript diverticulum of parietal peritoneum. PMID: 21929994 [PubMed - indexed for MEDLINE]

Management of cryptorchidism and gastroschisis.

Management of cryptorchidism and gastroschisis. J Pediatr Surg. 2011 Sep;46(9):1798-803 Authors: Hill SJ, Durham MM Abstract BACKGROUND: Cryptorchidism is commonly associated with gastroschisis. Management of the undescended testes varies with regard to technique and timing of orchidopexy. To evaluate the appropriate timing of and procedure for orchidopexy in patients with gastroschisis, we reviewed our experience. METHODS: Male neonates admitted between January 1999 and September 2010 with gastroschisis were reviewed. This retrospective study was conducted after institutional review board approval. Testis location at birth was recorded, and outcomes for those with undescended testes were analyzed. RESULTS: Sixty-two males with gastroschisis were identified, and 24 had cryptorchidism (38.7%) affecting 31 testes. All babies had an initial watch-and-wait approach without any attempt at orchidopexy during gastroschisis closure. Those with extraabdominal testes at birth had the testicle repositioned in the abdomen before gastroschisis closure. Mean follow-up was 27.3 months. At follow-up, 54.8% of the testes relocated without intervention and 38.7% required orchidopexy. Laparoscopy was used in 5 patients to perform the orchidopexy. A total of 3 testes required orchiectomy secondary to atrophy, one of which had previously undergone an orchidopexy. Two of the orchiectomies were performed laparoscopically. CONCLUSION: The watch-and-wait approach for cryptorchidism in gastroschisis is safe and appropriate, with a high rate of spontaneous migration during the first year of life and greater than 90% testes viable at follow-up. Laparoscopy is a safe and feasible option for management of undescended testes that remain intraabdominal at follow-up. PMID: 21929993 [PubMed - indexed for MEDLINE]

Robotic-assisted anorectal pull-through for anorectal malformations.

Robotic-assisted anorectal pull-through for anorectal malformations. J Pediatr Surg. 2011 Sep;46(9):1794-7 Authors: Albassam A, Gado A, Mallick MS, Alnaami M, Al-Shenawy W Abstract BACKGROUND/PURPOSE: Many reports have addressed the feasibility and safety of using robotic surgery in children. To our knowledge, no published report has described the use of a surgical robot in the repair of anorectal malformations (ARMs). METHODS: Included children underwent robotic-assisted repair of ARMs with rectourethral fistula between April 2006 and March 2010 at King Khalid University Hospital, Riyadh, Saudi Arabia, using the da Vinci Surgical System. Their medical records were reviewed with respect to demographic data, associated anomalies, techniques and operative procedures, complications, outcomes, and follow-up. RESULTS: Five male infants (mean age, 6.6 months) underwent robotic-assisted repair of ARMs with rectourethral fistula using the Georgeson technique. The fistulae were divided and ligated in 4 patients and was left open in 1. All procedures were successfully completed without conversion to an open technique. One patient developed left-sided epididymo-orchitis postoperatively. All the patients had their colostomy closed. The follow-up ranged from 6 to 36 months. Fecal continence was difficult to assess in 2 patients. Two patients have voluntary bowel movements without soiling. One infant has fecal soiling and is on a laxative/enema for constipation. CONCLUSIONS: Robotically assisted repair of ARMs with rectourethral fistula is feasible and safe. It offers a good alternative to the criterion standard, posterior sagittal anorectoplasty (PSARP), for repair of ARMs with rectourethral fistula. More patients and a longer follow-up period are needed for further evaluation of this novel approach. PMID: 21929992 [PubMed - indexed for MEDLINE]

Colorectal anomalies in patients with classic bladder exstrophy.

Colorectal anomalies in patients with classic bladder exstrophy. J Pediatr Surg. 2011 Sep;46(9):1790-3 Authors: Stec AA, Baradaran N, Tran C, Gearhart JP Abstract AIM: This study aims to determine the proportion and type of colorectal anomalies that occur in children born with classic bladder exstrophy (CBE). METHODS: All patients in a database of 1044 patients with the bladder exstrophy-epispadias-cloacal exstrophy complex were reviewed. Those with CBE had their complete medical records reviewed. Children noted to have gastrointestinal malformations were identified, and all aspects of their history were extracted. RESULTS: A total of 676 patients were identified with CBE, of whom 12 patients were identified who had a concomitant colorectal anomaly. In this population, the proportion of colorectal anomalies is 1.8%. The most common gastrointestinal anomaly was imperforate anus in 8 patients. Two patients had severe rectal stenosis requiring serial dilations, and 2 patients were born with congenital rectal prolapse. CONCLUSIONS: Excluding all variants and cloacal patients with exstrophy, isolated colorectal anomalies occur at a rate of 1.8% in children born with CBE, a 72-fold increase compared with the general population. Although uncommon in this rare birth defect, the morbidity is significant and warrants prompt evaluation and treatment of both the genitourinary and colorectal anomalies. PMID: 21929991 [PubMed - indexed for MEDLINE]

Vascular anomalies in 5,621 patients: guidelines for referral.

Vascular anomalies in 5,621 patients: guidelines for referral. J Pediatr Surg. 2011 Sep;46(9):1784-9 Authors: Greene AK, Liu AS, Mulliken JB, Chalache K, Fishman SJ Abstract OBJECTIVE: To characterize referrals to a vascular anomalies center to determine which lesions should be treated by specialists. STUDY DESIGN: Patients sent to our center between 1999 and 2010 were reviewed. Type of anomaly, anatomical location, sex, accuracy of referral diagnosis, and the geographic origin of the referred patient were analyzed. RESULTS: Five thousand six hundred twenty-one patients had a confirmed diagnosis: 35.2% had a tumor and 64.8% had a malformation. Types of tumors included infantile hemangioma (85.9%), hemangioendothelioma (7.8%), congenital hemangioma (5.4%), and pyogenic granuloma (0.9%). Malformations consisted of venous (36.8%), lymphatic (28.3%), arteriovenous (14.3%), capillary (11.0%), and combined slow-flow (9.6%) lesions. Forty-three percent of the cohort resided outside of our region; these patients were most likely to have a malformation (51.9%) or rare vascular tumor (74.5%). Only 53.0% of patients had a correct referral diagnosis: 77.8% for infantile hemangioma and pyogenic granuloma, compared with 45.6% and 34.7% for malformations and rare tumors, respectively. CONCLUSIONS: Two thirds of lesions sent to a vascular anomalies center are vascular malformations. Malformations and rare tumors are most likely to be misdiagnosed and referred from outside of the region. Vascular malformations (except for simple capillary lesions), rare tumors, and problematic infantile hemangiomas should be managed by specialists in this field. PMID: 21929990 [PubMed - indexed for MEDLINE]

Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges.

Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges. J Pediatr Surg. 2011 Sep;46(9):1777-83 Authors: Goldberg J, McClaine RJ, Cook B, Garcia VF, Brown RL, Crone K, Falcone RA Abstract PURPOSE: In children, mild traumatic brain injuries (TBI) account for 70% to 90% of head injuries. Without clear guidelines, many of these children may be exposed to excess radiation owing to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in reducing hospital charges and repeated imaging of pediatric patients. METHODS: Charts of all children who had at least one head computed tomography and were admitted to our level 1 trauma center with a blunt TBI and Glasgow Coma Scale of 13 to 15 were retrospectively reviewed. Patients were divided into 2 groups relative to the implementation of a TBI management guideline. RESULTS: A total of 742 patients were included, 389 preguideline and 353 postguideline. Implementation of the guideline was associated with reductions in the average number of head computed tomographies performed (1.6 vs 1.3, P = .006), length of stay (2.3 vs 1.7 days, P < .0001), and overall hospital charges ($21,760 vs $13,980, P = .006). No children were readmitted for missed injuries. CONCLUSIONS: Implementation of a simple guideline for the care of children with mild TBI can have significant impact on charges and length of stay while simultaneously reducing radiation exposure. Widespread implementation of such guidelines will improve efficiency without sacrificing quality of care in the management of mild TBI in the pediatric population. PMID: 21929989 [PubMed - indexed for MEDLINE]

Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review.

Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review. J Pediatr Surg. 2011 Sep;46(9):1771-6 Authors: Mohseni S, Talving P, Branco BC, Chan LS, Lustenberger T, Inaba K, Bass M, Demetriades D Abstract BACKGROUND: The objective of this study was to characterize the incidence, risk factors, and patterns of cervical spine injury (CSI) in different pediatric developmental ages. METHODS: A retrospective review of the National Trauma Data Bank was conducted for the period of January 2002 through December 2006 to identify pediatric patients admitted following blunt trauma. Patients were stratified into 4 developmental age groups: infants/toddlers (age 0-3 years), preschool/young children (age 4-9 years), preadolescents (age 10-13 years), and adolescents (age 14-17 years). Patients with a CSI were identified by the International Classification of Diseases, Ninth Revision codes. Demographics, clinical injury data, level of CSI, and outcomes were abstracted and analyzed. RESULTS: A total of 240,647 patients met the inclusion criteria. Of these, 1.3% (n = 3,035) sustained a CSI. The incidence of CSI in the stratified age groups was 0.4% in infants/toddlers, 0.4% in preschool/young children, 0.8% in preadolescents, and 2.6% in adolescents. The level of CSI (upper [C1-C4] vs lower [C5-C7]) according to the age groups was as follows: infants and toddlers, 70% vs 25%; preschool/young children, 74% vs 17%; preadolescents, 52% vs 37%; and adolescents, 40% vs 45%, respectively. The adjusted risk for CSI increased 2-fold in preadolescents and 5-fold in adolescents. CONCLUSION: The incidence of pediatric CSI increases in a stepwise fashion after 9 years of age. We noted an increase in lower CSI and a decrease in upper CSI after the age of 9 years. The incidence of upper CSI compared with lower CSI was higher in preadolescents (52% vs 37%) and almost equal in adolescents (40% vs 45%). PMID: 21929988 [PubMed - indexed for MEDLINE]

Development of a pediatric Level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation.

Development of a pediatric Level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation. J Pediatr Surg. 2011 Sep;46(9):1764-70 Authors: Notrica DM, Brown D, Garcia-Filion P Abstract BACKGROUND: Despite research correlating survival or better outcomes with pediatric trauma care at pediatric hospitals, almost 90% of injured children are treated at predominantly adult facilities. Although the reasons are likely multifactorial, attitudes of pediatric hospital staff may play a role in the development of a pediatric trauma center. METHODS: A survey of hospital staff was conducted to measure the attitude of staff on the effects of becoming a pediatric trauma center. The instrument was administered before and 6 months after trauma center designation. Major topic areas were staffing, organizational impact, education, safety, and financial issues. Attitudes were measured by Likert scale and compared between phases. RESULTS: A total of 404 staff participated before and 447 staff participated 6 months after designation. Nonphysician respondents dominated the survey respondent pool. Areas of concern included staffing, education, patient volume and acuity, and order and flow. Positive attitudes were seen in areas including quality of care, skill development, and recruitment. Overall improvement in attitudes was observed in several areas. CONCLUSIONS: Hospital staff consistently agreed on the positive impact on quality of care and overall employee benefit. Concerns were mostly diminished at follow-up. A persistent concern of adequate staffing mismatched actual needs. The findings of this study indicate that the staff perceive many measurable benefits to pediatric trauma center development, which have never previously been described. PMID: 21929987 [PubMed - indexed for MEDLINE]

Effectiveness of Biobrane for treatment of partial-thickness burns in children.

Effectiveness of Biobrane for treatment of partial-thickness burns in children. J Pediatr Surg. 2011 Sep;46(9):1759-63 Authors: Lesher AP, Curry RH, Evans J, Smith VA, Fitzgerald MT, Cina RA, Streck CJ, Hebra AV Abstract PURPOSE: Wound care for partial-thickness burns should alleviate pain, decrease hospital length of stay, and be readily applied to a variety of wounds. The effectiveness of Biobrane (UDL Laboratories, Rockford, IL) is compared with that of Beta Glucan Collagen (BGC; Brennan Medical, St. Paul, MN) in a retrospective cohort study. METHODS: A retrospective chart review of all children treated at a tertiary care pediatric hospital between 2003 and 2009 identified patients with partial-thickness burns treated with Biobrane. These patients were compared with historical controls treated with BGC. RESULTS: A total of 235 children between the ages of 4 weeks and 18 years with an average of 6.0% body surface area partial-thickness burns were treated with Biobrane. In a multivariate statistical analysis, patients treated with Biobrane healed significantly faster than those treated with BGC (Biobrane vs BGC: median, 9 vs 13 days; P = .019; hazard ratio, 1.68). In addition, patients who required inpatient treatment trended toward having shorter length of hospital stay in the Biobrane group (2.6 vs 4.1 days, P = .079). CONCLUSION: Partial-thickness burn care consists of early debridement and application of a burn wound dressing. Biobrane dressings result in faster healing compared with BGC and may decrease hospital length of stay for patients requiring inpatient admission. PMID: 21929986 [PubMed - indexed for MEDLINE]

Respiratory failure after pediatric scald injury.

Respiratory failure after pediatric scald injury. J Pediatr Surg. 2011 Sep;46(9):1753-8 Authors: Rocourt DV, Hall M, Kenney BD, Fabia R, Groner JI, Besner GE Abstract OBJECTIVE: A subset of children with scald burns develops respiratory failure despite no direct injury to the lungs. We examined these patients in an effort to elucidate the etiology of the respiratory failure. METHODS: The charts of pediatric patients with greater than 10% total body surface area (TBSA) scald burns were reviewed. Age, weight, burn distribution, percentage of TBSA burned, resuscitation volumes, Injury Severity Score, evidence of abuse, length of stay, days in the intensive care unit, and time and duration of intubation were recorded. RESULTS: Two hundred thirty-two patients met our inclusion criteria. Of these, 220 patients did not require intubation, and 12 of the patients did. No patient older than 3 years or with burns less than 15% TBSA required intubation. Fluid over resuscitation was not directly associated with respiratory failure requiring mechanical ventilation. CONCLUSIONS: We report the largest published series of patients with scald burns requiring mechanical ventilation in the absence of direct airway injury. Five percent of pediatric patients required mechanical ventilation after scald injury. We believe that a combination of causes including fluid resuscitation, young patient age, small patient size, and possible activation of the systemic inflammatory immune response may be responsible for the respiratory failure. PMID: 21929985 [PubMed - indexed for MEDLINE]

Mercaptoethylguanidine attenuates caustic esophageal injury in rats: a role for scavenging of peroxynitrite.

Mercaptoethylguanidine attenuates caustic esophageal injury in rats: a role for scavenging of peroxynitrite. J Pediatr Surg. 2011 Sep;46(9):1746-52 Authors: Guven A, Uysal B, Caliskan B, Oztas E, Ozturk H, Korkmaz A Abstract INTRODUCTION: After ingestion of caustic material, tissue damage is caused by reactive oxygen species and reactive nitrogen species such as peroxynitrite. Mercaptoethylguanidine (MEG) is a well-known scavenger of peroxynitrite. This study was designed to determine whether MEG has a beneficial effect on caustic esophageal injury. MATERIALS AND METHODS: Forty-five rats were allocated into 3 groups: sham-operated, untreated, and treated groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The rats were left untreated or treated with 10 mg/kg per day MEG intraperitoneally for 5 days. All rats were killed at 28 days. Efficacy of the treatment was assessed both histopathologically and biochemically. RESULTS: Of 15 rats, 6 (40%) died in the untreated group, and only 1 (7%) rat died in the treated group. The stenosis index (SI) and the histopathologic damage score were significantly lower in the MEG treatment group than the untreated group, which showed a correlation with tissue hydroxyproline level. In the untreated group, tissue oxidative stress parameters (malondialdehyde and protein carbonyl content) were significantly higher; and antioxidant enzyme activities (superoxide dismutase and glutathione peroxidase) were significantly lower. Administration of MEG ameliorated oxidative stress parameters and antioxidant enzyme activities. Urinary nitrate and nitrite levels increased in the treated and untreated groups in the first 3 days, suggesting increased nitrosative stress; but at the fourth day, nitrate and nitrite level reached control values in the treated group. CONCLUSION: Peroxynitrites play an important role in the healing process of caustic esophagitis. As a peroxynitrites scavenger, MEG potentially might be a useful adjuvant agent in the treatment of esophageal caustic burn by modulating the antioxidant defense mechanism. PMID: 21929984 [PubMed - indexed for MEDLINE]

Features and management of esophageal corrosive lesions in children in Sierra Leone: lessons learned from 175 consecutive patients.

Features and management of esophageal corrosive lesions in children in Sierra Leone: lessons learned from 175 consecutive patients. J Pediatr Surg. 2011 Sep;46(9):1739-45 Authors: Contini S, Scarpignato C, Rossi A, Strada G Abstract PURPOSE: This study aims to highlight the peculiar presentation and management of children's corrosive ingestions in developing countries associated with malnutrition, delay in management, lack of technology, and sporadic follow-up. METHODS: An observational study was carried out since 2005 on all children (<15 years old) admitted for caustic soda ingestion to the "Emergency" Surgical Center in Sierra Leone, either in the acute postinjury phase or for dilatation of esophageal strictures. Complications, mortality, stricture recurrence, and ability to swallow were the main outcome measures. Improvement in nutritional status (ie, gaining weight) and sustained esophageal patency were both considered reference points to successful treatment. RESULTS: In 4 years (2005-2009), 175 children were admitted, 53.7% at more than 1 month after ingestion. Dilatations were carried out in 77.7%, and a gastrostomy was placed in 64%. Perforations and death rate were 4.5% and 2.8%, respectively. Sixty-two patients (35.4%) required more than 7 dilatations, whereas 15 (8.5%) were unable to maintain a satisfactory luminal diameter. Follow-up (range, 1-36 months; median, 7 months) was possible in 52.7%. Long-term success according to the aforementioned criteria was observed in only 16%. CONCLUSIONS: Delayed presentations and complex strictures with repeated postdilatation recurrence are characteristics of children's corrosive ingestion in developing countries. Malnutrition is common, and gastrostomy is frequently compulsory. Esophageal patency with improvement in nutritional state is achieved only in a small percentage of patients. PMID: 21929983 [PubMed - indexed for MEDLINE]

Incidence of acute and chronic graft-versus-host disease and donor T-cell chimerism after small bowel or combined organ transplantation.

Incidence of acute and chronic graft-versus-host disease and donor T-cell chimerism after small bowel or combined organ transplantation. J Pediatr Surg. 2011 Sep;46(9):1732-8 Authors: Shin CR, Nathan J, Alonso M, Yazigi N, Kocoshis S, Tiao G, Davies SM Abstract PURPOSE: Graft-versus-host disease (GVHD) after organ transplantation is a rare but life-threatening complication with very high mortality. METHODS: A retrospective review was performed of all patients undergoing small bowel or combined organ transplantation at a single institution during 2003 to 2009. Patients with donor T-cell chimerism were analyzed in detail for development of GVHD. RESULTS: Thirty-two patients were included in the study. Of 32 patients, 11 (34%) had donor T-cell chimerism (range, 0%-53%) studies performed; 7 (64%) of those 11 patients demonstrated clinical features of GVHD. All patients who demonstrated GVHD had detectable donor T-cell chimerism. All patients with GVHD presented with skin involvement. Graft-versus-host disease responded to increased immune suppression therapy. Mortality was 43% (3/7) among patients with GVHD and was caused by multiorgan failure and sepsis in all cases. CONCLUSION: Acute and chronic GVHD were observed frequently after combined solid organ transplantation and were associated with significant mortality and morbidity. Alloreactive donor T cells cotransplanted with the organ likely play a role in the pathophysiology because levels of donor-derived T-cell chimerism correlated with the clinical course of GVHD. PMID: 21929982 [PubMed - indexed for MEDLINE]

C-reactive protein in the diagnosis of postoperative infection in pediatric patients: a prospective observational study of 103 patients.

C-reactive protein in the diagnosis of postoperative infection in pediatric patients: a prospective observational study of 103 patients. J Pediatr Surg. 2011 Sep;46(9):1726-31 Authors: Baez YL, Rodriguez MA, De Vicente Sánchez JC, Carretero PS, Martínez DA, Ferrer AP, Villoria CM, Rodríguez FG Abstract BACKGROUND: Surgical stress elicits a systemic inflammatory response syndrome that contributes to the development of septic complications. C-reactive protein (CRP) is an acute phase protein released in inflammatory states. To analyze the usefulness of CRP as a marker of infection in surgical pediatric patients, we analyzed its kinetics in these patients in comparison with usual markers, such temperature, leukocytes, or fibrinogen. METHODS: One hundred three pediatric patients undergoing major surgery were enrolled consecutively in this observational study. C-reactive protein, leukocytes, neutrophils, platelets, fibrinogen, glycemia, and temperature were determined daily after surgery. Patients were classified as infected or not infected. Sensitivity, specificity, positive predictive value, negative predictive value, efficiency, precocity, positive likelihood ratio, and number of subjects to be treated were calculated. RESULTS: Peak in CRP was detected at 48 ± 24 hours. C-reactive protein was higher in the infected group from the first day, with significant differences between groups from the second day. Best cutoff for detecting infection was increases in CRP of 11 mg/dL in 48 hours, with a sensitivity of 87%, specificity of 89%, precocity of 1.7 days (0.82-2.54), number of subjects to be treated of 1.7 (1.4-2.6), and positive likelihood ratio of 7.9. Application of other markers alone or in combination did not surpass the sensitivity, specificity, or precocity for increases in CRP of 11 mg/dL in 48 hours. CONCLUSIONS: Increases of CRP constitute an easy and cheap prognostic alert system and may be used to establish strategies aimed to detect infection in surgical pediatric patients. PMID: 21929981 [PubMed - indexed for MEDLINE]

Assessment of recurrent abdominal symptoms after Ladd procedure: clinical and radiographic correlation.

Assessment of recurrent abdominal symptoms after Ladd procedure: clinical and radiographic correlation. J Pediatr Surg. 2011 Sep;46(9):1720-5 Authors: Biko DM, Anupindi SA, Hanhan SB, Blinman T, Markowitz RI Abstract BACKGROUND/PURPOSE: Obstructive symptoms in a patient post-Ladd procedure raise the question of recurrent volvulus. Our objective is to determine the incidence and the radiographical evaluation of recurrent volvulus and abdominal complications after a Ladd procedure. METHODS: One hundred ninety-five patients who underwent a Ladd procedure for malrotation for 10 years were retrieved from a database. Forty-eight patients were excluded (false-positive studies, heterotaxy, diaphragmatic hernia, abdominal wall defects). Of the remaining 147, 38 patients presented with abdominal symptoms. Surgical records and imaging were reviewed. RESULTS: Of 38 patients, 33 had imaging studies including abdominal radiographs (AXR) and/or upper gastrointestinal examinations. Of these 33 patients, 17 had normal or expected imaging findings on AXR and/or upper gastrointestinal. Of the 11 patients who had surgery, 8 had an AXR. Of these, only a single patient had a normal AXR. The most common post-Ladd complication found at reoperation was small bowel obstruction secondary to adhesions (5.4%). One patient (0.7%) had midgut volvulus. CONCLUSION: Although recurrent volvulus is a feared postoperative Ladd complication, it rarely occurs. Adhesive small bowel obstruction is more common, and an AXR with clinical findings is sufficient for diagnosis. PMID: 21929980 [PubMed - indexed for MEDLINE]

A more efficient method to generate null mutants using Hprt-Cre with floxed alleles.

A more efficient method to generate null mutants using Hprt-Cre with floxed alleles. J Pediatr Surg. 2011 Sep;46(9):1711-9 Authors: Nichol PF, Botham R, Saijoh Y, Reeder AL, Zaremba KM Abstract PURPOSE: The generation of nonviable homozygous null mouse embryos from heterozygote null/+ breedings can be highly resource consuming, with only 25% of the embryos in the litter being null mutants. We hypothesized that (1) we could double the number of homozygous null mouse embryos in a litter without reducing litter size using Hypoxanthine-guanine phosphoribosyltransferase-Cre (Hprt)-Cre (which is active in the female germ line at the time of fertilization), and (2) these homozygous null mutants would be identical to mutants generated through traditional null/+ breedings. METHODS: To test this hypothesis, we used a conditional allele Fgfr2IIIb(flox). This allele when recombined is identical to the Fgfr2IIIb(null) allele. An F1 generation of Fgfr2IIIb(rec/+); Hprt(Cre/+) females was created by mating Fgfr2IIIb(+/+); Hprt(cre)(/cre) females to a Fgfr2IIIb(flox/flox) male. The F1 females were then mated to a Fgfr2IIIb(flox/flox) male. F2 embryos were genotyped, and the morphology and histology of the lungs, intestine, limbs, and brain were analyzed. RESULTS: The Hprt-Cre mating strategy results in 51% of pups being genotypic homozygous null embryos (85/166) vs 23% for the standard null/+ approach (38/167). These embryos did not express the Fgfr2IIIb transcript and were phenotypically identical to null embryos generated through standard null/+ breedings. CONCLUSIONS: The Hprt-Cre mating strategy increases the number of homozygous mutant embryos in a litter without decreasing litter size. Embryos generated through this approach are phenotypically identical to those from standard heterozygous breedings. We recommend this approach to investigators using a model system that relies on the generation of homozygous null embryos. PMID: 21929979 [PubMed - indexed for MEDLINE]

Partial splenectomy but not total splenectomy preserves immunoglobulin M memory B cells in mice.

Partial splenectomy but not total splenectomy preserves immunoglobulin M memory B cells in mice. J Pediatr Surg. 2011 Sep;46(9):1706-10 Authors: Tracy ET, Haas KM, Gentry T, Danko M, Roberts JL, Kurtzberg J, Rice HE Abstract PURPOSE: The mechanism by which partial splenectomy preserves splenic immune function is unknown. Immunoglobulin (Ig) M memory B cells are critical for the immune response against encapsulated bacteria and are reduced in asplenic patients, although it is unknown whether partial splenectomy can preserve memory B cells. We hypothesized that IgM memory B cells (murine B-1a cells) would be preserved after partial splenectomy but not after total splenectomy in mice. METHODS: We performed total splenectomy (n = 17), partial splenectomy (n = 10), or sham laparotomy (n = 16) on C57BL/6J mice. Mice were killed on postoperative day 10 or 30, and peritoneal washings were analyzed by multiparameter flow cytometry for expression of murine B-1a cells (IgM(pos)IgD(dull)CD5(pos)B220(dull)). RESULTS: We found that B-1a cells were significantly reduced after both total and partial splenectomies compared with sham laparotomy in the early postoperative period, although normal levels of B-1a cells returned by postoperative day 30 in mice undergoing partial splenectomy but not total splenectomy. CONCLUSION: Partial splenectomy but not total splenectomy preserves the B-1a B-cell population in mice within 30 days after surgery. Maintenance of these critical B cells may contribute to the preservation of a splenic-dependent immune response after partial splenectomy. PMID: 21929978 [PubMed - indexed for MEDLINE]

Acute to chronic postoperative pain in children: preliminary findings.

Acute to chronic postoperative pain in children: preliminary findings. J Pediatr Surg. 2011 Sep;46(9):1700-5 Authors: Fortier MA, Chou J, Maurer EL, Kain ZN Abstract BACKGROUND/PURPOSE: Chronic postoperative pain is a well-established clinical phenomenon that is associated with adverse outcomes. The incidence of this clinical phenomenon in children, however, is not well established. The purpose of this study was to identify the incidence of chronic pain in children after surgery. METHODS: Following a screening process, a total of 113 children and their parents were enrolled in this cross-sectional study. Data regarding persistence and characteristics of pain after surgery were obtained. RESULTS: Approximately 13% of the children, most of whom underwent orthopedic procedures, reported the existence of symptoms of chronic postoperative pain. Most of the children indicated that the pain started immediately after surgery, was localized to the surgery site, and was intermittent. Children reported a median duration of pain of 4.1 months, and approximately half of the children experienced pain most days of the week. Up to 30% of the children reported interference of pain in functioning in areas such as extracurricular activities and sleep. DISCUSSION: Given the large number of children at risk for experiencing chronic postoperative pain, preventative efforts are necessary. Large-scale cohort prospective studies are needed to confirm the results of this cross-sectional study. PMID: 21929977 [PubMed - indexed for MEDLINE]

Single-incision laparoscopic cholecystectomy in children: a retrospective comparison with traditional laparoscopic cholecystectomy.

Single-incision laparoscopic cholecystectomy in children: a retrospective comparison with traditional laparoscopic cholecystectomy. J Pediatr Surg. 2011 Sep;46(9):1695-9 Authors: Chandler NM, Danielson PD Abstract PURPOSE: The natural progression of minimal access surgery is to perform the same technical operation with minimal or no evidence of scarring. In children, small case series of single-incision laparoscopic cholecystectomy suggests that the operation is feasible; however, no comparison has been made to traditional, multiport laparoscopic cholecystectomy in patient safety, outcomes, and cost. METHODS: A retrospective review of consecutive single-incision laparoscopic cholecystectomies in children was performed from January 2009 to November 2010. Demographics and outcome measures were recorded, including operative time, operative costs, length of stay, need for intravenous analgesia, and operative complications. A concurrent group of pediatric patients undergoing traditional, multiport laparoscopic cholecystectomy was used for comparison. RESULTS: A total of 69 pediatric laparoscopic cholecystectomies were performed from January 2009 to October 2010. Forty-two patients with a mean age of 14.7 years (range, 5.9-18.9 years) underwent attempted single-incision laparoscopic cholecystectomy, and 27 patients with a mean age of 15 years (range, 2.8-19.4 years) underwent multiport laparoscopic cholecystectomy. Mean operative time (68 vs 64.5 minutes; P, not significant [NS]), length of stay (1.45 vs 1.19 days; P, NS), and doses of intravenous analgesia (1.7 vs 2; P, NS) were not significantly different for patients undergoing single-incision or multiport laparoscopic cholecystectomy, respectively. Two patients (5%) undergoing the single-incision approach required 1 additional port be placed to complete the operation. In addition, there was no significant difference in operative costs between the single-incision and multiport approach ($7766 vs $8383; P, NS). CONCLUSION: Single-incision laparoscopic cholecystectomy is safe and effective in the pediatric population. It can be performed with the same technical exposure and outcomes as multiport laparoscopy, with the added benefit of little to no scarring and no increase in cost. PMID: 21929976 [PubMed - indexed for MEDLINE]

Biliary atresia in England and Wales: results of centralization and new benchmark.

Biliary atresia in England and Wales: results of centralization and new benchmark. J Pediatr Surg. 2011 Sep;46(9):1689-94 Authors: Davenport M, Ong E, Sharif K, Alizai N, McClean P, Hadzic N, Kelly DA Abstract INTRODUCTION: Biliary atresia (BA) is a rare, potentially life-threatening condition of the newborn presenting with conjugated jaundice. Typically, it is treated by an initial attempt to restore bile flow (the Kasai portoenterostomy [KP]) as soon as possible after diagnosis and, if this fails, liver transplantation. Since 1999, the treatment of BA has been centralized to 3 centers in England and Wales able to offer both treatment options. The aim of this study was to review the outcome of this policy change and provide a national benchmark. METHODS: The management of all infants born within England and Wales during the period January 1999 to December 2009 was assessed using 3 key performance indicators such as median time to KP, percentage clearance of jaundice (≤20 mol/L) post-KP, and 5- and 10-year native liver and true survival estimates. Data are quoted as median (range), and P < .05 was considered significant. RESULTS: A total of 443 infants had confirmed BA; and of these, most were isolated BA (n = 359), with 84 having other significant anomalies (but predominantly BA splenic malformation syndrome). Four infants died before any biliary intervention. Kasai portoenterostomy was performed in 424 infants (median age, 54 [range 7-209] days), and a primary liver transplant was performed in 15. Clearance of jaundice post-KP was achieved in 232 (55%). There were 41 deaths, including 4 (10%) without any intervention, 24 (58%) post-KP usually because of end-stage liver disease and mostly on a transplant waiting list, and 13 (32%) post-LT usually because of multiorgan failure. Overall, the 5- and 10-year native liver survival estimates were 46% (95% confidence interval [CI], 41-51) and 40% (95% CI, 34-46), respectively. The 5- and 10-year true patient survival estimates were 90% (95% CI, 88-93) and 89% (95% CI, 86-93), respectively. Outcome was worse for those with other anomalies (lower clearance of jaundice post-KP [43% vs 57%; odds ratio, 1.7; 95% CI, 1.04-2.8]; P = .02) and an increased mortality overall (eg, at 5 years, 72 [95% CI, 64-83] vs 94 [95% CI, 91-96]; χ(2) = 33; P < .0001). CONCLUSIONS: National outcome measures in BA appear better than those from previously published series from comparable countries and may be attributed to centralization of surgical and medical resources. PMID: 21929975 [PubMed - indexed for MEDLINE]

Two cases of fetus in fetu.

Two cases of fetus in fetu. J Pediatr Surg. 2011 Sep;46(9):e9-e12 Authors: Gunaydin M, Celik FC, Tander B, Bozkurter AT, Sullu Y, Baris S, Rizalar R, Kucukoduk S Abstract Fetus in fetu (FIF) is a rare cause of abdominal mass in children. One of the malformed monozygotic diamniotic twins is located in the body of other twin. It is differentiated from teratoma by the presence of vertebral organization with limb buds and other organ systems. Diagnosis is based on radiologic findings. Surgical excision is the treatment of choice, leading to the complete removal of the mass. To our knowledge, less than 200 cases have been described in the literature. Herein, we report 2 cases of FIF, a newborn who was diagnosed antenatally and a three-and-half-year- old boy diagnosed with mediastinal FIF after admission for recurrent respiratory tract infections. PMID: 21929974 [PubMed - indexed for MEDLINE]

Imperforate anus, diaphragmatic hernia, horseshoe kidney, and pulmonary sling complex: case description.

Imperforate anus, diaphragmatic hernia, horseshoe kidney, and pulmonary sling complex: case description. J Pediatr Surg. 2011 Sep;46(9):e5-7 Authors: Walters D, Burjonrappa S, Chun K Abstract This report describes an infant with imperforate anus, delayed presentation of congenital diaphragmatic hernia, horseshoe kidney, and pulmonary sling complex, a unique combination of anomalies that we recently treated at our facility. PMID: 21929973 [PubMed - indexed for MEDLINE]

Successful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins.

Successful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins. J Pediatr Surg. 2011 Sep;46(9):e25-7 Authors: Chou YC, Peng HC, Chu CH, Tsai ST, Ling JC, Hsu YH, Chen SY, Harnod T Abstract Pygopagus conjoined twins are very rare, and half of all pygopagus twins have other anomalies. This report describes the successful surgical separation of pygopagus twins who had a conjoined thecal sac and an epidermal cyst. Meticulous preoperative planning, development of a model simulator, multispecialty teamwork, and a staged surgery contributed to a successful outcome. PMID: 21929972 [PubMed - indexed for MEDLINE]

Gastrectomy with isoperistaltic jejunal parallel pouch in a 15-year-old adolescent boy with gastric adenocarcinoma and autosomal recessive agammaglobulinemia.

Gastrectomy with isoperistaltic jejunal parallel pouch in a 15-year-old adolescent boy with gastric adenocarcinoma and autosomal recessive agammaglobulinemia. J Pediatr Surg. 2011 Sep;46(9):e21-4 Authors: Slotta JE, Heine S, Kauffels A, Krenn T, Grünhage F, Wagner M, Graf N, Schilling MK, Schuld J Abstract A 15-year-old adolescent boy with autosomal recessive agammaglobulinemia underwent endoscopy because of unexplained growth failure and malnutrition. Esophagogastroduodenoscopy revealed antropyloric stenosis, and a biopsy showed an invasive gastric adenocarcinoma. Chronic atrophic corpus gastritis type A and Helicobacter pylori were also identified. Abdominal magnetic resonance imaging confirmed the stenosis resulting from a semicircular intramural tumor without obvious local or distant metastatic spread. Gastrectomy with an extended lymphadenectomy was performed. Esophagoduodenal continuity was restored by an interposed jejunal parallel pouch developed from the first jejunal loop. Oral feeding was supplemented by parenteral nutrition via a Broviac catheter, and the patient is well 4 months later. Several cases of gastric cancer have been reported in children with hereditary agammaglobulinemia. Thus, endoscopy is mandatory in such patients with gastrointestinal symptoms to identify and treat tumors before metastasis occurs. Total gastrectomy, extended lymphadenectomy, and reconstruction using a jejunal reservoir with maintenance of duodenal continuity should be considered. PMID: 21929971 [PubMed - indexed for MEDLINE]