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Weil BR, Rich BS, Madenci AL, Stambough KC, Schmoke N, Peace A, Bruny JL, Rescorla FJ, Dicken BJ, Dietrich JE, Billmire DF. Critical elements in the operative management of pediatric malignant ovarian germ cell tumors. Semin Pediatr Surg 2023; 32:151342. [PMID: 38039829 DOI: 10.1016/j.sempedsurg.2023.151342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Performance of the appropriate operation is highly important to ensure that any patient with a suspected ovarian germ cell tumor receives optimal therapy that prioritizes cure while simultaneoulsy minimizing risk of short and long-term toxicities of treatment. The following critical elements of any operative procedure performed for a suspected pediatric or adolescent ovarian germ cell tumor are reviewed: 1. Complete resection of the tumor via ipsilateral oophorectomy while avoiding tumor rupture and spillage, and 2. Performance of complete intraperitoneal staging at the time of initial tumor resection.
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Affiliation(s)
- Brent R Weil
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard University, Boston, United State; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, United States.
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, NY, United States
| | - Arin L Madenci
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard University, Boston, United State
| | - Kathryn C Stambough
- Division of Pediatric and Adolescent Gynecology, Arkansas Children's Hospital, University of Arkansas School for Medical Sciences, Little Rock, United States
| | - Nicholas Schmoke
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Alyssa Peace
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Jennifer L Bruny
- Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado Anschutz Medical Center, Denver, United States
| | - Frederick J Rescorla
- Division of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, United States
| | - Bryan J Dicken
- Division of Pediatric Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Baylor College of Medicine, United States
| | - Deborah F Billmire
- Division of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, United States
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Hafezi N, Pecoraro A, Landman MP, Colgate C, Rescorla FJ. Pediatric Complicated Appendicitis During the COVID-19 Pandemic: A National Perspective. J Am Coll Surg 2021. [PMCID: PMC8531688 DOI: 10.1016/j.jamcollsurg.2021.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Hafezi N, Carpenter KL, Colgate CL, Gray BW, Rescorla FJ. Partial splenectomy in children: Long-term reoperative outcomes ☆. J Pediatr Surg 2021; 56:1998-2004. [PMID: 33468309 DOI: 10.1016/j.jpedsurg.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Partial, or subtotal, splenectomy (PS) has become an accepted alternative to total splenectomy (TS) for management of hematologic disorders in children, but little is known about its long-term outcomes. Here, we present our institutional experience with partial splenectomy, to determine rate of subsequent TS or cholecystectomy and identify if any factors affected this need. METHODS All patients who underwent partial splenectomy at a single tertiary children's hospital were retrospectively reviewed from 2002 through 2019 after IRB approval. Primary outcome of interest was rate of reoperation to completion splenectomy (CS) and rate of cholecystectomy. Secondary outcome were positive predictor(s) for these subsequent procedures. RESULTS Twenty-four patients underwent PS, at median age 6.0 years, with preoperative spleen size of 12.7 cm by ultrasound. At median follow up time of 8.0 years, 29% of all patients and 24% of hereditary spherocytosis (HS) patients underwent completion splenectomy at median 34 months and 45 months, respectively. Amongst HS patients who did not have a cholecystectomy with or prior to PS, 39% underwent a delayed cholecystectomy following PS. There were no significant differences in age at index procedure, preoperative splenic volume, weight of splenic specimen removed, transfusion requirements, preoperative or postoperative hematologic parameters (including hemoglobin, hematocrit, total bilirubin, and reticulocyte count) amongst patients of all diagnoses and HS only who underwent PS alone compared to those who went on to CS. There were no cases of OPSS or deaths. CONCLUSION Partial splenectomy is a safe alternative to total splenectomy in children with hematologic disease with theoretical decreased susceptibility to OPSS. However, families should be counseled of a 29% chance of reoperation to completion splenectomy, and, in HS patients, a 39% chance of delayed cholecystectomy if not performed prior to or with PS. Further studies are needed to understand predictors of these outcomes.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA
| | - Kyle L Carpenter
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 125, Indianapolis, IN 46202, USA
| | - Cameron L Colgate
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Indianapolis, IN, 46202, USA
| | - Brian W Gray
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA
| | - Frederick J Rescorla
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA.
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Jensen AR, McDuffie LA, Groh EM, Rescorla FJ. Outcomes for Correction of Long-Gap Esophageal Atresia: A 22-Year Experience. J Surg Res 2020; 251:47-52. [DOI: 10.1016/j.jss.2020.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 11/20/2019] [Accepted: 01/25/2020] [Indexed: 12/29/2022]
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Singla S, Wong J, Singla N, Krailo MD, Huang L, Shaikh F, Billmire DF, Rescorla FJ, Ross JH, Dicken BJ, Amatruda JF, Frazier AL, Bagrodia A. Clinicopathologic predictors of outcomes in children with stage I germ cell tumors: A pooled post hoc analysis of trials from the Children’s Oncology Group. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
418 Background: Patients with clinical stage I (CS I: cN0M0) germ cell tumors (GCT) exhibit favorable oncologic outcomes. While prognostic features can help inform treatment in adults with CS I GCT, we lack reliable means to predict relapse among pediatric patients. We sought to identify predictors of relapse in children with CS I GCT. Methods: We performed a pooled post hoc analysis on pediatric CS I GCT patients enrolled in 3 prospective trials: INT-0097 (phase II), INT-0106 (phase III), and AGCT0132 (phase III). Pathology was centrally reviewed. Patient demographics, pT stage, serum tumor markers, margin status, histology, relapse, and survival were compiled. Cox regression analyses were used to identify predictors of outcomes. Results: 88 patients were identified with histologic data available. Most patients were pT1-2 stage. Yolk sac tumor was present in 75%, while 16% had embryonal carcinoma, and 9% had choriocarcinoma. When evaluable, lymphovascular invasion (LVI) was present in 36/66 (55%) of patients. Over a median follow-up of 5.0 years, no patients died and 24 patients (27%) relapsed (median relapse-free survival not reached). Predictors of relapse included presence of choriocarcinoma (HR 4.3, p=0.004), embryonal carcinoma (HR 3.8, p=0.002), pT3 stage (HR 6.9, p=0.027), and age >12 years (HR 3.1, p=0.011). LVI (HR 2.4, p=0.072), serum tumor markers, and dominant tumor size did not reach significance. Pediatric CS I GCT patients exhibit remarkable 5-year survival. Conclusions: Using combined data from multiple prospective trials, our study identifies clinicopathologic features that predict relapse and potentially inform personalized treatment for these patients.
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Affiliation(s)
- Shyamli Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Justin Wong
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Li Huang
- Children's Oncology Group, Monrovia, CA
| | | | | | | | | | - Bryan J. Dicken
- Stollery Children’s Hospital, University of Alberta Hospital, Edmonton, AB, Canada
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Vandewalle RJ, Easton JC, Burns RC, Gray BW, Rescorla FJ. Review of Early Postoperative Metrics for Children Undergoing Resection of Congenital Pulmonary Airway Malformations and Report of Pleuropulmonary Blastoma at a Single Institution. Eur J Pediatr Surg 2019; 29:417-424. [PMID: 29920635 DOI: 10.1055/s-0038-1661333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to describe a single institution's 11-year experience treating children with congenital pulmonary airway malformations (CPAMs) and pleuropulmonary blastoma (PPB). MATERIALS AND METHODS An institutional database was sampled for all patients aged 0 to 18 years from January 1, 2005, to December 31, 2015. Patients with a pathologic diagnosis of CPAM or PPB during this period were reviewed. RESULTS A total of 51 patients with a pathologic diagnosis of CPAM (n = 45; 88.2%) or PPB (n = 6; 11.8%) underwent surgical resection. Among patients treated for PPB, one death occurred approximately 13 months after diagnosis. Although four patients with PPB (four out of six; 66.7%) had radiographic indicators highly suggestive of malignancy prior to surgery, two had a preoperative diagnosis of CPAM (two out of six; 33.3%). Twenty-four patients (24 out of 45; 53.3%) with CPAM underwent resection after developing symptoms and 21 (21 out of 45; 46.7%) were symptomatic at the time of surgery. Mann-Whitney's tests revealed a statistically significant difference in postoperative length of stay (median: 6 vs. 3 days; p < 0.001) and days with thoracostomy tube in place (median 3 vs. 2 days; p = 0.003) for symptomatic versus asymptomatic patients, respectively. CONCLUSION CPAM patients appear to recover faster from surgery, if performed before the onset of symptoms. There may be a benefit to waiting until at least 3 months of age to complete resection in the asymptomatic patient. A low threshold for resection should be maintained in patients where delineating CPAM from PPB is difficult.
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Affiliation(s)
- Robert J Vandewalle
- Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Joseph C Easton
- Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - R Cartland Burns
- Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Brian W Gray
- Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Frederick J Rescorla
- Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, Frazier AL, Billmire DF, Rescorla FJ, Weil BR, Weldon CB. Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 2019; 54:1921-1925. [PMID: 30867096 DOI: 10.1016/j.jpedsurg.2019.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to develop a pre-operative risk assessment tool for childhood and adolescent ovarian malignancy, in order to guide operative management of pediatric ovarian masses. METHODS We conducted a retrospective analysis of patients <18 years old who underwent ovarian surgery at two quaternary care pediatric centers over 4 years (1/1/13-12/31/16). Probability of malignancy was estimated based on imaging characteristics (simple cyst, heterogeneous, or solid), maximal diameter, and tumor markers (α-fetoprotein, β-human chorionic gonadotropin). RESULTS Among 188 children with ovarian masses, 11% had malignancies. For simple cysts, there were no malignancies (0/24, 95% CI = 0-17%). Among solid lesions, 44% (15/34, 95% CI = 28-62%) were malignant. Among marker-elevated heterogeneous masses, 40% (2/5, 95% CI = 12-77%) were malignant. Conversely, small (≤10 cm) and large (>10 cm) marker-negative heterogeneous lesions had malignancy proportions of 0% (0/39, 95% CI = 0-11%) and 5% (2/40, 95% CI = 1-18%), respectively. CONCLUSIONS Given the malignancy estimates identified from these multi-institutional data, we recommend an attempt at ovarian-sparing resection for simple cysts or tumor marker-negative heterogeneous lesions ≤10 cm. Oophorectomy is recommended for solid masses or heterogeneous lesions with elevated markers. Finally, large (>10 cm) heterogeneous masses with non-elevated markers warrant a careful discussion of ovarian-sparing techniques. Complete surgical staging is mandatory regardless of operative procedure. TYPE OF STUDY Study of Diagnostic Test. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Arin L Madenci
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Robert J Vandewalle
- Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Bryan V Dieffenbach
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA
| | - Deborah F Billmire
- Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Frederick J Rescorla
- Department of Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA
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Drucker NA, Marine MB, Rescorla FJ. Gastric pneumatosis: An unusual presentation of superior mesenteric artery syndrome. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Dicken BJ, Billmire DF, Krailo M, Xia C, Shaikh F, Cullen JW, Olson TA, Pashankar F, Malogolowkin MH, Amatruda JF, Rescorla FJ, Egler RA, Ross JH, Rodriguez-Galindo C, Frazier AL. Gonadal dysgenesis is associated with worse outcomes in patients with ovarian nondysgerminomatous tumors: A report of the Children's Oncology Group AGCT 0132 study. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26913. [PMID: 29286555 PMCID: PMC6219870 DOI: 10.1002/pbc.26913] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE In this report, we characterize the timing and behavior of malignant ovarian germ cell tumors (GCTs) in pediatric patients with dysgenetic gonads compared to those with normal gonadal development. PATIENTS AND METHODS Patients from the Children's Oncology Group AGCT0132 with malignant ovarian GCTs were included. Within this population, we sought to identify patients with gonadoblastoma, streak ovaries, or other evidence of gonadal dysgenesis (GD). Patients with malignant GCTs containing one or more of the following histologies-yolk sac tumor, embryonal carcinoma, or choriocarcinoma-were included. Patients were compared with respect to event-free survival (EFS) and overall survival (OS). RESULTS Nine patients with GD, including seven with gonadoblastoma (mean age, 9.3 years), were compared to 100 non-GD patients (mean age, 12.1 years). The estimated 3-year EFS for patients with GD was 66.7% (95% CI 28.2-87.8%) and for non-GD patients was 88.8% (95% CI 80.2-93.8%). The estimated 3-year OS for patients with GD was 87.5% (95% CI 38.7-98.1%) and for non-GD patients was 97.6% (95% CI of 90.6-99.4%). CONCLUSION Patients presenting with nongerminomatous malignant ovarian GCTs in the context of GD have a higher rate of events and death than counterparts with normal gonads. These findings emphasize the importance of noting a contralateral streak ovary or gonadoblastoma at histology for any ovarian GCT and support the recommendation for early bilateral gonadectomy in patients known to have GD with Y chromosome material. In contrast to those with pure dysgerminoma, these patients may represent a high-risk group that requires a more aggressive chemotherapy regimen.
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Affiliation(s)
- Bryan J. Dicken
- Stollery Children’s Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | - Mark Krailo
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Caihong Xia
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Furqan Shaikh
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John W. Cullen
- Rocky Mountain Hospital for Children-Presbyterian St Luke’s Medical Center, Denver, Colorado
| | - Thomas A. Olson
- Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | | | | | | | | | | | | | - A. Lindsay Frazier
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, Massachusetts
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Dolejs SC, Sheplock J, Vandewalle RJ, Landman MP, Rescorla FJ. Sclerotherapy for the management of rectal prolapse in children. J Pediatr Surg 2017; 53:S0022-3468(17)30637-1. [PMID: 29103788 DOI: 10.1016/j.jpedsurg.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse. METHODS This was a retrospective review of children <18years with rectal prolapse who underwent sclerotherapy, predominantly with peanut oil (91%), between 1998 and 2015. Patients with imperforate anus or cloaca abnormalities, Hirschprung disease, or prior pull-through procedures were excluded. RESULTS Fifty-seven patients were included with a median age of 4.9years (interquartile range (IQR) 3.2-9.2) and median follow-up of 52months (IQR 8-91). Twenty patients (n=20/57; 35%) recurred at a median of 1.6months (IQR 0.8-3.6). Only 3 patients experienced recurrence after 4months. Nine of the patients who recurred (n=9/20; 45%) were re-treated with sclerotherapy. This was successful in 5 patients (n=5/9; 56%). Two patients (n=2/20; 10%) experienced a mucosal recurrence which resolved with conservative management. Forty-four patients were thus cured with sclerotherapy alone (n=44/57; 77%). No patients undergoing sclerotherapy had an adverse event. Thirteen patients (n=13/20; 65%) underwent rectopexy after failing at least one treatment of sclerotherapy. Three of these patients (n=3/13; 23%) recurred following rectopexy and required an additional operation. CONCLUSIONS Injection sclerotherapy for children with rectal prolapse resulted in a durable cure of prolapse in most children. Patients who recur following sclerotherapy tend to recur within 4months. Another attempt at sclerotherapy following recurrence is reasonable and was successful half of the time. Sclerotherapy should be the preferred initial treatment for rectal prolapse in children and for the initial treatment of recurrence. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Treatment Study.
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Affiliation(s)
- Scott C Dolejs
- Indiana University School of Medicine, Division of Pediatric Surgery
| | - Justin Sheplock
- Indiana University School of Medicine, Division of Pediatric Surgery
| | | | - Mathew P Landman
- Indiana University School of Medicine, Division of Pediatric Surgery
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Lal DR, Gadepalli SK, Downard CD, Ostlie DJ, Minneci PC, Swedler RM, Chelius T, Cassidy L, Rapp CT, Deans KJ, Fallat ME, Finnell SME, Helmrath MA, Hirschl RB, Kabre RS, Leys CM, Mak G, Raque J, Rescorla FJ, Saito JM, St Peter SD, von Allmen D, Warner BW, Sato TT. Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2017; 52:1245-1251. [PMID: 27993359 DOI: 10.1016/j.jpedsurg.2016.11.046] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND/PURPOSE Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a rare congenital anomaly lacking contemporary data detailing patient demographics, medical/surgical management and outcomes. Substantial variation in the care of infants with EA/TEF may affect both short- and long-term outcomes. The purpose of this study was to characterize the demographics, management strategies and outcomes in a contemporary multi-institutional cohort of infants diagnosed with EA/TEF to identify potential areas for standardization of care. METHODS A multi-institutional retrospective cohort study of infants with EA/TEF treated at 11 children's hospitals between 2009 and 2014 was performed. Over the 5year period, 396 cases were identified in the 11 centers (7±5 per center per year). All infants with a diagnosis of EA/TEF made within 30days of life who had surgical repair of their defect defined as esophageal reconstruction with or without ligation of TEF within the first six months of life were included. Demographic, operative, and outcome data were collected and analyzed to detect associations between variables. RESULTS Prenatal suspicion or diagnosis of EA/TEF was present in 53 (13%). The most common anatomy was proximal EA with distal TEF (n=335; 85%) followed by pure EA (n=27; 7%). Clinically significant congenital heart disease (CHD) was present in 137 (35%). Mortality was 7.5% and significantly associated with CHD (p<0.0001). Postoperative morbidity occurred in 62% of the population, including 165 (42%) cases with anastomotic stricture requiring intervention, anastomotic leak in 89 (23%), vocal cord paresis/paralysis in 26 (7%), recurrent fistula in 19 (5%), and anastomotic dehiscence in 9 (2%). Substantial variation in practice across our institutions existed: bronchoscopy prior to repair was performed in 64% of cases (range: 0%-100%); proximal pouch contrast study in 21% (0%-69%); use of interposing material between the esophageal and tracheal suture lines in 38% (0%-69%); perioperative antibiotics ≥24h in 69% (36%-97%); and transanastomotic tubes in 73% (21%-100%). CONCLUSION Contemporary treatment of EA/TEF is characterized by substantial variation in perioperative management and considerable postoperative morbidity and mortality. Future studies are planned to establish best practices and clinical care guidelines for infants with EA/TEF. LEVEL OF EVIDENCE Type of study: Treatment study. Level IV.
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Affiliation(s)
- Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY, United States
| | - Daniel J Ostlie
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Department of Surgery, University of Ohio, Columbus, OH, United States
| | - Ruth M Swedler
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Thomas Chelius
- Division of Epidemiology, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Laura Cassidy
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Division of Epidemiology, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Cooper T Rapp
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Department of Surgery, University of Ohio, Columbus, OH, United States
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY, United States
| | - S Maria E Finnell
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Rashmi S Kabre
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine of Northwestern University, Chicago, IL, United States
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Grace Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL, United States
| | - Jessica Raque
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY, United States
| | - Frederick J Rescorla
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - Daniel von Allmen
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Brad W Warner
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
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Shaikh F, Cullen JW, Olson TA, Pashankar F, Malogolowkin MH, Amatruda JF, Villaluna D, Krailo M, Billmire DF, Rescorla FJ, Egler RA, Dicken BJ, Ross JH, Schlatter M, Rodriguez-Galindo C, Frazier AL. Reduced and Compressed Cisplatin-Based Chemotherapy in Children and Adolescents With Intermediate-Risk Extracranial Malignant Germ Cell Tumors: A Report From the Children's Oncology Group. J Clin Oncol 2017; 35:1203-1210. [PMID: 28240974 DOI: 10.1200/jco.2016.67.6544] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate whether event-free survival (EFS) can be maintained among children and adolescents with intermediate-risk (IR) malignant germ cell tumors (MGCT) if the administration of cisplatin, etoposide, and bleomycin (PEb) is reduced from four to three cycles and compressed from 5 to 3 days per cycle. Patients and Methods In a phase 3, single-arm trial, patients with IR MGCT (stage II-IV testicular, II-III ovarian, I-II extragonadal, or stage I gonadal tumors with subsequent recurrence) received three cycles of PEb. A parametric comparator model specified that the observed EFS rate should not be significantly < 92%. As recommended for trials that test a reduction of therapy, a one-sided P value ≤ .10 was used to indicate statistical significance. In a post hoc analysis, we also compared results to the EFS rate of comparable patients treated with four cycles of PEb in two prior studies. Results Among 210 eligible patients enrolled from 2003 to 2011, 4-year EFS (EFS4) rate was 89% (95% confidence interval, 83% to 92%), which was significantly lower than the 92% threshold of the comparison model ( P = .08). Among 181 newly diagnosed patients, the EFS4 rate was 87%, compared with 92% for 92 comparable children in the historical cohort ( P = .15). The EFS4 rate was significantly associated with stage (stage I, 100%; stage II, 92%; stage III, 85%; and stage IV, 54%; P < .001). Conclusion The EFS rate for children with IR MGCT observed after three cycles of PEb was less than that of a prespecified parametric model, particularly for patients with higher-stage tumors. These data do not support a reduction in the number of cycles of PEb from four to three. However, further investigation of a reduction in the number of cycles for patients with lower-stage tumors is warranted.
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Affiliation(s)
- Furqan Shaikh
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - John W Cullen
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Thomas A Olson
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Farzana Pashankar
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Marcio H Malogolowkin
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - James F Amatruda
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Doojduen Villaluna
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Mark Krailo
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Deborah F Billmire
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Frederick J Rescorla
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Rachel A Egler
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Bryan J Dicken
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Jonathan H Ross
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Marc Schlatter
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Carlos Rodriguez-Galindo
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - A Lindsay Frazier
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
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Dolejs SC, Smith JK, Sheplock J, Croffie JM, Rescorla FJ. Contemporary short- and long-term outcomes in patients with unremitting constipation and fecal incontinence treated with an antegrade continence enema. J Pediatr Surg 2017; 52:79-83. [PMID: 27817835 DOI: 10.1016/j.jpedsurg.2016.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/20/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE The primary aim of this study is to determine the natural history of patients who undergo an antegrade continence enema (ACE) procedure including complications, functional results, and long-term outcomes. METHODS Patients aged 3-18years who underwent an ACE procedure from 2008 to 2015 for unremitting constipation and fecal incontinence with at least thirty day follow-up were included. Patients with congenital anatomic disorders of the spine, rectum, and anus were excluded. RESULTS A total of 93 patients were included in the analysis with an average age of 10+/-4years and follow-up of 26+/-41months. The ACE procedure was rapidly effective, with 99% of patients experiencing improvement at 1month. At the end of follow-up, 83% of patients had normal bowel function, and 95% of patients noted improvement. Amongst patients with at least 24months of follow-up (n=51), 43% successfully stopped using their ACE at an average of 40+/-27months. Overall morbidity was 55%, mostly related to minor complications. However, 13% of patients required an additional operation. CONCLUSION The ACE procedure is very successful in the treatment of unremitting constipation with fecal incontinence in appropriately selected patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Scott C Dolejs
- Indiana University School of Medicine, Division of Pediatric Surgery
| | - John K Smith
- Indiana University School of Medicine, Division of Pediatric Surgery
| | - Justin Sheplock
- Indiana University School of Medicine, Division of Pediatric Surgery
| | - Joseph M Croffie
- Indiana University School of Medicine, Pediatric Gastroenterology
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Abdullah F, Salazar JH, Gause CD, Gadepalli S, Biester TW, Azarow KS, Brandt ML, Chung DH, Lund DP, Rescorla FJ, Waldhausen JHT, Tracy TF, Fallat ME, Klein MD, Lewis FR, Hirschl RB. Understanding the Operative Experience of the Practicing Pediatric Surgeon. JAMA Surg 2016; 151:735-41. [DOI: 10.1001/jamasurg.2016.0261] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fizan Abdullah
- Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jose H. Salazar
- Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Colin D. Gause
- Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Samir Gadepalli
- Department of Surgery, University of Michigan Health System, Ann Arbor
| | | | - Kenneth S. Azarow
- Department of Surgery, Oregon Health and Science University, Portland
| | - Mary L. Brandt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dennis P. Lund
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | | | | | - Thomas F. Tracy
- Department of Surgery, Brown University, Providence, Rhode Island
| | - Mary E. Fallat
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Michael D. Klein
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Ronald B. Hirschl
- Department of Surgery, University of Michigan Health System, Ann Arbor
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Shaikh F, Cullen JW, Olson TA, Pashankar F, Malogolowkin MH, Amatruda J, Villaluna D, Krailo MD, Billmire DF, Rescorla FJ, Egler RA, Dicken BJ, Ross JH, Schlatter M, Rodriguez-Galindo C, Frazier AL. Reduced and compressed cisplatin-based chemotherapy in children and adolescents with intermediate-risk extracranial malignant germ cell tumors: A report from the Children’s Oncology Group. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - John W Cullen
- Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO
| | | | | | | | - James Amatruda
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | - Bryan J Dicken
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada
| | | | - Marc Schlatter
- Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI
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16
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Billmire DF, Rescorla FJ, Ross JH, Schlatter MG, Dicken BJ, Krailo MD, Rodriguez-Galindo C, Olson TA, Cullen JW, Frazier AL. Impact of central surgical review in a study of malignant germ cell tumors. J Pediatr Surg 2015; 50:1502-5. [PMID: 25783295 PMCID: PMC5149399 DOI: 10.1016/j.jpedsurg.2014.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/07/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Verification of surgical staging has received little attention in clinical oncology trials. Central surgical review was undertaken during a study of malignant pediatric germ cell tumors. METHODS Children's Oncology Group study AGCT0132 included central surgical review during the study. Completeness of submitted data and confirmation of assigned stage were assessed. Review responses were: assigned status confirmed, assignment withheld pending review of additional information requested, or institutional assignment of stage disputed with explanation given. Changes in stage assignment were at the discretion of the enrolling institution. RESULTS A total of 206 patients underwent central review. Failure to submit required data elements or need for clarification was noted in 40%. Disagreement with stage assignment occurred in 10% with 17/21 discordant patients reassigned to stage recommended by central review. Four ovarian tumor patients not meeting review criteria for Stage I remained in that stratum by institutional decision. Two-year event free survival in Stage I ovarian patients was 25% for discordant patients compared to 57% for those meeting Stage I criteria by central review. CONCLUSIONS Central review of stage assignment improved complete data collection and assignment of correct tumor stage at study entry, and allowed for prompt initiation of chemotherapy in patients determined not to have Stage I disease.
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Affiliation(s)
- Deborah F. Billmire
- Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Frederick J. Rescorla
- Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Jonathan H. Ross
- Division of Urology, Case Western Reserve University, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Marc G. Schlatter
- Helen DeVos Children’s Hospital at Spectrum Health, Grand Rapids, MI
| | - Bryan J. Dicken
- Department of Surgery, University of Alberta, Stollery Childrens Hospital, Edmunton, Alberta
| | - Mark D. Krailo
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Thomas A. Olson
- Aflac Cancer and Blood Disorders Center, Childrens Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - John W. Cullen
- Rocky Mountain Hospital for Children, Presbyterian St Luke’s Medical, Denver, CO
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Crafts TD, Hunsberger EB, Jensen AR, Rescorla FJ, Yoder MC, Markel TA. Direct peritoneal resuscitation improves survival and decreases inflammation after intestinal ischemia and reperfusion injury. J Surg Res 2015; 199:428-34. [PMID: 26169030 DOI: 10.1016/j.jss.2015.06.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 06/07/2015] [Accepted: 06/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Direct peritoneal resuscitation (DPR) has previously been shown to alter blood flow in the small bowel mesenteric vessels in models of intestinal ischemia. However, a survival advantage or its effects on local tissue inflammation have not been previously demonstrated. We hypothesized that DPR would increase survival and decrease intestinal tissue inflammation after intestinal ischemia and reperfusion (I/R) injury. METHODS Eight-week-old male C57Bl6J mice were anesthetized and underwent midline laparotomy. I/R and DPR groups were exposed to superior mesenteric artery occlusion for 60 min with a nontraumatic clamp. Immediately after removal of the clamp, 1 mL of phosphate-buffered saline, 1 mL of minimal essential media, or 1 mL of minimal essential media supplemented with fetal bovine serum, penicillin and/or streptomycin, and glutamine were placed into the abdominal cavity of DPR groups. Animals were then closed in two layers and allowed to reperfuse for 6 h (cytokine analysis, n = 6 per group) or 7 d (survival analysis, n = 10 per group). After 6 h of reperfusion, animals were euthanized. Intestines were harvested and homogenized. Extracts were quantified for total protein content (Bradford assay), myeloperoxidase activity, tissue inflammatory cytokine, and growth factor production. P < 0.05 was significant. RESULTS I/R caused marked intestinal ischemia, significant mortality, and a significant increase in tissue cytokine and growth factor levels (P < 0.05). Seven-day survival was 30% for I/R without treatment and rose to 60% with DPR therapy using phosphate-buffered saline as the dialysate. DPR using plain MEM or MEM with supplements after ischemia increased 7-d survival to 90% (P < 0.05). DPR also significantly decreased intestinal tissue levels of myeloperoxidase, as well as intestinal tissue levels of multiple growth factors and inflammatory cytokines. CONCLUSIONS DPR increases survival and decreases intestinal inflammation after intestinal I/R injury. Translational applications are readily achievable and should be considered for patients with intestinal ischemic pathology.
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Affiliation(s)
- Trevor D Crafts
- Section of Pediatric Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health and, The Indiana University School of Medicine, Indianapolis, Indiana
| | - Erin Bailey Hunsberger
- Section of Pediatric Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health and, The Indiana University School of Medicine, Indianapolis, Indiana
| | - Amanda R Jensen
- Section of Pediatric Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health and, The Indiana University School of Medicine, Indianapolis, Indiana
| | - Frederick J Rescorla
- Section of Pediatric Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health and, The Indiana University School of Medicine, Indianapolis, Indiana
| | - Mervin C Yoder
- Section of Neonatology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and, The Indiana University School of Medicine, Indianapolis, Indiana
| | - Troy A Markel
- Section of Pediatric Surgery, Department of Surgery, Riley Hospital for Children at Indiana University Health and, The Indiana University School of Medicine, Indianapolis, Indiana.
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Billmire DF, Cullen JW, Rescorla FJ, Davis M, Schlatter MG, Olson TA, Malogolowkin MH, Pashankar F, Villaluna D, Krailo M, Egler RA, Rodriguez-Galindo C, Frazier AL. Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Children's Oncology Group. J Clin Oncol 2014; 32:465-70. [PMID: 24395845 DOI: 10.1200/jco.2013.51.1006] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection. PATIENTS AND METHODS Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m(2) on days 1 to 3, etoposide 167 mg/m(2) on days 1 to 3, bleomycin 15 U/m(2) on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method. RESULTS Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%). CONCLUSION Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.
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Affiliation(s)
- Deborah F Billmire
- Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian St Luke's Medical, Denver, CO; Mary Davis and Marc G. Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Thomas A. Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Marcio H. Malogolowkin, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI; Farzana Pashankar, Yale University, New Haven, CT; Doojduen Villaluna, Children's Oncology Group, Monrovia; Mark Krailo, Keck School of Medicine, University of Southern California, Los Angeles, CA; Rachel A. Egler, Rainbow Babies and Children's Hospital, Cleveland, OH; and Carlos Rodriguez-Galindo and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
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Papic JC, Finnell SME, Slaven JE, Billmire DF, Rescorla FJ, Leys CM. Predictors of ovarian malignancy in children: overcoming clinical barriers of ovarian preservation. J Pediatr Surg 2014; 49:144-7; discussion 147-8. [PMID: 24439599 DOI: 10.1016/j.jpedsurg.2013.09.068] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Ovarian preservation is desirable in girls with benign ovarian masses. We aimed to 1) identify clinical predictors of malignant ovarian masses, 2) investigate how often ovarian tissue is present to preserve in benign masses, and 3) identify factors associated with successful ovarian preservation. METHODS Retrospective analysis (1997-2012) of girls age 1-18years with an ovarian mass managed operatively. Data on presenting symptoms, imaging, biochemical markers, treatment, outcome, and pathology were extracted. RESULTS We identified 150 patients. Large mass size, solid components, and elevated tumor markers (AFP, βHCG, and/or LDH) were significantly predictive of malignancy. All masses <10cm, predominantly cystic, and with negative tumor markers were benign. Masses with all three of these characteristics would decrease a 20% malignancy pretest probability to a posttest probability of 0.25%. Benign masses managed by oophorectomy contained normal ovarian tissue in 76% of the specimens. For benign masses, successful ovarian preservation was significantly associated with size <10cm, predominantly cystic, laparoscopy, and absence of torsion or calcifications. CONCLUSION Ovarian masses that are <10cm, primarily cystic, and have negative tumor markers are most likely benign. Viable ovarian tissue is frequently present in benign masses, so significant efforts should be made for ovarian preservation.
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Affiliation(s)
- Jonathan C Papic
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - S Maria E Finnell
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA; Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Deborah F Billmire
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Frederick J Rescorla
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA.
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
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Ceppa EP, Pitt HA, Hunter JL, Leys CM, Zyromski NJ, Rescorla FJ, Sandrasegaran K, Fogel EL, McHenry LW, Watkins JL, Sherman S, Lehman GA. Hereditary pancreatitis: endoscopic and surgical management. J Gastrointest Surg 2013; 17:847-56; discussion 856-7. [PMID: 23435738 DOI: 10.1007/s11605-013-2167-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 02/06/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Hereditary pancreatitis is a rare cause of chronic pancreatitis. In recent years, genetic mutations have been characterized. The rarity of this disorder has resulted in a gap in clinical knowledge. The aims were to characterize patients with hereditary pancreatitis and establish clinical guidelines. METHODS Pediatric and adult endoscopic, surgical, radiologic, and genetic databases from 1998 to 2012 were searched. Patients with recurrent acute or chronic pancreatitis and genetic mutation for either PRSS-1, SPINK-1, or CFTR or those who met the family history criteria were included. Patients with pancreatitis due to other causes, without a positive family history, familial pancreatic cancer, or cystic fibrosis, were excluded. RESULTS Eighty-seven patients were identified. Genetic testing confirmed the diagnosis in 54 patients (62 %). Eighty-five patients (98 %) underwent 263 endoscopic procedures including sphincterotomy (72 %), stone removal (49 %), and pancreatic duct stenting (82 %). Twenty-eight patients (32 %) have undergone 37 operations which included 19 resections and 18 drainage procedures. The interval between procedures for recurrent pain was longer for surgery than for endoscopic therapy (9.1 vs. 3.4 years, p < 0.05). CONCLUSIONS Most children and young adults with hereditary pancreatitis can be managed initially with endoscopic therapy. When surgery is undertaken, the procedure should be tailored to the pancreatic anatomy and cancer risk.
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Affiliation(s)
- Eugene P Ceppa
- Department of Surgery, Indiana University Medical Center, Indianapolis, IN 46202, USA.
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21
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Webber EC, Rescorla FJ. Hemopneumothorax caused by vascularized bullae and a pulmonary hemangioma in an adolescent boy. J Pediatr Surg 2012; 47:e23-5. [PMID: 22498411 DOI: 10.1016/j.jpedsurg.2011.11.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/22/2011] [Accepted: 11/28/2011] [Indexed: 11/19/2022]
Abstract
Spontaneous hemopneumothorax is a rare, potentially life-threatening condition occurring in adolescence. In general, spontaneous hemopneumothorax has not been associated with other pulmonary vascular malformations in adolescents. We present a case of a 17-year-old adolescent boy with hemopneumothorax from vascularized pleural blebs who was also noted to have a pulmonary hemangioma.
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Affiliation(s)
- Emily C Webber
- Department of Pediatrics, Section of Pediatric Hospital Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
Pediatric germ cell tumors represent a diverse group of tumors that present from in utero through adolescence at many nongonadal locations, from the neck to the sacrococcygeal region. Surgical resection remains the central element of management, and accurate surgical staging is essential to properly ascertain the correct risk-based treatment. The management for all benign tumors (mature and immature teratomas) and select completely resectable malignant tumors is surgery alone. Modern-day chemotherapy is extremely effective in infants and children with unresectable and metastatic disease and these children have a very high survival rate. The use of neoadjuvant chemotherapy allows vital organ preservation and there is no role for resection of vital structures at the time of initial presentation.
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Affiliation(s)
- Frederick J Rescorla
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Weil BR, Leys CM, Rescorla FJ. The jury is still out: changes in gastroschisis management over the last decade are associated with both benefits and shortcomings. J Pediatr Surg 2012; 47:119-24. [PMID: 22244403 DOI: 10.1016/j.jpedsurg.2011.10.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/06/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE Management of gastroschisis has shifted from early primary closure to preformed silo placement and delayed closure. We aimed to identify how closure techniques have changed and how outcomes have been affected. METHODS Records of patients undergoing gastroschisis closure at a single institution from 2000 to 2009 were reviewed. Patient characteristics and outcomes were collected and compared among those undergoing primary closure vs preformed silo placement. Outcomes were also compared in an era when primary closure predominated (2000-2002) vs one when primary silo predominated (2003-2009). RESULTS From 2000 to 2009, 203 patients underwent gastroschisis closure. Primary closure was performed in 50% of patients from 2000 to 2002 vs 12.3% from 2003 to 2009. Preformed silos were placed in 34.7% of patients from 2000 to 2002 vs 84.4% from 2003 to 2009. Patients treated from 2000 to 2002 experienced shorter hospital stays and shorter time to achievement of full enteral nutrition. Patients treated from 2003 to 2009 developed fewer ventral hernias and wound infections and required less ventilator days. Patients undergoing early primary closure developed ventral hernias at higher rates compared with those treated with preformed silos. Intensive care unit stay was longer for patients receiving preformed silos. CONCLUSION Change in our management strategy has resulted in prolonged intensive care unit stay and time to full feeds but reduced postoperative hernias and wound infections.
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Affiliation(s)
- Brent R Weil
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Hollander LL, Leys CM, Weil BR, Rescorla FJ. Predictive value of response to steroid therapy on response to splenectomy in children with immune thrombocytopenic purpura. Surgery 2011; 150:643-8. [PMID: 22000175 DOI: 10.1016/j.surg.2011.07.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 07/18/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many but not all studies suggest that a favorable response to preoperative steroid therapy predicts a successful outcome after splenectomy in children with immune thrombocytopenic purpura (ITP). The purpose of this study is to further examine the relationship between steroid response and outcome after splenectomy in children. METHODS After institutional review board approval, records of children undergoing splenectomy for ITP were reviewed. Patients' responses were determined by platelet counts and grouped by complete response (CR; ≥ 150,000/μL), partial response (PR; 149,999- ≥ 50,000/μL), or no response (NR; <50,000/μL). RESULTS Thirty-seven children were identified. After steroid therapy, 20 patients (54%) had CR, 9 (24%) had PR, and 8 (22%) had NR. After splenectomy, 31 patients (84%) had CR, 6 (16%) had PR, and 0 had NR. Of the 20 patients that had a CR to steroid therapy, 18 (80%) had CR and 2 (20%) had PR to splenectomy. Of the 9 patients that had PR to steroids, 7 (78%) had CR to splenectomy and 2 (22%) had PR. Of the 8 patients that had NR to steroids, 6 (75%) had CR and 2 (25%) had PR to splenectomy. Response to splenectomy was not associated with response to steroids (P = .59). CONCLUSION These data suggest that response to splenectomy in children with ITP is unrelated to previous response to steroids.
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Affiliation(s)
- Lindsay L Hollander
- Section of General Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Draus JM, Kamel S, Seims A, Rescorla FJ. The Role of Laparoscopic Evaluation to Detect a Contralateral Defect at Initial Presentation for Inguinal Hernia Repair. Am Surg 2011. [DOI: 10.1177/000313481107701134] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH ( P = 0.0168). CPPV was associated with prematurity ( P = 0.0003) and age younger than 6 months ( P = 0.0001) but not with sex ( P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscope Although the rate of CPPV decreases after 6 months of age, girls older than 2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls.
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Affiliation(s)
- John M. Draus
- Kentucky Children's Hospital and the Division of Pediatric Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Sarah Kamel
- James Whitcomb Riley Hospital for Children, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron Seims
- James Whitcomb Riley Hospital for Children, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Frederick J. Rescorla
- James Whitcomb Riley Hospital for Children, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Draus JM, Kamel S, Seims A, Rescorla FJ. The role of laparoscopic evaluation to detect a contralateral defect at initial presentation for inguinal hernia repair. Am Surg 2011; 77:1463-1466. [PMID: 22196658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH (P = 0.0168). CPPV was associated with prematurity (P = 0.0003) and age younger than 6 months (P = 0.0001) but not with sex (P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscopy. Although the rate of CPPV decreases after 6 months of age, girls older than 2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls.
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Affiliation(s)
- John M Draus
- Kentucky Children's Hospital and the Division of Pediatric Surgery, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0298, USA.
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Zhong X, Rescorla FJ. Cell surface adhesion molecules and adhesion-initiated signaling: understanding of anoikis resistance mechanisms and therapeutic opportunities. Cell Signal 2011; 24:393-401. [PMID: 22024283 DOI: 10.1016/j.cellsig.2011.10.005] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/06/2011] [Accepted: 10/10/2011] [Indexed: 12/16/2022]
Abstract
Cells express various cell surface adhesion molecules (receptors) that not only mechanically serve as contacting sites between the cell and extracellular matrix (ECM) or adjacent cells, but also initiate intracellular signaling pathways modulating important cellular events including survival and proliferation. Normal cells undergo apoptosis when lacking ECM attachment. This type of cell death has been termed anoikis. Anoikis can be viewed as a normal process which ensures tissue homeostasis and failure to execute the anoikis program or resistance to anoikis could result in adherent cells surviving under suspension condition and proliferating at ectopic sites where the matrix proteins are different from those the cells originally contact. Resistance to anoikis is emerging as a hallmark of metastatic cancers which enables cancer cells to disseminate to distant organs through systemic circulation. In this review, we will discuss the molecular basis of adhesion-initiated signaling, the impact of loss of cell-ECM adhesion on normal cell survival, the role of cancer cell aggregate formation via intercellular adhesion under non-adherent condition, and mechanisms of anoikis resistance developed in metastatic cancer cells. Understanding of these aspects will provide opportunities to find new potential molecular targets, and therapeutic strategies based on these findings will likely prove to be more specific and effective.
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Affiliation(s)
- Xiaoling Zhong
- Department of Surgery, Section of Pediatric Surgery, and the Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, 46202, IN, USA.
| | - Frederick J Rescorla
- Department of Surgery, Section of Pediatric Surgery, and the Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, 46202, IN, USA
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Dicken BJ, Sergi C, Rescorla FJ, Breckler F, Sigalet D. Medical management of motility disorders in patients with intestinal failure: a focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia. J Pediatr Surg 2011; 46:1618-30. [PMID: 21843732 DOI: 10.1016/j.jpedsurg.2011.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/31/2011] [Accepted: 04/05/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intestinal failure (IF) is the dependence upon parenteral nutrition to maintain minimal energy requirements for growth and development. It may occur secondary to a loss of bowel length, disorders of motility, or both. Short bowel syndrome (SBS) is a malabsorptive state resulting from surgical resection, congenital defect, or diseases associated with loss of absorptive surface area. A particularly vexing problem is associated with whole bowel and/or segmental intestinal dysmotility. Motility disorders within the context of SBS and IF may relate to rapid intestinal transit secondary to loss of intestinal length, dysmotility associated with loss or poor antegrade peristalsis, or gastroparesis. Therapy may be classified into medical (prokinetic and antidiarrheal agents) and surgical to deal with the overdistended poorly motile bowel. METHODS We performed a systematic review of the literature pertaining to IF, SBS, and dysmotility in the pediatric population with gastroschisis, necrotizing enterocolitis, and intestinal atresia. In addition to the available treatment options, we have provided a review of the literature and a summary of the available evidence. CONCLUSION Despite relatively poor level of evidence regarding the application of promotility and antidiarrheal medications in patients with SBS and IF, these agents continue to be used. Herein, we provide a review of the physiology and pathophysiology of intestinal motility/dysmotility and available strategies for the use of promotility and antidiarrheal agents in patients with IF/SBS.
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Affiliation(s)
- Bryan J Dicken
- Division of Pediatric Surgery, Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada.
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Buesing KL, Tracy ET, Kiernan C, Pastor AC, Cassidy LD, Scott JP, Ware RE, Davidoff AM, Rescorla FJ, Langer JC, Rice HE, Oldham KT. Partial splenectomy for hereditary spherocytosis: a multi-institutional review. J Pediatr Surg 2011; 46:178-83. [PMID: 21238662 DOI: 10.1016/j.jpedsurg.2010.09.090] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 09/30/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Partial splenectomy has emerged as a surgical option for selected children with hereditary spherocytosis, with the goal of reducing anemia while preserving splenic function. This multi-institutional study is the largest series to date examining outcomes data for partial splenectomy in patients with hereditary spherocytosis. METHODS Data were collected retrospectively from 5 North American pediatric hospitals. Sixty-two children underwent partial splenectomy for hereditary spherocytosis between 1990 and 2008. RESULTS At 1 year following partial splenectomy, mean hemoglobin significantly increased by 3.0 ± 1.4 g/dL (n = 52), reticulocyte count decreased by 6.6% ± 6.6% (n = 41), and bilirubin level decreased by 1.3 ± 0.9 mg/dL (n = 25). Patients with poor or transient hematologic response were found to have significantly more splenic regeneration postoperatively compared with patients with a durable clinical response (maximal spleen dimension, 9.0 ± 3.4 vs 6.3 ± 2.2 cm). Clinically significant recurrence of anemia or abdominal pain led to completion splenectomy in 4.84% of patients. No patients developed postsplenectomy sepsis. CONCLUSIONS Our multi-institutional review indicates that partial splenectomy for hereditary spherocytosis leads to sustained and clinically significant improvement in hematologic profiles and clinical symptoms in most patients. Our data support partial splenectomy as an alternative for selected children with hereditary spherocytosis.
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Affiliation(s)
- Keely L Buesing
- Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Breckler FD, Rescorla FJ, Billmire DF. Wound infection after colostomy closure for imperforate anus in children: utility of preoperative oral antibiotics. J Pediatr Surg 2010; 45:1509-13. [PMID: 20638534 DOI: 10.1016/j.jpedsurg.2009.10.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/21/2009] [Accepted: 10/23/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE There is little published data on the efficacy of surgical infection prophylaxis in children. The purpose of this study was to assess wound infection rate in children undergoing colostomy closure for imperforate anus and evaluate the impact of bowel preparation and antibiotics. METHODS Children younger than 18 years with imperforate anus who had a colostomy closure between January 1996 and December 2007 were identified. Data collected included demographics, bowel preparation, antibiotics, operative details, and postoperative infections. Comparison of mechanical bowel preparation and intravenous antibiotics with and without oral antibiotics was compared using chi(2) tests. Significance was defined as P < .05. RESULTS A total of 118 patients were identified. Primary skin closure was done in 97%. Mechanical bowel preparation was used in 93%, intravenous antibiotics in 97%, and oral preoperative antibiotics in 52%. Wound infections occurred in 14% (n = 17). The addition of oral antibiotics to the standard regimen of mechanical bowel preparation with intravenous antibiotics did not alter infection rate (13% versus 17%, P = .64). CONCLUSION Wound infection in children undergoing elective colostomy closure for imperforate anus was 14%. Infection rate was not affected by use of oral antibiotics. Future studies may allow specific guideline development for infection prophylaxis in pediatric patients.
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Affiliation(s)
- Francine D Breckler
- Division of Pediatric Surgery, Riley Hospital for Children, Indianapolis, IN 46202, USA
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Kumar HR, Zhong X, Rescorla FJ, Hickey RJ, Malkas LH, Sandoval JA. Proteomic approaches in neuroblastoma: a complementary clinical platform for the future. Expert Rev Proteomics 2009; 6:387-94. [PMID: 19681674 DOI: 10.1586/epr.09.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neuroblastoma (NB) is one of the most common solid tumors of childhood and displays a remarkable diversity in both biologic characteristics and clinical outcomes. Availability of high-throughput 'omics technologies and their subsequent application towards oncology has provided insight into the complex pathways of tumor formation and progression. Investigation of NB 'omics profiles may better define tumor behavior and provide targeted therapy with the goal of improving outcomes in patients with high-risk disease. Utilization of these technologies in NB has already led to advances in classification and risk stratification. The gradual emergence of NB-directed proteomics adds a layer of intricacy to the analysis of biologic organization but may ultimately provide a better comprehension of this complex disease. In this review, we cite specific examples of how NB-directed proteomics has provided information regarding novel biomarkers and possible therapeutic targets. We finish by examining the impact of high-throughput 'omics in the field of NB and speculate on how these emerging technologies may further be incorporated into the discipline.
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Affiliation(s)
- Hari R Kumar
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 202, Indianapolis, IN 46202, USA.
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Zhong X, Hoelz DJ, Kumar HR, Sandoval JA, Rescorla FJ, Hickey RJ, Malkas LH. Bin1 is linked to metastatic potential and chemosensitivity in neuroblastoma. Pediatr Blood Cancer 2009; 53:332-7. [PMID: 19418541 DOI: 10.1002/pbc.22068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neuroblastoma (NB) is the most common extracranial solid tumor in children. At the time of diagnosis, the tumor has metastasized in as many as 7 of 10 cases, and survival in high-risk patients remains poor. Accurate classification of high-risk patients is very important since this determines treatment plan, and although a consensus risk classification system has been established for NB, it contains few specific molecular markers that account for aggressive nature and metastatic potential of the tumor. Bin1 expression is reduced in breast, NB, and other cancer types and the reduction correlates with high-risk clinical features. Here we hypothesize that Bin1 has an inhibitory role in metastasis, and therefore decrease in its expression may be a marker of high-risk NB. PROCEDURE Initially, breast cancer and NB cell lines derived from metastasis were examined for Bin1 expression. Then, a stable Bin1-overexpressing NB cell line was created and evaluated for in vitro metastatic behaviors using anoikis, invasion, and migration assays, and chemoresponsiveness using MTT assay. RESULTS Reduced Bin1 was detected in all cancer cell lines examined, and forced Bin1 overexpression increased NB cell anoikis and enhanced the cell killing by doxorubicin. However, Bin1 overexpression did not significantly affect cell invasion, motility, or proliferation. CONCLUSIONS Bin1 appears to function as a metastasis suppressor and chemosensitizer in NB, and resistance to anoikis may be an important metastatic mechanism. Thus, Bin1 expression status could serve as a marker for metastatic potential and chemosensitivity thereby allowing for more accurate classifications of high-risk NB patients.
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Affiliation(s)
- Xiaoling Zhong
- Department of Surgery, Section of Pediatric Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Turner KE, Kumar HR, Hoelz DJ, Zhong X, Rescorla FJ, Hickey RJ, Malkas LH, Sandoval JA. Proteomic Analysis of Neuroblastoma Microenvironment: Effect of the Host–Tumor Interaction on Disease Progression. J Surg Res 2009; 156:116-22. [DOI: 10.1016/j.jss.2009.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 01/08/2009] [Accepted: 02/16/2009] [Indexed: 01/28/2023]
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Novotny NM, Vegeler RC, Breckler FD, Rescorla FJ. Percutaneous endoscopic gastrostomy buttons in children: superior to tubes. J Pediatr Surg 2009; 44:1193-6. [PMID: 19524739 DOI: 10.1016/j.jpedsurg.2009.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 02/17/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a paucity of literature comparing outcomes of percutaneous endoscopic gastrostomy (PEG) tubes vs PEG buttons. Primary PEG buttons offer an advantage of being a single-step low-profile enteral access device with potentially fewer complications. METHODS A retrospective review of patients undergoing PEG tubes and buttons (January 2006-August 2007) was performed. Power analysis demonstrated that 105 patients in each group were needed. Patient characteristics were collected in each group and evaluated by chi(2) and t tests. P values of less than .05 were considered significant. RESULTS A total of 223 children having undergone PEG (110 tubes, 113 buttons) were identified. No differences were found in operative time, intraoperative complications, clogging, breakage, infections, emergency department visits, or hospital readmissions. However, children undergoing PEG button placement were more likely to spend only one night in the hospital vs PEG tube (60% vs 25%, respectively; P < .001). In addition, PEG buttons had fewer dislodgements (4 vs 15; P < .05). CONCLUSION The PEG buttons are less likely to become dislodged than PEG tubes. Infection rates were not found to be different between groups. Children with PEG buttons were more likely to be discharged earlier than children with PEG tubes. Primary PEG buttons are clinically comparable to PEG tubes with less concern for dislodgements.
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Abstract
This is a reflection on 2 people who have had a profound influence on many lives and a review of changes in pediatric surgery.
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Affiliation(s)
- Frederick J Rescorla
- Department of Pediatric Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Riley Hospital for Children, 702 Barnhill Drive, Rm 2500, Indianapolis, IN 46202-5200, USA.
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Abstract
INTRODUCTION Fistula in ano is a common malady in infancy. However, relatively little literature is devoted to it. Our aim was to describe the natural history and identify predictors of which children will ultimately recur. METHODS A retrospective review of patients less than 3 years old undergoing anal fistulotomy was performed between May 2002 and November 2007 at a tertiary children's hospital. Demographics, preoperative, operative, and postoperative characteristics were collected in each group and evaluated by biostatistical analysis. P values <0.05 were considered significant. RESULTS A total of 92 children undergoing anal fistulotomy were identified. The median age was 6 months. Twelve children (13%) had recurrences and two of the 12 had multiple recurrences. Children who had recurrences were older (12.9 vs. 7.5 months, P < 0.05) and were more likely to have a previous abscess (20 vs. 6%, P < 0.05). In addition, children with recurrences had pus noted at the time of surgery more than children who did not recur (23 vs. 8%, respectively, P < 0.05). There were no major complications. CONCLUSIONS Fistula in ano in infants is a relatively benign process with most children having no serious sequelae. However, a not insignificant portion (13%) of children developed recurrences. Older children who developed fistulas were more likely to have a recurrence than younger, and children who had previous episodes of perianal abscess or pus noted at the time of surgery were more likely to recur.
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Affiliation(s)
- Nathan M Novotny
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 202, Indianapolis, IN 46202, USA.
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Markel TA, Crisostomo PR, Lahm T, Novotny NM, Rescorla FJ, Tector AJ, Meldrum DR. Stem cells as a potential future treatment of pediatric intestinal disorders. J Pediatr Surg 2008; 43:1953-63. [PMID: 18970924 PMCID: PMC2584666 DOI: 10.1016/j.jpedsurg.2008.06.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 05/18/2008] [Accepted: 06/22/2008] [Indexed: 12/27/2022]
Abstract
All surgical disciplines encounter planned and unplanned ischemic events that may ultimately lead to cellular dysfunction and death. Stem cell therapy has shown promise for the treatment of a variety of ischemic and inflammatory disorders where tissue damage has occurred. As stem cells have proven beneficial in many disease processes, important opportunities in the future treatment of gastrointestinal disorders may exist. Therefore, this article will serve to review the different types of stem cells that may be applicable to the treatment of gastrointestinal disorders, review the mechanisms suggesting that stem cells may work for these conditions, discuss current practices for harvesting and purifying stem cells, and provide a concise summary of a few of the pediatric intestinal disorders that could be treated with cellular therapy.
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Affiliation(s)
- Troy A. Markel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul R. Crisostomo
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tim Lahm
- Department of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nathan M. Novotny
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - A. Joseph Tector
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Daniel R. Meldrum
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana,Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana,Center for Immunobiology, Indiana University School of Medicine, Indianapolis, Indiana
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Kumar HR, Zhong X, Hoelz DJ, Rescorla FJ, Hickey RJ, Malkas LH, Sandoval JA. Three-dimensional neuroblastoma cell culture: proteomic analysis between monolayer and multicellular tumor spheroids. Pediatr Surg Int 2008; 24:1229-34. [PMID: 18797883 PMCID: PMC2804865 DOI: 10.1007/s00383-008-2245-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Solid tumors, such as neuroblastoma (NB), are associated with a heterogeneous cell environment. Multicellular tumor spheroid (MCTS) cultures have been shown to better mimic growth characteristics of in vivo solid tumors. Because tumor spheroid growth patterns may be quite different from standard two-dimensional culture systems, we sought to compare the protein expression profiles of two- and three-dimensional in vitro NB cultures, i.e., monolayers and MCTS. MATERIALS AND METHODS Human NB cells were grown as both monolayers and spheres. Nuclear and cytosolic proteins were analyzed for differentially secreted proteins by two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) and selected polypeptides were identified by mass spectrometry (LC-MS/MS). RESULTS Several metabolic (transketolase, triosephosphate isomerase, pyruvate kinase M1/M2, alpha enolase, and phosphoglycerate mutase-1), cell stress response (heat shock proteins (HSP) 90, 70, and 60; antioxidant, thioredoxin), cell structure (septin 2, adenyl cyclase-associated protein-1), tubulin beta-2 chain, actin, translationally controlled tumor protein and cofilin), signal transduction (peptidyl prolyl cis/trans isomerase A), biosynthetic (phosphoserine aminotransferase) and transport (cellular retinoic acid binding protein 1) polypeptides were overexpressed in spheroids. Several protein groups were differentially expressed between NB monolayers and spheroids. CONCLUSION The altered proteins among NB spheroids may represent an important link between monolayer cell cultures and in vivo experiments and thus a more ideal in vitro culture system for determining the precise three-dimensional microenvironment of NB.
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Affiliation(s)
- Hari R. Kumar
- Section of Pediatric Surgery, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill, Dr. EH202, Indianapolis, IN 46202, USA
| | - Xiaoling Zhong
- Section of Pediatric Surgery, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill, Dr. EH202, Indianapolis, IN 46202, USA
| | - Derek J. Hoelz
- Division of Hematology/Oncology, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill, Dr. EH202, Indianapolis, IN 46202, USA
| | - Frederick J. Rescorla
- Section of Pediatric Surgery, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill, Dr. EH202, Indianapolis, IN 46202, USA
- Department of Surgery, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill Dr. EH202, Indianapolis, IN 46202, USA, e-mail:
| | - Robert J. Hickey
- Division of Hematology/Oncology, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill, Dr. EH202, Indianapolis, IN 46202, USA
| | - Linda H. Malkas
- Division of Hematology/Oncology, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill, Dr. EH202, Indianapolis, IN 46202, USA
| | - John A. Sandoval
- Department of Surgery, Indiana University School of Medicine and Riley Children’s Hospital, 545 N. Barnhill Dr. EH202, Indianapolis, IN 46202, USA, e-mail:
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Abstract
Duplications of the entire colon are very rare. An 18-month-old boy presented with symptoms of chronic constipation and was noted with a complete colonic duplication. The presentation and management are discussed.
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Affiliation(s)
- Julie R Fuchs
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN 46202, USA
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Sandoval JA, Sheehan MP, Stonerock CE, Shafique S, Rescorla FJ, Dalsing MC. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: An increasing population at risk. J Vasc Surg 2008; 47:837-43. [DOI: 10.1016/j.jvs.2007.11.054] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 11/17/2007] [Accepted: 11/23/2007] [Indexed: 01/29/2023]
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Markel TA, Rescorla FJ. J Surg Res 2008; 145:176-177. [DOI: 10.1016/j.jss.2007.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mattix KD, Novotny NM, Shelley AA, Rescorla FJ. Malone antegrade continence enema (MACE) for fecal incontinence in imperforate anus improves quality of life. Pediatr Surg Int 2007; 23:1175-7. [PMID: 17938937 DOI: 10.1007/s00383-007-2026-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The MACE procedure has been used in patients with imperforate anus (IA) to improve fecal continence. Our aim was to assess the impact of the MACE on the quality of life (QOL) in children with IA and fecal incontinence. A retrospective review was performed of children with IA that underwent the MACE procedure between 1997 and 2004. Patients and their parents were contacted by telephone survey regarding continence and its psychosocial effects before and after MACE. The same survey was given to the patients' teachers. Responses to 15 questions were compiled and a QOL score calculated and significance evaluated by t-test (P < or = 0.05). IRB approval was obtained. Thirty-two patients were identified with a mean age at operation of 9 years (4-19 years) and mean follow-up of 3.8 years (7 months to 8 years). Four patients had a low malformation, 8 were intermediate, 15 were high, and 5 had a cloacal anomaly. Twenty patients had documented sacral/spinal anomalies, including five with tethered cord. Post-MACE complications included stenosis in 16 (50%), with 11 requiring an operative revision at a mean of 21.7 months (2 months to 6 years), takedown in one at 4 years and volvulus in one at 18 months. Prior to the MACE, 18/25 (72%) had poor QOL scores. Post-MACE QOL results were similar between patients, parents and teachers. Patients' mean QOL score improved from 59.9 to 26.3% (P < 0.001), with parents from 59.7 to 26.4% (P < 0.001). QOL score improved >50% in nine families, 25-50% in ten and <25% in six. All patients and parents interviewed reported an improvement in their QOL following the MACE. This procedure should be offered to children with IA with the expectation of significant improvement in QOL.
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Affiliation(s)
- Kelly D Mattix
- Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, 545 N. Barnhill Dr. EH202, Indianapolis, IN 46202, USA
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Abstract
OBJECTIVES The purpose of this report is to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in children. METHODS Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; average age 7.69 years) undergoing laparoscopic splenic procedures. RESULTS Two hundred twenty-three children underwent laparoscopic splenectomy (211 total; 12 partial) by the lateral approach. Indication for splenectomy was hereditary spherocytosis (111), immune thrombocytopenic purpura (36), sickle cell disease (SCD) (51), and other (25). Four (2%) required conversion to an open procedure. Eight additional laparoscopic splenic procedures were performed: splenic cystectomy for epithelial (4) or traumatic (2) cyst, and splenopexy for wandering spleen (2). Average length of stay was 1.5 days. Complications (11% overall, 22% in SCD patients) included ileus (5), bleeding (4), acute chest syndrome (5), pneumonia (2), portal vein thrombosis (1), priapism (1), hemolytic uremic syndrome (1), diaphragm perforation (2), colonic injury (1), missed accessory spleen (1), trocar site hernia (1), subsequent total splenectomy after an initial partial (1), and recurrent cyst (1). Subsequent operations were open in 3 (colon repair, hernia, and missed accessory spleen) and laparoscopic in 2 (completion splenectomy, and cyst excision). There were no deaths, wound infections, or instances of pancreatitis. CONCLUSIONS Laparoscopic splenic procedures are safe and effective in children and are associated with low morbidity, higher complication rate in SCD, low conversion rate, zero mortality, and short length of stay. Laparoscopic splenectomy has become the procedure of choice for most children requiring a splenic procedure.
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Affiliation(s)
- Frederick J Rescorla
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Sandoval JA, Turner KE, Hoelz DJ, Rescorla FJ, Hickey RJ, Malkas LH. Serum protein profiling to identify high-risk neuroblastoma: preclinical relevance of blood-based biomarkers. J Surg Res 2007; 142:268-74. [PMID: 17727886 PMCID: PMC2040037 DOI: 10.1016/j.jss.2007.03.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/01/2007] [Accepted: 03/04/2007] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Development of early detection assays for advanced stage neuroblastoma (NB) remains elusive. We have previously shown that serum protein profiling technologies can differentiate healthy from NB children. As various sources of patient related bias exist in serum proteins, we hypothesized a well controlled animal model may provide a better method to identify tumor blood-based markers during NB progression. METHODS Tumors were induced in the left kidneys of nude mice by the injection of cultured human NB cells (10(6)). Sera were collected from control and tumor-bearing mice at 2, 4, and 6 wk. Albumin-depleted sera were subjected to comparative proteomic profiling using 2D gel electrophoresis. Paired samples at each time point were analyzed and differentially expressed serum proteins were identified by mass spectrometry. Additionally, sera proteomic analysis from children with Stage IV NB and healthy controls were performed. RESULTS Overexpression of five mouse serum proteins [alpha(1)-acid glycoprotein, alpha(1)-antitrypsin, alpha(2)-macroglobulin, serum amyloid P-component, and serum amyloid A) were found only in NB-bearing mice. Changes in protein abundance were found to increase 2.5-fold (P < or = 0.05) between 2-, 4-, and 6-wk old mice. Underexpression of immunoglobulin kappa chain constant region was observed in the sera of tumor bearing mice compared with controls (2.5-fold, P < or = 0.05). Among NB patients, alpha(1)-acid glycoprotein, apolipoprotein A-IV, haptoglobin, and serum amyloid A were found to be up-regulated. CONCLUSIONS We identified distinct acute phase proteins that show up-regulation in both an animal tumor model and high-risk NB patients. As these serum proteins have been recognized as markers of tumor progression and prognosis in human malignancies, the validation of these polypeptides may enable serum proteomic profiling to become a valuable tool for identifying high-risk NB.
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Affiliation(s)
- John A Sandoval
- Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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Markel TA, Crisostomo PR, Wang M, Herring CM, Lahm T, Meldrum KK, Lillemoe KD, Rescorla FJ, Meldrum DR. Iron chelation acutely stimulates fetal human intestinal cell production of IL-6 and VEGF while decreasing HGF: the roles of p38, ERK, and JNK MAPK signaling. Am J Physiol Gastrointest Liver Physiol 2007; 292:G958-63. [PMID: 17204543 DOI: 10.1152/ajpgi.00502.2006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bacteria have developed mechanisms to sequester host iron via chelators such as deferoxamine (DFO). Interestingly, DFO has been shown to stimulate acute intestinal epithelial cell inflammatory cytokine production in the absence of bacteria; however, this mechanism has not been elucidated. Intestinal epithelial cell production of IL-6 and TNF-alpha is elevated in various gastrointestinal pathologies, including acute intestinal ischemia. Similarly, VEGF and HGF are essential to intestinal epithelial cell integrity. Therapeutic strategies that decrease IL-6 and TNF-alpha while increasing VEGF and HGF therefore have theoretical appeal. We hypothesized that 1) fetal human intestinal epithelial cells acutely produce increased IL-6, TNF-alpha, VEGF, and HGF during iron chelation and 2) the MAPK pathway mediates these effects. Fetal human intestinal epithelial cells were stimulated by iron chelation (1 mM DFO) with and without p38 MAPK, ERK, or JNK inhibition. Supernatants were harvested after 24 h of incubation, and IL-6, TNF-alpha, VEGF, and HGF levels were quantified by ELISA. Activation of MAPK pathways was confirmed by Western blot analysis. DFO stimulation resulted in a significant increase in epithelial cell IL-6 and VEGF production while yielding a decrease in HGF production (P<0.05). Unexpectedly, TNF-alpha was not detectable. p38 MAPK, ERK, and JNK inhibition significantly decreased IL-6, VEGF, and HGF production (P<0.05). In conclusion, DFO acutely increases fetal human intestinal epithelial cell IL-6 and VEGF expression while causing an unexpected decrease in HGF expression and no detectable TNF-alpha production. Furthermore, chelator-induced intestinal epithelial cell cytokine expression depends on p38, ERK, and JNK MAPK pathways.
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Affiliation(s)
- Troy A Markel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Breckler FD, Fuchs JR, Rescorla FJ. Survey of pediatric surgeons on current practices of bowel preparation for elective colorectal surgery in children. Am J Surg 2007; 193:315-8; discussion 318. [PMID: 17320526 DOI: 10.1016/j.amjsurg.2006.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 09/20/2006] [Accepted: 09/20/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines regarding bowel preparation exist for the adult but not the pediatric population. Our aim was to evaluate the bowel preparation practices, including antibiotic usage for elective colorectal operations in children. METHODS A survey was designed and administered to a nationwide group of pediatric surgeons to ascertain current practices of bowel preparation. RESULTS Four hundred ninety-three surveys were administered, and 136 physicians responded (28%). Mechanical bowel preparation was used by 96% of the respondents. Preoperative intravenous antibiotics were used by 99% of respondents. The number of years in practice did not significantly affect the use of oral antibiotics (P = .62) or the duration of intravenous antibiotics (P = .78). CONCLUSIONS There is a wide variation in bowel preparation practices in children. A prospective, randomized trial would be helpful to identify the role of oral antibiotics and optimal duration of intravenous antibiotics in this population.
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Affiliation(s)
- Francine D Breckler
- James Whitcomb Riley Hospital for Children, Department of Pharmacy, Clarian Health Partners, Room 1016, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
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Rabinovich A, Rescorla FJ, Howard TJ, Grosfeld J, Lillemoe KD. Pancreatic Disorders in Children: Relationship of Postoperative Morbidity and the Indication for Surgery. Am Surg 2006. [DOI: 10.1177/000313480607200714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreatic surgery in children is a rare occurrence, and this unfamiliarity can be associated with the assumption of significant morbidity and mortality. The indication for pediatric pancreatic surgery and its relationship to postoperative complications and mortality was evaluated. Patients with pancreatic disease requiring surgical intervention from 1992 to 2004 at a tertiary referral center were retrospectively reviewed. Disorders were divided into 3 categories: 1) pancreatitis, 2) trauma, and 3) tumors. Sixty-two patients (28 males and 34 females), average age was 9.5 years (range, 1 week–18 years), underwent 72 operations. Thirty-seven procedures in 30 category I patients, 18 procedures in 15 category II, and 17 operations in 17 category III. There was only one death. A total of 33.9 per cent of the patients had postoperative complications that included: infection (11%), pseudocyst (6%), diabetes mellitus (5.6%), pancreatic fistula (3%), bowel obstruction (1.3%), extracellular fluid (1.3%), pleural effusion (1.3%), and recurrent abdominal pain (13%) (all in category I patients). There was equivalent morbidity between all 3 groups but unique differences with in the categories. Recurrent abdominal pain characterized category I patients, fistulas were more common in category II, and diabetes mellitus was primarily related to near total excisions in category III. Pancreatic surgery in children is associated with a very low mortality (1.6%) and morbidity equal to that of adult patients. Unique types of morbidities occur with each category of disease state.
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Affiliation(s)
- Aaron Rabinovich
- From Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana
| | - Frederick J. Rescorla
- From Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana
| | - Thomas J. Howard
- From Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana
| | - Jay Grosfeld
- From Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana
| | - Keith D. Lillemoe
- From Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana
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Sandoval JA, Eppstein AC, Hoelz DJ, Klein PJ, Linebarger JH, Turner KE, Rescorla FJ, Hickey RJ, Malkas LH, Schmidt CM. Proteomic Analysis of Neuroblastoma Subtypes in Response to Mitogen-Activated Protein Kinase Inhibition: Profiling Multiple Targets of Cancer Kinase Signaling. J Surg Res 2006; 134:61-7. [PMID: 16650873 DOI: 10.1016/j.jss.2006.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 02/03/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Survival for high-risk neuroblastoma (NB) remains poor despite aggressive therapy. Novel therapies are vital for improving prognosis. We previously showed differential NB subtype sensitivity to p42/44 mitogen-activated protein kinase (ERK/MAPK) pathway inhibition. In this study, we investigated proteomic changes associated with resistance or sensitivity to MAPK kinase (MEK) inhibition in NB subtypes. MATERIALS AND METHODS SH-SY5Y (N-type), BE(2)-C (I-type), and SK-N-AS (S-type) were treated with MEK inhibitor U0126 (10 microM) for 1 and 24 h. Proteins were extracted from untreated and treated cells and analyzed for differential expression by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE). Selected polypeptides were extracted from the gel and identified by liquid chromatography-linked tandem mass spectrometry (LC-MS/MS). RESULTS We identified 15 proteins that were decreased by 2.5-fold between untreated and 1 h treated cells and subsequently up-regulated 5-fold after 24 h drug treatment. N-type NB (MEK-resistant) showed the least altered proteomic profile whereas the I-type (MEK-sensitive) and S-type NB (MEK-intermediate) generated significant protein changes. The majority of proteins identified were induced by stress. CONCLUSIONS Protein differences exist between MEK inhibitor-treated NB subtypes. Identified polypeptides all have roles in mediating cellular stress. These data suggest that inhibition of the ERK/MAPK in NB subtypes leads to an intracellular stress response. The most resistant NB cell line to MEK inhibitor treatment generated the least protective protein profile, whereas the intermediate and most sensitive NB cells produced the most stress response. These findings suggest stress related protein expression may be targeted in assessing a response to ERK/MAPK therapeutics.
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Affiliation(s)
- John A Sandoval
- Department of Surgery, Indiana University School of Medicine and JW Riley Hospital for Children, Indianapolis, Indiana 46202, USA
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Rabinovich A, Rescorla FJ, Howard TJ, Grosfeld J, Lillemoe KD. Pancreatic disorders in children: relationship of postoperative morbidity and the indication for surgery. Am Surg 2006; 72:641-3. [PMID: 16875089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pancreatic surgery in children is a rare occurrence, and this unfamiliarity can be associated with the assumption of significant morbidity and mortality. The indication for pediatric pancreatic surgery and its relationship to postoperative complications and mortality was evaluated. Patients with pancreatic disease requiring surgical intervention from 1992 to 2004 at a tertiary referral center were retrospectively reviewed. Disorders were divided into 3 categories: 1) pancreatitis, 2) trauma, and 3) tumors. Sixty-two patients (28 males and 34 females), average age was 9.5 years (range, 1 week-18 years), underwent 72 operations. Thirty-seven procedures in 30 category I patients, 18 procedures in 15 category II, and 17 operations in 17 category III. There was only one death. A total of 33.9 per cent of the patients had postoperative complications that included: infection (11%), pseudocyst (6%), diabetes mellitus (5.6%), pancreatic fistula (3%), bowel obstruction (1.3%), extracellular fluid (1.3%), pleural effusion (1.3%), and recurrent abdominal pain (13%) (all in category I patients). There was equivalent morbidity between all 3 groups but unique differences with in the categories. Recurrent abdominal pain characterized category I patients, fistulas were more common in category II, and diabetes mellitus was primarily related to near total excisions in category III. Pancreatic surgery in children is associated with a very low mortality (1.6%) and morbidity equal to that of adult patients. Unique types of morbidities occur with each category of disease state.
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Affiliation(s)
- Aaron Rabinovich
- Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana 46202-5125, USA
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