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

2 positions in greenville region of NC :: North Carolina :: Healthcare Recruitment Counselors, LLC

1) Seeking a full time Chief of Pediatric Surgery to develop a full service Division of Pediatric Surgery over the next several years. As Chief of Pediatric Surgery, He/she would work collaboratively

Pediatric surgeon needed in New York :: New York :: Weatherby Locums

Job 9603703-0008 This short-staffed group practice in New York is looking for a Pediatric Surgeon to provide coverage in March. General Pediatric Surgery. New York medical license required. Board Certification

Pediatric Surgeon needed in Texas :: Texas :: Weatherby Locums

Job 9554455-0004 This short-staffed group practice in Texas is in need of a Pediatric Surgeon to provide coverage beginning in April and ongoing. Physician must provide coverage in General and Pediatric

Call for location :: New York :: Medical Doctor Associates

Would you like to work in New York ? This is my territory for Pediatric Surgery and I would like to talk to you. Let me know the location and the kind of practice you want and I will do my best to find

Call for location :: Pennsylvania :: Medical Doctor Associates

Would you like to work in Pennsylvania? This is my territory for Pediatric Surgery and I would like to talk to you. Let me know the location and the kind of practice you want and I will do my best to

Great Location :: Wisconsin :: Onyx M.D.

A Pediatric General Surgeon is needed in Wisconsin to start ASAP. This gig is bread and butter Pediatric General Surgery. The schedule is Monday through Friday 8am to 5pm, with night and weekend call.

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

NorthEast :: Indiana :: Intelligent Placement Solutions, Inc

100% Pediatric Surgery opportunity for a Pediatric General Surgeon to join one other PD/GS and a nurse practitioner. Call is 1:2 but limited. This is a hospital employed position, referrals from 23

SouthWest :: Louisiana :: Intelligent Placement Solutions, Inc

Hospital in S.Louisiana is seeking a solo Pediatric Surgeon! Area has experienced significant growth in recent years. Convenient access to Houston and New Orleans. Call (888) 346-3624, ext. 121, eknight@jobs4med.com.

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

East :: North Carolina :: Intelligent Placement Solutions, Inc

Chief of Pediatric Surgery to develop a full service Division of Pediatric Surgery over the next several years. The successful candidate will have a record of clinical excellence, administrative ability

East :: North Carolina :: Intelligent Placement Solutions, Inc

Need two full time Pediatric Surgeons. These individuals would be part of a three-person division. The candidate should be Board Certified in Pediatric Surgery. Candidates must have excellent clinical

Bronx doctors from Montefiore hospital changed forever by Haitian relief trip - New York Daily News

New York Daily NewsBronx doctors from Montefiore hospital changed forever by Haitian relief tripNew York Daily NewsDr. Dominique Jan, chief of pediatric surgery at Montefiore Medical Center, checks on Fedora, 12, a Haitian girl who was trapped in rubble ...

A Nation at Large: Seminars help guide patients through process - Marietta Times

A Nation at Large: Seminars help guide patients through processMarietta TimesThe band is undergoing approval for adolescents, although I'm not a pediatric surgeon so I don't do that," Kaplan said, noting that younger LAP-BAND ...and more »

Children's Hospital opens specialty clinic - Bucyrus Telegraph Forum

Children's Hospital opens specialty clinicBucyrus Telegraph Forum1 at 680 Park Avenue West Suite G05, will provide north central Ohio residents with three specialty clinics in pediatric surgery, neurology and urology. ...

'Grey's Anatomy' Fan Columnist: State of Love and Trust Review - BuddyTV

BuddyTV'Grey's Anatomy' Fan Columnist: State of Love and Trust ReviewBuddyTV... in the end we get confirmation of what's been building for awhile (way back in the Addison days): Alex is meant to be a pediatric surgeon. ...'Grey's Anatomy': Derek's first day doesn't go as plannedLos Angeles Times (blog)Grey's Anatomy: A new chief in townThaindian.comall 28 news articles »

Pediatric hospitals find profits, growth - FierceHealthcare

Pediatric hospitals find profits, growthFierceHealthcare... Hospital has opened a Close To Home Center in Mansfield to provide area counties with specialty clinics in pediatric surgery, neurology and urology. ...and more »

Rejoicing Over Clinical Rotation Schedules - ADVANCE for Physician Assistants

ADVANCE for Physician AssistantsRejoicing Over Clinical Rotation SchedulesADVANCE for Physician AssistantsStay tuned! My first rotation will be emergency medicine and my last one will be trauma pediatric surgery. It's going to be a fun ride!

Azad for Early Filling of Specialist Vacancies - Kashmir Observer

Azad for Early Filling of Specialist VacanciesKashmir Observer... Medical Oncology, Surgical Oncology, Endocrinology, Clinical Hematology, pulmonary medicine, plastic surgery and Pediatric Surgery, he added. ...

Pediatric surgeon lists Central District 3BD for $2.25M - Blockshopper

BlockshopperPediatric surgeon lists Central District 3BD for $2.25MBlockshopperDr. Hatch is a pediatric general surgeon at Swedish Medical Center. He also is affiliated with the University of Washington Medical Center and Overlake ...

Transforming Human Fat Into Stem Cells - Science Daily (press release)

Transforming Human Fat Into Stem CellsScience Daily (press release)"This discovery represents research from four different departments: pediatrics, surgery, cardiology and radiology. We were all doing our own things, ...and more »

Weed killer atrazine may be linked to birth defect - Reuters

Weed killer atrazine may be linked to birth defectReutersIn 2007, Indiana researchers reported in the Journal of Pediatric Surgery that in their state, where rates of such birth defects are also very high, ...and more »

Enterolithiasis: a case report and review.

Related Articles Enterolithiasis: a case report and review. J Pediatr Surg. 2009 Nov;44(11):2249-50; author reply 2250 Authors: Hutson JM PMID: 19944243 [PubMed - indexed for MEDLINE]

The patent umbilical vein had a mucosal lining and could be cannulated under local anesthetics to provide ready access to the left branch of the portal vein.

Related Articles The patent umbilical vein had a mucosal lining and could be cannulated under local anesthetics to provide ready access to the left branch of the portal vein. J Pediatr Surg. 2009 Nov;44(11):2249 Authors: White JJ PMID: 19944242 [PubMed - indexed for MEDLINE]

Facial animation in children with Moebius and Moebius-like syndromes.

Related Articles Facial animation in children with Moebius and Moebius-like syndromes. J Pediatr Surg. 2009 Nov;44(11):2236-42 Authors: Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna E BACKGROUND: Moebius syndrome, a rare congenital disorder of varying severity, involves multiple cranial nerves and is characterized predominantly by bilateral or unilateral paralysis of the facial and abducens nerves. The paralysis of the VI and VII cranial nerves leads to a lack of function in the muscles they supply. Facial paralysis often causes bilabial incompetence with speech difficulties, oral incompetence, problems with eating and drinking, including pocketing of food in the cheek and dribbling, as well as severe drooling. METHODS: In this study, we report on pediatric patients with Moebius and Moebius-like syndromes seen and treated surgically from 2003 to September 2007 at the Operative Unit of Maxillofacial Surgery, Head and Neck Department, University of Parma, Italy. RESULTS: Twelve patients underwent microsurgical reconstruction for restoration of facial movement. The contralateral facial nerve was used as a motor donor nerve in 4 procedures, the motor nerve to the masseter muscle was used in 8 patients, and the gracilis muscle was used in all operations, with a total of 17 free-muscle transplantations. All free-muscle transplantations survived transfer, and no flap was lost. We observed a significant improvement in drooling, drinking, speech, and facial animation with a high degree of patient satisfaction. CONCLUSIONS: The gracilis muscle free transfer is a surgical procedure well tolerated by the young patients and well accepted by their families. We consider it a safe and reliable technique for facial reanimation with good aesthetical and functional results in children with Moebius and Moebius-like syndromes. PMID: 19944241 [PubMed - indexed for MEDLINE]

Single-stage feminizing genitoplasty in aphallia through an anterior saggital approach.

Related Articles Single-stage feminizing genitoplasty in aphallia through an anterior saggital approach. J Pediatr Surg. 2009 Nov;44(11):2233-5 Authors: Mane SB, Thakur A, Dhende NP, Obaidah A, Acharya H PURPOSE: An ideal feminizing genitoplasty in aphallia should achieve good cosmesis and capacious vagina in a single-stage repair. Most of the techniques described in the literature are variations of the posterior sagittal approach with staged repair. We describe a single-stage anterior sagittal approach for feminizing genitoplasty in cases of aphallia. MATERIALS AND METHODS: A case of aphallia was operated through an anterior sagittal approach, and a spiral Monti tube of sigmoid colon was used to create a neovagina. Preservation of the skin tag around the urethra and its placement in the perineum gives it the appearance of the clitoris. RESULT: The patient has been observed for 7 months. She is continent and has a satisfactory cosmetic appearance and capacious vagina. CONCLUSION: A single-stage operation through an anterior sagittal approach is a good alternative technique for genital reconstruction in the case of aphallia. PMID: 19944240 [PubMed - indexed for MEDLINE]

Giant omental lipoma in a 13-year-old adolescent girl.

Related Articles Giant omental lipoma in a 13-year-old adolescent girl. J Pediatr Surg. 2009 Nov;44(11):2230-2 Authors: Abubakar AM, Mayun AA, Pindiga UH, Chinda JY, Adamu SA Although lipoma is a common benign mesenchymal tumor, its occurrence in the omentum is a rare finding. We report an unusual case of omental lipoma in a 13-year-old adolescent girl. The mass was completely excised and weighed 12.3 kg. The patient is alive and well with no evidence of recurrence at 4 months of follow-up. PMID: 19944239 [PubMed - indexed for MEDLINE]

Penislike clitorises with megalourethras in nonvirilized female fetuses and a newborn. A histopathologic study and its bearing on their pathogenesis.

Related Articles Penislike clitorises with megalourethras in nonvirilized female fetuses and a newborn. A histopathologic study and its bearing on their pathogenesis. J Pediatr Surg. 2009 Nov;44(11):2223-9 Authors: van der Putte SC PURPOSE: The aim of the study was to analyze the microstructure of penislike clitorises in female pseudohermaphroditism in relation to their pathogenesis. METHODS: Penislike clitorises from 2 fetuses and 1 newborn with anorectal malformations and multiple other caudal anomalies and 1 fetus with phallic urethra duplication were histologically examined in toto. RESULTS: The penislike clitorises revealed basically female features in the histogenesis of the corpora cavernosa and glans and in the absence of penile raphe, septum, fasciae, and periurethral glands. In 2 cases, the "phallic urethra" was completely surrounded by a single corpus cavernosum and in 3 cases by a circular glans. Labia minora and vestibular bulbs had not developed in 3 cases. The urethras had transformed into fusiform or scaphoid megalourethras with stenotic meatuses in 3 specimens and an extra orifice in the fourth specimen. CONCLUSIONS: Penislike clitorises in female pseudohermaphroditism show a fundamental dysgenesis of major structural elements. The pattern favors the hypothesis of an early error in the formation of the cloacal membrane and adjacent cloaca in embryos between 26 and 29 days postovulation that may lead to dysregulation of molecular developmental interactions during the following formation of the genital tubercle. PMID: 19944238 [PubMed - indexed for MEDLINE]

Nipple adenoma in infancy.

Related Articles Nipple adenoma in infancy. J Pediatr Surg. 2009 Nov;44(11):2219-22 Authors: Clune JE, Kozakewich HP, VanBeek CA, Labow BI, Greene AK We report the first patient with a nipple adenoma presenting in infancy. Nipple adenoma is a benign lesion typically affecting women between 45 and 55 years of age. This lesion can occur in the pediatric population and should be included in the differential diagnosis of an infantile breast lesion. Management of children with nipple adenoma requires consideration for breast development; excision before maturity may cause nipple-areola deformity or injury to the breast bud. PMID: 19944237 [PubMed - indexed for MEDLINE]

Pharyngeal perforation masquerading as esophageal atresia.

Related Articles Pharyngeal perforation masquerading as esophageal atresia. J Pediatr Surg. 2009 Nov;44(11):2216-8 Authors: Knight RB, Webb DE, P Coppola C We present a case of pharyngeal perforation from a nasogastric tube mistakenly diagnosed as esophageal atresia with tracheoesophageal fistula in a full term infant female. The correct diagnosis was identified with rigid bronchoscopy and esophagoscopy immediately prior to the planned thoracotomy which was aborted. After one week of oral restriction and antibiotics, the healed perforation did not demonstrate leakage on a contrasted pharyngoesophagogram and bottle feeds were initiated. The infant was discharged to home on day of life 13 without any further complications. PMID: 19944236 [PubMed - indexed for MEDLINE]

Congenital absence of intestinal smooth muscle: a case report and review of the literature.

Related Articles Congenital absence of intestinal smooth muscle: a case report and review of the literature. J Pediatr Surg. 2009 Nov;44(11):2211-5 Authors: Stephens D, Arensman R, Pillai S, Alagiozian-Angelova V Herein is reported case of an otherwise healthy full-term infant girl who presented with numerous spontaneous intestinal perforations with congenital absence of intestinal muscularis mucosae and muscularis propria. Few other cases are reported in the English literature with varying presentations. We review those cases, theories of pathogenesis, embryology, and possible connections to various clinical presentations. PMID: 19944235 [PubMed - indexed for MEDLINE]

Bilateral cystic pulmonary glial heterotopia and palatinal teratoma causing respiratory distress in an infant.

Related Articles Bilateral cystic pulmonary glial heterotopia and palatinal teratoma causing respiratory distress in an infant. J Pediatr Surg. 2009 Nov;44(11):2206-10 Authors: Dettmer P, Beck M, Eufinger H, Rossler L, Tannapfel A, Coerdt W, Tröbs RB We report on a male infant with extensive, bilateral cystic and solid lung lesions who presented postnatally with respiratory distress caused by bilateral cystic lung lesions. Parenchyma-sparing resections were performed. Histology revealed the presence of neuroglial cell-lined cysts and glial nodules. In addition, a neural element containing palatinal teratoma was detected and excised. Based on previously published cases, the pathogenesis and clinical features of pulmonary neuroglial heterotopia are discussed. PMID: 19944234 [PubMed - indexed for MEDLINE]

Invasive cholangiocarcinoma identified in congenital biliary dilatation in a 3-year-old boy.

Related Articles Invasive cholangiocarcinoma identified in congenital biliary dilatation in a 3-year-old boy. J Pediatr Surg. 2009 Nov;44(11):2202-5 Authors: Saikusa N, Naito S, Iinuma Y, Ohtani T, Yokoyama N, Nitta K We herein report a 3-year-old male demonstrating invasive cholangiocarcinoma (CC) associated with congenital biliary dilatation (CBD). A 3-year-old Japanese boy was admitted to our hospital with abdominal pain and vomiting. Computed tomography and magnetic resonance imaging demonstrated a dilated extrahepatic bile duct. A diagnosis of Todani's type 1a CBD was made. Intraoperative cholangiography demonstrated the presence of pancreaticobiliary maljunction but could not reveal any tumor lesion in the bile duct. The excision of extrahepatic bile duct and gallbladder and Roux-en-Y hepaticojejunostomy were performed. On gross inspection, we could not find any tumor lesion in the resected specimen. However, the postoperative histopathologic examinations confirmed the presence of well-differentiated tubular adenocarcinoma with lymphovascular invasion. Most of the carcinoma remained within the mucosal layer, and the carcinoma was identified at both the distal and proximal surgical margins of the bile duct. We scheduled additional surgery to eradicate the residual carcinoma, but informed consent for the extra surgery could not be obtained. A close follow-up with abdominal computed tomography has been going on without either additional surgery or adjuvant chemotherapy about for 1 year. The patient has so far been clinically doing well without any obvious symptoms of recurrent disease. To our knowledge, this report is the youngest case of CC associated with CBD. PMID: 19944233 [PubMed - indexed for MEDLINE]

A systematic review of serologic tests in the diagnosis of necrotizing enterocolitis.

Related Articles A systematic review of serologic tests in the diagnosis of necrotizing enterocolitis. J Pediatr Surg. 2009 Nov;44(11):2192-201 Authors: Evennett N, Alexander N, Petrov M, Pierro A, Eaton S BACKGROUND: Although many serologic markers have been suggested for diagnosis of necrotizing enterocolitis, there is little consensus on which of these is potentially clinically useful. Our aims were (i) to systematically review circulating markers that are potentially useful in the diagnosis of NEC and (ii) to compare the relative performance of each serologic marker of NEC by pooling estimates of marker accuracies and presenting their combined diagnostic accuracies. METHODS: We undertook a systematic review of the literature to identify studies that reported serologic markers at the time of diagnosis of necrotizing enterocolitis. Where possible, we constructed 2-by-2 tables of diagnostic accuracy from each article, if 2 or more studies investigated the same test, their results were meta-analyzed by pooling estimates of sensitivity, specificity, likelihood ratio for positive index test (LR+), likelihood ratio for negative index test (LR-), diagnostic odds ratio, and their corresponding 95% confidence intervals. RESULTS: Twenty-five articles provided information on serology at the time of diagnosis of necrotizing enterocolitis. Of these, it was possible to construct diagnostic accuracy tables from 16 articles and to combine data from studies that used C-reactive protein, intestinal fatty acid binding protein, and platelet-activating factor. Of these C-reactive protein was a sensitive but nonspecific marker for necrotizing enterocolitis, whereas platelet-activating factor and intestinal fatty acid binding protein were both sensitive and specific. CONCLUSIONS: Most serologic markers of necrotizing enterocolitis have been used in too few studies to evaluate their use. Of those tests that have been tested repeatedly, platelet-activating factor and intestinal fatty acid binding protein are potentially useful, although their use must be further tested in larger prospective studies. PMID: 19944232 [PubMed - indexed for MEDLINE]

Pediatric thyroid fine-needle aspiration cytology: a meta-analysis.

Related Articles Pediatric thyroid fine-needle aspiration cytology: a meta-analysis. J Pediatr Surg. 2009 Nov;44(11):2184-91 Authors: Stevens C, Lee JK, Sadatsafavi M, Blair GK BACKGROUND: There is conflicting evidence in the current literature regarding the use of fine-needle aspiration (FNA) biopsy in the diagnosis of a thyroid nodule in the pediatric population. There are numerous studies that look at the sensitivity and specificity of this test with varying results. A meta-analysis will provide further insight into this topic. PURPOSE: Our objective was to investigate the diagnostic parameters of FNA biopsy in the diagnosis of a thyroid nodule in the pediatric population, specifically, to determine the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the test in differentiating malignant vs benign tumors. MATERIAL AND METHODS: We performed a literature search of Medline, Embase, and evidence based medicine (EBM) reviews for English studies that looked at FNA biopsy in thyroid nodules in the pediatric population, in which diagnostic values were present or could be calculated and where FNA results were compared to an acceptable reference standard. Two reviewers independently selected all abstracts, and from these, studies to review. Two reviewers also independently checked diagnostic values in the studies or calculated them from data available. A meta-analysis was performed, and pooled diagnostic test values were calculated using a random-effects, bivariate meta-regression model. Studies were also assessed for quality using the quality assessment for diagnostic accuracy studies tool. RESULTS: Twelve studies were included for review. The quality of the studies in general was good. The pooled estimate of sensitivity and specificity were 94% (95% confidence interval [CI], 86%-100%) and 81% (95% CI, 72%-91%), respectively. Assuming 20% of nodules are malignant, the accuracy, PPV, and NPV were 83.6%, 55.3%, and 98.2%, respectively. CONCLUSION: This meta-analysis provides good evidence that FNA biopsy of thyroid nodules is a sensitive test in the pediatric population and may be a useful tool for excluding malignancy in young patients. Future prospective studies are needed to evaluate this further. PMID: 19944231 [PubMed - indexed for MEDLINE]

Interpretation of radiologic abnormalities in patients with chronically infected ingrown toenails with regard to a possible exogenic osteomyelitis.

Related Articles Interpretation of radiologic abnormalities in patients with chronically infected ingrown toenails with regard to a possible exogenic osteomyelitis. J Pediatr Surg. 2009 Nov;44(11):2179-83 Authors: Majcen ME, Wilfinger CC, Pilhatsch A BACKGROUND: Chronic infection of ingrown toenails may lead to exogenous osteomyelitis. Therefore, plain x-rays are commonly taken in children with significant inflammation. We evaluated the preoperative radiologic findings and their clinical significance, especially with regard to exogenic osteomyelitis. PATIENTS AND METHODS: We retrospectively evaluated all patients who underwent surgery for infected ingrown toenails during a 5-year period. Data collection included the history of infection, preoperative laboratory tests, preoperative x-rays, and intraoperative presentation. FINDINGS: One hundred thirty-four patients with infected ingrown nails of the hallux underwent 161 surgical procedures. Mean age at surgery was 14.1 years. Preoperative x-rays were taken in 113 (70.2%) cases. The treating surgeon classified 76 (67.2%) x-rays as negative (no bone affection), 16 (14.2%) as positive (definite bone affection), and 21 (18.6%) as suspicious for bone affection. Only 11 (30%) of 37 children with positive or suspicious x-rays showed bone affection during surgery, which presented as a softening of the cortical bone. None of the children had significantly elevated inflammation markers in the preoperative laboratory tests. Children with positive or suspicious x-rays had a significant longer history of infection compared to those without radiologic abnormalities (8 vs 4.5 weeks mean; P = .024). A reevaluation of the x-rays by an experienced radiologist was undertaken and revealed no case of definite osteolysis. CONCLUSION: In about one third of all infected ingrown toenails, radiologic changes of the distal phalanx occur. These changes primarily represent periostal reactions. A typical osteomyelitis as a complication of chronically infected ingrown toenails is rare. PMID: 19944230 [PubMed - indexed for MEDLINE]

Pyomyositis in children: early diagnosis and treatment.

Related Articles Pyomyositis in children: early diagnosis and treatment. J Pediatr Surg. 2009 Nov;44(11):2173-8 Authors: Mitsionis GI, Manoudis GN, Lykissas MG, Sionti I, Motsis E, Georgoulis AD, Berisa AE PURPOSE: This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis. METHODS: Between 2001 and 2006, 6 children with a mean age of 7.2 years were diagnosed and treated for pyomyositis in our clinic. The most common site of involvement was the hip and thigh region. All patients underwent early magnetic resonance imaging (MRI) examination that played a significant role in the early diagnosis and management of the disease. RESULTS: Staphylococcus aureus was the most common pathogen and was identified in 3 cases. Intravenous antibiotics were administered and were followed by oral agents for an additional period. The duration of therapy ranged from 3 to 6 weeks. No surgical intervention was needed. Magnetic resonance imaging was used to evaluate response to the therapy. CONCLUSIONS: Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis. PMID: 19944229 [PubMed - indexed for MEDLINE]

Laparoscopic orchidopexy: the easy way to go.

Related Articles Laparoscopic orchidopexy: the easy way to go. J Pediatr Surg. 2009 Nov;44(11):2168-72 Authors: Burjonrappa SC, Al Hazmi H, Barrieras D, Houle AM, Franc-Guimond J BACKGROUND/PURPOSE: Intraabdominal testes represent less than 10% of cryptorchid testicles, and yet, they are the most challenging to correct. In the last 15 years, the two-stage Fowler-Stephens orchidopexy has gained popularity. The traditional approach includes laparoscopic or open clipping of the testicular vessels (first stage) and open inguinal orchidopexy (second stage). We present our experience with 2-stage orchidopexy with both stages done through a laparoscopic approach. MATERIALS AND METHODS: Over a recent 5-year period, we reviewed patients operated for intraabdominal testis using a two-stage laparoscopic orchidopexy with a minimum of 1-year follow-up. In this study, success is defined as a nonatrophic, intrascrotal testis. Fifteen patients met the inclusion criteria, and none were lost to follow-up. RESULTS: In the 15 patients, 11 had a unilateral intraabdominal testis, and 4 had bilateral cryptorchidism, with one of the 2 testes intraabdominal. The first stage was done at a mean age of 32 months, and the average time between the two stages was 9.7 months. All procedures (31) were done on an outpatient basis. Only 2 complications occurred, one scrotal hematoma and one redo first stage because of unsuccessful clipping noted at the time of planned second stage. The success rate is 93.3% (14/15). All testicles are intrascrotal, and all but 1 have maintained preoperative volume. CONCLUSION: Two-stage laparoscopic orchidopexy is a fairly easy surgical procedure with minimum morbidity and high short term success rate. A larger cohort of patients with long-term follow-up is needed to substantiate these findings. PMID: 19944228 [PubMed - indexed for MEDLINE]

Effects of compression/stretching of the spermatic cord and blunt dissection on testicular growth and fertility.

Related Articles Effects of compression/stretching of the spermatic cord and blunt dissection on testicular growth and fertility. J Pediatr Surg. 2009 Nov;44(11):2163-7 Authors: Choi SE, Kook MC, Kim CJ, Lee SC, Park KW, Jung SE, Kim WK PURPOSE: This study was performed to investigate whether compression/stretching of the spermatic cord or blunt dissection influences testicular development and fertility. In addition, the authors evaluated whether the extents of testicular damage differ between these 2 surgical manipulations. METHODS: Forty-four prepubertal male Sprague-Dawley (SD) rats (Harlan Sprague-Dawley Inc, Indianapolis, Ind) were divided into 3 groups: (1) the control group (CG) animals underwent a sham operation in the right groin, (2) the experimental group 1 (EG1) underwent compression/stretching of the right spermatic cord, and (3) the experimental group 2 (EG2) underwent dissection around the right spermatic cord structures. Testicular volumes, weights, mean seminiferous tubular diameters (MSTDs), mean testicular biopsy scores, and numbers of offspring and of pregnant females were evaluated. RESULTS: Right (operative) and left (nonoperative) testicular volumes were smaller in the EG2 group than in the CG or EG1 groups. Left MSTDs in the EG1 and EG2 groups increased more than in the CG group. Numbers of Sertoli cells in left testes differed in the 3 groups, in the order EG1 < CG < EG2. Mean testicular biopsy scores, offspring numbers, and pregnant female numbers were no different in the 3 groups. CONCLUSIONS: Both surgical manipulations influenced testicular growth, but they did not compromise spermatogenesis or fertility in SD rats. PMID: 19944227 [PubMed - indexed for MEDLINE]

Pouch colon associated with anorectal malformations fails to show spontaneous contractions but responds to acetylcholine and histamine in vitro.

Related Articles Pouch colon associated with anorectal malformations fails to show spontaneous contractions but responds to acetylcholine and histamine in vitro. J Pediatr Surg. 2009 Nov;44(11):2156-62 Authors: Tyagi P, Mandal MB, Mandal S, Patne SC, Gangopadhyay AN PURPOSE: Congenital pouch colon (CPC) associated with anorectal malformation (ARM) is most commonly reported from Northern India. So far, no physiologic study comparing the detailed contractile status of CPC with non-CPC conditions are available. The present article deals with the contractile study and histopathologic observations in CPC, which may be useful for better surgical management. METHODS: Freshly excised 12 neonatal CPC and similar number of non-CPC (control) specimens were transferred to ice-cold (4 degrees C-6 degrees C) Krebs-Ringer solution bubbled with 100% oxygen. Longitudinally prepared 2 to 4 colonic strips were obtained from central part of each specimen and subjected to the contraction recording after exposure to cumulative concentrations of acetylcholine (ACh) and histamine. Acetylcholine-induced contractions were evaluated after application of atropine (muscarinic blocker), and histaminergic contractions were recorded after pheniramine (H(1) blocker), lignocaine (neuronal blocker), and atropine. Histopathologic observations were made by using H&E and Masson trichrome stains. RESULTS: Control specimens showed spontaneous contractions, but CPC strips did not. Both control and CPC responded to ACh and histamine. The response to histamine was greater (P < .05) in CPC as compared to control, whereas the response to ACh was more (P < .05) in control. In CPC, response of histamine (100 micromol/L) was blocked by pheniramine (0.32 mmol/L) and lignocaine (4 mmol/L) by 97% and 80%, respectively, and enhanced by 57% after preapplication of atropine (10 micromol/L). Acetylcholine (100 micromol/L)-induced contractions were attenuated (86%) in presence of atropine. Histopathologic examination showed fewer mature ganglion cells with various changes in muscle layers including fibrosis, disruption, hypertrophy, atrophy, and constriction bands. CONCLUSION: Congenital pouch colon associated with ARM lacks normal spontaneous contractions but retains ACh and histamine-induced contractility. In view of the functional and histologic abnormalities, we propose that CPC associated with ARM is an abnormally functional and developed tissue. Therefore, resection of the pouch should be considered for better functional outcome of the remaining bowel. PMID: 19944226 [PubMed - indexed for MEDLINE]

Early and late outcomes of primary laparoscopic endorectal colon pull-through leaving a short rectal seromuscular sleeve for Hirschsprung disease.

Related Articles Early and late outcomes of primary laparoscopic endorectal colon pull-through leaving a short rectal seromuscular sleeve for Hirschsprung disease. J Pediatr Surg. 2009 Nov;44(11):2153-5 Authors: Nguyen TL, Bui DH, Tran AQ, Vu TH AIM: To report early and late outcomes of laparoscopic colon pull-through leaving a short rectal sleeve for Hirschsprung disease. METHODS: Laparoscopic endorectal colon pull-through was performed using 4 ports. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. The rest of the procedure was carried out according to Georgeson's technique. However, we left a short rectal seromuscular sleeve of 1.5 to 2 cm above the dentate line. RESULTS: From January 2001 to December 2007, 200 patients were operated upon by the same surgeon. Ages ranged from 14 days to 36 months old. The aganglionic segment was located in the rectum in 112 patients, in the sigmoid colon in 80 children, and in the left colon in 8 patients. The median operating time was 152 minutes. There were no perioperative deaths. Conversion to open surgery was required in four patients. There was minimal blood loss during the surgery. Oral intakes of clear fluid were started 12 hours after surgery and advanced to formula on the second day. In 1 patient, a small intestinal perforation occurred 3 days after surgery, requiring a diverting ileostomy. The mean hospital stay was 6.6 days (range, 4-12 days). Follow-up ranging from 5 to 85 months was obtained in 157 patients; 124 patients (79%) had 1 to 4 defecations a day, 17 (11%) had 5 to 6, and 8 had more than 6. Fecal incontinence occurred in 3 patients (2.0%), constipation in 5 patients (3.0%), and enterocolitis in 15 patients (9.5%). Anastomotic fistula occurred in 2 patients. CONCLUSION: Laparoscopic endorectal pull-through leaving a short rectal seromuscular sleeve is a safe and effective procedure for Hirschsprung disease. PMID: 19944225 [PubMed - indexed for MEDLINE]

Tetrandrine ameliorated reperfusion injury of small bowel transplantation.

Related Articles Tetrandrine ameliorated reperfusion injury of small bowel transplantation. J Pediatr Surg. 2009 Nov;44(11):2145-52 Authors: Chen Y, Wu JM, Lin TY, Wu CC, Chiu KM, Chang BF, Tseng SH, Chu SH PURPOSE: In small bowel transplantation, the bowel graft is susceptible to reperfusion injury. This study investigated the effects of tetrandrine, a bisbenzylisoquinoline alkaloid, on the development of intestinal reperfusion injury in small bowel transplantation in pigs. MATERIALS AND METHODS: Pigs underwent small bowel transplantation and were treated with tetrandrine or a vehicle. Blood and small bowel specimens were harvested at 1, 3, and 24 hours after reperfusion. Histopathologic analysis of the small bowel was assessed for tissue damage. Serum levels of tumor necrosis factor-alpha, interleukin-1beta (IL-1beta), and IL-6 were measured by enzyme-linked immunosorbent assay. Reverse-transcriptase polymerase chain reaction analysis was performed to analyze the expression of proinflammatory cytokines, and immunohistochemical analysis was used to study the expression of intercellular adhesion molecule-1 (ICAM-1) in the small bowel. Myeloperoxidase staining detected neutrophil infiltration in the small bowel and the number of myeloperoxidase positively stained cells was counted. RESULTS: Pigs receiving small bowel transplantation had elevated serum proinflammatory cytokine levels. The transplanted small bowel showed mucosal damage, increased expression of proinflammatory cytokines and ICAM-1, and prominent neutrophil infiltration. Tetrandrine administration reduced mucosal damage, serum and tissue proinflammatory cytokine levels, ICAM-1 expression, and neutrophil accumulation in the transplanted small bowel. CONCLUSIONS: Tetrandrine reduced the reperfusion injury in porcine intestinal transplantation during the first 24 hours after the procedure. PMID: 19944224 [PubMed - indexed for MEDLINE]

Outcomes of intestinal failure--a comparison between children with short bowel and dysmotile intestine.

Related Articles Outcomes of intestinal failure--a comparison between children with short bowel and dysmotile intestine. J Pediatr Surg. 2009 Nov;44(11):2139-44 Authors: Pakarinen MP, Koivusalo AI, Rintala RJ BACKGROUND: We investigated whether mortality, intestinal adaptation, and liver function differ between intestinal failure (IF) patients with either short bowel (SB) or bowel dysmotility (DM). PATIENTS AND METHODS: Twenty-six consecutive patients with SB (n = 20) or DM (n = 6) treated between 2000 and 2007 were retrospectively assessed. Intestinal failure was defined as less than 25% of age-adjusted small intestinal length or dependence on parenteral nutrition (PN) more than 6 months. RESULTS: Median age-adjusted small intestinal length (17% vs 45%) and gestational age (35 vs 40 weeks) were (P < .05) shorter, whereas proportion of the remaining colon (86% vs 0%) was (P < .05) higher in the SB group relative to the DM group. Overall survival was 92%. Median peak serum bilirubin (80 vs 25 micromol/L) and rate of cholestasis (11/20 vs 0/6) were higher (P < .05) in the SB group. Short bowel rather than DM as an etiology of IF predicted weaning off PN (RR, 39.3; 95% confidence interval [CI], 1.43-526; P < .01) and development of cholestasis (risk ration [RR], 18.3; 95% CI, 0.658-127; P < .05). Three SB children developed liver failure and two died, whereas neither of these occurred in the DM group. CONCLUSIONS: Children with SB are more likely to wean off PN but more prone to cholestatic liver disease than those with DM as an etiology of IF. PMID: 19944223 [PubMed - indexed for MEDLINE]

Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines.

Related Articles Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines. J Pediatr Surg. 2009 Nov;44(11):2133-8 Authors: Chouikha A, Fodha I, Maazoun K, Ben Brahim M, Hidouri S, Nouri A, Trabelsi A, Steele AD BACKGROUND: A licensed rotavirus vaccine was withdrawn from use because of an increased risk of intussusception. The association of rotavirus vaccination with intussusception raised concerns about a potential link between natural rotavirus disease and intussusception. The objectives of the present study were to determine whether an epidemiological association with natural rotavirus infection existed. METHODS: From 1984 to 2003, all children younger than 5 years with intussusception were retrospectively identified by medical charts, and from 1995 to 2003, a prospective surveillance study of rotavirus infection in children younger than 5 years was independently conducted. Epidemiological characteristics of intussusception and rotavirus infection were then compared. RESULTS: A total of 533 cases of intussusception and 146 cases of rotavirus infection were identified. The incidence of intussusception for infants younger than 1 year was 62/100,000 child-years. The age distributions of intussusception and rotavirus gastroenteritis overlapped, and a masculine predominance was noted in both cases. No significant association was observed between the monthly distribution of intussusception and rotavirus infection. CONCLUSION: The present study has not convincingly shown that rotavirus diarrhea plays a major role in intussusception. However, data about age and sex distributions supported the biologic plausibility of such an association. PMID: 19944222 [PubMed - indexed for MEDLINE]

Diminishing role of contrast enema in simple meconium ileus.

Related Articles Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg. 2009 Nov;44(11):2130-2 Authors: Copeland DR, St Peter SD, Sharp SW, Islam S, Cuenca A, Tolleson JS, Dassinger MS, Little DC, Jackson RJ, Kokoska ER, Smith SD PURPOSE: Contrast enema is the initial study of choice for simple meconium ileus to confirm diagnosis and to relieve obstruction. Despite favorable historically published results, our clinical impression suggests decreased effectiveness of the contrast enema resulting in more surgical interventions in contemporary practice. METHODS: A retrospective multiinstitutional review for a 12-year period was conducted for neonates diagnosed with meconium ileus by contrast enema. The neonates were divided into 2 groups-historic group (HG = before 2002) and contemporary group (CG = after 2002). T test was used for comparison of continuous variables and chi(2) for categorical data. RESULTS: Thirty-seven total patients were identified (21 females and 16 males). Obstruction was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the CG group was 5.5% (1/18) compared to 39% (7/18) in HG. CONCLUSIONS: In this review, success of contrast enema for relief of meconium ileus has significantly decreased over time. These findings may be because of reluctance to repeat enemas, change in radiologist experience, or use of contrast agent. As a result, higher rates of operative intervention are now observed. In stable patients, surgeons should recommend repeat enemas before exploration. PMID: 19944221 [PubMed - indexed for MEDLINE]

Staged reduction of gastroschisis using preformed silos: practicalities and problems.

Related Articles Staged reduction of gastroschisis using preformed silos: practicalities and problems. J Pediatr Surg. 2009 Nov;44(11):2126-9 Authors: Lansdale N, Hill R, Gull-Zamir S, Drewett M, Parkinson E, Davenport M, Sadiq J, Lakhoo K, Marven S PURPOSE: Previous single-center studies have reported favorable outcomes when preformed silos (PFS) are used for the staged reduction of gastroschisis. The aim of this study was to assess the frequency and nature of complications associated with PFS in a large population and provide an insight into the practicalities of their routine use. METHODS: A retrospective review was carried out of all cases of gastroschisis managed with PFS in 4 UK neonatal surgical units for a 6-year period. RESULTS: One hundred fifty infants were included, and 139 (92.7%) silos were applied at cot side (no sedation, n = 93). Median silo size was 4 cm, and time of application was 2.5 hours. Enlarging the defect by incision of fascia was required in 17 (11%). Defect closure was performed at a median of 4 days (0-47) with 93 (62%) being at cot side. Methods of closure were adhesive strips/dressings (n = 94), sutures (n = 48), and patch (n = 8). Discoloration of the viscera occurred in 16 (11%), managed successfully by simple methods (change of PFS, aspirating the stomach, or incision of the defect fascia) (n = 8), conversion to operative silo (n = 3), and operative reduction (n = 1). Four required bowel resection. Other complications included missed atresia (n = 5; 3.3%) and nectrotizing enterocolitis (n = 11; 7%). There were 5 deaths in the series (3.3%). CONCLUSIONS: Staged reduction of gastroschisis with PFS is simple, convenient, and safe. The low rates of associated complications and mortality appear favorable when compared to infants managed with more traditional techniques. We recommend that PFS should be used for the routine management of gastroschisis. PMID: 19944220 [PubMed - indexed for MEDLINE]

Impact of surgical approach on outcome in 622 consecutive pyloromyotomies at a pediatric teaching institution.

Related Articles Impact of surgical approach on outcome in 622 consecutive pyloromyotomies at a pediatric teaching institution. J Pediatr Surg. 2009 Nov;44(11):2119-25 Authors: Perger L, Fuchs JR, Komidar L, Mooney DP PURPOSE: The aim of this study is to compare the outcome of 3 different approaches to pyloromyotomy in a large single institution series. METHODS: Records of consecutive patients undergoing pyloromyotomy for an 8-year period were reviewed. Patients' age, sex, weight, operating time, length of stay, number of emeses, and complications were recorded. Variables were compared between right upper quadrant (RUQ), umbilical (UMB), and laparoscopic (LAP) approaches. RESULTS: Six hundred twenty-two patients were included in the study. Operating time was significantly shorter for LAP and RUQ compared to UMB. Length of stay did not differ between the groups. There were fewer episodes of emesis in the LAP group. There was a trend toward a higher rate of complications in UMB group. CONCLUSION: Outcomes after pyloromyotomy are institution dependent and cannot be generalized. Patient safety is the first concern, followed by patient comfort and cosmesis. Laparoscopic pyloromyotomy can be as fast and efficient as open, without an increased rate of complications, with excellent cosmetic results, and less analgesic requirement. If skill and experience to replicate good outcomes of laparoscopy are not available, open pyloromyotomy is a safer technique. The UMB approach is an alternative method to achieve good cosmesis without laparoscopy in the hands of a surgeon proficient in this method. PMID: 19944219 [PubMed - indexed for MEDLINE]

Pierre Robin sequence: appearances and 25 years of experience with an innovative treatment protocol.

Related Articles Pierre Robin sequence: appearances and 25 years of experience with an innovative treatment protocol. J Pediatr Surg. 2009 Nov;44(11):2112-8 Authors: Bütow KW, Hoogendijk CF, Zwahlen RA PURPOSE: The aim of the study was to evaluate the largest number of Pierre Robin sequence (PRS) cases to date and its treatment outcome. DESIGN: This is a retrospective study. SETTINGS: The study was conducted in a tertiary care university hospital. PATIENTS: One hundred eighty-eight patients with PRS have been subjected to analysis, defined by the clinical triad of glossoptosis, retro/micrognathia, and cleft or agenesis of the palate, for incidence, risk factors, associated syndromes, other concomitant abnormalities, airway and feeding difficulties, and outcome regarding the neonatal and perinatal surgical and nonsurgical management. RESULTS: The incidence of PRS was 6.02%. Risk factors were found in 41.5% of mothers with children with PRS. Eleven other syndromes/appearances were associated. Feeding difficulties were seen in 51.8% of the patients. Glossopexy (6.9%) and tracheotomy (2.13%) for airway management were performed very seldom. The suction and drinking plate as well as the surgical treatment protocol may be considered to be the reasons for reduced airway (up to 91.0%), feeding problems (up to 79.9%), and mortality rate (2.1%). CONCLUSION: The Pierre Robin sequence, as seen as a heterogeneous group, presents with variation of the cleft palate defects with glossoptosis and concomitant micrognathic mandible. The surgical management and certain prepalatal intervention as nonsurgical management with an innovative treatment strategy were evaluated. PMID: 19944218 [PubMed - indexed for MEDLINE]

Tracheal diverticula after tracheoesophageal fistula repair: case series and review of the literature.

Related Articles Tracheal diverticula after tracheoesophageal fistula repair: case series and review of the literature. J Pediatr Surg. 2009 Nov;44(11):2107-11 Authors: Shah AR, Lazar EL, Atlas AB BACKGROUND: Tracheoesophageal fistula (TEF) is the most common congenital tracheal abnormality, frequently associated with esophageal atresia. Respiratory symptoms are associated with all types of TEF, even after surgical repair of the fistula. Gastroesophageal reflux (GER) with aspiration of gastric contents, structural instability of the airways (tracheomalacia), abnormal respiratory epithelium, abnormal esophageal motility, recurrent TEF, and esophageal stenosis contribute to postsurgical complications. METHODS: We review 7 patients between 4 and 14 years of age with a history of TEF repair and persistent or worsening respiratory symptoms despite conventional airway clearance techniques and treatment of GER. RESULTS: Bronchoscopic evaluation in all 7 patients revealed tracheomalacia and a diverticulum on the posterior wall of the trachea at the fistula repair site. CONCLUSION: We hypothesize that the diverticula impaired airway clearance and contributed to persistent respiratory symptoms. Possible mechanisms for the diverticulum contributing to poor airway clearance include facilitating the pooling of secretions and acting as a "barrier" to the lower airway clearance mechanism. The diagnosis of a diverticulum should be considered early in patients with persistent respiratory symptoms after management of GER and tracheomalacia. Early obliteration of tracheal diverticula might improve respiratory status in some patients. PMID: 19944217 [PubMed - indexed for MEDLINE]

Evaluating mortality and disease severity in congenital diaphragmatic hernia using the McGoon and pulmonary artery indices.

Related Articles Evaluating mortality and disease severity in congenital diaphragmatic hernia using the McGoon and pulmonary artery indices. J Pediatr Surg. 2009 Nov;44(11):2101-6 Authors: Takahashi S, Oishi Y, Ito N, Nanba Y, Tsukamoto K, Nakamura T, Ito Y, Hayashi S, Sago H, Kuroda T, Honna T PURPOSE: Lung hypoplasia is associated with mortality in congenital diaphragmatic hernia (CDH). However, the association between lung hypoplasia and disease severity is unclear. Early prediction of disease severity would provide parents with more precise information about the anticipated course of treatment, minimize treatment disruption, and maximize the efficient management of patients with CDH. We aimed at identifying the relationship between McGoon index (MGI) and pulmonary artery index (PAI) scores and disease severity among infants with CDH. METHODS: We retrospectively reviewed the medical records of 19 high-risk patients with CDH born between January 2006 and December 2007. McGoon index and PAI scores were determined on admission. We evaluated statistically the relationship between these scores and variables representing severity as follows: number of vasodilators, use of inhaled nitric oxide (iNO), closed method of diaphragm, duration of intubation, duration of hospitalization, and use of home oxygen therapy. Statistical significance was P < .05. RESULTS: Overall median MGI and PAI scores were 1.40 and 108, respectively; scores for nonsurvivors were significantly (P < .05 and P < .01, respectively) lower than those for survivors. Among survivors, PAI scores were significantly (P < .05) lower in infants requiring iNO than in infants not requiring iNO and patch repair. The PAI scores were significantly correlated with the number of vasodilators (r = -0.789; P < .01) and duration of intubation (r = -0.610; P < .05). CONCLUSIONS: McGoon index (cutoff value, 1.31) and PAI (cutoff value, 90) are reliable indices for predicting mortality in CDH. Pulmonary artery index appears to be more useful than MGI for predicting disease severity among survivors. PMID: 19944216 [PubMed - indexed for MEDLINE]

Radionuclide imaging study of long-term pulmonary function after lobectomy in children with congenital cystic lung disease.

Related Articles Radionuclide imaging study of long-term pulmonary function after lobectomy in children with congenital cystic lung disease. J Pediatr Surg. 2009 Nov;44(11):2096-100 Authors: Komori K, Kamagata S, Hirobe S, Toma M, Okumura K, Muto M, Kasai S, Hayashi A, Suenaga M, Miyakawa T PURPOSE: We evaluated the long-term pulmonary function after lobectomy for congenital cystic lung disease, in both infants and children, using radionuclide imaging (RI). METHODS: We performed a retrospective review of 93 patients who underwent resection of cystic lung lesions between 1974 and 2001. The results of postoperative lung volume/perfusion scintigraphy at 1 (n = 64), 5 (n = 32), and 10 years (n = 18) after surgery (V1, 5, 10/Q1, 5, 10) and mean transit time (MTT-a marker for air-trapping) at 1, 5, and 10 years after surgery (MTT1, 5, 10) were compared with respect to age at operation, preoperative infection, underlying disease, and type of surgery. RESULTS: Patients who were younger than 1 year at the time of surgery showed a significantly lower MTT5 (1.09 +/- 0.08) and MTT10 (1.15 +/- 0.11) than patients who were older than 1 year at the time of surgery (MTT5, 1.49 +/- 0.67; MTT10, 1.54 +/- 0.33). The noninfected group had significantly higher Q10 and lower MTT10 values (P < .05) compared to the infected group. No significant differences were observed between patients with single lobe vs multiple lobe resection. CONCLUSIONS: The optimal age for surgery in patients with congenital cystic lung disease appears to be less than 1 year. PMID: 19944215 [PubMed - indexed for MEDLINE]

Upregulation of Slit-2 and Slit-3 gene expressions in the nitrofen-induced hypoplastic lung.

Related Articles Upregulation of Slit-2 and Slit-3 gene expressions in the nitrofen-induced hypoplastic lung. J Pediatr Surg. 2009 Nov;44(11):2092-5 Authors: Doi T, Hajduk P, Puri P PURPOSE: The pathogenesis of pulmonary hypoplasia in the nitrofen-induced congenital diaphragmatic hernia (CDH) is not clearly understood. Slit-2 and Slit-3 are expressed in fetal lung and play a key role in directing the functional organization and differentiation of lung mesenchyme during branching morphogenesis. We hypothesized that the pulmonary gene expression levels of Slit genes are altered in the nitrofen-induced CDH. MATERIALS AND METHODS: Pregnant rats were exposed to either olive oil or nitrofen on day 9 of gestation (D9). Fetal lungs were harvested on D15 and D21 and divided into 2 groups as follows: CDH (n = 9 at each time-point) and control (n = 9 at each time-point). The pulmonary gene expression levels of Slit-2, Slit-3, Robo1, and Robo2 were analyzed by real time reverse transcription polymerase chain reaction. Student's t test or Mann-Whitney U test was used for statistical analysis. RESULTS: Relative messenger RNA expression levels of Slit-2 and Slit-3 were significantly increased in CDH lungs compared to control at both D15 and D21 (P < .05). However, there were no significant differences between CDH and controls in the pulmonary gene expression levels of Robo1 and Robo2 at each time-point. CONCLUSION: Our results provide evidence, for the first time, that Slit genes are upregulated in nitrofen-induced hypoplastic lungs in both early and late stages of lung development. Altered pulmonary Slit gene expression may disrupt branching lung morphogenesis resulting in pulmonary hypoplasia. PMID: 19944214 [PubMed - indexed for MEDLINE]

Partial splenectomy prevents splenic sequestration crises in sickle cell disease.

Related Articles Partial splenectomy prevents splenic sequestration crises in sickle cell disease. J Pediatr Surg. 2009 Nov;44(11):2088-91 Authors: Vick LR, Gosche JR, Islam S PURPOSE: Acute splenic sequestrations (SSs) are potentially fatal complications in sickle cell disease (SCD). Total splenectomies in young patients may predispose them to a higher risk of overwhelming infections, whereas partial splenectomy may maintain immunocompetence. We present our series of partial splenectomies in patients with multiple SS episodes. METHODS: We retrospectively reviewed the records of 6 patients who underwent open partial splenectomies for SS. Data on their clinical courses were collected and analyzed. RESULTS: None of the 6 patients had SS postprocedure, down from 2.1 +/- 1.0 (P = .003) sequestrations per year and 3.5 +/- 1.4 (P = .002) total sequestrations per patient. The transfusion requirements were significantly reduced postoperatively (10.2 +/- 5.6 vs 2.0 +/- 3.1 per year; P = .002). There was no increase in the infection-related hospital admissions during the period of follow-up (1.5 +/- 1.8 vs 0.8 +/- 0.8 per year after partial splenectomy; P = .363). The upper pole was preserved in all cases with blood supply off the main splenic artery. CONCLUSIONS: Partial splenectomy decreases the risk of SS in SCD and reduces the need for blood transfusions. Infection rates did not increase after the procedure during the follow-up period. Partial splenectomy should be considered for patients who experience multiple acute SS crises or have long-term transfusion requirements. PMID: 19944213 [PubMed - indexed for MEDLINE]

Surgical treatment of hepatic tumors in children: lessons learned from liver transplantation.

Related Articles Surgical treatment of hepatic tumors in children: lessons learned from liver transplantation. J Pediatr Surg. 2009 Nov;44(11):2083-7 Authors: Tannuri AC, Tannuri U, Gibelli NE, Romão RL PURPOSE: Hepatectomy remains a complex operation even in experienced hands. The objective of the present study was to describe our experience in liver resections, in the light of liver transplantation, emphasizing the indications for surgery, surgical techniques, complications, and results. METHODS: The medical records of 53 children who underwent liver resection for primary or metastatic hepatic tumors were reviewed. Ultrasonography, computed tomographic (CT) scan, and needle biopsy were the initial methods used to diagnose malignant tumors. After neoadjuvant chemotherapy, tumor resectability was evaluated by another CT scan. Surgery was performed by surgeons competent in liver transplantation. As in liver living donor operation, vascular anomalies were investigated. The main arterial anomalies found were the right hepatic artery emerging from the superior mesenteric artery and left hepatic artery from left gastric artery. Hilar structures were dissected very close to liver parenchyma. The hepatic artery and portal vein were dissected and ligated near their entrance to the liver parenchyma to avoid damaging the hilar vessels of the other lobe. During dissection of the suprahepatic veins, the venous infusion was decreased to reduce central venous pressure and potential bleeding from hepatic veins and the vena cava. RESULTS: Fifty-three children with hepatic tumors underwent surgical treatment, 47 patients underwent liver resections, and in 6 cases, liver transplantation was performed because the tumor was considered unresectable. There were 31 cases of hepatoblastoma, with a 9.6% mortality rate. Ten children presented with other malignant tumors-3 undifferentiated sarcomas, 2 hepatocellular carcinomas, 2 fibrolamellar hepatocellular carcinomas, a rhabdomyosarcoma, an immature ovarian teratoma, and a single neuroblastoma. These cases had a 50% mortality rate. Six children had benign tumors-4 mesenchymal hamartoma, 1 focal nodular hyperplasia, and a mucinous cystadenoma. All of these children had a favorable outcome. Hepatic resections included 22 right lobectomies, 9 right trisegmentectomies, 8 left lobectomies, 5 left trisegmentectomies, 2 left segmentectomies, and 1 case of monosegment (segment IV) resection. The overall mortality rate was 14.9%, and all deaths were related to recurrence of malignant disease. The mortality rate of hepatoblastoma patients was less than other malignant tumors (P = .04). CONCLUSION: The resection of hepatic tumors in children requires expertise in pediatric surgical practice, and many lessons learned from liver transplantation can be applied to hepatectomies. The present series showed no mortality directly related to the surgery and a low complication rate. PMID: 19944212 [PubMed - indexed for MEDLINE]

Hereditary pancreatitis in children: surgical implications with special regard to genetic background.

Related Articles Hereditary pancreatitis in children: surgical implications with special regard to genetic background. J Pediatr Surg. 2009 Nov;44(11):2078-82 Authors: Schmitt F, Le Henaff G, Piloquet H, Leclair MD, David A, Heloury Y, Podevin G PURPOSE: Hereditary pancreatitis (HP) is the primary etiology of chronic pancreatitis during childhood, progressing through recurrent episodes of acute pancreatitis and finally leading to pancreatic insufficiencies. Hereditary pancreatitis is because of mutations of the cationic trypsinogen (PRSS1) gene. Some other genes, such as SPINK1 or CFTR, have been associated with familial idiopathic chronic pancreatitis. The aim of our study was to clearly define diagnostic and therapeutic strategies for HP patients, through an analysis of our study group and a review of the literature. METHODS: All children admitted from 1995 to 2007 with a final diagnosis of hereditary pancreatitis were restrospectively included in the study. We analyzed all medical records with special attention given to cases involving genetic screening (PRSS1, SPINK1, and CFTR genes). RESULTS: Ten children were included. Eight had HP with PRSS1 mutation, 2 of them without a familial history of chronic pancreatitis. The 2 others patients had SPINK1 mutations. Three HP patients were operated on for acute complications of pancreatitis and are well with a mean follow-up of 5.5 years. No patient had pancreatic insufficiencies or weight loss. CONCLUSIONS: Hereditary pancreatitis is associated with severe pancreatitis, with a greater risk of developing pancreatic cancer. It must therefore be diagnosed correctly and treated to prevent its considerable complications. PMID: 19944211 [PubMed - indexed for MEDLINE]

Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction-an experimental study in growing animals.

Related Articles Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction-an experimental study in growing animals. J Pediatr Surg. 2009 Nov;44(11):2071-7 Authors: Andrade Wde C, Tannuri U, da Silva LF, Alves VA BACKGROUND: Many chronic liver diseases lead to progressive hepatic fibrosis, a condition that can ultimately result in loss of organ function and severe portal hypertension necessitating hepatic transplantation. Within the last few decades, studies have been conducted to demonstrate the possibility of drug modulation of hepatic fibrogenesis. Regarding biliary obstruction, it has been suggested that administration of corticosteroids could promote better late outcomes for children with biliary atresia submitted to Kasai's portoenterostomy. Models used to test potential antifibrogenic drugs such as pentoxifylline (PTX) have not included growing animals. METHODS: In this experimental study, 119 young rats (21st or 22nd days) were submitted to laparotomy and common bile duct ligation (CBDL) or to sham surgery (SHAM). Animals were allocated into 5 groups, according to surgical procedure, and administered the following solutions: (1) CBDL + distilled water, (2) SHAM + distilled water, (3) CBDL + PTX, (4) CBDL + prednisolone (PRED), and (5) CBDL + PTX + PRED (PTX + PRED). Each group was further divided into 2 subgroups according to the length of the experiment (15 or 30 days). At the end of the defined period, animals were weighed, and a hepatic fragment was collected from each one for analyses. RESULTS: The PTX animals exhibited increased weight gain compared to animals in the PRED or PTX + PRED groups. Animals from the 3 therapeutic groups (PTX, PRED, and PTX + PRED) showed diminished collagen-filled area in portal spaces. Total portal space area was increased in the PTX group. CONCLUSIONS: Hepatic fibrosis induced by bile duct ligation in young rats could be modulated by pharmacologic interventions. Administration of PTX or PRED, or the combination of both, resulted in diminished collagen-filled areas in portal spaces. PMID: 19944210 [PubMed - indexed for MEDLINE]

Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass.

Related Articles Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass. J Pediatr Surg. 2009 Nov;44(11):2067-70 Authors: Lautz TB, Sundaram SS, Whitington PF, Keys L, Superina RA BACKGROUND: Extrahepatic portal vein obstruction (EHPVO) has been associated with growth impairment in children. We hypothesized that growth parameters improve after reversal of portal hypertension and restoration of mesenteric venous blood flow to the liver by the mesenterico-left portal vein bypass (MLPVB). METHODS: A retrospective review of 45 children with idiopathic EHPVO who underwent MLPVB between 1997 and 2007 and had follow-up data for analysis was carried out. Growth was assessed using SD scores (z scores) for height, weight, and body mass index (BMI) at the time of operation and at early (5-12 months) and late (13-24 months) follow-up. RESULTS: The mean height and weight of children with EHPVO was significantly lower than the general population before surgery. Mean BMI was also lower, although statistically insignificant. All parameters increased significantly after MLPVB as follows: height from -0.42 before surgery to -0.12 (P = .027) at 5 to 12 months and -0.14 (P = .026) at 13 to 24 months; weight from -0.49 before surgery to 0.03 (P < .001) at 5 to 12 months and 0.35 (P < .001) at 13 to 24 months; and BMI from -0.22 before surgery to 0.17 (P = .001) at 5 to 12 months and 0.48 (P < .001) at 13 to 24 months. CONCLUSION: Restoration of portal blood flow to the liver by MLPVB improves growth in children with EHPVO. PMID: 19944209 [PubMed - indexed for MEDLINE]

Modified technique of meso-Rex shunt in case of insufficient length of the jugular vein graft.

Related Articles Modified technique of meso-Rex shunt in case of insufficient length of the jugular vein graft. J Pediatr Surg. 2009 Nov;44(11):e9-12 Authors: Chardot C, Darani A, Dubois R, Mure PY, Pracros JP, Lachaux A Meso-Rex shunt (MRS) can relieve portal hypertension and restore a physiological portal flow in patients with portal vein thrombosis. We describe a technical variant where the autologous internal jugular vein (IJV) was too short to bridge the superior mesenteric vein (SMV) and the Rex recessus. PATIENT: A 15-year-old boy with portal cavernoma had several episodes of gastrointestinal bleeding despite repeated sclerotherapy. Preoperative assessment, including retrograde transjugular portography, showed persistent esophageal and gastric varices, severe hypertensive gastropathy, obstructed portal vein, patent SMV and splenomesenteric confluence, patent intrahepatic portal branches, and normal transhepatic pressure gradient. An MRS was planned. The left IJV was retrieved from its infracranial part to its confluence with subclavian vein. After performing the Rex recessus to IJV graft anastomosis, the IJV graft proved to be too short for classical end-to-side anastomosis onto the SMV. After clamp testing showing good tolerance of the small bowel, the proximal jejunal branches of the SMV were tied, the proximal SMV was mobilized and transsected 4 cm below the pancreas, and an end-to-end anastomosis between SMV and IJV was performed. Portal pressure decreased from 23 to 13 mm Hg, and intraoperative Ultra Sound Doppler (US Doppler) showed good flows in the shunt. Postoperative course was uneventful, and 1 year after surgery, the child is clinically well, off medication, with a patent shunt, and no portal hypertension. CONCLUSION: This modified MRS technique may be useful when the autologous IJV graft is too short, avoiding the need for prosthetic conduits and prolonged postoperative anticoagulation. PMID: 19944208 [PubMed - indexed for MEDLINE]

A Triton tumor mimicking sacrococcygeal teratoma.

Related Articles A Triton tumor mimicking sacrococcygeal teratoma. J Pediatr Surg. 2009 Nov;44(11):e5-8 Authors: Sönmez K, Türkyilmaz Z, Karabulut R, Kapisiz A, Eser EP, Memiş L, Başaklar AC A newborn female infant delivered after a normal pregnancy was found to have a large sacrococcygeal mass. Imaging and laboratory studies suggested this was a sacrococcygeal teratoma. On the 16th day of age, the tumor was completely removed. Histopathologic examination of the tumor showed malignant Triton tumor (MTT). Thus, we describe a female newborn without a family history of neurofibromatosis with an MTT that mimics a sacrococcygeal teratoma. To our knowledge, this is the first report of a sacrococcygeal MTT detected in a neonate. PMID: 19944207 [PubMed - indexed for MEDLINE]

In utero diagnosis of congenital pyloric atresia in a single twin using MRI and ultrasound.

Related Articles In utero diagnosis of congenital pyloric atresia in a single twin using MRI and ultrasound. J Pediatr Surg. 2009 Nov;44(11):e21-4 Authors: Yu DC, Voss SD, Javid PJ, Jennings RW, Weldon CB Congenital pyloric atresia (CPA) is a rare disorder that has traditionally been diagnosed in the postnatal period. With improvements in ultrasound technology and increasing use of MRI, CPA is now diagnosed with increasing accuracy in utero. This also allows for identification of concomitant anomalies, which greatly affects infant survival. In addition, antenatal diagnosis of CPA and associated anomalies allow for family counseling and planning of treatment for the perinatal period including early referral to a center with pediatric surgical services. Here, we present a case of CPA with preoperative diagnosis using ultrasound and MRI. PMID: 19944206 [PubMed - indexed for MEDLINE]

Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child.

Related Articles Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child. J Pediatr Surg. 2009 Nov;44(11):e17-20 Authors: Dominguez S, Wildhaber BE, Spadola L, Mehrak AD, Chardot C We report on a 3-year-old boy who, after ingestion of turpentine, had an x-ray and was incidentally diagnosed with an intrahepatic needle. He was asymptomatic with no history of needle ingestion. Imaging (ultrasound and computed tomographic scans) showed a needle in segment 1, close to the inferior vena cava, with a proximal end in contact with the superior angle of the duodenum. Because of the localization of the needle and subsequent risks of complications, removal was proposed. Laparoscopy showed dense adhesions between liver and duodenum, confirming the migration route. Laparoscopic extraction of an entire sewing needle was performed. Postoperative course was uneventful; the child was discharged home after 2 days and is alive and well 19 months after surgery. Laparoscopy may be useful in children for extraction of intrahepatic foreign bodies, after transduodenal migration. PMID: 19944205 [PubMed - indexed for MEDLINE]

Tripartite esophagus.

Related Articles Tripartite esophagus. J Pediatr Surg. 2009 Nov;44(11):e13-5 Authors: Lawther SP, Mc Callion WA, Dick AC, Mc Cullagh M Esophageal atresia can exhibit many variations as a result of embryological derangements. We present a variation not previously described. PMID: 19944204 [PubMed - indexed for MEDLINE]

Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management.

Related Articles Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management. J Pediatr Surg. 2009 Nov;44(11):e1-4 Authors: Romão RL, de Barros F, Maksoud Filho JG, Gonçalves ME, Cardoso S, Tannuri AC, Tannuri U Primary tracheal malignant neoplasms are very rare. Histologically, squamous cell and adenoid cystic carcinomas are the most common types of malignant primary tracheal tumors when all age groups are studied. In the past 5 years, we treated 2 children with tracheal mucoepidermoid carcinoma. Herein we report both cases and review the literature on the subject with particular emphasis on diagnosis and surgical management. PMID: 19944203 [PubMed - indexed for MEDLINE]