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Scalise PN, Koo DC, Durgin JM, Truche BS, Staffa SJ, Greco C, Solodiuk J, Lee EJ, Demehri FR, Kim HB. Cold Therapy for Pain Control in Pediatric Appendectomy Patients: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:1304-1308. [PMID: 38570264 DOI: 10.1016/j.jpedsurg.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Topical ice has been shown to reduce pain scores and opioid use in adults with midline abdominal incisions. This study was designed to evaluate the efficacy of a cold therapy system in children following laparoscopic appendectomy. METHODS Patients 7 years and older who underwent laparoscopic appendectomy at our institution from December 2021-September 2022 were eligible. Patients were randomized to standard pain therapy (control) or standard plus cold therapy (treatment) utilizing a modified ice machine system with cool abdominal pad postoperatively. Pain scores on the first 3 postoperative days (PODs), postoperative narcotic consumption, and patient satisfaction were analyzed. RESULTS Fifty-eight patients were randomized, 29 to each group. Average survey response rate was 74% in control and 89% in treatment patients. There was no significant difference in median pain scores or narcotic use between groups. Cold therapy contributed to subjective pain improvement in 71%, 74%, and 50% of respondents on PODs 1, 2, and 3 respectively. CONCLUSION A majority of patients reported cold therapy to be a helpful adjunct in pain control after appendectomy, though it did not reduce postoperative pain scores or narcotic use in our cohort - likely due to this population's naturally expedient recovery and low baseline narcotic requirement. TYPE OF STUDY Randomized Controlled Trial. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- P Nina Scalise
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
| | - Donna C Koo
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jonathan M Durgin
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Brianna Slatnick Truche
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Christine Greco
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jean Solodiuk
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Eliza J Lee
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
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Chillura I, Restivo GA, Callari S, Cibella S, D’Alessandro MM, Corrado C, Vallone M, Antona V, Corsello G. A novel NF1 mutation in a pediatric patient with renal artery aneurysm. Ital J Pediatr 2022; 48:186. [PMID: 36411470 PMCID: PMC9677909 DOI: 10.1186/s13052-022-01382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a neurocutaneous syndrome, due to heterozygous pathogenic variants in NF1 gene. The main clinical manifestations are multiple café au lait spots, axillary and inguinal freckling, cutaneous and plexiform neurofibromas, optic glioma, Lisch nodules and osseous lesions, such as sphenoid and tibial dysplasia. Vasculopathy is another feature of NF1; it consists of stenosis, aneurysms, and arteriovenous malformations, frequently involving renal arteries. CASE PRESENTATION We report on a 9-year-old girl with a novel mutation in NF1 gene and renal artery aneurysm, treated by coil embolization and complicated with hypertension. CONCLUSION Vasculopathy is a complication of NF1, affecting from 0.4 to 6.4% of patients with NF1. Among the vascular abnormalities, renal artery aneurysm is a rare manifestation, with only a few cases regarding adult patients and no pediatric reports described in current literature. The finding of a vascular abnormality in a specific site requires the evaluation of the entire vascular system because multiple vessels could be involved at the same time.
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Affiliation(s)
- Ilenia Chillura
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Giulia Angela Restivo
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Simonetta Callari
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Sabrina Cibella
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Maria Michela D’Alessandro
- Pediatric Nephrology Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, Via dei Benedettini, 1, 90134 Palermo, Italy
| | - Ciro Corrado
- Pediatric Nephrology Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, Via dei Benedettini, 1, 90134 Palermo, Italy
| | - Mario Vallone
- Radiology Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 4, 90127 Palermo, Italy
| | - Vincenzo Antona
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
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Higa S, Nagano T, Ito J, Uejo A, Nakaema M, Kise Y, Yamashiro S. Three Arterial Ruptures in a Patient with Neurofibromatosis Type 1. Ann Vasc Dis 2021; 14:168-172. [PMID: 34239644 PMCID: PMC8241549 DOI: 10.3400/avd.cr.20-00174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Neurofibromatosis type 1 (NF-1) is a rare disease known to cause vascular fragility. A case of a 59-year-old man with NF who had ruptures in three different arteries within a month is presented. The first rupture occurred in the right renal artery and was treated using a stent graft and embolization coils. The second and third ruptures occurred in an artery that had been compressed by a hematoma formed during the first bleed; both were embolized. In patients with NF-1, blood vessel fragility must be considered in treatment selection, especially when performing surgery or other invasive procedures near the great vessels.
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Affiliation(s)
- Shotaro Higa
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Takaaki Nagano
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Junji Ito
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Akino Uejo
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Moriyasu Nakaema
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Yuya Kise
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Satoshi Yamashiro
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
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