Pub Date : 2024-08-01Epub Date: 2023-04-26DOI: 10.1055/a-2081-1288
Ryan Billar, Stijn Heyman, Sarina Kant, René Wijnen, Frank Sleutels, Serwet Demirdas, J Marco Schnater
Background: Potential underlying genetic variations of pectus excavatum (PE) are quite rare. Only one-fifth of PE cases are identified in the first decade of life and thus are of congenital origin. The objective of this study is to test if early-onset PE is more likely to be part of genetic variations than PE that becomes apparent during puberty or adolescence.
Materials and methods: Children younger than 11 years who presented with PE to the outpatient clinic of the Department of Pediatric Surgery at our center between 2014 and 2020 were screened by two clinical geneticists separately. Molecular analysis was performed based on the differential diagnosis. Data of all young PE patients who already had been referred for genetic counseling were analyzed retrospectively.
Results: Pathogenic genetic variations were found in 8 of the 18 participants (44%): 3 syndromic disorders (Catel-Manzke syndrome and two Noonan syndromes), 3 chromosomal disorders (16p13.11 microduplication syndrome, 22q11.21 microduplication syndrome, and genetic gain at 1q44), 1 connective tissue disease (Loeys-Dietz syndrome), and 1 neuromuscular disorder (pathogenic variation in BICD2 gene).
Conclusion: Early-onset PE is more likely to be part of genetic variations than PE that becomes apparent during puberty or adolescence. Referral for genetic counseling should therefore be considered.
Trial registration: NCT05443113.
背景:开胸症(PE)潜在的基因变异相当罕见。仅有五分之一的胸大肌病例是在出生后的前十年被发现的,因此是先天性的。本研究的目的是检验与青春期或少年期显现的 PE 相比,早发性 PE 是否更有可能是遗传变异的一部分:由两名临床遗传学家分别对 2014 年至 2020 年期间在本中心小儿外科门诊就诊的 11 岁以下 PE 患儿进行筛查。根据鉴别诊断结果进行分子分析。对所有已转诊接受遗传咨询的年轻 PE 患者的数据进行了回顾性分析:结果:18 名参与者中有 8 人(44%)发现了致病基因变异:结果:18 名参与者中有 8 人(44%)发现了致病基因变异:3 种综合征疾病(Catel-Manzke 综合征和两种努南综合征)、3 种染色体疾病(16p13.11 微重复综合征、22q11.21 微重复综合征和 1q44 基因增殖)、1 种结缔组织疾病(Loeys-Dietz 综合征)和 1 种神经肌肉疾病(BICD2 基因的致病变异):结论:与在青春期或少年期显现的 PE 相比,早发性 PE 更有可能是基因变异的一部分。因此,应考虑转诊接受遗传咨询:试验注册:NCT05443113。
{"title":"Early-Onset Pectus Excavatum Is More Likely to Be Part of a Genetic Variation.","authors":"Ryan Billar, Stijn Heyman, Sarina Kant, René Wijnen, Frank Sleutels, Serwet Demirdas, J Marco Schnater","doi":"10.1055/a-2081-1288","DOIUrl":"10.1055/a-2081-1288","url":null,"abstract":"<p><strong>Background: </strong> Potential underlying genetic variations of pectus excavatum (PE) are quite rare. Only one-fifth of PE cases are identified in the first decade of life and thus are of congenital origin. The objective of this study is to test if early-onset PE is more likely to be part of genetic variations than PE that becomes apparent during puberty or adolescence.</p><p><strong>Materials and methods: </strong> Children younger than 11 years who presented with PE to the outpatient clinic of the Department of Pediatric Surgery at our center between 2014 and 2020 were screened by two clinical geneticists separately. Molecular analysis was performed based on the differential diagnosis. Data of all young PE patients who already had been referred for genetic counseling were analyzed retrospectively.</p><p><strong>Results: </strong> Pathogenic genetic variations were found in 8 of the 18 participants (44%): 3 syndromic disorders (Catel-Manzke syndrome and two Noonan syndromes), 3 chromosomal disorders (16p13.11 microduplication syndrome, 22q11.21 microduplication syndrome, and genetic gain at 1q44), 1 connective tissue disease (Loeys-Dietz syndrome), and 1 neuromuscular disorder (pathogenic variation in <i>BICD2</i> gene).</p><p><strong>Conclusion: </strong> Early-onset PE is more likely to be part of genetic variations than PE that becomes apparent during puberty or adolescence. Referral for genetic counseling should therefore be considered.</p><p><strong>Trial registration: </strong> NCT05443113.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9543162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-12DOI: 10.1055/a-2127-5751
Sjoerd C J Nagelkerke, R Bakx
{"title":"Re: Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review.","authors":"Sjoerd C J Nagelkerke, R Bakx","doi":"10.1055/a-2127-5751","DOIUrl":"10.1055/a-2127-5751","url":null,"abstract":"","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2023-07-12DOI: 10.1055/a-2128-0974
Diego Gil Mayo, Pascual Sanabria Carretero, Luis Gajate Martin, Jose Alonso Calderón, Maria Gomez Rojo, Francisco Hernández Oliveros
Objective: Surgical intervention in pediatric patients can cause variable degrees of psychological stress with potential consequences in the perioperative period and even in the long term, after hospital discharge in the form of behavioral changes days and months later. The aim of our study was to determine which preoperative preparation strategy reduces postoperative maladaptive behavioral changes in children undergoing ambulatory pediatric surgery.
Materials and methods: This prospective observational study included 638 pediatric American Society of Anesthesiologists physical status I or II patients who underwent ambulatory pediatric surgery. They were grouped into four preoperative preparation groups: not premedicated (NADA), premedicated with midazolam (MDZ), parental presence during induction of anesthesia (PPIA), and parental presence during induction of anesthesia and premedicated with midazolam (PPIA + MDZ). All patients included in the study were contacted by telephone during 1 year posthospital discharge to assess the postoperative maladaptive behavioral changes using the Posthospitalization Behavior Questionnaire (PHBQ). We performed a multivariate analysis to evaluate the influence of type of preparation and behavioral changes.
Results: Patients in the PPIA and PPIA + MDZ preparation groups presented less postoperative maladaptive behavioral changes compared to patients in the NADA and MDZ groups (odds ratio [OR]: 1.8 [1.1-2.8] and OR 2.2 [1.03-4.49]) during the first week and first month. The intensity of emergence delirium measured by the Pediatric Anesthesia Emergence Delirium (PAED) scale increases the probability of postoperative maladaptive behavioral changes (OR: 1.05 [1.006-1.103]).
Conclusion: The presence of parents during induction of anesthesia (PPIA and PPIA + MDZ) is a very effective strategy in reducing postoperative behavioral changes. These benefits are more significant in children under 5 years of age.
目的:对小儿患者进行手术治疗会造成不同程度的心理压力,在围手术期甚至出院后的数天或数月内都可能产生行为变化。我们的研究旨在确定哪种术前准备策略可减少接受门诊儿科手术的儿童术后适应不良行为的变化:这项前瞻性观察研究纳入了 638 名接受非卧床儿科手术的美国麻醉医师协会体能状态 I 级或 II 级儿科患者。他们被分为四个术前准备组:未预服药组(NADA)、预服咪达唑仑组(MDZ)、麻醉诱导时父母在场组(PPIA)、麻醉诱导时父母在场并预服咪达唑仑组(PPIA + MDZ)。在患者出院后一年内,我们通过电话与所有参与研究的患者取得联系,使用 "出院后行为问卷"(PHBQ)评估其术后适应不良行为的变化。我们进行了多变量分析,以评估准备类型和行为变化的影响:结果:与NADA组和MDZ组患者相比,PPIA组和PPIA+MDZ组患者在术后第一周和第一个月出现的不良行为改变较少(几率比[OR]:1.8 [1.1-2.8]和OR 2.2 [1.03-4.49])。用小儿麻醉谵妄(PAED)量表测量的谵妄强度会增加术后不良行为改变的概率(OR:1.05 [1.006-1.103]):结论:麻醉诱导期间(PPIA 和 PPIA + MDZ)父母在场是减少术后行为改变的有效策略。这些益处对 5 岁以下儿童更为明显。
{"title":"Parental Presence during Induction of Anesthesia and Emergence Delirium Influence the Incidence of Postoperative Maladaptive Behavioral Changes.","authors":"Diego Gil Mayo, Pascual Sanabria Carretero, Luis Gajate Martin, Jose Alonso Calderón, Maria Gomez Rojo, Francisco Hernández Oliveros","doi":"10.1055/a-2128-0974","DOIUrl":"10.1055/a-2128-0974","url":null,"abstract":"<p><strong>Objective: </strong> Surgical intervention in pediatric patients can cause variable degrees of psychological stress with potential consequences in the perioperative period and even in the long term, after hospital discharge in the form of behavioral changes days and months later. The aim of our study was to determine which preoperative preparation strategy reduces postoperative maladaptive behavioral changes in children undergoing ambulatory pediatric surgery.</p><p><strong>Materials and methods: </strong> This prospective observational study included 638 pediatric American Society of Anesthesiologists physical status I or II patients who underwent ambulatory pediatric surgery. They were grouped into four preoperative preparation groups: not premedicated (NADA), premedicated with midazolam (MDZ), parental presence during induction of anesthesia (PPIA), and parental presence during induction of anesthesia and premedicated with midazolam (PPIA + MDZ). All patients included in the study were contacted by telephone during 1 year posthospital discharge to assess the postoperative maladaptive behavioral changes using the Posthospitalization Behavior Questionnaire (PHBQ). We performed a multivariate analysis to evaluate the influence of type of preparation and behavioral changes.</p><p><strong>Results: </strong> Patients in the PPIA and PPIA + MDZ preparation groups presented less postoperative maladaptive behavioral changes compared to patients in the NADA and MDZ groups (odds ratio [OR]: 1.8 [1.1-2.8] and OR 2.2 [1.03-4.49]) during the first week and first month. The intensity of emergence delirium measured by the Pediatric Anesthesia Emergence Delirium (PAED) scale increases the probability of postoperative maladaptive behavioral changes (OR: 1.05 [1.006-1.103]).</p><p><strong>Conclusion: </strong> The presence of parents during induction of anesthesia (PPIA and PPIA + MDZ) is a very effective strategy in reducing postoperative behavioral changes. These benefits are more significant in children under 5 years of age.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10240918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The possibilities, recent advances, and pitfalls in the histopathologic workup of specimens submitted for the diagnosis of Hirschsprung's disease (HSCR) are presented.
Materials and methods: A literature research was performed in the database PubMed including the years 2000 to 2024.
Results: The pathologist is involved in the diagnosis of HSCR in three scenarios: (1) the primary diagnosis in a child with the typical clinical symptoms, (2) the intra-operative guidance of surgery in a case where the diagnosis is already established, and (3) the confirmation of the diagnosis and the documentation of the extent of the disease in the resected specimen. Identification of ganglion cells in the enteric neural plexuses excludes HSCR, and the histological confirmation of a complete absence of these ganglion cells is the gold standard for its diagnosis. However, difficulties in the detection of ganglion cells with standard stains and/or a limited amount of tissue in the specimen submitted for diagnosis make supportive histologic stains and techniques, e.g., calretinin immunohistochemistry or acetylcholinesterase histochemistry necessary for an unequivocal diagnosis of HSCR.
Conclusions: Improving the diagnostic accuracy of this life-threating disease is an interdisciplinary task. A good communication between pathologist and clinician, as well as mutual knowledge of skills and challenges of the other discipline, is necessary for a successful diagnostic teamwork.
{"title":"The Pathologist's Role in the Diagnosis of Hirschsprung's Disease.","authors":"Andreas Erbersdobler","doi":"10.1055/s-0044-1788562","DOIUrl":"https://doi.org/10.1055/s-0044-1788562","url":null,"abstract":"<p><strong>Introduction: </strong> The possibilities, recent advances, and pitfalls in the histopathologic workup of specimens submitted for the diagnosis of Hirschsprung's disease (HSCR) are presented.</p><p><strong>Materials and methods: </strong> A literature research was performed in the database PubMed including the years 2000 to 2024.</p><p><strong>Results: </strong> The pathologist is involved in the diagnosis of HSCR in three scenarios: (1) the primary diagnosis in a child with the typical clinical symptoms, (2) the intra-operative guidance of surgery in a case where the diagnosis is already established, and (3) the confirmation of the diagnosis and the documentation of the extent of the disease in the resected specimen. Identification of ganglion cells in the enteric neural plexuses excludes HSCR, and the histological confirmation of a complete absence of these ganglion cells is the gold standard for its diagnosis. However, difficulties in the detection of ganglion cells with standard stains and/or a limited amount of tissue in the specimen submitted for diagnosis make supportive histologic stains and techniques, e.g., calretinin immunohistochemistry or acetylcholinesterase histochemistry necessary for an unequivocal diagnosis of HSCR.</p><p><strong>Conclusions: </strong> Improving the diagnostic accuracy of this life-threating disease is an interdisciplinary task. A good communication between pathologist and clinician, as well as mutual knowledge of skills and challenges of the other discipline, is necessary for a successful diagnostic teamwork.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Can İhsan Öztorun, Çiğdem Ulukaya Durakbaşa, Tutku Soyer, Coşkun Özcan, Binali Fırıncı, Berat Dilek Demirel, İlhan Çiftçi, Ayşe Parlak, Mustafa Onur Öztan, Gülnur Göllü Bahadır, İbrahim Akkoyun, Ayşe Karaman, Cengiz Gül, Gül Şalcı, Hüseyin İlhan, Akgün Oral, Rahşan Özcan, Seyithan Özaydın, Şeref Selçuk Kılıç, Gürsu Kıyan, Ali Onur Erdem, Osman Uzunlu, Abdullah Yıldız, Esra Özçakır, Nazile Ertürk, Başak Erginel, Tülin Öztaş, Ahmet Atıcı, Mehmet Mert, Hakan Samsum, Mehmet Ali Özen, Emrah Aydın, Serpil Sancar
Introduction: Anastomotic stricture (AS) is the second most common complication after esophageal atresia (EA) repair. We aimed to evaluate the data in the Turkish Esophageal Atresia Registry to determine the risk factors for AS development after EA repair in a large national cohort of patients.
Methods: The data between 2015 and 2021 were evaluated. Patients were enrolled into two groups according to the occurrence of AS. Patients with AS (AS group) and without AS (non-AS group) were compared according to demographic and operative features, postoperative intubation status, and postoperative complications, such as anastomotic leaks, fistula recanalization, and the presence of gastroesophageal reflux (GER). A multivariable logistic regression analysis was performed to define the risk factors for the development of AS after EA repair.
Results: Among the 713 cases, 144 patients (20.19%) were enrolled into the AS group and 569 (79.81%) in the non-AS group. The multivariable logistic regression showed that, being a term baby (odds ratio [OR]: 1.706; p = 0.006), having a birth weight over 2,500 g (OR: 1.72; p = 0.006), presence of GER (OR: 5.267; p < 0.001), or having a recurrent tracheoesophageal fistula (TEF, OR: 4.363; p = 0.006) were the risk factors for the development of AS.
Conclusions: The results of our national registry demonstrate that 20% of EA patients developed AS within their first year of life. In patients with early primary anastomosis, birth weight greater than 2,500 g and presence of GER were risk factors for developing AS. When patients with delayed anastomosis were included, in addition to the previous risk factors, being a term baby, and having recurrent TEF also became risk factors.
Level of evidence: III.
导言:吻合口狭窄(AS)是食管闭锁(EA)修复术后第二大常见并发症。我们旨在评估土耳其食道闭锁登记处的数据,以确定全国大型患者队列中食道闭锁修复术后出现吻合口狭窄的风险因素:方法: 对2015年至2021年的数据进行评估。根据 AS 的发生情况,患者被分为两组。根据人口统计学和手术特征、术后插管情况以及术后并发症(如吻合口漏、瘘管再通和胃食管反流(GER)),对有AS患者(AS组)和无AS患者(无AS组)进行比较。为了确定EA修复术后发生强直性脊柱炎的风险因素,研究人员进行了多变量逻辑回归分析:在713例患者中,144例(20.19%)被纳入强直性脊柱炎组,569例(79.81%)被纳入非强直性脊柱炎组。多变量逻辑回归结果显示,足月儿(OR 1.706; p = 0.006)、出生体重超过 2500 克(OR 1.72; p = 0.006)、存在 GER(OR 5.267; p结论:我们的全国登记结果表明,20% 的 EA 患者在出生后第一年内发展为 AS。在早期初次吻合的患者中,出生体重大于 2500 克和存在胃食管反流是患 AS 的风险因素。如果将吻合术延迟的患者包括在内,除了之前的风险因素外,足月儿和复发性 TEF 也成为风险因素。
{"title":"Determining the Risk Factors for Anastomotic Stricture Development after Esophageal Atresia Repair: Results from the Turkish Esophageal Atresia Registry.","authors":"Can İhsan Öztorun, Çiğdem Ulukaya Durakbaşa, Tutku Soyer, Coşkun Özcan, Binali Fırıncı, Berat Dilek Demirel, İlhan Çiftçi, Ayşe Parlak, Mustafa Onur Öztan, Gülnur Göllü Bahadır, İbrahim Akkoyun, Ayşe Karaman, Cengiz Gül, Gül Şalcı, Hüseyin İlhan, Akgün Oral, Rahşan Özcan, Seyithan Özaydın, Şeref Selçuk Kılıç, Gürsu Kıyan, Ali Onur Erdem, Osman Uzunlu, Abdullah Yıldız, Esra Özçakır, Nazile Ertürk, Başak Erginel, Tülin Öztaş, Ahmet Atıcı, Mehmet Mert, Hakan Samsum, Mehmet Ali Özen, Emrah Aydın, Serpil Sancar","doi":"10.1055/a-2340-9078","DOIUrl":"10.1055/a-2340-9078","url":null,"abstract":"<p><strong>Introduction: </strong> Anastomotic stricture (AS) is the second most common complication after esophageal atresia (EA) repair. We aimed to evaluate the data in the Turkish Esophageal Atresia Registry to determine the risk factors for AS development after EA repair in a large national cohort of patients.</p><p><strong>Methods: </strong> The data between 2015 and 2021 were evaluated. Patients were enrolled into two groups according to the occurrence of AS. Patients with AS (AS group) and without AS (non-AS group) were compared according to demographic and operative features, postoperative intubation status, and postoperative complications, such as anastomotic leaks, fistula recanalization, and the presence of gastroesophageal reflux (GER). A multivariable logistic regression analysis was performed to define the risk factors for the development of AS after EA repair.</p><p><strong>Results: </strong> Among the 713 cases, 144 patients (20.19%) were enrolled into the AS group and 569 (79.81%) in the non-AS group. The multivariable logistic regression showed that, being a term baby (odds ratio [OR]: 1.706; <i>p</i> = 0.006), having a birth weight over 2,500 g (OR: 1.72; <i>p</i> = 0.006), presence of GER (OR: 5.267; <i>p</i> < 0.001), or having a recurrent tracheoesophageal fistula (TEF, OR: 4.363; <i>p</i> = 0.006) were the risk factors for the development of AS.</p><p><strong>Conclusions: </strong> The results of our national registry demonstrate that 20% of EA patients developed AS within their first year of life. In patients with early primary anastomosis, birth weight greater than 2,500 g and presence of GER were risk factors for developing AS. When patients with delayed anastomosis were included, in addition to the previous risk factors, being a term baby, and having recurrent TEF also became risk factors.</p><p><strong>Level of evidence: </strong> III.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michaela Klinke, Nina Dietze, Tina Trautmann, Marietta Jank, Richard Martel, Julia Elrod, Michael Boettcher
Introduction: Abdominal adhesions following surgery can lead to complications like intestinal obstruction and pelvic pain. While no molecular therapies currently target the underlying adhesion formation process, various barrier agents exist. 4DryField® has shown promise in reducing bleeding and adhesions in adults. This study aimed to assess its effectiveness in children.
Methods: The study examined all pediatric patients who underwent laparotomy between January 2018 and February 2022. It compared outcomes between those treated with 4DryField® and a control group. Key endpoints included surgical revision, adhesion recurrence, infections, insufficiencies, fever, C-reactive protein (CRP) levels, and time to gastrointestinal passage.
Results: In total, 233 children had surgery for bowel adhesions. After propensity score matching, 82 patients were included in the analysis: 39 in the control and 43 in the 4DryField® group. 4DryField® did not affect the readhesion rate. Children in the treatment group had significantly more complications (47 vs. 15%, p = 0.002), more often fever, and higher CRP levels.
Conclusions: 4DryField® did not show potential in reducing adhesion formation, but it was associated with significantly more complications in pediatric patients. Thus, future prospective studies are needed to evaluate the safety and effectiveness of 4DryField® in children.
{"title":"Evaluation of 4DryField® as an Adhesion Prophylaxis in Pediatric Patients: A Propensity-Score Matched Study.","authors":"Michaela Klinke, Nina Dietze, Tina Trautmann, Marietta Jank, Richard Martel, Julia Elrod, Michael Boettcher","doi":"10.1055/a-2340-9373","DOIUrl":"10.1055/a-2340-9373","url":null,"abstract":"<p><strong>Introduction: </strong> Abdominal adhesions following surgery can lead to complications like intestinal obstruction and pelvic pain. While no molecular therapies currently target the underlying adhesion formation process, various barrier agents exist. 4DryField® has shown promise in reducing bleeding and adhesions in adults. This study aimed to assess its effectiveness in children.</p><p><strong>Methods: </strong> The study examined all pediatric patients who underwent laparotomy between January 2018 and February 2022. It compared outcomes between those treated with 4DryField® and a control group. Key endpoints included surgical revision, adhesion recurrence, infections, insufficiencies, fever, C-reactive protein (CRP) levels, and time to gastrointestinal passage.</p><p><strong>Results: </strong> In total, 233 children had surgery for bowel adhesions. After propensity score matching, 82 patients were included in the analysis: 39 in the control and 43 in the 4DryField® group. 4DryField® did not affect the readhesion rate. Children in the treatment group had significantly more complications (47 vs. 15%, <i>p</i> = 0.002), more often fever, and higher CRP levels.</p><p><strong>Conclusions: </strong> 4DryField® did not show potential in reducing adhesion formation, but it was associated with significantly more complications in pediatric patients. Thus, future prospective studies are needed to evaluate the safety and effectiveness of 4DryField® in children.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandra Castrillo, Laura García-Martínez, Ana Laín, Carlos Giné, María Díaz-Hervás, Manuel López
Introduction: The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years as an alternative to the "pull-technique" gastrostomy (P-PEG). This study aimed to compare P-PEG and T-PEG complications.
Materials and methods: A retrospective observational study of pediatric patients who underwent percutaneous endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky technique and was replaced after 6 months by a balloon gastrostomy under sedation. T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without sedation. Complications were recorded.
Results: In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities were comparable (p > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%) in the T-PEG group (p > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6% [p < 0.05]). P-PEG was associated with more early tube dislodgement during the first replacement (7.2 vs. 1.4% [p = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was solved endoscopically. Altogether, P-PEG was associated with more complications that required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [p < 0.05]).
Conclusions: P-PEG was associated with more sedation, complications during first button replacement, and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared with T-PEG.
{"title":"Percutaneous Endoscopic Gastrostomy with T-Fasteners versus \"Pull Technique\": Analysis of Complications.","authors":"Alejandra Castrillo, Laura García-Martínez, Ana Laín, Carlos Giné, María Díaz-Hervás, Manuel López","doi":"10.1055/a-2340-9475","DOIUrl":"10.1055/a-2340-9475","url":null,"abstract":"<p><strong>Introduction: </strong> The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years as an alternative to the \"pull-technique\" gastrostomy (P-PEG). This study aimed to compare P-PEG and T-PEG complications.</p><p><strong>Materials and methods: </strong> A retrospective observational study of pediatric patients who underwent percutaneous endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky technique and was replaced after 6 months by a balloon gastrostomy under sedation. T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without sedation. Complications were recorded.</p><p><strong>Results: </strong> In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities were comparable (<i>p</i> > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%) in the T-PEG group (<i>p</i> > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6% [<i>p</i> < 0.05]). P-PEG was associated with more early tube dislodgement during the first replacement (7.2 vs. 1.4% [<i>p</i> = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was solved endoscopically. Altogether, P-PEG was associated with more complications that required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [<i>p</i> < 0.05]).</p><p><strong>Conclusions: </strong> P-PEG was associated with more sedation, complications during first button replacement, and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared with T-PEG.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suvi Alikärri, Ilkka Helenius, Susanna Heiskanen, Johanna Syvänen, Teemu Kemppainen, Eliisa Löyttyniemi, Mika Gissler, Arimatias Raitio
Introduction: Duodenal atresia (DA) is the most common atresia of the small bowel. This study aims to assess the prevalence, mortality, and associated anomalies related to DA in Finland from 2004 to 2017.
Material and methods: A nationwide study based on registers maintained by the Finnish Institute for Health and Welfare and Statistics Finland containing data on all live births and stillbirths and terminations of pregnancy. The cases were identified based on the ICD-9 and 10 (International Classification of Diseases revisions 9 and 10) codes. Associated anomalies were classified based on the EUROCAT criteria; minor anomalies were excluded.
Results: There were 249 DA cases including 222 (89.2%) live births, 16 (6.4%) stillbirths, and 11 (4.4%) terminations. There was no significant change in the prevalence rates between 2004 and 2017. Live birth prevalence was 2.75/10,000 and total prevalence was 3.08/10,000 births. A total of 100 (40.2%) cases were isolated, 67 (26.9%) had other multiple congenital anomalies, and 83 (33.3%) were syndromic. There were no terminations in isolated DA. Most associated anomalies were cardiac (36.1%), followed by other gastrointestinal tract anomalies (23.7%) and limb deformities/defects (7.2%). Trisomy 21 was observed in 63 cases (25.3%). Neonatal mortality was 3.6% (n = 8) and at 1 year 95.0% were alive. Both neonatal and infant mortalities were associated with cardiac anomalies (p < 0.001 and p = 0.001, respectively). All neonatal deaths had associated cardiac defect(s).
Conclusions: The prevalence of DA in Finland remains stable and among the highest reported. DA is often associated with cardiac anomalies, which portend a high risk for mortality. Despite the burden of associated anomalies, overall survival is high.
导言:十二指肠闭锁(DA)是最常见的小肠闭锁。本研究旨在评估2004-2017年间芬兰十二指肠闭锁的发病率、死亡率和相关畸形。材料与方法 这是一项基于芬兰卫生与福利研究所(Finnish Institute for Health and Welfare)和芬兰统计局(Statistics Finland)登记的全国性研究,其中包含所有活产、死产和终止妊娠的数据。根据 ICD-9 和 10 编码确定病例。相关畸形根据EUROCAT标准进行分类;轻微畸形除外。结果 249 例 DA 包括 222 例活产(89.2%)、16 例死胎(6.4%)和 11 例终止妊娠(4.4%)。2004 年至 2017 年间,患病率无明显变化。活产患病率为 2.75/10000,总患病率为 3.08/10000。100例(40.2%)为孤立畸形,67例(26.9%)伴有其他重大先天畸形,83例(33.3%)为综合征。孤立型先天性心脏病中没有终止妊娠的病例。大多数伴发畸形是心脏畸形(36.1%),其次是其他胃肠道畸形(23.7%)和肢体畸形/缺陷(7.2%)。有 63 例(25.3%)观察到 21 三体综合征。新生儿死亡率为 3.6%(8 例),一年后 95.0% 的婴儿存活。新生儿和婴儿死亡率均与心脏畸形有关(p
{"title":"Duodenal Atresia in Finland from 2004 to 2017: Prevalence, Mortality, and Associated Anomalies-A Population-Based Study.","authors":"Suvi Alikärri, Ilkka Helenius, Susanna Heiskanen, Johanna Syvänen, Teemu Kemppainen, Eliisa Löyttyniemi, Mika Gissler, Arimatias Raitio","doi":"10.1055/a-2338-5873","DOIUrl":"10.1055/a-2338-5873","url":null,"abstract":"<p><strong>Introduction: </strong> Duodenal atresia (DA) is the most common atresia of the small bowel. This study aims to assess the prevalence, mortality, and associated anomalies related to DA in Finland from 2004 to 2017.</p><p><strong>Material and methods: </strong> A nationwide study based on registers maintained by the Finnish Institute for Health and Welfare and Statistics Finland containing data on all live births and stillbirths and terminations of pregnancy. The cases were identified based on the ICD-9 and 10 (International Classification of Diseases revisions 9 and 10) codes. Associated anomalies were classified based on the EUROCAT criteria; minor anomalies were excluded.</p><p><strong>Results: </strong> There were 249 DA cases including 222 (89.2%) live births, 16 (6.4%) stillbirths, and 11 (4.4%) terminations. There was no significant change in the prevalence rates between 2004 and 2017. Live birth prevalence was 2.75/10,000 and total prevalence was 3.08/10,000 births. A total of 100 (40.2%) cases were isolated, 67 (26.9%) had other multiple congenital anomalies, and 83 (33.3%) were syndromic. There were no terminations in isolated DA. Most associated anomalies were cardiac (36.1%), followed by other gastrointestinal tract anomalies (23.7%) and limb deformities/defects (7.2%). Trisomy 21 was observed in 63 cases (25.3%). Neonatal mortality was 3.6% (<i>n</i> = 8) and at 1 year 95.0% were alive. Both neonatal and infant mortalities were associated with cardiac anomalies (<i>p</i> < 0.001 and <i>p</i> = 0.001, respectively). All neonatal deaths had associated cardiac defect(s).</p><p><strong>Conclusions: </strong> The prevalence of DA in Finland remains stable and among the highest reported. DA is often associated with cardiac anomalies, which portend a high risk for mortality. Despite the burden of associated anomalies, overall survival is high.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2023-05-01DOI: 10.1055/s-0043-57238
Lulu Yuan, Jia Wang
Objective: The objective of the study was to compare the effective rate, cure rate, adverse reaction rate, and effective time of three methods in the treatment of infantile hemangioma, hoping to provide reference for improving the clinical therapeutic effect.
Methods: This is a retrospective study of 307 infantile hemangioma patients admitted to the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, from January 2014 to October 2021. The patients were divided into three groups. In group A, timolol maleate solution was introduced by the nano-microneedle technique (97 cases); in group B, timolol maleate drops dipped in medical swabs were applied (107 cases); and group C patients took propranolol orally (103 cases). The effective rate, cure rate, adverse reaction rate, and effective time of treatment were recorded and compared.
Results: The total effective rate, total cure rate, and total adverse reaction rate of the three groups were 87.6, 65.2, and 9.4%, respectively. The results showed that the effective and cure rates of group A were higher than those of group B (92.8 and 76.3%, respectively; p < 0.05), the adverse reaction rate of group C was higher than that of group B (17.5%, p < 0.05), and the effective time of group A was shorter than that of groups B and C. In most patients, symptoms significantly improved within 2 months (p < 0.05).
Conclusion: Timolol maleate introduced by nanometer microneedles is an effective and safe treatment for superficial hemangioma in infants with the highest effective and cure rates, lower incidence of adverse reactions, and the shortest effective treatment time.
研究目的比较三种方法治疗婴幼儿血管瘤的有效率、治愈率、不良反应率、有效时间,为提高临床治疗效果提供参考:本研究以2014年1月-2021年10月中国医科大学口腔医学院口腔颌面外科收治的307例婴幼儿血管瘤患者为研究对象,进行回顾性研究。患者被分为三组。A组采用纳米微针技术导入马来酸噻吗洛尔溶液(97例);B组采用医用棉签蘸取马来酸噻吗洛尔滴剂(107例);C组患者口服普萘洛尔(103例)。记录并比较有效率、治愈率、不良反应率和治疗有效时间:结果:三组患者的总有效率、总治愈率和总不良反应率分别为 87.6%、65.2% 和 9.4%。结果显示,A 组的有效率和治愈率(分别为 92.8%和 76.3%)均高于 B 组(P P P P 结论:A 组的有效率和治愈率均高于 B 组(分别为 92.8%和 76.3%):用纳米微针导入马来酸噻吗洛尔治疗婴儿浅表血管瘤是一种有效、安全的治疗方法,其有效率和治愈率最高,不良反应发生率较低,有效治疗时间最短。
{"title":"Efficacy and Safety of Introduction Timolol Maleate by Manometer Microneedles among Infantile Hemangioma: A Retrospective Study in China.","authors":"Lulu Yuan, Jia Wang","doi":"10.1055/s-0043-57238","DOIUrl":"10.1055/s-0043-57238","url":null,"abstract":"<p><strong>Objective: </strong> The objective of the study was to compare the effective rate, cure rate, adverse reaction rate, and effective time of three methods in the treatment of infantile hemangioma, hoping to provide reference for improving the clinical therapeutic effect.</p><p><strong>Methods: </strong> This is a retrospective study of 307 infantile hemangioma patients admitted to the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, from January 2014 to October 2021. The patients were divided into three groups. In group A, timolol maleate solution was introduced by the nano-microneedle technique (97 cases); in group B, timolol maleate drops dipped in medical swabs were applied (107 cases); and group C patients took propranolol orally (103 cases). The effective rate, cure rate, adverse reaction rate, and effective time of treatment were recorded and compared.</p><p><strong>Results: </strong> The total effective rate, total cure rate, and total adverse reaction rate of the three groups were 87.6, 65.2, and 9.4%, respectively. The results showed that the effective and cure rates of group A were higher than those of group B (92.8 and 76.3%, respectively; <i>p</i> < 0.05), the adverse reaction rate of group C was higher than that of group B (17.5%, <i>p</i> < 0.05), and the effective time of group A was shorter than that of groups B and C. In most patients, symptoms significantly improved within 2 months (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong> Timolol maleate introduced by nanometer microneedles is an effective and safe treatment for superficial hemangioma in infants with the highest effective and cure rates, lower incidence of adverse reactions, and the shortest effective treatment time.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9763595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}