Pediatric Surgery International最新文献

Background: The spleen and liver are the most injured organs in pediatric blunt abdominal trauma that can lead to life-threatening hemorrhage. Appropriate imaging via ultrasonography (US) and computed tomography (CT) is essential in identifying the need for operative management in the pediatric blunt liver and spleen injury (BLSI) patients to prevent bleeding complications. Studies have shown increased cancer risks associated with repeated CT use in pediatric patients, but the extent to which CT utilization should be reduced is still unclear. This study aimed to compare pediatric patients who received US only and those who received US followed by CT to determine if imaging modality is associated with clinical outcomes.

Materials and methods: The National Trauma Data Bank (NTDB) was queried for patients ≤ 18 years admitted between 2019-2023 with BLSI who received US and/or CT imaging. Patients with penetrating injuries; concomitant non-abdominal injuries with AIS score ≥ 3; who received CT imaging only; and/or received CT followed by US were excluded. Included patients received US imaging only (US-only), or US followed by CT (US-CT). Baseline characteristics and clinical outcomes were compared between these groups. Primary outcomes measured were incidences of embolization and laparotomy for hemorrhage control. Secondary outcomes measured were mortality; ICU admission; ICU length of stay (LOS); and hospital LOS. Multivariable regression was performed on clinical outcomes with respect to baseline characteristics.

Results: 2062 patients met inclusion criteria from 2019 to 2023. Of these patients, 815/2062 (40%) received US only, and 1247/2062 (60%) received US followed by CT. Between groups, no significant differences existed in incidences of embolization (1% vs. 2%, p = 0.20) or laparotomy (3% vs. 3%, p = 0.95). Patients who received US only had a higher incidence of mortality (1% vs. 0%, p < 0.001); shorter ICU LOS (median 2 days vs. 2, p < 0.005); and shorter hospital LOS (3 days vs. 4, p < 0.001). ICU admission was similar between groups (47% vs. 50%, p = 0.24). On multivariable regression analysis, US-CT had no association with ICU admission (OR 0.99, 95% CI 0.70-1.22). Patients presenting to Level I pediatric trauma centers had a lower likelihood of ICU admission (OR 0.58, 95% CI 0.46-0.74).

Conclusion: The addition of CT imaging to US did not appear to affect decision-making for operative management in pediatric BLSI patients. It appears that Level I centers and non-pediatric verified centers have a higher US followed by CT protocol. Further study is needed to determine the use of US and FAST in managing BLSI. Adoption of guidelines emphasizing conservative imaging utilization in pediatric BLSI is necessary to better allocate limited resources.

Objectives: Minimally Invasive Repair of Pectus Excavatum (MIRPE) is the most popular technique to repair pectus excavatum in young patients. One or more metallic bars are inserted and maintained for at least 2-3 years. Only a few reports on possible metal release in these patients have been published. The study aimed to search for an increase in blood metal levels in patients after MIRPE and to investigate if surgical details (number of bars and stabilizers) were correlated with metal release.

Methods: We have prospectively studied blood levels of chromium, nickel, molybdenum and manganese before bar implant in a group of patients undergoing MIRPE between 2017 and 2019 and, in the same patients, at the moment of bar removals between 2020 and 2022. All our patients had the same stainless-steel bar. Blood samples were analysed using inductively coupled plasma mass spectrometry.

Main results: We included a total of 53 (10 females) patients. Median age at MIRPE was 15.4 years. After a median bar maintenance time of 3.1 years, we observed significantly higher mean levels of chromium (2.43 vs. 0.52 µg/L) and molybdenum (1.87 vs. 0.35 µg/L; p < 0.05). Nickel (4.24 vs. 80.80 µg/L) and manganese (12.69 vs. 19.81 µg/L) were also higher, although not statistically significant. No differences were found regarding the number of bars, stabilizers implanted or gender. No patients had clinical symptoms of metallosis.

Conclusions: We demonstrated that metal blood levels increase in patients with retrosternal bars after MIRPE. Clinical implications of our finding are still unknown.

Background: First branchial cleft anomalies are uncommon paediatric congenital lesions that may present as persistent pre-auricular or post-auricular sinuses and can involve the parotid region and facial nerve. We present a single-centre 10-year experience describing presentation, imaging, management and outcomes.

Methods: Retrospective review of a prospectively collected local dataset of paediatric patients with first branchial arch cleft cysts/tracts who underwent evaluation and surgery at a tertiary paediatric centre. Data elements included age at presentation, presenting symptoms, imaging modality, surgical treatment, postoperative complications, facial nerve dysfunction, fistula course, recurrence and follow-up.

Results: Eleven patients were included (mean age 5.55 years, median 4 years). The commonest presentation was a persistent sinus with purulent discharge (9/11). Laterality was predominantly left-sided (8/11). MRI was the most used imaging modality (8/11). Postoperative wound infection occurred in 3/11 patients (27%); marginal mandibular branch weakness was recorded in 2/11 (both documented as transient/resolved). One patient had documented recurrence. The fistula/tract most commonly tracked from level II to the ear canal (9/11).

Conclusion: In this paediatric series, first branchial arch cleft anomalies most commonly presented as persistent left-sided sinuses with purulent discharge. MRI was commonly used for preoperative assessment. Surgical excision was associated with wound infection in a minority and transient marginal mandibular weakness in several cases. Larger multi-centre series with systematic prospective follow-up are needed.