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Hawkinson EK, Davis LM, Barsness KA. Design and development of a laparoscopic gastrostomy tube placement simulator. Stud Health Technol Inform 2014; 196:155-158. [PMID: 24732498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Laparoscopic gastrostomy tube placement is a common surgical procedure performed in infants. There are currently no commercially available simulation tools for pediatric surgeons to use for surgical training and practice purposes. We have created a low cost and reusable laparoscopic gastrostomy tube placement model for use in pediatric surgical education.
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Naiditch JA, Barsness KA, Fitz C, Hackam DJ. Massive congenital lymphatic malformation of the small intestine: Case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Meyer M, Barsness KA. Umbilical arteriovenous malformation: a case report and literature review. Pediatr Surg Int 2013; 29:851-3. [PMID: 23474574 DOI: 10.1007/s00383-013-3297-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/29/2022]
Abstract
Arteriovenous malformations can lead to life-threatening complications, particularly in neonates. Only a few case reports document arteriovenous malformations of the umbilicus, all presenting with complications and necessitating urgent surgical intervention. We report the case of a neonate with an incidentally noted umbilical arteriovenous malformation, treated with laparoscopic assisted resection.
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Barsness KA, Rooney DM, Davis LM. The Development and Evaluation of a Novel Thoracoscopic Diaphragmatic Hernia Repair Simulator. J Laparoendosc Adv Surg Tech A 2013; 23:714-8. [DOI: 10.1089/lap.2013.0196] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Naiditch JA, Barsness KA. The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients. J Pediatr Surg 2013; 48:1283-7. [PMID: 23845619 DOI: 10.1016/j.jpedsurg.2013.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/08/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The purposes of this study were to (1) determine the positive and negative predictive value (NPV) of transabdominal color Doppler ultrasound (CDU) for diagnosing ovarian torsion (OT) in pediatric patients and 2) identify predictors of a false-positive CDU result for OT. METHODS An IRB-approved retrospective chart review was performed on all female patients who underwent transabdominal CDU evaluation of the ovaries (664 CDUs in 605 patients) for acute abdominal pain. CDU reports were categorized as positive for OT if the report stated "cannot rule out torsion" or "positive for torsion." RESULTS There were 47 false-positive ultrasounds, 3 false negatives, 11 true positives, and 603 true negatives for OT. Sensitivity was 78.6%, specificity 92.3%, positive predictive value (PPV) 19.0%, and NPV 99.5%. False-positive CDU when compared to true positives were more common in older patients (p=0.004) and were more commonly read as "cannot rule out torsion" (p<0.001). Ovarian cysts were larger in true-positive CDU than in false-positive CDU (p<0.001). However, cyst presence/absence did not predict a true positive result. CONCLUSION Transabdominal CDU has a low PPV and a high NPV for ovarian torsion in pediatric patients. False-positive results are more common in older patients and associated with small ovarian cysts.
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Davis LM, Barsness KA, Rooney DM. Design and development of a novel thoracoscopic tracheoesophageal fistula repair simulator. Stud Health Technol Inform 2013; 184:114-116. [PMID: 23400141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) is a technically challenging surgical procedure. This congenital anomaly is rare; therefore, training opportunities for surgical trainees are limited. There are currently no validated simulation tools available to help train pediatric surgery trainees. The simulator that was developed is a low-cost, reusable model. It simulates the right side of a term neonate chest and contains a tissue block that has been surgically modified to replicate the anatomy of EA/TEF.
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Naiditch JA, Lautz TB, Raval MV, Madonna MB, Barsness KA. Effect of Resident Postgraduate Year on Outcomes After Laparoscopic Appendectomy for Appendicitis in Children. J Laparoendosc Adv Surg Tech A 2012; 22:715-9. [PMID: 22845738 DOI: 10.1089/lap.2012.0032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011; 46:1935-41. [PMID: 22008331 DOI: 10.1016/j.jpedsurg.2011.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/13/2011] [Accepted: 05/11/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus. METHODS The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression. RESULTS Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P < .001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P < .001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006. CONCLUSION The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.
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Lautz TB, Raval MV, Reynolds M, Barsness KA. Adhesive Small Bowel Obstruction in Children and Adolescents: Operative Utilization and Factors Associated with Bowel Loss. J Am Coll Surg 2011; 212:855-61. [DOI: 10.1016/j.jamcollsurg.2011.01.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/27/2022]
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Naiditch JA, Lautz T, Barsness KA. Postoperative Complications in Children Undergoing Gastrostomy Tube Placement. J Laparoendosc Adv Surg Tech A 2010; 20:781-5. [DOI: 10.1089/lap.2010.0191] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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St Peter SD, Little DC, Barsness KA, Copeland DR, Calkins CM, Yoder S, Rothenberg SS, Islam S, Tsao K, Ostlie DJ. Should we be concerned about jejunoileal atresia during repair of duodenal atresia? J Laparoendosc Adv Surg Tech A 2010; 20:773-5. [PMID: 20701544 DOI: 10.1089/lap.2010.0173] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION During repair for duodenal atresia, it has been emphasized that inspection of the small bowel to identify a second atresia is required. The laparoscopic approach for repair of duodenal atresia has been criticized for its limitation to perform this step. Given that duodenal atresia and jejunoileal atresias do not share common embryologic origins, we question the validity of this concern. Therefore, we conducted a multicenter retrospective review of duodenal atresia patients to quantify the incidence of jejunoileal atresia in this population. METHODS After institutional review board approval (IRB #07-12-187X), a retrospective review was conducted on all patients who have undergone duodenal atresia repair at seven institutions over the past 7-12 years. Demographics and the presence or absence of a jejunoileal atresia were recorded. RESULTS Four hundred eight patients with duodenal atresia were identified. The mean gestaational age was 36.3 ± 2.9 weeks, and the mean weight was 2.5 ± 0.8 kg. Mean age at operation was 19 days (range, 1-1314). There was a 28% incidence of trisomy 21. Two patients (0.5%) were identified as having a second intestinal atresia, and both were type IIIb. One patient was diagnosed at the time of duodenal atresia repair; the other was a delayed diagnosis. Both patients did well after repair. CONCLUSIONS In this, the largest series of duodenal atresia patients compiled to date, the rate of a concomitant jejunoileal atresia is less than 1%. This low incidence is not high enough to mandate extensive inspection of the entire bowel in these patients, and a second atresia should not be a concern during laparoscopic repair of duodenal atresia.
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Raval MV, Cohen ME, Barsness KA, Bentrem DJ, Phillips JD, Reynolds M. Does hospital type affect pyloromyotomy outcomes? Analysis of the Kids' Inpatient Database. Surgery 2010; 148:411-9. [DOI: 10.1016/j.surg.2010.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 04/16/2010] [Indexed: 11/24/2022]
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Marecek GS, Barsness KA, Sarwark JF. Relief of superior mesenteric artery syndrome with correction of multiplanar spinal deformity by posterior spinal fusion. Orthopedics 2010; 33:519. [PMID: 20608618 DOI: 10.3928/01477447-20100526-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Superior mesenteric artery syndrome is obstruction of the third portion of the duodenum by compression between the abdominal aorta and superior mesenteric artery. Pediatric orthopedists are familiar with this entity, as the association between superior mesenteric artery syndrome and spinal fusion or body casting has been well established. However, patients with spinal deformities usually experience superior mesenteric artery syndrome after orthopedic intervention, with rates after corrective spinal surgery reported between 0.5% and 2.4%. Symptoms of superior mesenteric artery syndrome typically include nausea, bilious emesis, abdominal pain, early satiety, and anorexia. Initial treatment focuses on gastric decompression and maintaining euvolemia and electrolyte balance. The patient should receive enteral nutrition via nasojejunal tube or parenteral nutrition to allow for weight gain and subsequent resolution of the obstruction. The superior mesenteric artery takes off from the duodenum at an angle of 45 degrees to 60 degrees in normal individuals. The third portion of the duodenum is suspended between these vessels by the ligament of Treitz. Any variation in this relationship that decreases the arteriomesenteric angle may induce obstruction. Specifically, lumbar hyperextension or hyperlordosis can traction the mesentery and vessels. Only 2 cases of superior mesenteric artery syndrome in patients with sagittal plane spinal deformity have been described in the literature. In patients with concomitant superior mesenteric artery syndrome and spinal deformity, correction of the deformity may help alleviate the obstruction and result in faster recovery. The contribution of spinal column deformity to the arteriomesenteric angle should not be overlooked.
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Barsness KA, St Peter SD, Holcomb GW, Ostlie DJ, Kane TD. Laparoscopic fundoplication after previous open abdominal operations in infants and children. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S47-9. [PMID: 19371151 DOI: 10.1089/lap.2008.0131.supp] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There have been multiple reports in the adult literature stating that previous open operations should no longer be considered a contraindication to the laparoscopic approach. However, there are little data on this topic in the pediatric population, particularly in patients with neonatal abdominal pathology unique to the newborn population. Therefore, we reviewed our experience with laparoscopic fundoplication after a variety of previous abdominal conditions and operations in the pediatric population. METHODS An institutional review board-approved retrospective chart review was performed on all patients undergoing laparoscopic fundoplication after a previous open operation between October 2000 and December 2007. The data collected demographics, comorbid conditions, previous abdominal operations, gastrostomy tube placement, time interval between the initial operation and laparoscopic fundoplication, conversions, and complications. RESULTS Forty-five patients underwent a laparoscopic Nissen fundoplication after an open operation during the study interval. Mean age was 41.3 months (range, 1-233) with a mean weight of 14.3 kg (range, 2.9-63.6), and 31 were (78.9%) male. A total of 61 previous abdominal operations were performed (range, 1-4). Mean time between last open operation and laparoscopic fundoplication was 27.3 months (range, 0.5-147). Mean operative time was 161 minutes (range, 73-420). There were no conversions and 3 perioperative complications occurred (splenic hematoma, clogged gastrostomy tube, and liver bleed). Early reoperations were performed in 2 patients (4.4%): 1 for bleeding on day 2 and the other for leaking gastrostomy day 12. CONCLUSION Our data demonstrate that laparoscopic fundoplication after a previous open operation is feasible and safe.
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Kabre R, Chin A, Rowell E, Browne M, Barsness KA, Luck S, Jona J. Hazardous complications of multiple ingested magnets: report of four cases. Eur J Pediatr Surg 2009; 19:187-9. [PMID: 19023855 DOI: 10.1055/s-2008-1038824] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Foreign body ingestion is a common occurrence in the pediatric population. Frequent culprits include coins, toys, sharp objects and bones, which most often pass spontaneously. Magnet ingestion, however, can be a serious matter, especially when more than one is taken in. The extremely strong magnetic force between multiple magnets may result in numerous complications including bowel necrosis, perforation, obstruction, fistula formation, volvulus and death. We present the largest series reported to date, with four cases of multiple magnet ingestion at our institution with varied presentations and findings. We review the literature, and discuss the importance of having a high index of suspicion.
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Barsness KA, St. Peter SD, Holcomb GW, Ostlie DJ, Kane TD. Laparoscopic Fundoplication After Previous Open Abdominal Operations in Infants and Children. J Laparoendosc Adv Surg Tech A 2008. [DOI: 10.1089/lap.2008.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shah SR, Gittes GK, Barsness KA, Kane TD. Thoracoscopic patch repair of a right-sided congenital diaphragmatic hernia in a neonate. Surg Endosc 2008; 23:215. [DOI: 10.1007/s00464-008-0071-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/18/2008] [Indexed: 11/30/2022]
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Barsness KA, Feliz A, Potoka DA, Gaines BA, Upperman JS, Kane TD. Laparoscopic versus open Nissen fundoplication in infants after neonatal laparotomy. JSLS 2007; 11:461-5. [PMID: 18237511 PMCID: PMC3015845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described. METHODS This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a surgical antireflux operation within the first year of life. Twelve infants underwent laparoscopic Nissen fundoplication versus 14 infants who underwent open Nissen fundoplication. Parameters like age, weight, operative time, number of previous operations, length of stay following fundoplication, time to feedings, and complications were compared between the 2 groups. RESULTS No statistically significant differences existed between most of the parameters compared following laparoscopic vs open Nissen fundoplication. No conversions to open procedures were necessary in infants undergoing laparoscopic fundoplication, and these infants resumed enteral feeds earlier than those who underwent the open procedure. CONCLUSION Laparoscopic compared with open Nissen fundoplication performed in infants after a neonatal laparotomy were comparable procedures across most data points studied. However, a laparoscopic fundoplication did allow for earlier return to enteral feeds compared with the open approach. Laparoscopic Nissen fundoplication is technically feasible, safe, and effective in the treatment of gastroesophageal reflux in infants with a previous neonatal laparotomy.
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Barsness KA, Bensard DD, Partrick D, Hendrickson R, Koyle M, Calkins CM, Karrer F. Renovascular Injury: An Argument for Renal Preservation. ACTA ACUST UNITED AC 2004; 57:310-5. [PMID: 15345978 DOI: 10.1097/01.ta.0000141329.74804.e2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Renovascular injury is uncommon among children. This study hypothesized that preservation of the severely injured kidney can be achieved safely without renal insufficiency, postinjury hypertension, or the need for hemodialysis. METHODS Retrospective chart review of renal injuries seen between 1997 and 2001 at a level 1 pediatric trauma center was conducted. Severity of injury was graded by the American Association for the Surgery of Trauma Organ Injury Severity Scale. The outcome variables included the need for hemodialysis, impaired renal function (creatinine), and postinjury hypertension. RESULTS In this study, 34 children presented with grade 1, 2, or 3 injury (74%), whereas 13 children presented with grade 4 or 5 renovascular injury (28%). The children with unilateral renovascular injury who underwent either nephrectomy or renal preservation had comparable outcomes with no hypertension, hemodialysis, or renal insufficiency in either group. CONCLUSIONS The treatment outcomes were not different between the patients who underwent renal preservation and those who had immediate nephrectomy. The authors conclude that renal preservation should be attempted for all children with grade 4 or 5 renovascular injury.
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Barsness KA, Bensard DD, Partrick DA, Calkins CM, Hendrickson RJ, McIntyre RC. Endotoxin induces an exaggerated interleukin-10 response in peritoneal macrophages of children compared with adults. J Pediatr Surg 2004; 39:912-5; discussion 912-5. [PMID: 15185224 DOI: 10.1016/j.jpedsurg.2004.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children have a lower incidence of postinjury multiple organ failure (MOF) compared with adults with equivalent injury severity. Because MOF appears to be the end result of systemic hyperinflammation, children may have either an attenuated proinflammatory response or an augmented antiinflammatory response compared with adults. The purpose of this study was to determine the lipopolysaccharide (LPS)-induced pro- and antiinflammatory cytokine response of pediatric versus adult peritoneal macrophages (PM). The authors hypothesized that pediatric PMs would have an enhanced antiinflammatory response compared with adults. METHODS Human PMs were collected during elective laparoscopic procedures and stimulated with LPS. (Pediatric cohort: n = 9 [mean, 5.4 years], adult cohort: n = 8 [mean, 41.6 years]). P less than.05 was accepted as significant. RESULTS LPS-induced a 50-fold increase in interleukin-10 (IL-10) antiinflammatory cytokine production in pediatric versus adult PMs. LPS-induced tumor necrosis factor-alpha (TNF-alpha) production was also increased in pediatric versus adult PMs. The anti-proinflammatory cytokine ratio (IL-10 to TNF-alpha) was 20-fold higher in pediatric versus adult PMs. CONCLUSIONS LPS-induced macrophage production of both IL-10 and TNF-alpha was increased in children. The anti-proinflammatory cytokine ratio (IL-10 to TNF-alpha) was strikingly higher in pediatric versus adult PMs. These data suggest that the age-related balance of anti- and proinflammatory cytokines in resident macrophages is different in children compared with adults.
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Barsness KA, Arcaroli J, Harken AH, Abraham E, Banerjee A, Reznikov L, McIntyre RC. Hemorrhage-induced acute lung injury is TLR-4 dependent. Am J Physiol Regul Integr Comp Physiol 2004; 287:R592-9. [PMID: 15072965 DOI: 10.1152/ajpregu.00412.2003] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Toll-like receptor 4 (TLR-4), initially identified as an LPS receptor, is critical to the signaling of a variety of danger signals, including heat shock protein 60, fibrinogen, and fibronectin. Recent data also suggest that TLR-4 plays a role in determining survival in both endotoxemia and hemorrhagic shock. We hypothesized that a functional TLR-4 would be required for hemorrhage and endotoxin-induced acute lung injury. Hemorrhage- and endotoxin-induced lung TNF-alpha mRNA and protein production, neutrophil accumulation, and protein permeability were dependent on a functional TLR-4. Hemorrhage-induced nuclear factor (NF)-kappaB activation was independent of functional TLR-4, whereas endotoxin-induced activation of NF-kappaB requires a functional TLR-4 for full response. Therefore, we conclude that 1) hemorrhage-induced acute lung injury is TLR-4 dependent and 2) hemorrhage has a different and distinct TLR-4-dependent intracellular activation mechanism compared with endotoxemia.
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Barsness KA, Bensard DD, Partrick DA, Calkins CM, Hendrickson RJ, Banerjee A, McIntyre RC. IL-1beta induces an exaggerated pro- and anti-inflammatory response in peritoneal macrophages of children compared with adults. Pediatr Surg Int 2004; 20:238-42. [PMID: 15103492 DOI: 10.1007/s00383-003-1118-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children have a lower incidence of acute lung injury (ALI) compared with adults. Because ALI appears to be the end result of systemic hyperinflammation, children may either have 1) an attenuated pro-inflammatory response or 2) an augmented anti-inflammatory response compared with adults. The purpose of this study was to determine the IL-1-induced pro- and anti-inflammatory response of pediatric vs. adult peritoneal macrophages (PMs). We hypothesized that pediatric PMs would have an enhanced anti-inflammatory response compared with adult PMs. Human PMs were collected during elective laparoscopic procedures, cultured, and stimulated with IL-1beta. IL-6, IL-8, IL-10, and TNFalpha production were determined by ELISA. Statistical analyses were by ANOVA; a P <0.05 was significant. Our results showed that IL-1beta induced an 11-fold increase in IL-10 production in pediatric PMs (659+/-103 vs. 60+/-25 control, P <0.05). There was no IL-10 production in IL-1beta-stimulated adult PMs. IL-1beta-induced TNF production was greater in children compared with adults (2152+/-166 vs. 592+/-188, P <0.05). Similarly, IL-1beta-induced IL-6 production was greater in pediatric PMs compared with adults (532+/-3 vs. 444+/-52, P <0.05). There was no difference in IL-1beta-induced IL-8 production in children compared with adults. The IL-10:TNFalpha ratio after IL-1beta stimulation was 0.306+/-0.056 in pediatric macrophages and 0.020+/-0.015 in adult macrophages ( P<0.01). In conclusion, IL-1beta-induced IL-6 and TNFalpha production were greater in pediatric than adult PMs. Furthermore, pediatric PMs had an 11-fold increase in IL-1beta-induced IL-10 production, while adult PMs did not produce IL-10. Therefore, IL-1beta induces both a pro- and an anti-inflammatory response in pediatric PMs, whereas adult PMs produce only pro-inflammatory cytokines in response to IL-1beta. The exaggerated anti-inflammatory IL-10 response in children may be an important factor in the observed differences in ALI between children and adults.
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Barsness KA, Bensard DD, Ciesla D, Partrick DA, Hendrickson R, Karrer FM. Blunt Diaphragmatic Rupture in Children. ACTA ACUST UNITED AC 2004; 56:80-2. [PMID: 14749570 DOI: 10.1097/01.ta.0000103989.78049.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although several series of blunt diaphragmatic rupture in adults have been published, this injury remains largely uncharacterized in the pediatric population. METHODS We queried our trauma registry for all children admitted with blunt diaphragmatic rupture over a 10-year period at a Level I pediatric trauma center. RESULTS Six children (aged 2-15 years; mean, 7 years) were identified with blunt diaphragmatic rupture (three right, two left, one bilateral), representing 0.4% of admissions. All of the children had associated injuries (4.5 per child), with a mean Injury Severity Score of 32. Four diaphragmatic injuries were identified during the initial evaluation. The two missed injuries were diagnosed at postinjury days 5 and 8. There were no deaths and all children were eventually discharged without sequelae. CONCLUSION Blunt diaphragmatic rupture occurs in children with a frequency and severity commensurate with that observed in adults. Our data suggest improved survival compared with adults with this injury.
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Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. THE JOURNAL OF TRAUMA 2003; 54:1107-10. [PMID: 12813330 DOI: 10.1097/01.ta.0000068992.01030.a8] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT. METHODS We reviewed the medical records and imaging of all children with rib fractures over a 6-year period. NAT was determined by the Child Advocacy and Protection team. RESULTS In children younger than 3 years of age, the positive predictive value (PPV) of a rib fracture as an indicator of NAT was 95%. The positive predictive value increased to 100% once historical and clinical circumstance excluded all other causes for rib fractures. CONCLUSION In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.
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Raeburn CD, Calkins CM, Zimmerman MA, Arya J, Barsness KA, Harken AH. Toll-like receptors and surgical disease. Surgery 2002; 131:477-83. [PMID: 12019398 DOI: 10.1067/msy.2002.121096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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