Pediatric RSS : Gourt

Close to Orlando and Tampa's attractions, enjoy a fantastic combination of one of Florida's best beaches coupled with modern upscale lifestyle. :: Florida :: Candidate Direct Physician Staffing

Pediatric Surgeon Jobs - Florida Physician Job Type: Permanent in FL Start: Immediate Opening Shift: To be disussed during interview Salary: Pediatric surgeon job at hospital owned group provides

With a population of 200,975 this service area is home to the fifth largest city in the entire Pacific Northwest. :: Washington :: Candidate Direct Physician Staffing

Pediatric Surgeon Jobs - Washington Physician Job Type: Permanent Start: Immediate Opening Shift: Details not available Salary: This pediatric surgeon job offers salary based compensation with

Pediatric Surgery Opportunity - Children's Hospital- Atlantic Coastal South Florida Location :: Florida :: CompHealth Inc

Job 656483 PEDIATRIC SURGERY OPPORTUNITY for a fellowship trained candidate in this high profile children's hospital opportunity. A thriving practice that is the exclusive pediatric surgical practice

Pediatric Surgeon needed for Predominant health care provided in Major Metro Area :: Iowa :: CompHealth Inc

Job 657480 Excellent compensation package with great benefits Full service facility with academic ties Wonderful area to live and raise a family Malpractice Paid 6 Weeks Vacation, CME Voluntary Retirement

Pediatric Surgeon Needed in Pennsylvania February 2010 Ongoing! :: Pennsylvania :: LocumTenens.com

Pediatric Surgeon Needed in Pennsylvania February 2010 Ongoing! Come enjoy the countless activities within the Philadelphia area. Pediatric surgeons will be responsible for clinic, call and scheduled

Pacific Northwest Needs Fellowship Trained Pediatric Surgeon :: Washington :: CompHealth Inc

Job 6511229 Busy Pediatric Surgeon is planning to retire; turnkey practice Hospital Employed Position Academic affiliation possible Possible sponsorship for H1's or J1 Visa State-of-the-Art Children's

Pediatric Surgeon needed in Virginia starting May 2010 :: Virginia :: LocumTenens.com

Pediatric Surgeon needed in Virginia starting in May 2010 Virginia not only has 35 State Parks that were voted "America's Best" but it is also home to the ever popular Shenandoah National Park. Virginia's

Pediatric Surgeon needed in Texas for November dates :: Texas :: LocumTenens.com

Pediatric Surgeon needed in Texas for November dates! A day trip or weekend getaway in Texas might be just the ticket to shrug off the stress of daily life. There are numerous travel ideas for Texas,

Pediatric Surgeon Needed to Join Another :: Indiana :: CompHealth Inc

Job 659487 Enjoy Midwest Quality of Life in a state renowned for being "Physician-friendly" High acuity cases; complex cases Join a partner; partnership track is streamlined Tremendous growth opportunity

Top 100 Hospital, Great Lakes, #2774 :: Minnesota :: Timeline Recruiting

GREAT LAKES PEDIATRIC SURGERY OPPORTUNITY TOP 100 HOSPITAL, NACHRI DESIGNATION. Seize this rare opportunity to develop the regions first pediatric surgery program, serving a population of over 450,000,

Pediatric Surgeon Needed :: Minnesota :: CompHealth Inc

Job 657737 Spearhead Pediatric Surgery program Full support from large group with call of 1:3 or 1:4 Full state-of-the-art PICU and NICU facility Incredible Salary; above the 85th percentile for Pediatric

Great Location :: Iowa :: Onyx M.D.

Pediatric surgeon wanted for a metro city in Iowa. A small pediatric group needs to replace a retiring peds surgeon. This is a locum-to-perm pediatric surgeon job opportunity. This pediatric physician

Not Disclosed :: North Carolina :: Locum Medical Group

Join two Board Certified Pediatric Surgeons that work out of one hospital just outside of Charlotte, North Carolina. The physicians currently perform a wide range of surgical procedures including: Endocrine

Lake Charles :: Louisiana :: Community Health Systems

PRACTICE OPPORTUNITY IN SOUTH LOUISIANA Women and Children's Hospital in Lake Charles, Louisiana is seeking a solo Pediatric Surgeon. EOE Community, Facility, & Organization Women and Children's

Fort Wayne :: Indiana :: Community Health Systems

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

Des Moines :: Iowa :: Mercy Medical Center - Des Moines

Exciting practice opportunity available at The Children's Center for BC/BE Pediatric Surgeon. The Children's Center at Mercy is located in Des Moines, Iowa. No, we cant offer you the mountains or

Anchorage :: Alaska :: Providence Health & Services

Anchorage, Alaska -- Providence Alaska Medical Center is seeking BE/BC pediatric surgeon to join our busy clinic. Statewide referrals. Clinic is part of The Children's Hospital at Providence with all

Portland :: Oregon :: Providence Health & Services

Portland, Oregon -- Providence Health & Services is seeking an outstanding pediatric surgeon to join us in the Portland area. Excellent opportunity for experienced surgeon to help guide further development

Spokane :: Washington :: Providence Health & Services

Spokane, Washington -- Sacred Heart Children's Hospital is seeking a BE/BC Pediatric Surgeon to join an established, busy, single-specialty practice in this sunny eastern Washington city. Excellent subspecialty

'Grey's Anatomy': Jessica Capshaw shines as Arizona Robbins - Los Angeles Times

E! Online'Grey's Anatomy': Jessica Capshaw shines as Arizona RobbinsLos Angeles TimesShe began her rounds by warning her residents that pediatric surgery wasn't just a miniature version of general surgery. "These are the tiny humans. ...Grey's Anatomy 6x08 'Invest In Love' recapExaminer.comGrey's Anatomy: Where the Magic HappensNew York Magazineall 35 news articles »

Insurance Coverage Status Affects Mortality Rate in Pediatric Trauma Patients - Reuters

Boston GlobeInsurance Coverage Status Affects Mortality Rate in Pediatric Trauma PatientsReutersThe article, "Lack of Insurance Negatively Affects Trauma Mortality in US Children," is published in the October issue of the Journal of Pediatric Surgery. ...Trauma Deadlier for Kids Without InsuranceU.S. News & World Reportall 46 news articles »

Children's hospital opens in Mesa - KTAR.com

East Valley TribuneChildren's hospital opens in MesaKTAR.com... including "pediatric pulmonary service, for Level 3 newborn intensive care unit, for pediatric surgery, for pediatric neurosurgery, for pediatric ...Cardon Children's opens 7-story towerEast Valley TribuneNew children's hospital brings smiles to its new patientsAZ Central.comNew Children's Medical Center opens in MesaArizona Republicall 13 news articles »

New specialists at hospitals - Arizona Republic

New specialists at hospitalsArizona RepublicGeneral surgery residency at Mayo Clinic in Rochester, Minn., Pediatric surgery fellowship at British Columbia children's Hospital in Vancouver. ...Arizona kids hospitals get $1 billion boostAZ Central.comall 6 news articles »

Morbidly Obese Kids Could Opt for Lap Band Surgery - MedIndia

Morbidly Obese Kids Could Opt for Lap Band SurgeryMedIndia... distribution of weight loss after Lap band surgery in adolescents," said Dr Evan Nadler, the lead author and pediatric surgeon at Children's National. ...

Lap Band Surgery Effective For Morbidly Obese Children, Study Finds - Science Daily (press release)

Lap Band Surgery Effective For Morbidly Obese Children, Study FindsScience Daily (press release)... distribution of weight loss after Lap band surgery in adolescents," said Evan Nadler, MD, the lead author and pediatric surgeon at Children's National. ...and more »

Health investigation sheds light on gastroschisis birth defect - UNR NevadaNews

UNR NevadaNewsHealth investigation sheds light on gastroschisis birth defectUNR NevadaNews“In addition, we are thankful to have local pediatric surgeon Frieda Hulka, who is an expert in gastroschisis repair and is able to perform the necessary ...and more »

Surgery may not be the best option for children with obstructive sleep apnea - News-Medical.net

Surgery may not be the best option for children with obstructive sleep apneaNews-Medical.netApproximately 500000 children undergo a tonsillectomy each year to treat the condition making this the most common major pediatric surgery. ...and more »

More pint-sized patients getting grown-up surgeries - TIME

More pint-sized patients getting grown-up surgeriesTIME... Lap band surgery in adolescents," said Evan Nadler, MD, lead author and a pediatric surgeon at Children's National Medical Center in Washington, DC. ...

Most Viewed Stories - SouthCoastToday.com

Most Viewed StoriesSouthCoastToday.comDr. Roustom returned to Syria in 1962 holding a Master in Surgery from New York University, and a specialization in Pediatric Surgery from the Boston City ...

Amyand's hernia in infancy: why laparoscopy?

Related Articles Amyand's hernia in infancy: why laparoscopy? J Pediatr Surg. 2009 Aug;44(8):1673-4 Authors: Baldassarre E, Ferrero C, Da Costa Duarte D, Barone M, Prosperi Porta I PMID: 19635331 [PubMed - indexed for MEDLINE]

Re: Thoracoscopic-assisted central line placement for a thrombosed superior vena cava.

Related Articles Re: Thoracoscopic-assisted central line placement for a thrombosed superior vena cava. J Pediatr Surg. 2009 Aug;44(8):1672-3; author reply 1623 Authors: Bax KN PMID: 19635329 [PubMed - indexed for MEDLINE]

Early history of endoscopic correction of vesico-ureteric reflux: the Dublin contribution.

Related Articles Early history of endoscopic correction of vesico-ureteric reflux: the Dublin contribution. J Pediatr Surg. 2009 Aug;44(8):1672 Authors: Guiney EJ, Fitzgerald RJ PMID: 19635328 [PubMed - indexed for MEDLINE]

A selective sac extraction method: another minimally invasive procedure for inguinal hernia repair in children: a technical innovation with satisfactory surgical and cosmetic results.

Related Articles A selective sac extraction method: another minimally invasive procedure for inguinal hernia repair in children: a technical innovation with satisfactory surgical and cosmetic results. J Pediatr Surg. 2009 Aug;44(8):1666-71 Authors: Ikeda H, Hatanaka M, Suzuki M, Fujino J, Tahara K, Ishimaru Y PURPOSE: To achieve satisfactory surgical and cosmetic results with minimal surgical invasiveness without laparoscopic assistance in childhood inguinal hernia repair, a novel technique, the selective sac extraction method (SSEM), was devised. The technical feasibility of this method was retrospectively examined. METHODS: The method was applied to 162 consecutive hernia repairs in 153 patients, 79 boys and 74 girls, excluding patients with incarcerated or irreducible hernia, sliding hernia of the ovary (hernia with palpable ovary at repair), or hernia associated with an undescended testis. Hernia repair was performed by several young surgeons under the guidance of one teaching surgeon. RESULTS: Patients' ages ranged from 1 month to 12 years (median, 3 years), and their body weights ranged from 2.9 to 41 kg (median, 14.4 kg). The SSEM was accomplished in 149 (92%) of 162 repairs, and lengths of incision at the end of the procedure were less than 10 mm in all repairs. The success rate was 72 (88%) of 82 repairs in male patients and 77 (96%) of 80 repairs in female patients. In the remaining 13 (8%) repairs in 13 patients, 10 males and 3 females, the procedure was converted to a conventional open method by extending the incision to 10 mm or longer. The ages of the 13 patients ranged from 1 month to 8 years (median, 3 months), being significantly younger than patients whose repair was accomplished by the SSEM (P = .006). The reason for conversion in 9 repairs was a huge or thickened sac that could not be extracted from the small incision, of which 6 involved male infants younger than 11 months. Obesity (the body mass index was 22.2 and >97th percentile for the patient's age) and thick subcutaneous tissue characteristic of early infancy were also reasons, both of which hindered the approach to the inguinal canal. Other reasons included malpositioning of the skin incision and difficulty in sac identification. The lengths of incision at the end of the 162 repairs ranged from 4.5 to 13.0 mm (median, 7.0 mm). Those in female patients, 4.5 to 11.5 mm (median, 6.5 mm), were significantly shorter than in male patients, 5.0 to 13.0 mm (median, 7.5 mm) (P < .001). The median length of the operation was 25 minutes. A follow-up interview revealed that there was no hernia recurrence with a median follow-up time of 20 months (range, 12-29 months). No postoperative complications were reported by the parents. As for the parents' satisfaction with wound cosmesis, 93% of them rated it as good or excellent. CONCLUSIONS: Inguinal hernia repair with the SSEM through a minimal skin incision is technically feasible, with very satisfactory surgical and cosmetic results. As it has the potential to be a standard method for inguinal hernia repair in children, a prospective study to confirm the safety of the procedure should be carried out. PMID: 19635327 [PubMed - indexed for MEDLINE]

Flexor tendon repair in children with zone 2 injuries: an innovative technique using autogenous vein.

Related Articles Flexor tendon repair in children with zone 2 injuries: an innovative technique using autogenous vein. J Pediatr Surg. 2009 Aug;44(8):1662-5 Authors: Mousavi SR, Mehdikhah Z, Tadayon N OBJECTIVES: This is a new technique for tendon repair that may improve the results of existing methods. METHODS: The study is a nonrandomized retrospective study using historical (nonconcurrent) controls. From May 1994 to March 2004, 53 children aged 5 to 15 years requiring tendon repair (test group) were compared to 53 children conventionally repaired (control group). All patients had flexor tendon injuries, involving zone 2. In the test group (53 patients), a modified Kessler repairing of tendons with 4-0 prolene was used, followed by a core suture of running 7-0 nylon or prolene epitendinous suture. After the tendon repair, a segment of vein through which the tendon had been passed before or a vein patch used as a tendon sheath substitute was used to repair the sheath defects. The results during 6 months of follow-up were compared with those of the control group that were operated using the conventional technique (modified Kessler method). RESULTS: We assessed the results by measuring the range of motion of the metacarpophalangeal, distal interphalangeal, and proximal interphalangeal joints in the follow-up period and graded them as excellent, good, fair, and poor. In the test group, 86% were graded as excellent, 11% good, 3% fair, and 0% poor results; and in the control group, 0% were excellent, 12% good, 38% fair, and 50% poor results. The differences were significant (P < .005). CONCLUSIONS: Our preliminary results appeared encouraging when compared with the outcomes achieved by the conventional tendon repair technique. As the new technique decreases the need for intensive physiotherapy, it may serve as a substitute method for the conventional tendon repair and eventually become a standard technique in the future. PMID: 19635326 [PubMed - indexed for MEDLINE]

Infarction of an epiploic appendage in a pediatric patient.

Related Articles Infarction of an epiploic appendage in a pediatric patient. J Pediatr Surg. 2009 Aug;44(8):1659-61 Authors: Fraser JD, Aguayo P, Leys CM, St Peter SD, Ostlie DJ Epiploic appendagitis or infarction of an epiploic appendage is an uncommon cause of abdominal pain in pediatric patients. Few cases have been reported. Diagnosis based on clinical examination alone is nearly impossible, and therefore, adjunctive radiographic measures are necessary to aid in the diagnosis, including ultrasound and computed tomography. We present the case of an 8-year-old boy whose diagnosis of epiploic infarction was suggested by computed tomography and was confirmed and treated via laparoscopy. PMID: 19635325 [PubMed - indexed for MEDLINE]

Cricopharyngeal myotomy for the treatment of cricopharyngeal achalasia.

Related Articles Cricopharyngeal myotomy for the treatment of cricopharyngeal achalasia. J Pediatr Surg. 2009 Aug;44(8):1656-8 Authors: Jain V, Bhatnagar V Three cases of cricopharyngeal achalasia are being presented. The preoperative diagnosis was established by a contrast swallow. Cricopharyngeal myotomy was performed in all patients. One child died in the postoperative period because of respiratory failure secondary to aspiration pneumonitis, whereas in the other two, symptoms were relieved, and they remain asymptomatic on follow-up. PMID: 19635324 [PubMed - indexed for MEDLINE]

A case report of a congenital left subcostal hernia in a neonate.

Related Articles A case report of a congenital left subcostal hernia in a neonate. J Pediatr Surg. 2009 Aug;44(8):1653-5 Authors: Nicksa GA, Christensen EP, Buchmiller TL We present an unusual case of a congenital left subcostal hernia in a female born at 39 weeks by caesarean delivery to a 39 year-old gravida(2)para(1-2)abortus(0) mother. The pregnancy was complicated by gestational diabetes, although she had normal prenatal imaging. After an uneventful caesarean delivery, the patient's initial physical examination was normal although subsequently was found to have a left subcostal hernia. During surgical evaluation, a reducible hernia was found along with left renal agenesis and no underlying masses. At 4 weeks of age, the patient's hernia was successfully repaired with no sequela. We present the first reported case of a congenital subcostal hernia, evaluation, and treatment. PMID: 19635323 [PubMed - indexed for MEDLINE]

Parathyroid carcinoma in a child: an unusual case of an ectopically located malignant parathyroid gland with tumor invading the thymus.

Related Articles Parathyroid carcinoma in a child: an unusual case of an ectopically located malignant parathyroid gland with tumor invading the thymus. J Pediatr Surg. 2009 Aug;44(8):1649-52 Authors: Fiedler AG, Rossi C, Gingalewski CA Parathyroid carcinoma is exceptionally rare in children. Parathyroid carcinoma in the pediatric population most typically presents with significant hypercalcemia and a palpable neck mass. The authors report the seventh case of parathyroid carcinoma diagnosed in a child younger than 16 years. To our knowledge, this case is the first documented case, in the pediatric population, of parathyroid carcinoma in an ectopically located parathyroid gland with tumor invading the thymus. PMID: 19635322 [PubMed - indexed for MEDLINE]

Noncommunicating tubular duplication of the upper pouch in esophageal atresia without fistula.

Related Articles Noncommunicating tubular duplication of the upper pouch in esophageal atresia without fistula. J Pediatr Surg. 2009 Aug;44(8):1646-8 Authors: Tröbs RB, Barenberg K, Vahdad MR, Tannapfel A We report a unique combination of an esophageal atresia without fistula associated with a tubular noncommunicating esophageal duplication. The diagnosis was made at delayed repair and led to a successful outcome. PMID: 19635321 [PubMed - indexed for MEDLINE]

Successful endoscopic unroofing for a pediatric choledochocele.

Related Articles Successful endoscopic unroofing for a pediatric choledochocele. J Pediatr Surg. 2009 Aug;44(8):1643-5 Authors: Saeki I, Takahashi Y, Matsuura T, Takahata S, Tanaka M, Taguchi T A choledochocele (type 3 choledochal cyst) is rarely observed in children. A 6-year-old boy experienced abdominal pain approximately 6 times in the previous 5 months. Magnetic resonance cholangiopancreatography findings revealed a small cyst in the distal common bile duct. An endoscopic examination was performed, and a choledochocele was detected at the duodenal papilla. Endoscopic unroofing was successfully performed, and the postoperative course was uneventful. PMID: 19635320 [PubMed - indexed for MEDLINE]

A male adolescent with left iliac thrombophlebitis and heterozygosity for factor V Leiden mutation.

Related Articles A male adolescent with left iliac thrombophlebitis and heterozygosity for factor V Leiden mutation. J Pediatr Surg. 2009 Aug;44(8):1640-2 Authors: Lovejoy AE, Bush RA, Pong AL, Hilfiker ML The epidemiology of deep vein thrombosis in adolescents has 2 potential associations. First, there is a demonstrated association with a congenital anomaly of the inferior vena cava (Dean SM, Tytle TL. Vas Med. 2006;11:165-169; Schnieider JG, Eynatten MV, Dugi KA, et al. J Intern Med. 2002;252:276-280). Secondly, resistance to activated protein C as a result of factor V Leiden is associated with thromboembolic disease at an early age (Price DT, Ridker PM. Ann Intern Med. 1997;127:895-903). Imaging modalities, central venous catheters, and improved life expectancy for critically and chronically ill children have resulted in an increased diagnosis of thromboembolic disease in the pediatric population (Journeycake MM, Manco-Johnson MJ. Hematol Oncol Clin N Am. 2004;18;1315-1338), and evaluation for thrombophilia should be performed for any child with thromboembolic disease. PMID: 19635319 [PubMed - indexed for MEDLINE]

American Pediatric Surgical Association Trauma Committee position statement on the use of all-terrain vehicles by children and youth.

Related Articles American Pediatric Surgical Association Trauma Committee position statement on the use of all-terrain vehicles by children and youth. J Pediatr Surg. 2009 Aug;44(8):1638-9 Authors: Burd R PMID: 19635318 [PubMed - indexed for MEDLINE]

Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis.

Related Articles Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis. J Pediatr Surg. 2009 Aug;44(8):1631-7 Authors: Sola JE, Neville HL PURPOSE: The aim of the study was to determine whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the most effective intervention in infants with hypertrophic pyloric stenosis. METHODS: A systematic review of the published literature was undertaken in February 2009. Prospective studies comparing LP and OP were selected. Age, weight, complications, duration of operation, time to full feedings, postoperative vomiting, and postoperative length of stay (LOS) data were extracted. RESULTS: Six prospective studies (5 level I, 1 level II) with 625 (303 LP, 322 OP) participants met selection criteria. Combined estimates indicated that LP had a lower total complication rate (odds ratio [OR], 0.58 [0.35, 0.97]; P = .04), mostly due to a lower wound complication rate (OR, 0.42 for LP [0.20, 0.91]; P = .03). Patients who underwent LP also had shorter time to full feedings (mean difference [MD], -11.52 hours [-12.77, -10.27]; P < .00001) and shorter postoperative LOS (MD, -5.71 hours [-8.90, -2.52]; P = .0005). No statistically significant differences were noted in the rates of mucosal perforation, wound infection, postoperative emesis, or operating time. Incomplete pyloromyotomy occurred in 6 patients who underwent LP (OR, 7.74 [0.94, 63.38]; P = .06). CONCLUSIONS: This meta-analysis favors the laparoscopic approach with significantly reduced rate of total complications, which is mostly due to a lower wound complication rate. PMID: 19635317 [PubMed - indexed for MEDLINE]

Minimizing limb amputations in meningococcal sepsis by early microsurgical arteriolysis.

Related Articles Minimizing limb amputations in meningococcal sepsis by early microsurgical arteriolysis. J Pediatr Surg. 2009 Aug;44(8):1625-30 Authors: Boeckx WD, Nanhekhan L, Vos GD, Leroy P, Van den Kerckhove E PURPOSE: Surgical treatment of children with meningococcal sepsis has mainly involved debridement of necrotic skin and amputation of limbs. This resulted in major functional impairment. On the contrary, when early microsurgical arteriolysis was performed, freeing up the blood vessels, the impaired blood flow could be restored, thereby significantly reducing the amputation levels. METHODS: We prospectively evaluated 14 patients affected by meningococcal sepsis. In 7 patients, microsurgical arteriolysis was performed; standard sepsis treatment was performed on the remaining 7. Ischemia levels on admission were compared with permanent amputation levels after 1 year. RESULTS: Statistically significant decreases (P = .005) in ischemia values were achieved by the arteriolysis, in comparison with final amputation percentages. The functional impairment of the affected limbs was highly reduced compared with the probable loss of function observed on admission. CONCLUSIONS: Our findings show that early microsurgical arteriolysis is a reliable method to reduce the devastating amputations normally found in patients with meningococcal sepsis. This significantly improves the functional outcome in severely ischemic limbs in meningococcal induced septic children. PMID: 19635316 [PubMed - indexed for MEDLINE]

Laparoscopic-assisted repair of Morgagni hernia in children.

Related Articles Laparoscopic-assisted repair of Morgagni hernia in children. J Pediatr Surg. 2009 Aug;44(8):1621-4 Authors: Mallick MS, Alqahtani A PURPOSE: Morgagni hernia is a rare entity that accounts for less than 6% of all surgically treated diaphragmatic hernias in pediatric age group. They are mostly asymptomatic and discovered incidentally. Open surgical repair has been the gold standard in all cases once diagnosed. However, since the introduction of minimal access surgery, different laparoscopic techniques of Morgagni hernia repair have been reported in the literatures. Most of them are reporting on few cases and the immediate outcomes. Herein, we report the largest experience to date assessing the safety and efficacy of laparoscopic-assisted full-thickness anterior abdominal wall repair of Morgagni hernia in children with more emphasis on the short-term outcomes, such as the recurrence and the fate of the hernia sac. METHODS: Fifteen children with Morgagni hernias underwent primary laparoscopic repair by placement of interrupted nonabsorbable sutures through the full thickness of the anterior abdominal wall, incorporating the hernia sac, the posterior rim of the defect, and returning back out through the anterior abdominal wall with the sutures tied in the subcutaneous tissue. RESULT: Between January 2004 and January 2008, 15 children with Morgagni hernia were treated laparoscopically in our institution-affiliated hospitals. Male-female ratio was 2:1. Mean age was 21.7 months. The average operative time was 42.6 minutes. Average time to full feed was 22.9 hours. Postoperative analgesia requirement was minimal. The average hospital stay was 24 hours. All operations were completed laparoscopically. None of the patients developed intraoperative or postoperative complications. The maximum follow-up was 48 months (mean, 20 months). All patients are in good health without recurrence or significant sac residual. CONCLUSION: Laparoscopic-assisted Morgagni hernia repair is a safe and effective modality of treatment. It is well tolerated and gives all the advantages of minimal access surgery, without adverse effects from leaving the sac plicated in place. PMID: 19635315 [PubMed - indexed for MEDLINE]

Effect of prenatal tetrandrine administration on transforming growth factor-beta1 level in the lung of nitrofen-induced congenital diaphragmatic hernia rat model.

Related Articles Effect of prenatal tetrandrine administration on transforming growth factor-beta1 level in the lung of nitrofen-induced congenital diaphragmatic hernia rat model. J Pediatr Surg. 2009 Aug;44(8):1611-20 Authors: Xu C, Liu W, Chen Z, Wang Y, Xiong Z, Ji Y PURPOSE: Tetrandrine (Tet) is a bisbenzylisoquinoline alkaloid isolated from the root of Stephania tetrandra, which has been used in traditional Chinese medicine to treat patients with silicosis, asthma, and pulmonary hypertension, and others and can be used as a pulmonary therapeutic agent. We hypothesized that it can also improve the lung growth in congenital diaphragmatic hernia (CDH) for its multiple biological effects. There are increasing evidences that suggest transforming growth factor beta1(TGF-beta1) plays a crucial role in fetal lung growth and morphogenesis. The aim of this study was to evaluate the effect of prenatal administration of Tet and to investigate its possible mechanism on the expression of TGF-beta1 in the lung of nitrofen-induced CDH rat model. METHODS: A CDH model was induced in pregnant Sprague-Dawley rats by administration of nitrofen on day 9.5 of gestation (Ed9.5 term, day 22). Tetrandrine (30 mg/kg) was given through gavage (once a day, for 3 days) on Ed11.5. Accordingly, there were 3 groups as follows: control (n = 9), CDH (n = 9), and CDH + Tet (n = 9). All the fetuses were delivered by cesarean delivery on Ed16.5, 18.5, and 21.5, respectively, to check if diaphragmatic hernia existed on each fetus, then the lung tissue weight (LW) and body weight (BW) of each fetus were recorded. Histologic evaluations and TGF-beta1 immunohistochemistry staining in the lung sample were performed for image analysis. RESULTS: Diaphragmatic hernia was observed in 95 of the 112 rat fetuses in CDH and CDH + Tet groups on Ed18.5 and Ed21.5 (84.8%), the incidence between the 2 groups had no statistical significance (P = .642). Lung weight/body weight in the CDH group and the CDH + Tet group were lower than that in the control group (P < .01), and LW/BW in the CDH group was lower than that in the CDH + Tet group (P < .05). Observed under the light microscope and electron microscope, marked hypoplasia of the lungs in fetuses among the CDH groups was observed, in contrast to improvement of the lungs in CDH + Tet fetuses. Statistical differences in morphological parameters (percentage of alveoli area, counting bronchus) were found even on Ed16.5 when diaphragm had not closed (P < .01). The number of type II pneumocytes and lamellar bodies in each group had no significant difference (P > .05). The immunoreactivity of TGF-beta1 in CDH group and CDH + Tet group were markedly stronger than that in the control group (P < .01). In addition, TGF-beta1 expression in the CDH group was stronger than that in the CDH + Tet group (P < .01). CONCLUSION: Nitrofen can interfere with lung development early in the fetal rat development before and separate from diaphragm development, and increased expression of TGF-beta1 in the lung of CDH rat model may suppress lung growth and development. Prenatal treatment with Tet can improve the growth of the lung of the nitrofen-induced CDH fetuses and its mechanism seems to be involved in downregulating the expression of TGF-beta1. It is a likely new approach to treat CDH and its coexistent lung hypoplasia by maternal Tet administration. PMID: 19635314 [PubMed - indexed for MEDLINE]

Effect of preextracorporeal membrane oxygenation ventilation days and age on extracorporeal membrane oxygenation survival in critically ill children.

Related Articles Effect of preextracorporeal membrane oxygenation ventilation days and age on extracorporeal membrane oxygenation survival in critically ill children. J Pediatr Surg. 2009 Aug;44(8):1606-10 Authors: Nance ML, Nadkarni VM, Hedrick HL, Cullen JA, Wiebe DJ PURPOSE: The aim of the study is to test the effect of age and preextracorporeal membrane oxygenation (pre-ECMO) days of ventilation on ECMO survival in the pediatric population. METHODS: Retrospective analysis of noncardiac, pediatric (age >30 days) ECMO patients for the period January 1984 to June 2006. Pre-ECMO demographic, ventilatory, and lung injury severity variables were modeled with stepwise logistic regression to estimate survival probabilities associated with pre-ECMO ventilation duration and patient age. Patients were excluded from review for the following: pre-ECMO cardiac arrest, pre-ECMO ventilation of more than 30 days (chronic), or multiple runs on ECMO. RESULTS: For the period of review, 2550 patients met inclusion/exclusion criteria. The population had a mean age of 3.6 +/- 5.1 years (median age, 1 year). The mean pre-ECMO days of ventilation were 5.2 +/- 4.9 (median, 4 days). The overall survival probability was 58.6%. The mean oxygen index and Pao(2)/Fio(2) ratio were 62.2 +/- 48.2 and 95.5 +/- 48.2, respectively. The population overall demonstrated a statistically significant, exponential decline in survival as pre-ECMO days of ventilation increased (P < .05). For each additional year of age, survival decreased by an average of 2.5%. For each additional day of pre-ECMO ventilation, survival decreased by an average of 2.9%. Younger ages were generally associated with higher survival probabilities at each ventilation day. CONCLUSIONS: In the pediatric population, survival decreases significantly as pre-ECMO ventilator days increase. Survival is also inversely related to patient age. Thus, patient age and duration of ventilation should be considered when evaluating suitability for ECMO. PMID: 19635313 [PubMed - indexed for MEDLINE]

Childhood obesity: a risk factor for injuries observed at a level-1 trauma center.

Related Articles Childhood obesity: a risk factor for injuries observed at a level-1 trauma center. J Pediatr Surg. 2009 Aug;44(8):1601-5 Authors: Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP PURPOSE: Obesity is an independent risk factor in trauma-related morbidity in adults. The purpose of this study was to investigate the effect of obesity in the pediatric trauma population. METHODS: All patients (6-20 years) between January 2004 and July 2007 were retrospectively reviewed and defined as non-obese (body mass index [BMI] <95th percentile for age) or obese (BMI > or =95th percentile for age). Groups were compared for differences in demographics, initial vital signs, mechanisms of injury, length of stay, intensive care unit stay, ventilator days, Injury Severity Score, operative procedures, and clinical outcomes. RESULTS: Of 1314 patients analyzed, there were 1020 (77%) nonobese patients (mean BMI = 18.8 kg/m(2)) and 294 (23%) obese patients (mean BMI = 29.7 kg/m(2)). There was no significant difference in sex, heart rate, length of stay, intensive care unit days, ventilator days, Injury Severity Score, and mortality between the groups. The obese children were significantly younger than the nonobese children (10.9 +/- 3.3 vs 11.5 +/- 3.5 years; P = .008) and had a higher systolic blood pressure during initial evaluation (128 +/- 17 vs 124 +/- 16 mm Hg, P < .001). In addition, the obese group had a higher incidence of extremity fractures (55% vs 40%; P < .001) and orthopedic surgical intervention (42% vs 30%; P < .001) but a lower incidence of closed head injury (12% vs 18%; P = .013) and intraabdominal injuries (6% vs 11%; P = .023). Evaluation of complications showed a higher incidence of decubitus ulcers (P = .043) and deep vein thrombosis (P = .008) in the obese group. CONCLUSION: In pediatric trauma patients, obesity may be a risk factor for sustaining an extremity fracture requiring operative intervention and having a higher risk for certain complications (ie, deep venous thrombosis [DVT] and decubitus ulcers) despite having a lower incidence of intracranial and intraabdominal injuries. Results are similar to reports examining the effect(s) of obesity on the adult population. PMID: 19635312 [PubMed - indexed for MEDLINE]

Long-term health condition in major pediatric trauma: a pilot study.

Related Articles Long-term health condition in major pediatric trauma: a pilot study. J Pediatr Surg. 2009 Aug;44(8):1591-600 Authors: Janssens L, Gorter JW, Ketelaar M, Kramer WL, Holtslag HR PURPOSE: Major trauma is the leading cause of death in children of developed countries. However, little is known about its long-term health consequences in survivors. Our aim was to describe the health condition in children at long-term after major trauma. METHODS: Prospective cohort study of severely injured children (Injury Severity Score > or =16, age <16) admitted to a Dutch level I trauma center in 1999 to 2000 (N = 40). About 7 years after trauma (median, 7.3; range, 6.3-8.2 years), survivors' health condition was assessed with the following: guides to the evaluation of permanent impairment of the American Medical Association (AMA-guides), Glasgow Outcome Scales (GOS/GOSE), Vineland Adaptive Behavior Scales (VABS), Child Behavior Checklist (CBCL), and Strengths and Difficulties Questionnaire (SDQ). RESULTS: Of 40 children, 28 were followed up. Most (n = 16; 57%) had no impairments (AMA guides); minor to severe impairments were found in 12 of the respondents. About 80% (n = 22) had good recovery (GOS 5 and GOSE 7/8); the remaining had moderately disability (GOS 4 or GOSE 5/6). The mean scores on the VABS and the frequency of behavioral problems on the CBCL (24%) and the SDQ (20%) were comparable to healthy peers. CONCLUSIONS: This long-term follow-up study after major trauma revealed that most children had a health condition comparable to healthy peers; about 40% of the respondents was physically impaired or restricted in daily activities. Our experiences with different measures may be helpful to apply age-appropriate outcome measures for the clinical follow-up of children after major trauma and to design future longitudinal studies. PMID: 19635311 [PubMed - indexed for MEDLINE]

Early experience with the use of rhomboid excision and Limberg flap in 16 adolescents with pilonidal disease.

Related Articles Early experience with the use of rhomboid excision and Limberg flap in 16 adolescents with pilonidal disease. J Pediatr Surg. 2009 Aug;44(8):1586-90 Authors: Yamout SZ, Caty MG, Lee YH, Lau ST, Escobar MA, Glick PL BACKGROUND: Rhomboid excision with Limberg flap (RELF) repair has been shown to be effective in the management of pilonidal disease (PD) in adults. Wide excision allows complete removal of diseased tissue, and the rotational flap allows tensionless coverage as well as helps flatten the natal crease, which is believed to contribute to the recurrence of PD. METHODS: This study is a retrospective review of all adolescents who underwent excision of pilonidal disease using RELF at a single institution for a period of 18 months. RESULTS: Sixteen adolescents with PD were treated with RELF during this period. All procedures were completed with no intraoperative complications. Mean operative time and hospital stay were 92 +/- 30 minutes and 1.8 +/- 0.29 days, respectively. Mean follow-up was 11 +/- 6.0 months. One patient had recurrence of his disease, and one needed prolonged wound care after wound breakdown. Six others had minor complications including 4 patients (25%) who had superficial wound separation that resolved promptly with dressing change. One patient had a superficial wound infection. One patient had residual pain. CONCLUSION: Rhomboid excision with Limberg flap is effective in the management of PD in adolescents. The 6% recurrence rate is similar to that reported in the adult literature. Despite the limitations of this study, the low morbidity, hospital stay, and recurrence rate noted with our initial experience are very encouraging. PMID: 19635310 [PubMed - indexed for MEDLINE]

Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience.

Related Articles Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience. J Pediatr Surg. 2009 Aug;44(8):1581-5 Authors: Kaselas C, Molinaro F, Lacreuse I, Becmeur F PURPOSE: The purpose of the study was to determine and evaluate the incidence of postoperative bowel obstruction (PBO) after laparoscopic and open appendectomy in children. MATERIAL AND METHODS: The medical files of children who have undergone an appendectomy, either via the laparoscopic or open approach, at our department from 1992 until 2007 were reviewed. Collected data included age at appendectomy, initial surgical approach, time interval to PBO, and type of definitive treatment. The incidences of PBO after laparoscopic and open appendectomy were compared with the chi(2) analysis. RESULTS: From the 1684 children who were found, 1371 had nonperforated appendicitis and 313 had perforated appendicitis. Laparoscopic appendectomy was performed in 954 patients of the nonperforated group and in 221 of the perforated group. Open appendectomy was performed in 417 and 92 patients of the 2 groups, respectively. Overall, the incidence of PBO development was 2.2%. In the laparoscopic appendectomy population, a significantly low incidence of 1.19% of PBO development was detected, compared with the 4.51% of the open appendectomy group (P < .0001). CONCLUSION: Laparoscopic appendectomy diminishes the potential of PBO development. The overall incidence of PBO is not related to the severity of the disease but only to the initial operative approach. PMID: 19635309 [PubMed - indexed for MEDLINE]

Antegrade enemas for defecation disorders: do they improve the colonic motility?

Related Articles Antegrade enemas for defecation disorders: do they improve the colonic motility? J Pediatr Surg. 2009 Aug;44(8):1575-80 Authors: Aspirot A, Fernandez S, Di Lorenzo C, Skaggs B, Mousa H PURPOSE: The aim of the study was to describe the changes in colonic motility occurring after chronic antegrade enema use in children and young adults. METHODS: Colonic manometry tracings of patients who had used antegrade enemas for at least 6 months and were being evaluated for possible discontinuation of this treatment were retrospective reviewed. RESULTS: Seven patients (median age of 12 years, range 3-15 years) met our inclusion criteria. Four patients had idiopathic constipation, 2 had tethered cord, and 1 had Hirschsprung disease. Colonic manometry before the use of antegrade enemas showed dysmotility in 6 (86%) children, mostly in the distal colon. None of the patients underwent colonic resection between the 2 studies. All the patients had colonic manometry repeated between 14 and 46 months after the creation of the cecostomy. All patients with abnormal colonic manometry improved with the use of antegrade enema with a complete normalization of colonic motility in 5 (83%) patients. CONCLUSION: Use of antegrade enema alone, without diversion or resection, may improve colonic motility. PMID: 19635308 [PubMed - indexed for MEDLINE]

Temporal and spatial expression of caudal-type homeobox gene-1 in the development of anorectal malformations in rat embryos.

Related Articles Temporal and spatial expression of caudal-type homeobox gene-1 in the development of anorectal malformations in rat embryos. J Pediatr Surg. 2009 Aug;44(8):1568-74 Authors: Zhang T, Bai YZ, Zhang D, Zhang SW, Wang da J, Jia HM, Yuan ZW, Wang WL PURPOSE: The aim of this study was to determine caudal-type homeobox gene-1 (Cdx1) expressions during anorectal development in normal and anorectal malformation (ARMs) embryos and investigate the possible role of Cdx1 in the pathogenesis of ARM. MATERIALS AND METHODS: Anorectal malformation was induced by ethylenethiourea on the 10th gestational day (GD10) in rat embryos. Cesarean deliveries were performed to harvest embryos from GD13 to GD21. The temporal and spatial expression of Cdx1 was evaluated in normal rat embryos (n = 334) and ARM embryos (n = 328) from GD13 to GD20 using immunohistochemistry staining, reverse transcriptase polymerase chain reaction (RT-PCR), and Western blot analysis. RESULTS: Immunostaining revealed that in normal embryos, on GD13.5, Cdx1 expression was mainly located on the epithelium of the dorsal urorectal septum (URS), cloacal membrane, and the hindgut. On GD15, increased positive tissue staining was noted on the fused tissue of URS, especially in the very thin anal membrane. In the ARM embryos, however, the epithelium of the cloaca, URS, and anorectum was negative or faint for Cdx1. In Western blot and RT-PCR, in the normal group, Cdx1 protein and Cdx1 messenger RNA expression showed time-dependent changes in the developing hindgut, on GD14, GD14.5, and GD15. The expression level reached a peak when the anus was forming. Once the anus was open, Cdx1 expression gradually decreased. In addition, the expression level of Cdx1 in the ARM group from GD13 to GD16 was significant lower than that of the normal group (P < .05). CONCLUSIONS: In ARM embryos, an imbalance of spatiotemporal expression of Cdx1 was noted during anorectal morphogenesis from GD13 to GD16. This suggests that downregulation of Cdx1 at the time of cloacal separation into rectum and urethra might be related to the development of ARM. PMID: 19635307 [PubMed - indexed for MEDLINE]

Management strategies for infants with total intestinal aganglionosis.

Related Articles Management strategies for infants with total intestinal aganglionosis. J Pediatr Surg. 2009 Aug;44(8):1564-7 Authors: Kimura O, Ono S, Furukawa T, Higuchi K, Deguchi E, Iwai N PURPOSE: This study investigated appropriate management strategies for infants with total intestinal aganglionosis (TIA), focusing on surgical and medical managements. METHODS: Six infants with TIA or near TIA treated in our institution between 1980 and 2007 were reviewed retrospectively. Surgery was performed as a simple jejunostomy, 65 to 70 cm below the ligament of Treitz (LOT) in 2 infants, and 30 cm below LOT in 1 without extended myectomy-myotomy (EMM). Jejunostomy with EMM 30 to 35 cm below LOT were performed in 3. RESULTS: Two infants with jejunostomy 65 cm or 70 cm distal from LOT died of sepsis at 7 months and 8 months of age, respectively. One infant with jejunostomy 30 cm from LOT without EMM died of cholestatic liver failure at the age of 1 year and 8 months. To date, the remaining 3 infants with jejunostomy 30 cm or 35 cm distal from LOT in addition to EMM have survived 10 years, 3 years and 10 months, and 2 years of age, respectively. Nutritional managements such as parenteral nutrition with 80 to 100 kcal/kg/day and oral feeding with elemental diet (ED) were preferable to reduce the occurrence of enteritis, sepsis, and cholestatic liver dysfunction. CONCLUSION: A good combination of cyclic parenteral nutrition and oral intake with elemental diet after short proximal jejunostomy with EMM may be a key for the survival of infants with TIA. In addition, in infants whose absorptive function was not ameliorated by EMM, medical management such as GH administration might be worth trying. PMID: 19635306 [PubMed - indexed for MEDLINE]

The preliminary study of modified Swenson procedure in Hirschsprung disease.

Related Articles The preliminary study of modified Swenson procedure in Hirschsprung disease. J Pediatr Surg. 2009 Aug;44(8):1560-3 Authors: Yokoi A, Satoh S, Takamizawa S, Muraji T, Tsugawa C, Nishijima E PURPOSE: We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen). We hypothesized that (1) omitting anterior wall dissection would not affect postoperative anorectal function, and (2) reduced dissection with better visualization via laparoscopy would reduce operative risks. METHOD: Charts of 89 patients with Hirschsprung disease operated on between 1990 through 2005 were retrospectively reviewed. Comparisons between Swen and mSwen, as well as between mSwen and LapmSwen, were analyzed in terms of operating time, blood loss, and complications. RESULTS: Mean operating times (minutes) were 312 for Swen, 284 for mSwen (P = .152), and 302 for LapmSwen ( mSwen, P = .218). Mean blood loss (mL) were 64.8 for Swen, 60.3 for mSwen (P = .669), and 8.7 for LapmSwen (as compared to mSwen, P = .001). We noted leakage in 7 Swen, 2 mSwen, and no LapmSwen patients. There were no significant differences between Swen and mSwen, or between mSwen and LapmSwen, in the incidence of enterocolitis, constipation, and soiling. CONCLUSION: LapmSwen appeared to be comparable to the standard and modified Swenson procedures in most measures. Operative blood loss may be reduced in the LapmSwen approach. PMID: 19635305 [PubMed - indexed for MEDLINE]

Nutritional effects of the serial transverse enteroplasty procedure in experimental short bowel syndrome.

Related Articles Nutritional effects of the serial transverse enteroplasty procedure in experimental short bowel syndrome. J Pediatr Surg. 2009 Aug;44(8):1552-9 Authors: Kaji T, Tanaka H, Wallace LE, Kravarusic D, Holst J, Sigalet DL BACKGROUND/PURPOSE: The serial transverse enteroplasty (STEP) procedure appears beneficial clinically, but the mechanism(s) underlying these effects remains unclear. The present study evaluated the nutritional, hormonal, and morphologic effects of the STEP procedure in a rodent model of short bowel syndrome. METHODS: With institutional animal care ethics approval, Sprague-Dawley rats underwent an 80% distal bowel resection, anastomosing the 30 cm remnant of jejunum to the ascending colon; at day 14, animals were randomly assigned to control or a STEP procedure (n = 8/group). Animals were pair-fed with normal chow; after a further 3 weeks, intestinal transit, hormonal and metabolic balance studies were done, and intestinal tissues were taken for analysis. RESULTS: The STEP group had increased weight gain (resected: -0.34% +/- 2.9% vs STEP: 2.5% +/- 1.5%), increased bowel length (34.1 +/- 1.5 vs 36.9 +/- 2.2 cm), increased jejunal villus height (555 +/- 59 vs 635 +/- 65 microm), decreased rates of crypt cell apoptosis, increased expression of mRNA for the GLP-2 receptor, and increased postprandial production of glucagon-like peptide 2 (45 +/- 14 vs 65 +/- 12 pmol/L) (P < .05 by Student t test). There were no differences in intestinal transit; absorption of total calories, protein, fat, or carbohydrate; crypt cell proliferation rates; or the expression of intestinal transporter proteins (SGLT-1, GLUT-2, and GLUT-5). CONCLUSIONS: The STEP procedure improves weight gain and augments gross and microscopic intestinal morphology in severe experimental short bowel syndrome. Postprandial GLP-2 levels are increased, as is the expression of the GLP-2 receptor; these mechanisms may contribute to these metabolic effects and may be useful in guiding the use of the STEP procedure clinically. PMID: 19635304 [PubMed - indexed for MEDLINE]

Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study.

Related Articles Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study. J Pediatr Surg. 2009 Aug;44(8):1546-51 Authors: Mac Bird T, Robbins JM, Druschel C, Cleves MA, Yang S, Hobbs CA, BACKGROUND: Primary prevention efforts for both gastroschisis and omphalocele are limited by the lack of known risk factors. Our objective was to investigate associations between potential maternal risk factors and gastroschisis and omphalocele within a large population-based sample of participants enrolled in the National Birth Defects Prevention Study (NBDPS). METHODS: Demographic, health-related, and environmental exposure data from the NBDPS were collected from women with expected delivery dates between October 1997 and December 2003. Data were collected on 485 cases of gastroschisis, 168 cases of omphalocele, and 4967 controls. RESULTS: Women who had offspring with gastroschisis were younger (adjusted odds ratio [AOR], 0.84; 95% confidence interval [CI], 0.81-0.86) and less likely to be black (AOR, 0.54; 95% CI, 0.34-0.85) than controls. They also were more likely to have smoked (AOR, 1.51; 95% CI, 1.12-2.03), taken ibuprofen (AOR, 1.61; 95% CI, 1.23-2.10), and consumed alcohol (AOR, 1.38; 95% CI, 1.06-1.79) than controls. Women who had offspring with omphaloceles were more likely to have consumed alcohol (AOR, 1.53; 95% CI, 1.04-2.25) and be heavy smokers (AOR, 4.26; 95% CI, 1.58-11.52) than controls. CONCLUSIONS: Our results suggest a moderately increased risk of gastroschisis among women who used tobacco, alcohol, and ibuprofen during early pregnancy. A modestly elevated risk was observed for omphaloceles among women who used alcohol during the first trimester and among women who were heavy smokers. PMID: 19635303 [PubMed - indexed for MEDLINE]

Erythropoietin increases reticulocyte counts and maintains hematocrit in neonates requiring surgery.

Related Articles Erythropoietin increases reticulocyte counts and maintains hematocrit in neonates requiring surgery. J Pediatr Surg. 2009 Aug;44(8):1540-5 Authors: Bierer R, Roohi M, Peceny C, Ohls RK BACKGROUND: Limited erythropoietin (Epo) production diminishes neonates' ability to regenerate blood removed by phlebotomy. Neonates requiring surgery are at risk to receive multiple transfusions. We sought to determine if recombinant Epo administration to neonates requiring surgery would stimulate erythropoiesis. METHODS: Infants were randomized in double-masked fashion to receive Epo (200 units kg(-1) d(-1)) or placebo for 14 days. Complete blood count, absolute reticulocyte count (ARC), phlebotomy losses, and transfusions were measured during the study period. Infants were transfused using a strict transfusion protocol. RESULTS: In the Epo group (n = 10, 2034 +/- 308 g, 8 +/- 2 days old; mean +/- SEM), ARC increased significantly, whereas in the placebo group (n = 10, 2400 +/- 184 g, 7 +/- 2 days old), ARC remained low. Hematocrits in the Epo group trended upward from 34.4 1.7% to 37.3 1.9% (although not statistically significant) despite phlebotomy losses of 53 +/- 12 mL/kg. Hematocrits in the placebo group were 35.9 1.8% and 33.2 1.6% on days 1 and 15, respectively, with phlebotomy losses of 27 +/- 5 mL/kg. There were no differences in absolute neutrophil counts or platelet counts between groups at the end of the study. No adverse effects were noted. CONCLUSIONS: Infants randomized to Epo increased reticulocyte counts and hematocrits without adverse effects. Erythropoietin administration may provide an adjunct to present care in decreasing or eliminating erythrocyte transfusions in surgical neonates. PMID: 19635302 [PubMed - indexed for MEDLINE]

Is mortality rate influenced by the site of involvement in neonates undergoing laparotomy for necrotizing enterocolitis?

Related Articles Is mortality rate influenced by the site of involvement in neonates undergoing laparotomy for necrotizing enterocolitis? J Pediatr Surg. 2009 Aug;44(8):1534-9 Authors: de Souza JC, Fraga JC PURPOSE: The aim of the study was to evaluate the effect of disease site on the mortality rate of newborns with necrotizing enterocolitis (NEC) undergoing exploratory laparotomy. METHODS: The study used prospective cohort of 141 consecutive newborns with NEC who underwent laparotomy from November 1991 to December 2005. RESULTS: One hundred nineteen (84.4%) newborns were premature. Small for gestational age was observed in 57 (40.4%). Sixty-eight (48.2%) infants died. Bivariate analysis revealed that involvement of the jejunum and ileum was associated with high mortality rates (20 deaths; 76.9%; odds ratio [OR], 20; 95% confidence interval [CI], 4.6-96.3; P < .001) and that coinvolvement of the jejunum was associated with greater disease extent. After controlling for individual variables, logistic regression showed that the mortality associated with jejunum and ileum involvement (OR, 0.61; 95% CI, 0.06-6.14; P = .68) did not differ from that associated with large bowel involvement (OR, 2.91; 95% CI, 0.81-10.50; P = .10). When the jejunum was involved with the disease, the percentage of involvement of the entire intestine was 72%, and the mortality rate was 85.1%. When the other bowel segments were involved, the global percentage of disease extent ranged from 42% to 49%, and the mortality rate from 51.9% to 71.8%. After multivariable adjustment disease site, jejunal involvement appeared to be only a surrogate marker of disease extent. CONCLUSIONS: The NEC-related mortality in newborns undergoing laparotomy was not influenced by disease site (small or large bowel). However, jejunum coinvolvement was a marker of greater disease extent and therefore of poor prognosis. PMID: 19635301 [PubMed - indexed for MEDLINE]

Total thyroidectomy for benign disease in the pediatric patient--feasible and safe.

Related Articles Total thyroidectomy for benign disease in the pediatric patient--feasible and safe. J Pediatr Surg. 2009 Aug;44(8):1529-33 Authors: Raval MV, Browne M, Chin AC, Zimmerman D, Angelos P, Reynolds M PURPOSE: Total thyroidectomy (TT) is a safe and efficacious treatment of malignant thyroid disease in children. The role of TT in benign thyroid disease is less well-defined. The goal of this study was to compare the safety of TT performed for benign and malignant disease. METHODS: The medical records of 31 patients undergoing TT from January 2000 to June 2007 at a single center were reviewed. The benign cohort totaled 15 patients consisting of 12 with Graves' disease, 2 with hyperthyroidism, and 1 with large and symptomatic multinodular goiter. The malignant cohort totaled 16 patients consisting of 9 with malignant disease, 4 with a nodule and history of cancer or radiation exposure, and 3 with RET proto-oncogene mutations. RESULTS: The most common complication was transient hypocalcemia observed in 7 (46%) of 15 patients with benign disease and 9 (56%) of 16 patients with malignancy (P = .72). Permanent hypocalcemia, defined as need for calcium supplement 6 months postprocedure, was observed in 1 patient with benign disease (6.67%) and 1 patient with malignancy (6.25%; P = 1.0). A single parathyroid gland was reimplanted in 2 patients with malignancy and 2 patients with benign disease (P = 1.0). One case of keloid scar was noted, and no cases of recurrent laryngeal nerve palsy, nerve paralysis, tracheal injury, tracheostomy, or wound infection were encountered in either cohort. There were no cases of relapse hyperthyroidism in the benign cohort. CONCLUSIONS: Similar rates of postoperative complications can be expected with TT for benign thyroid disease as compared to TT for malignant disease. Total thyroidectomy is a safe treatment option for benign thyroid disease in children. PMID: 19635300 [PubMed - indexed for MEDLINE]

Loss of carcinoembryonic antigen-related cell adhesion molecule 1 expression predicts metachronous pulmonary metastasis and poor survival in patients with hepatoblastoma.

Related Articles Loss of carcinoembryonic antigen-related cell adhesion molecule 1 expression predicts metachronous pulmonary metastasis and poor survival in patients with hepatoblastoma. J Pediatr Surg. 2009 Aug;44(8):1522-8 Authors: Tsukada M, Wakai T, Matsuda Y, Korita PV, Shirai Y, Ajioka Y, Hatakeyama K, Kubota M PURPOSE: Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a member of the carcinoembryonic antigen family of immunoglobulin-like adhesion molecules. The aim of this study was to test the hypothesis that loss of CEACAM1 expression in hepatoblastoma cells may promote hematogeneous metastasis and function as an adverse prognostic factor. METHODS: Immunohistochemical expression of CEACAM1 in surgically resected specimens from 19 patients with hepatoblastoma was examined retrospectively. The CEACAM1 expression in the epithelial area of the tumor was classified into 2 categories as follows: diffuse expression, characterized by positive staining throughout the tumor specimen, or loss of expression, in which there were distinct areas of negative staining within the tumor specimen. RESULTS: Of the 19 patients, 12 were classified as having tumors with diffuse expression, and 7 had loss-of-expression tumors. Survival after treatment was significantly worse in patients with tumors with loss of CEACAM1 expression (cumulative 5-year survival rate, 29%) than in patients with diffuse CEACAM1 expression (cumulative 5-year survival rate, 92%; P = .0062). Loss of CEACAM1 expression was a significant risk factor for metachronous pulmonary metastases (P = .0105). CONCLUSIONS: Loss of CEACAM1 expression may reflect a high metastatic potential and thus indicate a poor prognosis for patients with hepatoblastoma. PMID: 19635299 [PubMed - indexed for MEDLINE]

Pediatric melanoma: a single-institution experience of 150 patients.

Related Articles Pediatric melanoma: a single-institution experience of 150 patients. J Pediatr Surg. 2009 Aug;44(8):1514-21 Authors: Aldrink JH, Selim MA, Diesen DL, Johnson J, Pruitt SK, Tyler DS, Seigler HF PURPOSE: Differentiating pigmented skin lesions from malignant melanoma in the pediatric population has been a challenge. Despite guidelines describing clinical features and histopathologic criteria to distinguish these lesions, misdiagnoses still occur. We report our experience over 30 years in a pediatric population with malignant melanoma. METHODS: We performed a retrospective review of 150 pediatric patients treated for malignant melanoma between 1973 and 2007 at our institution. Outcomes measured included age, Breslow thickness, Clark level of invasion, tumor location, local and distant failure rates, and overall survival. RESULTS: One hundred fifty pediatric patients were evaluated. The mean age was 15.1 years. The mean Breslow thickness was 2.05 mm and corresponding Clark level of invasion was 3.47. There were 43 known recurrences (29%); 29 distant, 14 nodal, and 7 local. Overall survival was 84% with a mean follow-up of 8.5 years. Sixteen patients (10.7%) were incorrectly diagnosed on initial pathologic examination. Overall survival in the misdiagnosed group was 66%. CONCLUSION: Pigmented skin lesions in the pediatric population represent a diagnostic challenge to pathologists and clinicians. Improvements in diagnostic techniques with rigorous characterization, as well as increased physician awareness, should lead to a reduction in errors of diagnosis. PMID: 19635298 [PubMed - indexed for MEDLINE]

Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results.

Related Articles Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results. J Pediatr Surg. 2009 Aug;44(8):1509-13 Authors: Tong Q, Zheng L, Tang S, Du Z, Wu Z, Mei H, Ruan Q OBJECTIVES: Varicocele is a relatively rare disorder in children that can lead to testicular atrophy and infertility. The ideal surgical treatment for varicoceles is still a matter of controversy because of the frequency of postoperative complications. Here, we report our series of children who underwent lymphatic sparing laparoscopic Palomo varicocelectomy. PATIENTS AND METHODS: A total of 46 boys, 9 to 14 years old, underwent laparoscopic repair for varicoceles between January 2002 and December 2007. All of them had a left-sided varicocele. The varicocele was diagnosed by physical examination and Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the lymphatic vessels, followed by double ligation of the spermatic vessels. Follow-up for these children included physical examination and Doppler ultrasonography. RESULTS: Lymphatic sparing laparoscopic Palomo varicocelectomy was feasible in all 46 (100%) of the children. Mean operative time was 34.2 minutes (range, 25-42 minutes). There were no intraoperative complications. One patient recurred because of incomplete ligation of spermatic vein. Mean follow-up was 20 months (range, 7-32 months). Hydrocele formation, testicular atrophy, and testicular hypertrophy were not observed postoperatively. However, 2 preoperative hypotrophic testes were noted with 10.4% and 12.5% decreases in size. CONCLUSIONS: Our study reveals that lymphatic sparing laparoscopic Palomo varicocelectomy in children is safe, effective, and the reliable treatment of pediatric varicocele. However, long-term follow-up is required to best characterize ultimate outcome. PMID: 19635297 [PubMed - indexed for MEDLINE]

Diagnosis and treatment of pediatric vaginal and genital tract abnormalities by small diameter hysteroscope.

Related Articles Diagnosis and treatment of pediatric vaginal and genital tract abnormalities by small diameter hysteroscope. J Pediatr Surg. 2009 Aug;44(8):1506-8 Authors: Smorgick N, Padua A, Lotan G, Halperin R, Pansky M The vaginal speculum can be safely and efficaciously replaced by the less traumatic small diameter continuous flow hysteroscopic vaginoscopy for diagnosis and treatment of genital tract lesion in children and adolescents. PMID: 19635296 [PubMed - indexed for MEDLINE]

Laparoscopic hernia repair in children by the hook method: a single-center series of 433 consecutive patients.

Related Articles Laparoscopic hernia repair in children by the hook method: a single-center series of 433 consecutive patients. J Pediatr Surg. 2009 Aug;44(8):1502-5 Authors: Tam YH, Lee KH, Sihoe JD, Chan KW, Wong PY, Cheung ST, Mou JW BACKGROUND: The relatively high recurrence rate reported in laparoscopic hernia repair in children using intracorporeal suturing technique remains a concern. We aimed to investigate the effectiveness of the hook method during hernia repair that allows extraperitoneal passage of suture to close the hernia sac without creating any tension or skip areas and does not require laparoscopic suturing skills. METHODS: A retrospective review was conducted on 433 consecutive children who underwent laparoscopic hernia repair using the hook method by 1 of 4 surgeons from July 2004 to June 2007. RESULTS: A total of 572 successful laparoscopic hernia repairs were performed among the 433 children with an age range of 1 week to 15 years (mean = 56 months). Conversion rate was 1.04%. Contralateral patent processus vaginalis was found in 26.8%. Mean operating time was 23.8 and 40.2 minutes for unilateral and bilateral repair, respectively. At a median follow-up of 20 months, there were 2 recurrences (0.35%), 2 hydroceles, 1 ascending testis, and 1 instance of testicular atrophy. No serious complications were associated with the procedure. CONCLUSIONS: Medium-term results suggest that laparoscopic hernia repair with the hook method is a sound alternative to open herniotomy in children. PMID: 19635295 [PubMed - indexed for MEDLINE]

Calcitonin gene-related peptide is a survival factor, inhibiting apoptosis in neonatal rat gubernaculum in vitro.

Related Articles Calcitonin gene-related peptide is a survival factor, inhibiting apoptosis in neonatal rat gubernaculum in vitro. J Pediatr Surg. 2009 Aug;44(8):1497-501 Authors: Chan JJ, Farmer PJ, Southwell BR, Sourial M, Hutson JM BACKGROUND: Testicular descent is proposed to occur in 2 stages. During the second stage, calcitonin gene-related peptide (CGRP) released from the genitofemoral nerve (GFN) causes maximal mitosis in the gubernacular bulb. As normal development requires a balance between cell proliferation and apoptosis, this study explored the effect of CGRP on apoptosis in the rat gubernacular bulb. METHODS: Gubernacula were collected from male Sprague-Dawley rats at birth (D0) or 2 days post birth (D2), and placed in organ culture for 24 hours with or without CGRP (0.001 mol/L). The D2 rats were pretreated with capsaicin (sensory nerve toxin) or flutamide (antiandrogen) or untreated. D0 rats were untreated (n = 64). Sections of the bulb were stained using the TUNEL method to identify apoptotic cells. Apoptosis was calculated as the percentage of positive cells per hundred cells. RESULTS: Normal Sprague-Dawley rat gubernacula showed reduced apoptosis when cultured with CGRP, in D0 (7.0% vs 4.8%, P < .05) and D2 (4.9% vs 2.3%, P < .001). Greater apoptosis occurred at D0 compared to D2, without CGRP added (7.0% vs 4.9%, P < .05) and with CGRP (4.8% vs 2.3%, P < .001). For D2 gubernacula, capsaicin treatment increased apoptosis compared to controls, without CGRP added (4.9% vs 7.3%, P < .05) and with CGRP (2.3% vs 6.7%, P < .001). There was no difference in apoptosis when cultured with or without CGRP (7.3% vs 6.7%, nonsignificant) after capsaicin treatment. Flutamide treatment increased apoptosis compared to controls, but only with CGRP (2.3% vs 7.3%, P < .001). There was no difference in apoptosis when cultured with or without CGRP (7.1% vs 7.3%, nonsignificant) after flutamide. CONCLUSIONS: Calcitonin gene-related peptide (CGRP) acts as a survival factor in the rat gubernaculum, possibly to steer cells away from a defined apoptotic pathway. Greater apoptosis occurs earlier in development. However, in vivo CGRP released from the genitofemoral nerve may be required to prevent apoptosis, as shown by pretreatment with the sensory nerve toxin capsaicin. Androgen is also involved in the pathway controlling apoptosis, as androgen blockade with flutamide inhibited the action of CGRP. PMID: 19635294 [PubMed - indexed for MEDLINE]

Long-term physical, hormonal, and sexual outcome of males with disorders of sex development.

Related Articles Long-term physical, hormonal, and sexual outcome of males with disorders of sex development. J Pediatr Surg. 2009 Aug;44(8):1491-6 Authors: Kojima Y, Mizuno K, Nakane A, Kato T, Kohri K, Hayashi Y PURPOSE: We investigated the long-term physical, hormonal, and sexual outcomes of males with disorders of sex development (DSD) and discussed the necessity of long-term follow-up for these patients after surgery. PATIENTS AND METHOD: Twelve DSD patients (average age, 21.0 +/- 3.6 years old) who had been designated as male in childhood (3 ovotesticular DSD, four 45,XO/46,XY mixed gonadal dysgenesis, four 46,XX testicular DSD, and one 46,XY DSD; androgen insensitivity syndrome) were enrolled. For these patients, height, penile length, and testicular volume were evaluated in adulthood. Serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone were also measured during follow-up. In addition, sexual function and romantic relationships were evaluated. RESULTS: Development of the penis and testes was poor. According to the hormonal study, these patients were diagnosed with hypergonadotropic hypogonadism or normogonadism; 90% patients had experienced penile erection and masturbation at the time of participation, and 70% and 40% patients had experienced ejaculation and sexual intercourse with female partners, respectively. No patients preferred to avoid sexual contact with women. CONCLUSION: Although DSD males had an undeveloped penis and testis and had hypergonadotropic hypogonadism or normogonadism, most had male sexual potential and male sex identity as long as testicular tissues were preserved. PMID: 19635293 [PubMed - indexed for MEDLINE]

Prevention of the murine model of biliary atresia after live rotavirus vaccination of dams.

Related Articles Prevention of the murine model of biliary atresia after live rotavirus vaccination of dams. J Pediatr Surg. 2009 Aug;44(8):1479-90 Authors: Bondoc AJ, Jafri MA, Donnelly B, Mohanty SK, McNeal MM, Ward RL, Tiao GM PURPOSE: Biliary atresia (BA) is a neonatal disease that results in the obliteration of the biliary tree. The murine model of BA has been established where rhesus rotavirus (RRV) infection of newborn mice leads to an obstructive cholangiopathy. We determined whether maternal postconception rotavirus vaccination could prevent the murine model of BA. MATERIALS AND METHODS: Female mice were mated and injected intraperitoneally with one of the following materials: purified rotavirus strains RRV or Wa, high or low-dose Rotateq (Merck and Co Inc, Whitehouse Station, NJ) (a pentavalent rotavirus vaccine [PRV]), purified recombinant viral antigens of rotavirus (VP6) or influenza (NP), or saline. B-cell-deficient females also underwent postconception PRV injection. RESULTS: Maternal vaccination with PRV improves survival of pups infected with RRV. Serum rotavirus IgG, but not IgA, levels were increased in pups delivered from dams who received RRV, Wa, PRV, or VP6, but in the case of the Wa, PRV, and VP6 groups, these antibodies were not neutralizing. Postconception injection of high-dose PRV did not improve survival of pups born to B-cell-deficient dams. CONCLUSION: Maternal vaccination against RRV can prevent the rotavirus-induced murine model of BA in newborn mouse pups. PMID: 19635292 [PubMed - indexed for MEDLINE]

Solitary hepatic lymphangioma in a 22-day-old infant.

Related Articles Solitary hepatic lymphangioma in a 22-day-old infant. J Pediatr Surg. 2009 Aug;44(8):E9-11 Authors: Shahi KS, Geeta B, Rajput P Lymphangiomas are congenital malformations of the lymphatic system composed of dilated endothelial lined spaces of varying sizes containing lymph. Hepatic lymphangioma is a rare finding, exclusively present in children and adolescents. Most reported cases occur as part of diffuse lymphangiomatosis. Solitary lymphangioma of the liver in infants is extremely rare. This report describes a case of unilocular, solitary hepatic lymphangioma in a 22-day-old infant. PMID: 19635291 [PubMed - indexed for MEDLINE]

Lambert-Eaton myasthenic syndrome revealing an abdominal neuroblastoma.

Related Articles Lambert-Eaton myasthenic syndrome revealing an abdominal neuroblastoma. J Pediatr Surg. 2009 Aug;44(8):E5-7 Authors: de Buys Roessingh AS, Loriot MH, Wiesenauer C, Lallier M Lambert-Eaton myasthenic syndrome is a paraneoplastic syndrome that may reveal a primitive tumor. Neuroblastoma in children and small cell lung carcinoma in adults are the leading tumors revealed or expressed by paraneoplastic phenomena. The clinical neurologic manifestations of Lambert-Eaton myasthenic syndrome are muscular weakness, sleepiness, absence of reflexes, and dysautonomia. Neurologic manifestations are explained by the induction of an autoimmune response because of the presence of antigens that are expressed by the tumor. Neurologic paraneoplastic disorders may also be the result of toxicity of drugs, coagulopathy, infection, or metabolic diseases. We describe the case of a 13-month-old child with unusual neurologic symptoms because of the presence of an abdominal neuroblastoma. PMID: 19635290 [PubMed - indexed for MEDLINE]

Carotid artery thrombosis and delayed stroke associated with the use of a shoulder belt in a teenager.

Related Articles Carotid artery thrombosis and delayed stroke associated with the use of a shoulder belt in a teenager. J Pediatr Surg. 2009 Aug;44(8):E29-33 Authors: Levack MM, Pettitt BJ, Winston AD Blunt carotid artery injury caused by shoulder belts is rare and requires a high index of suspicion to diagnose before the onset of neurologic sequelae. Neurologic abnormalities may be erroneously attributed to concomitant head trauma, and the onset of neurologic abnormalities may be delayed for hours or days. The case of a young, teenaged driver with a "seatbelt sign" and presentation of signs and symptoms of carotid artery thrombosis 13 days after injury is described. Occult vascular injury should be suspected if neurologic deterioration occurs after a lucid interval and/or computed tomography of the head is inconsistent with neurologic findings. Screening criteria and possible screening modalities are discussed. PMID: 19635289 [PubMed - indexed for MEDLINE]

Multiorgan developmental anomalies presenting as a variation of the serpentine-like syndrome: cervical fusion and brachioesophagus with intrathoracic stomach and malposition of duodenopancreas and spleen.

Related Articles Multiorgan developmental anomalies presenting as a variation of the serpentine-like syndrome: cervical fusion and brachioesophagus with intrathoracic stomach and malposition of duodenopancreas and spleen. J Pediatr Surg. 2009 Aug;44(8):E25-8 Authors: Deprez FC, Debauche C, Clapuyt P, de Ville de Goyet J Congenital brachioesophagus with secondary intrathoracic stomach is an extremely rare condition. In association with rachischisis, the latter condition has been described recently as "serpentine-like syndrome." We report here a unique case of a male infant with normal karyotype from healthy nonconsanguinous parents, presenting with a complex malformative syndrome combining ultrashort brachioesophagus with intrathoracic stomach, duodenum, pancreas, and spleen associated with short neck because of posterior fusion and scoliosis. This case report details aspects of diagnostic and management of this unusual clinical presentation and includes a review of the literature. PMID: 19635288 [PubMed - indexed for MEDLINE]

Local resection of metanephric adenoma with kidney preservation.

Related Articles Local resection of metanephric adenoma with kidney preservation. J Pediatr Surg. 2009 Aug;44(8):E21-3 Authors: Liniger B, Wolf RW, Fleischmann A, Kluwe W Metanephric adenoma (MA) is a rare renal neoplasm present at any age. Usually, a total nephrectomy is performed. Some successful partial nephrectomies or selective tumor resections are described in adults but not in children. We present here the case of a 15-month-old boy, the youngest patient yet to be reported with an MA. We performed a local resection of the tumor. Today, 2 1/2 years after surgery, we can document a favorable clinical course and normal ultrasound findings in the follow-up of the operated kidney. This case gives further evidence that organ-sparing resection of MA is feasible in selected cases. A close clinical and ultrasound follow-up is mandatory for this approach. PMID: 19635287 [PubMed - indexed for MEDLINE]

Treatment of severe osteitis after elastic intramedullary nailing of a radial bone shaft fracture by using cancellous bone graft in Masquelet technique in a 13-year-old adolescent girl.

Related Articles Treatment of severe osteitis after elastic intramedullary nailing of a radial bone shaft fracture by using cancellous bone graft in Masquelet technique in a 13-year-old adolescent girl. J Pediatr Surg. 2009 Aug;44(8):E17-9 Authors: Powerski M, Maier B, Frank J, Marzi I We present here an unfortunate long-lasting case of sever osteitis after elastic intramedullary nailing of a radial bone shaft fracture in a 13-year-old adolescent girl and the final treatment by using a modified Masquelet technique (Palacos spacer and cancellous bone graft in a second session in addition to a plate osteosynthesis) to reconstruct the severely destroyed proximal radial bone. PMID: 19635286 [PubMed - indexed for MEDLINE]

Growth spurt-related recurrence after Nuss procedure.

Related Articles Growth spurt-related recurrence after Nuss procedure. J Pediatr Surg. 2009 Aug;44(8):E13-6 Authors: Ishimaru T, Kitano Y, Uchida H, Kawashima H, Gotoh C, Satoh K, Yoshida M, Sugita A, Iwanaka T We report 2 cases of growth spurt-related recurrence after Nuss procedure. Each of the 2 cases underwent bar insertion at the age of 6 and 11 years, respectively. The support bar was removed 2 years later followed by severe redepression during the growth spurt. One patient underwent redo Nuss procedure elsewhere. The other patient was diagnosed as idiopathic precocious puberty and is in treatment. The possibility of growth spurt-related recurrence must be explained to those who undergo early correction before surgery, and follow-up is mandatory at least until patients' puberty is over. PMID: 19635285 [PubMed - indexed for MEDLINE]

Mayer-Rokitansky-Kuster-Hauser syndrome with H-type anovestibular fistula.

Related Articles Mayer-Rokitansky-Kuster-Hauser syndrome with H-type anovestibular fistula. J Pediatr Surg. 2009 Aug;44(8):E1-3 Authors: Mahajan JK, Venkatesh MA, Bawa M, Rao KL Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by Mullerian duct structures agenesis. Anorectal malformations are uncommonly associated with MRKH syndrome, and among them, rectovestibular fistula and cloacal malformations have been commonly described. H-type of anovestibular fistula associated with MRKH syndrome has not been reported previously. One such case along with its treatment is reported. PMID: 19635284 [PubMed - indexed for MEDLINE]