ResearchPad - pediatric-surgery https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Massively Dilated Lower Pole Ectopic Megaureter with Involuted Lower Pole Renal Moiety and Collecting System: An Exception to the Meyer-Weigert Rule]]> https://www.researchpad.co/article/elastic_article_11609 Duplicated collecting systems have a predictable draining pattern that is described by the Meyer-Weigert rule. When there are abnormalities associated with duplicating collecting systems, the upper pole moiety drains inferomedially (most commonly associated with obstruction), and the lower pole moiety drains superolaterally (most commonly associated with vesicoureteral reflux). We present a case of an infant with a duplicated collecting system that violates the Meyer-Weigert rule with lower pole megaureter with massive dilation, ectopic insertion, and associated involuted lower pole renal moiety. To our knowledge, this is the only reported case of a lower pole ectopic ureter with an involuted lower pole renal moiety. 

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<![CDATA[Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey]]> https://www.researchpad.co/article/elastic_article_11233 Global surgery is a growing field studying the determinants of safe and affordable surgical care and advocating to gain the global health community's attention. In Cameroon, little is known about the level of knowledge and attitudes of students. Our survey aimed to describe the knowledge and attitudes of Cameroonian medical students towards global surgery.Materials and methodsWe performed an anonymous online survey of final-year Cameroonian medical students. Mann-Whitney U test and Spearman correlation analysis were used for bivariate analysis, and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.Results204 respondents with a mean age of 24.7 years (±2.0) participated in this study. 58.3% were male, 41.6% had previously heard or read about global surgery, 36.3% had taken part in a global surgery study, and 10.8% had attended a global surgery event. Mercy Ships was well known (46.5%), and most students believed that surgical interventions were more costly than medical treatments (75.0%). The mean score of the global surgery evaluation was 47.4% (±29.6%), and being able to recognize more global surgery organizations was correlated with having assumed multiple roles during global surgery studies (p = 0.008) and identifying more global surgery indicators (p = 0.04). Workforce, infrastructure, and funding were highlighted as the top priorities for the development of global surgery in Cameroon.ConclusionMedical students are conscious of the importance of surgical care. They lack the opportunities to nurture their interest and should be taught global surgery concepts and skills. ]]> <![CDATA[Disseminated Hydatid Disease in a Child Involving Multiple Organ Systems: A Case Report]]> https://www.researchpad.co/article/N7ebc225b-e465-453d-a1d2-2bbe81177e01

Hydatid disease is a parasitic infestation by Echinococcus granulosus, which involves the liver and lungs primarily. The authors report a case of disseminated hydatid disease involving multiple organs simultaneously in a 7-year-old child from Kabul, Afghanistan. The patient under examination had been having a complaint of cough and low-grade fever for the last one year. Computed tomography (CT) and ultrasonography (USG) demonstrated cystic lesions in his liver, lungs, spleen, and suprarenal region. The literature review showed that it was very rare for hydatid disease to involve multiple organs simultaneously, even in endemic areas, and the management of disseminated disease was very challenging, especially in the pediatric population.

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<![CDATA[A Rare Case of Pancreatoblastoma in a Pediatric Patient]]> https://www.researchpad.co/article/N717bdf16-bbe2-43cc-a5fa-5e5735ad7249

Pancreatoblastoma (PB) is a rare pancreatic neoplasm which arises when a group of pancreatic cells start to go through uncontrollable growth. The diagnosis of PB is challenging due to its vague symptoms. The initial diagnosis is made by imaging, afterwards the management is usually by resection of the tumor with or without chemotherapy which depends on the size and grade of the tumor. We report a case of a nine-year-old girl who was diagnosed with pancreotoblastoma and underwent complete resection with chemotherapy.

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<![CDATA[The Diagnosis and Treatment of Impalpable Testes at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia]]> https://www.researchpad.co/article/Nf076e935-b76b-4873-822c-acdd0f315a1e

Background

Impalpable testes may be caused by atrophy, congenital dysgenesis/agenesis, or the presence of testes at unusual sites. Early intervention can improve patient outcomes. The recommended age for surgery ranges from 6 to 18 months.

Objective

To investigate the diagnosis, treatment, and outcomes of impalpable testes and sensitivity and specificity of ultrasonography to diagnose impalpable testes at King Salman Armed Forces Hospital (KSAFH), Tabuk, Saudi Arabia.

Methods

We conducted a retrospective study to review cases of impalpable testes admitted to KSAFH, Tabuk, Saudi Arabia from January 1, 2015 to May 20, 2019. Fifty patients diagnosed with impalpable testes were treated surgically in our center during the period. Patients’ data were tabulated, and statistical analysis was performed using Statistical Package for Social Sciences software (SPSS, version 22; IBM, Armonk, NY). 

Results

We included 50 patients in our study, with a total number of 66 impalpable testes. The median age at diagnosis was 7 months, while the median age at surgery was 17.5 months. The median interval between diagnosis and surgery was 8.5 months, with 44% of cases undergoing surgery after the age of 1.5 years. Two-thirds of the cases were unilateral. The most common site was intracanalicular (57.6%) followed by intra-abdominal (34.8%). The testicular size was average in 36.4%, small in 42.4%, and atrophic in 21.2% of the evaluated cases. 

Conclusions

The overall sensitivity of ultrasonography was 56.1% (it correctly detected the location of 37 out of 66 impalpable testes). The sensitivity of ultrasonography for the detection of intra-abdominal testes was 43.5%, while that of intracanalicular testes was 71.1%.

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<![CDATA[A Study of Mortality in Cardiac Patients in a Pediatric Intensive Care Unit]]> https://www.researchpad.co/article/N537d3251-ee84-41e7-8bfb-ab5887955150

Objective: One of the major causes of mortality in the pediatric intensive care unit (PICU) is heart disease. This study aimed to determine the causes of mortality in children with pre-existing cardiac abnormalities who were admitted into the PICU.

Methods: Data were collected through patient profile assessment and outcome and heart diseases affecting prognosis were analyzed. Medical records of children were reviewed retrospectively. The updated Pediatric Index of Mortality 2 (PIM2) scores were used. Exploratory data analysis was performed using descriptive measures. Kolmogorov-Smirnov tests were used to test the normality of data distribution.

Results: Out of 566 admissions into PICU, 76 (13.4%) had cardiac abnormalities. Median and range of PICU stay were 5.50 and 417.88 days. The mean PIM2 score on admission was found to be 31.05. The most common admission was due to atrioventricular septal defect (AVSD) (15.7%), cardiomyopathy (13.1%), ventricular septal defect (VSD) (11.8%), tetralogy of Fallot (10.5%) and others (48.9%). There were multiple cardiac anomalies in 3.9% of patients. The most important cause of cardiac mortality in PICU was septic shock (26.0%) followed by cardiogenic shock (20.6%), and cardiac failure (13.7%). The nosocomial infection rate of cardiac patients in PICU was 10.5%.

Conclusions: Our study reconfirmed that the PIM2 score is a good indicator of cardiac diseases. Infections, nosocomial infections, pneumonia, and septic shock were the leading causes of mortality in cardiac patients. Better infection control in the PICU may have a significant impact on decreasing mortality rates.

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<![CDATA[An Atypical Variant of Apple Peel Atresia: Reporting a Rare Case]]> https://www.researchpad.co/article/Nefba8c36-d7b3-4f64-80db-dceca5210ce4

Apple peel intestinal atresia is a rare congenital malformation. It consists of a proximal jejunum ending in a blind pouch and distal small bowel wrapped around its vascular supply in a spiral fashion. A combination of type IIIb jejunoileal atresia (apple peel atresia) and type IV (multiple intestinal atresias) is a rare entity. The diagnosis and management of such complicated cases is a challenge, especially in resource-limited settings. We report a case of a four-day-old female who presented to the neonatal intensive care unit with complaints of vomiting, yellow discoloration of the skin, and failure to pass meconium since birth. The baby was born preterm (34 weeks) via spontaneous vaginal delivery. The physical examination concluded a jaundiced and dehydrated child with a soft, non-tender abdomen and absent gut sounds. X-ray abdomen showed two air-fluid areas in the left hypochondrium. The upper gastrointestinal gastrografin study revealed that contrast opacified the third part of the duodenum and no contrast was observed beyond it. On exploratory laparotomy, proximal jejunal atresia with four distal atresias in apple peel fashion and a viable 20 cm of small bowel was observed. The apple peel segments were supplied by mesenteric vessels. Unfortunately, our patient expired despite all supportive measures. The case highlights the significance of the prenatal and early postnatal diagnosis of such a complex combination of intestinal atresias for adequate and timely management.

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<![CDATA[Selection of Pneumatic Reduction in Invagination Treatment and the Factors Affecting the Success of This Method]]> https://www.researchpad.co/article/N67371963-ea21-4650-957f-5754027b3474

Objective

To retrospectively evaluate the success rates of fluoroscopy-guided pneumatic reduction in children with intussusception and to determine the risk factors and patient characteristics affecting the success of this method.

Materials and methods

Retrospective evaluation was made of a total of 183 children diagnosed with ultrasonography (USG) and treated in the pediatric surgery clinic between August 2010 and December 2017. Data related to gender, age (month), date of presentation, invaginated segment localizations and treatment modalities were retrieved from the patient files.

In children who underwent pneumatic reduction, surgical success was determined as the visualization of air flow through the small intestine on fluoroscopy and patients who received reduction were followed up in our clinic. No progress of the air given or failure to see the air flow to the small intestine despite some progression of the air was evaluated as failure and surgical procedure was started in 39 patients. All patients were followed up at the hospital for at least 24 to 48 hours after the procedures.

Patients with perforation, peritonitis, vital instability, or general condition disorder during presentation at our clinic (n = 29) were directly admitted for surgery.

Results

The study included a total of 183 children, comprising 116 (63.4%) males and 67 (36.6%) females with a mean age of 61.3 ± 34.3 months. While mesenteric lymphadenitis (n = 7) was determined as the most common lesion in cases where a pathologic lead point was detected (7.6%), Meckel’s diverticulum was observed in four patients, polyps in two patients, and an involvement associated with Henoch Schönlein Vasculitis in one patient. Pneumatic reduction procedure was applied in 154 (84.1%) patients and successful results were obtained in 115 (74.7%) patients, while surgical intervention was required in 39 (25.3%) patients.

While frequency of admission to direct surgery following the failure of pneumatic reduction in children under the age of two years was determined to be higher than the frequency of healing, the successful pneumatic reduction and admission to direct surgery rates in children between the ages of 0-4 years was found to be significantly higher than those in other age groups (p < 0.001). The pneumatic reduction success rate was determined to decrease significantly in children aged ≥6 years (p < 0.001). The mean hospitalization duration of the patients who underwent surgery after pneumatic reduction (five days) was determined to be significantly longer compared to that of the patients who underwent direct surgery and for whom a successful pneumatic reduction was ensured (p = 0.001 and p = 0.008, respectively).

Conclusion

Fluoroscopy-guided pneumatic reduction has a high success rate and is still one of the first option methods in the treatment of idiopathic intussusception. The application of the method under operating room conditions is more appropriate for patient safety. It is considered that the non-operative reduction success may increase with the detailed evaluation of intussusception cases determined to have pathologic lead points in children aged <2 years and >6 years.

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<![CDATA[Management of Giant Omphalocele Leading to Early Fascial Closure]]> https://www.researchpad.co/article/N08750865-26d5-4cd4-945a-ea9563755010

Objective

The aim of the study was to present the clinical outcomes of patients diagnosed with giant omphalocele, treated with early primary closure combined with bandaging and povidone-iodine staining and powder spray antibiotics.

Materials and methods

The study included a total of 22 infants with omphalocele. The omphalocele sacs of the patients were cleaned daily with topical povidone-iodine. A powdered spray antibiotic combination was then applied topically twice a day and the sac was wrapped in a sterile elastic bandage. Following the observation of eschar formation and epithelization, the patients were operated on in the early period and the sac was removed by placing a graft.

Results

Evaluation was made of a total of 14 female and eight male patients with mean duration of conservative monitoring of 11 days and mean total hospital stay of 35. The mean giant omphalocele (GO) defect size of the patients followed-up was 10 cm. Since seven of the patients in the present study died in the 1st week, conservative and elastic bandages were applied for the GO treatment of 15 patients for 9-14 days. After the conservative follow-up, it was determined that the patients who were applied with a graft at an average of 11 days were hospitalized for an average of 24 days postoperatively.

Conclusion

In conclusion, it is possible to reduce the length of hospital stay with primary closure in the early period by providing faster epithelialization with the combination of povidone-iodine and antibiotic powder together with elastic bandage application in infants with GO.

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<![CDATA[Harmonic Shears in the Surgical Treatment of Laryngomalacia]]> https://www.researchpad.co/article/Nc52528ba-1606-40e3-a618-434b4c3fe5a9

Introduction

Laryngomalacia (LM) is a condition that is clinically diagnosed in the pediatric period with inspiratory stridor and is caused by a congenital or acquired collapse of laryngeal suprastructures. Endoscopic supraglottoplasty is the modern gold standard surgical treatment for severe or complicated laryngomalacia. Various cold and powered surgical devices have been used to approach the aryepiglottic folds, and their advantages and drawbacks have been widely discussed. The applicability of Ultracision Harmonic shears (Ethicon Inc., NJ, US) for the sake of supraglottoplasty has not been previously advocated in the literature and is the subject of this study.

Methods

This was a review of the medical records of pediatric patients, with moderate to severe congenital laryngomalacia, who underwent supraglottoplasty with Harmonic at a single institution, from 2013 to 2019.

Results

A total of six patients underwent bilateral aryepiglottic fold division with the use of Ultracision in the study period (4 male, 2 female; mean age 7+/-9 months, age range 1m-24m). Postoperatively, all of the children were extubated and admitted to the pediatric intensive care unit (PICU) as a precaution measure. There were no early or late complications after the intervention. The postoperative endoscopic picture was evaluated in three patients (two of which for another reason). A stable laryngeal frame with no collapse or excessive scarring was observed. None of the patients required repeat surgery.

Conclusion

Based on the ease of surgical access, performance, surgical precision, and postoperative results, the use of Harmonic scissors appears to be a safe, practical, affordable, and easily applicable alternative for supraglottoplasty Type 2.

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<![CDATA[Multiple Magnet Ingestion leading to Bowel Perforation: A Relatively Sinister Foreign Body]]> https://www.researchpad.co/article/Nd2c18782-e29a-424c-8f45-c28b9ecd1ed9

Foreign body ingestion is a common reason for seeking emergency care among children. One of the more serious foreign bodies are the ingestion of multiple magnets or concurrent ingestion of a magnet and a metallic foreign body. Conservative management with serial imaging can be misleading in such cases. Multiple magnets tend to have strong attractive forces among them and may encase loops of bowel within them. Once entrapped, pressure necrosis and perforation will ensue, and thus, a low threshold should be adopted for surgical exploration in such cases. We present the case of a two-year-old male who had an accidental, unwitnessed ingestion of multiple magnets and also report the subsequent surgical management and associated morbidity

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<![CDATA[Efficacy and Reliability of Retrograde Intrarenal Surgery in Treatment of Pediatric Kidney Stones]]> https://www.researchpad.co/article/5ca26265d5eed0c4846ddd44

Introduction 

Surgical treatment of pediatric kidney stones has dramatically changed in recent years due to the miniaturization of surgical instruments and the availability of intracorporeal lithotriptors. Retrograde intrarenal surgery (RIRS) technique is now considered an effective and minimally invasive procedure in renal stones. However, in the pediatric age group, the number of studies on this subject is very limited. The aim of this study was to evaluate the efficacy and safety of the RIRS in the treatment of kidney stones in children.

Material and methods 

The data of 25 pediatric stone patients who underwent RIRS with the diagnosis of kidney stones were analyzed retrospectively. Demographic characteristics, operative data, and success rates of the patients were recorded.

Results 

Fourteen (56%) of the cases were male and 11 (46%) were female. The mean age was 10.43 ± 4.26 (3-15) in boys and 10.18 ± 4.92 (4-16) in girls. Eleven stones (46%) were in the left kidney and 14 (56%) in the right kidney. The mean stone size was 10.08 ± 4.33 mm (4-23). Stone localizations were renal pelvis in 15 (60%) cases, upper calyx in four (16%) cases, middle calyx in five (20%) cases, and lower calyx in one (4%) case. The mean operation time was 41.20 ± 6.96 minutes (30-60), the mean duration of scope was 17.40 ± 3.85 seconds (10-30), and the mean hospital stay was 2.32 ± 0.63 days (2-4). Three patients (12%) had undergone percutaneous nephrolithotomy (PCNL), and two (8%) patients underwent shockwave lithotripsy (ESWL) before this surgery. In six (24%) patients, a double J (DJ) catheter was inserted due to stenosis at the lower end of the ureter. Body mass index (BMI) of these patients was below 18. An access sheath was implanted in six (24%) patients in the second operation. In 18 cases, the first operation was performed with a direct flexible renoscope. In all cases, a postoperative DJ catheter was inserted. Postoperative fever was observed in one (4%) patient, and ureteric steinstrasse was observed in one (4%) patient. The stone-free rate was achieved as 17% (68%) after the first operation and 100% after the second RIRS session.

Conclusion 

RIRS appears to be an effective and reliable method in the pediatric age group. However, there is a need for multicentre studies involving more cases.

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<![CDATA[Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23-28 weeks of gestation]]> https://www.researchpad.co/article/5c6dc9e3d5eed0c48452a424

This study aimed to determine the natural course of patent ductus arteriosus (PDA) with noninterventional conservative management and whether the presence and/or prolonged duration of hemodynamically significant (HS) PDA increased the risk of mortality and morbidities in extremely preterm (EPT) infants. We retrospectively reviewed the medical records of EPT infants born at 23–28 weeks of gestation (n = 195) from January 2011 to June 2014, when PDA was managed with noninterventional conservative treatment. We stratified infants into three subgroups of 23–24, 25–26, and 27–28 weeks and analyzed the prevalence and natural evolution of HS PDA, defined as ventilator dependency and PDA size ≥2 mm. Multivariate regression analyses determined if the presence and/or prolonged duration of HS PDA increased the risk for mortality and/or morbidities. The overall incidence of HS PDA was 57% (111/195) at the end of the first postnatal week. In subgroup analyses, infants with 23–24 weeks of gestation had the highest incidence (93%, 50/54), with 64% (47/74) for 25–26 weeks and 21% (14/67) for 27–28 weeks. Six (5%) of 111 infants with HS PDA were discharged without ductus closure, 4 had spontaneous PDA closure on follow up, and device closure was performed for 2 infants. In the multivariate analyses, the presence or prolonged duration (per week) of HS PDA was not associated with the risk of mortality and/or morbidities. Spontaneous closure of HS PDA was mostly achieved, even in EPT infants, with a noninterventional conservative approach. In conclusion, our data showed the incidence and natural course of HS PDA in EPT infants and suggested that the presence or prolonged duration of HS PDA might not increase the rate of mortality or morbidities.

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<![CDATA[Numerical and in-vitro experimental assessment of the performance of a novel designed expanded-polytetrafluoroethylene stentless bi-leaflet valve for aortic valve replacement]]> https://www.researchpad.co/article/5c5b528cd5eed0c4842bcb44

The expanded polytetrafluoroethylene (ePTFE) heart valve can serve as a viable option for prosthetic aortic valve. In this study, an ePTFE bi-leaflet valve design for aortic valve replacement (AVR) is presented, and the performance of the proposed valve was assessed numerically and experimentally. The valve was designed using CAE software. The dynamic behavior of the newly designed bi-leaflet valve under time-varying physiological pressure loading was first investigated by using commercial finite element code. Then, in-vitro tests were performed to validate the simulation and to assess the hemodynamic performance of the proposed design. A tri-leaflet ePTFE valve was tested in-vitro under the same conditions as a reference. The maximum leaflet coaptation area of the bi-leaflet valve during diastole was 216.3 mm2. When fully closed, no leakage gap was observed and the free edges of the molded valve formed S-shaped lines. The maximum Von Mises stress during a full cardiac cycle was 4.20 MPa. The dynamic performance of the bi-leaflet valve was validated by the in-vitro test under physiological aortic pressure pulse. The effective orifice area (EOA), mean pressure gradient, regurgitant volume, leakage volume and energy loss of the proposed valve were 3.14 cm2, 8.74 mmHg, 5.93 ml/beat, 1.55 ml/beat and 98.99 mJ, respectively. This study reports a novel bi-leaflet valve design for AVR. The performance of the proposed valve was numerically and experimentally assessed. Compared with the reference valve, the proposed design exhibited better structural and hemodynamic performances, which improved valve competency. Moreover, the performance of the bi-leaflet design is comparable to commercialized valves available on the market. The results of the present study provide a viable option for the future clinical applications.

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<![CDATA[Orthotopic Liver Transplantation After Stereotactic Body Radiotherapy for Pediatric Hepatocellular Carcinoma with Central Biliary Obstruction and Nodal Involvement]]> https://www.researchpad.co/article/5c47a8b0d5eed0c484c84b70

Here we describe the case of a 10-year-old boy with a history of chronic hepatitis B who was diagnosed with hepatocellular carcinoma (HCC) with a large central hepatic mass and metastatic disease in a celiac lymph node. His tumor was unresectable, due to location and lack of clear margins, and he could not receive chemotherapy due to elevated bilirubin. He was treated with stereotactic body radiotherapy (SBRT) to the primary site and involved nodal region. After completing radiotherapy, his total bilirubin level fell below 1.0 mg/dL, allowing him to begin systemic therapy with cisplatin and doxorubicin. At three months after SBRT, his bilirubin was 0.1 mg/dL, alpha-fetoprotein (AFP) was 88 ng/mL, and imaging demonstrated a decrease in tumor size (total volume 28.7 cc), with no evidence of local or distant disease progression. He then developed distant disease within the liver, but his disease remained controlled at the primary site and nodes that had been treated with SBRT. He underwent orthotopic liver transplantation (OLT) with an uneventful operative course and remains with no evidence of disease at seven months after OLT. This is one of the first reported cases of successful downstaging of pediatric HCC with nodal involvement to allow for OLT, and it argues for consideration of similar patients for OLT.

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<![CDATA[Acute Appendicitis After Spine Fusion for Adolescent Idiopathic Scoliosis: A Case Report]]> https://www.researchpad.co/article/5c47a89ad5eed0c484c8427c

Appendicitis is a common cause of pediatric abdominal pain, largely occurring in the second decade of life. We present the case of a 14-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis, who later developed abdominal pain, nausea, and emesis secondary to acute appendicitis. Her hospital course was significant for prolonged intravenous use of narcotics for pain control and subsequent constipation but negative for abdominal pain or tenderness during her admission. While gastrointestinal complications are a common cause of unplanned 30-day readmissions in the pediatric population, appendicitis has yet to be reported. To our knowledge, this is the first case report of acute appendicitis after posterior spinal fusion, likely resulting from postoperative pain management.

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<![CDATA[A comparison of surgical outcomes between pre-and full-term patients with exotropia]]> https://www.researchpad.co/article/5c141eadd5eed0c484d27ba2

Purpose

To compare the surgical outcomes between pre- and full-term patients with exotropia and to examine the factors associated with surgical outcomes.

Methods

This retrospective study included 48 pre- and 432 full-term patients with basic-type exotropia who underwent unilateral or bilateral lateral rectus muscle (ULR or BLR) recession. Preoperative characteristics and surgical outcomes were compared between the pre- and full-term infants. Additionally, factors affecting the surgical outcomes were evaluated in all patients.

Results

The preoperative characteristics were significantly different between the pre- and full-term groups in terms of neurodevelopmental disabilities (p = 0.020). There were no significant differences between the pre- and full-term groups in terms of the success, overcorrection, and recurrence rates after the mean follow-up period of 34.6 ± 13.9 months (p = 0.697). The major cause of surgical failure was recurrence in both groups. Pre-term birth was not a risk factor for overcorrection and recurrence. However, regardless of the pre- or full-term birth status, the presence of neurodevelopmental disabilities significantly affected final overcorrection (p = 0.004).

Conclusions

Pre-term patients with exotropia showed similar surgical outcomes to full-term controls. The presence of neurodevelopmental disabilities was a risk factor for final overcorrection.

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<![CDATA[Evidence Supporting Selective Dorsal Rhizotomy for Treatment of Spastic Cerebral Palsy]]> https://www.researchpad.co/article/5c2bbcc6d5eed0c484743242

The objective of this review is to analyze the evidence supporting selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). We reviewed 85 outcome studies from 12 countries between 1990 and 2017. The published results are overwhelmingly supportive of SDR, and 39 studies form a basis for this review. Also included is some of the clinical experience of the senior author.

The results show that SDR plus postoperative physiotherapy (PT) improved gait, functional independence, and self-care in children with spastic diplegia. In adults with a follow-up of 20 to 28 years, the early improvements after childhood SDR were sustained and improved quality of life. Furthermore, majority of the adults who underwent SDR as children would recommend SDR to others. On the clinical side, while SDRs through multilevel laminectomies or laminoplasty were associated with spinal deformities (i.e., scoliosis, hyperlordosis, kyphosis, spondylolisthesis, spondylolysis, and nonhealing of laminoplasty), SDRs through a single level laminectomy prevented SDR-related spinal problems. The outcomes of SDR specific to spastic quadriplegia require further investigation because of the relatively small patient population with quadriplegia. Lastly, we found that SDR can prevent or reverse premature aging in adolescents and adults with spastic diplegia. In conclusion, the evidence supporting the efficacy of SDR is strong, and SDR is a well-established option for spasticity management in spastic CP.

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<![CDATA[The impact of Joint Commission International accreditation on time periods in the operating room: A retrospective observational study]]> https://www.researchpad.co/article/5bae98fe40307c0c23a1c156

The Joint Commission International (JCI) is responsible for upholding standards in healthcare and organizations in compliance receive accreditation. JCI requires quality improvement on patient safety goals, but requirements may prolong the total procedure/surgery time and reduce efficiency. Here, we evaluate the impact of JCI requirements on time periods in the operating room. We included patients who received elective and emergency surgeries under general anesthesia at Juntendo University Hospital between December 2014 and June 2016. Patients were classified as before and after JCI accreditation on December 12, 2015. The primary outcome was total procedure/surgery time. Secondary outcomes include five time periods comprising the total procedure/surgery time: pre-anesthesia time, anesthesia induction time, procedure/surgery time, anesthesia awareness time and post-anesthesia time. We compared these time periods between patients before and after JCI accreditation and patients were matched for age, sex and the specific type of surgery. Although total procedure/surgery time did not change significantly, pre-anesthesia time significantly increased (8.2 ± 6.9 minutes vs. 8.5 ± 6.9 minutes, before vs. after JCI, respectively, p = 0.028) and anesthesia induction time significantly decreased (34.4 ± 16.1 minutes vs. 33.6 ± 15.4 minutes, before vs. after JCI, respectively, p = 0.037) after JCI accreditation. Other secondary study outcomes did not change significantly. Quality improvement initiatives associated with time periods in the operating room can be achieved without undermining efficiency.

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<![CDATA[How does nonsyndromic craniosynostosis affect on bone width of nasal cavity in children? – Computed tomography study]]> https://www.researchpad.co/article/5b6003a1463d7e38dd0d05b4

Craniosynostosis is caused by premature fusion of one or more cranial sutures, restricting skull, brain and face growth. Nonsyndromic craniosynostosis could disturb the proportions of face. Although morphometric diameters of nasal cavity in healthy children are already known, they have not been established yet in children with nonsyndromic craniosynostosis. The aim our study was to check whether diameters of bone structures of nasal cavity in children with nonsyndromic craniosynostosis measured in CT are within normal range. 249 children aged 0–36 months (96 with clinical diagnosis of nonsyndromic craniosynostosis and 153 in control group) were included into the study. The following diameters were measured on head CT scans: anterior bony width (ABW), bony choanal aperture width (BCAW), right and left posterior bony width (between bone sidewall and nasal cavity septum—RPBW and LPBW). The study group has been divided into 4 categories, depending on child’s age. The dimensions measured between bone structures of nasal cavity were statistically significantly lower in comparison to the control group. They did not depend on the sex for ABW, nor on age in groups 7–12 months and < 2 years for BCAW, RPBW and LPBW. The measured dimensions increased with age. In children with nonsyndromic craniosynostosis the diameter of pyriform aperture and bony choanal aperture were lower than in controls, what may be described as fronto-orbital anomalies. Morphometric measurements of anthropometric indicators on CT scans could be used as standards in the clinical identification of craniosynostosis type and may help in planning surgical procedures, particularly in the facial skeleton in children.

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