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Lamoshi A, Lay R, Wakeman D, Edwards M, Wallenstein K, Fabiano T, Singh Z, Zipkin J, Park S, Yu J, Chess M, Vali K. Validation of the predictive model for operative intervention after blunt abdominal trauma in children with equivocal computed tomography findings: a multi-institutional study. Pediatr Surg Int 2024; 40:39. [PMID: 38270628 DOI: 10.1007/s00383-023-05616-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We recently developed a preliminary predictive model identifying clinical and radiologic factors associated with the need for surgery following blunt abdominal trauma (BAT) in children. Our aim in this study was to further validate the factors in this predictive model in a multi-institutional study. METHODS A retrospective chart review of pediatric patients from five pediatric trauma centers who experienced BAT between 2011 and 2020 was performed. Patients under 18 years of age who had BAT and computed tomography (CT) abdomen imaging were included. Children with evidence of pneumoperitoneum, and hemodynamic instability were excluded. Fisher's exact test was used for statistical analysis of the association between the following risk factors and need for laparotomy: abdominal wall bruising (AWB), abdominal pain/tenderness (APT), thoracolumbar fracture (TLF), presence of free fluid (FF), presence of solid organ injury (SOI). A predictive logistic regression model was then estimated employing these factors. FINDINGS Seven hundred thirty-four patients were identified in this multi-institutional dataset with BAT and abdominal CT imaging, and 726 were included. Of those, 59 underwent surgical intervention (8.8%). Univariate analysis of association between the studied factors and need for surgical management showed that the presence of TLF (p < 0.01), APT (p < 0.01), FF (p < 0.01), and SOI (p < 0.01) were significantly associated. A predictive model was created using the 5 factors resulting in an area under the curve (AUC) of 0.80. For the motor vehicle collisions (MVC) group, only FF, SOI, and TLF are significantly associated with the need for surgical intervention. The AUC for the MVC group was 0.87. CONCLUSIONS A clinical and radiologic prediction rule was validated using a large multi-institutional dataset of pediatric BAT patients, demonstrating a high degree of accuracy in identifying children who underwent surgery. FF, SOI, and TLF are the most important factors associated with the need for surgical intervention. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Raymond Lay
- University of Rochester Medical Center, Rochester, NY, USA
| | - Derek Wakeman
- University of Rochester Medical Center, Rochester, NY, USA
| | - Mary Edwards
- Albany Medical College and Center, Albany, NY, USA
| | | | | | | | - Jacob Zipkin
- Albany Medical College and Center, Albany, NY, USA
| | | | | | - Mitchell Chess
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kaveh Vali
- John R. Oishei Children's Hospital, Buffalo, NY, USA
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Arshad SA, Garcia EI, Bell C, Avritscher EBC, Kumar M, Brahmamdam P, Fraser JA, St Peter SD, Aranda A, Hill M, Marquart J, Van Arendonk K, Plumblee L, Streck CJ, Zamora IJ, Ghani MOA, Reichard KW, Sacks K, Kallis M, Hong A, Richards H, Lin S, Gross ER, Kabeer MH, Reyna T, Paton EA, Camp LB, Stephenson K, Dassinger M, Vali K, Filipescu R, DeUgarte DA, Krishna V, Slater B, Islam S, Thompson G, Moore JT, Englum BR, Scholz S, Sharbaugh E, Gander JW, Tsao K. Multicenter Assessment of Cryoanalgesia Use in Minimally Invasive Repair of Pectus Excavatum: A 20-center Retrospective Cohort Study. Ann Surg 2023; 277:e1373-e1379. [PMID: 35797475 DOI: 10.1097/sla.0000000000005440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE). BACKGROUND MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS). MATERIALS AND METHODS A multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant. RESULTS Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P =0.07), including a similar rate of emergency department visit, readmission, and/or reoperation. CONCLUSIONS Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery.
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Affiliation(s)
- Seyed A Arshad
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Elisa I Garcia
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Cynthia Bell
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Elenir B C Avritscher
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | | | | | | | | | | | | | - John Marquart
- Medical College of Wisconsin/Children's Hospital of Wisconsin
| | | | - Leah Plumblee
- Medical University of South Carolina Shawn Jenkins Children's Hospital
| | | | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt
| | - Muhammad O A Ghani
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt
| | | | | | | | - Andrew Hong
- Northwell Health/Cohen Children's Medical Center
| | - Holden Richards
- Oregon Health and Science University/Doernbecher Children's Hospital
| | - Saunders Lin
- Oregon Health and Science University/Doernbecher Children's Hospital
| | - Erica R Gross
- Stony Brook Medicine/Stony Brook Children's Hospital
| | | | - Troy Reyna
- The University of California Irvine/CHOC Children's Hospital
| | - Elizabeth A Paton
- The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
| | - Lauren B Camp
- The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
| | - Krista Stephenson
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital
| | - Melvin Dassinger
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital
| | - Kaveh Vali
- University at Buffalo/Oishei Children's Hospital
| | | | | | - Vikram Krishna
- University of California-Los Angeles/Mattel Children's Hospital
| | | | - Saleem Islam
- University of Florida/Shands Children's Hospital
| | | | - James T Moore
- University of Maryland School of Medicine/University of Maryland Children's Hospital
| | - Brian R Englum
- University of Maryland School of Medicine/University of Maryland Children's Hospital
| | - Stefan Scholz
- University of Pittsburgh/UPMC Children's Hospital of Pittsburgh
| | | | - Jeffrey W Gander
- University of Virginia/University of Virginia Children's Hospital. Excluding those from the lead site, authors are listed by alphabetical order of their institution's name
| | - KuoJen Tsao
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
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Muhammad H, L'Huillier JC, Benson Ham P, Vali K. Strategies for appropriate positioning and repositioning the Avalon ECMO cannula in a 17-year-old with left hepatic vein malposition. Perfusion 2023; 38:645-650. [PMID: 34927476 DOI: 10.1177/02676591211063829] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is a well-recognized therapy in children with refractory hypoxia. Different cannulas have been used with reported complications with placement, such as cardiac perforation, and multiple reports focusing on avoiding this. However, strategies to avoid hepatic vein cannulation and reposition when it occurs are not well described. CASE REPORT Here, we report a case where a 27-Fr Avalon bicaval double lumen cannula in the left hepatic vein was successfully repositioning using serial chest X-rays (CXR) and transthoracic echocardiography (TTE) in a 17-year-old female. DISCUSSION While venovenous (VV) ECMO is preferred by many, placement of the Avalon catheter, a cannula available for VV ECMO, may be challenging due to migration or positioning issues. Specific techniques of wire and catheter advancement as well as confirming wire position in the infra-hepatic inferior vena cava can help ensure appropriate positioning while avoiding hepatic vein cannulation and enabling successful repositioning when it occurs. CONCLUSION Wire position in the infra-hepatic inferior vena cava helps ensure safe and appropriate Avalon cannula position and placement. The Avalon cannula can be successfully repositioned from the left hepatic vein by retracting the cannula, reinserting the wire and introducer together, and then manipulation techniques using serial CXR and TTE.
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Affiliation(s)
- Haris Muhammad
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA
| | - Joseph C L'Huillier
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Phillip Benson Ham
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kaveh Vali
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Lamoshi A, Ham PB, Chen Z, Wilding G, Vali K. Timing of the definitive procedure and ileostomy closure for total colonic aganglionosis HD: Systematic review. J Pediatr Surg 2020; 55:2366-2370. [PMID: 32106964 DOI: 10.1016/j.jpedsurg.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/02/2019] [Revised: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
AIM To establish the cogency of recommendations for the appropriate age for pull-through and ileostomy closure in Total Colonic Aganglionosis-Hirschsprung Disease's (TCA-HD). METHOD Medline, PubMed, Cochrane, and the ClinicalKey databases were searched without date restriction. The studies that reported TCA-HD cases were evaluated for the number of cases, age at the definitive procedure, age at the ileostomy closure, reported complications, and the type of procedure. Perianal excoriation and diaper rash rates were analyzed using SPSS software, with p < 0.05 considered significant. RESULTS Twenty-five studies mentioned TCA-HD findings between 1968 and 2019. The total number of patients who had definitive surgery was 218. Analysis showed no correlation between development of diaper rash and the age of the patient at the time of the definitive surgery or ileostomy closure. Studies scored between six and nine of nine possible stars on the NOS scoring system. CONCLUSION There is no correlation between age of surgery and postoperative diaper rash. Delaying the definitive procedure or ileostomy closure for TCA-HD has limited support on a review of current studies. The perianal excoriation/diaper rash is not reported in the literature at a high enough frequency to warrant keeping a diverting ileostomy until toilet trained of urine. TYPE OF STUDY Systematic review and meta-analysis. Levels of evidence IV.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
| | - P Benson Ham
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY
| | - Z Chen
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - G Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Kaveh Vali
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY
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Calabro KA, Harmon CM, Vali K. Fluorescent Cholangiography in Laparoscopic Cholecystectomy and the Use in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2020; 30:586-589. [PMID: 32301652 DOI: 10.1089/lap.2019.0204] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy and carries an incidence of 0.3%-0.7%. Recently indocyanine green (ICG) fluorescent cholangiography (FC) has been used as an adjunct to identify the biliary tract during adult laparoscopic cholecystectomy, allowing intraoperative identification of biliary anatomy. The objective of this article is to show its successful use in pediatric laparoscopic cholecystectomies. Method: From July 1, 2017, to November 30, 2018, surgeons at John R. Oishei Children's Hospital and Women and Children's Hospital of Buffalo have been utilizing ICG-FC as an adjunct in patients undergoing laparoscopic cholecystectomy. Thirty-one patients undergoing laparoscopic cholecystectomy had 1 mL of dilute ICG (2.5 mg) injected intravenously in the operating room (OR) before trocar placement. Demographics, intraoperative details, and subjective surgeon data were recorded for elective laparoscopic cholecystectomy cases involving ICG. We hypothesize that use of ICG-FC in the pediatric and adolescent patient population is a safe, reliable, and reproducible adjunct for identification of the biliary tree. Secondary outcomes were to identify rate of biliary anatomy identification, utilization ease, and operative times while using ICG technology in pediatric patients. Results: ICG-FC was used in 31 pediatric laparoscopic cholecystectomies performed by 5 surgeons at our institution. Ages ranged from 6 to 18 years. In all cases, the cystic duct-CBD junction was visualized while performing dissection of the triangle of Calot. No intraoperative complications occurred. Conclusions: ICG-FC provides a noninvasive real-time visualization of the extrahepatic biliary tree in children and adolescents. We demonstrate that ICG-FC can successfully be used as an adjunct in pediatric patients and has the potential to facilitate with the dissection and minimize risk of bile duct injuries during pediatric laparoscopic cholecystectomies.
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Affiliation(s)
- Kristen A Calabro
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kaveh Vali
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Dorman RM, Ventro G, Cairo SB, Vali K, Rothstein DH. The use of perioperative ketorolac in the surgical treatment of pediatric spontaneous pneumothorax. J Pediatr Surg 2018; 53:456-460. [PMID: 28728827 DOI: 10.1016/j.jpedsurg.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/06/2017] [Revised: 05/25/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We sought to determine the effect of ketorolac on pediatric primary spontaneous pneumothorax recurrence after operation. METHODS The Pediatric Health Information System database was queried for patients ages 10-16years discharged in the years 2004-2014 with pneumothorax or pleural bleb and a related operative procedure. Deaths and secondary pneumothorax were excluded. Variables included demographics, chronic disease, intensive care unit admission, mechanical ventilation, and lung resection or plication. The primary variable was any ketorolac administration between post-operative day 0 and 5. Outcomes included reintervention within 1year, readmission, post-operative length of stay (LOS), and cost. Bivariate and multivariate logistic regression analyses were performed. RESULTS Of 1678 records that met inclusion criteria, 395 (23%) were subsequently excluded, leaving 1283 patients for analysis. Most patients had a lung resection recorded (78%) and the majority were administered ketorolac (57%); few required reintervention (20%) or readmission (18%). Mean postoperative LOS was 5.2±3.8days and mean cost was $17,649±$10,599. On bivariate analysis, ketorolac administration did not correlate with any measured outcome. On both bivariate and multivariate analysis, no variable was predictive of reintervention, and only lung resection correlated with readmission (adjusted odds ratio 0.63 [95% C.I. 0.45-0.90]). CONCLUSION Post-operative ketorolac administration was not associated with an increased likelihood of reintervention or readmission within 1year of operative treatment of primary spontaneous pneumothorax, suggesting that it may be used safely as part of a post-operative pain control regimen. Effects on postoperative length of stay and cost, however, were not demonstrated. LEVEL OF EVIDENCE AND TYPE OF STUDY Level III treatment study.
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Affiliation(s)
- R Michael Dorman
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo.
| | - George Ventro
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - Sarah B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - Kaveh Vali
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
| | - David H Rothstein
- Department of Surgery, University at Buffalo, SUNY; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo
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Dorman RM, Vali K, Rothstein DH. Trends in treatment of infectious parapneumonic effusions in U.S. children's hospitals, 2004-2014. J Pediatr Surg 2016; 51:885-90. [PMID: 27032611 DOI: 10.1016/j.jpedsurg.2016.02.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/10/2016] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine trends in the treatment of patients with infectious parapneumonic effusions in U.S. children's hospitals over the past decade. METHODS The PHIS database was queried for patients younger than 18years old with pneumonia and pleural effusion in three yearlong periods over the past decade. Variables included age, gender, payer, race/ethnicity, hospital region, hospital type, markers of illness severity, and treatment group (antibiotics alone, chest tube thoracostomy±thrombolytics, video-assisted thoracoscopy (VATS), or thoracotomy). RESULTS 5569 patients were included in the final analysis. The proportion of patients treated with antibiotics alone increased from 62% to 74% from 2004 to 2014 (p<0.001). Among patients requiring pleural space drainage, the frequency of VATS peaked in 2009 (50.8%), dropping to 36.4% in 2014 (p<0.001), while tube thoracostomy, usually with fibrinolytics, rose from 39.0% in 2009 to 53.2% in 2014 (p<0.001). CONCLUSION In a select cohort of free-standing, tertiary care U.S. children's hospitals, antibiotic administration alone remains the most common treatment approach to infectious parapneumonic effusions. VATS treatment for those patients requiring pleural space drainage is being gradually supplanted by thoracostomy tube placement with instillation of fibrinolytics.
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Affiliation(s)
- Robert M Dorman
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY
| | - Kaveh Vali
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY.
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Vali K, Kokta V, Beaunoyer M, Fetni R, Teira P, Sartelet H. Extraosseous Ewing sarcoma with foci of neuroblastoma-like differentiation associated with EWSR1(Ewing sarcoma breakpoint region 1)/FLI1 translocation without prior chemotherapy. Hum Pathol 2012; 43:1772-6. [DOI: 10.1016/j.humpath.2012.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/28/2012] [Accepted: 03/02/2012] [Indexed: 11/28/2022]
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Lemoine C, Paris C, Morris M, Vali K, Beaunoyer M, Aspirot A. Open transumbilical pyloromyotomy: is it more painful than the laparoscopic approach? J Pediatr Surg 2011; 46:870-3. [PMID: 21616243 DOI: 10.1016/j.jpedsurg.2011.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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: 01/31/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Open transumbilical pyloromyotomy (UMBP) and laparoscopic pyloromyotomy (LAP) have been compared on different outcomes, but postoperative pain as a primary end point had never been assessed. The aim of this study was to compare the use of analgesia in UMBP and LAP patients. METHODS Infants with hypertrophic pyloric stenosis treated by UMBP in 2008-2009 were matched with LAP-treated infants. Demographics, type and use of analgesia, and length of stay were recorded. Statistical analysis was performed using the Fisher exact test. RESULTS Each group contained 19 patients (N = 38) with comparable demographics and no comorbid condition. Bupivacaine was injected intraoperatively in all UMBP and 89% of LAP infants. There was a trend toward increased acetaminophen use in LAP infants (79% vs 58%, P = .61) in the recovery room. There was no difference in opiates use (3 UMBP vs 1 LAP, P = .60). In the ward, more UMBP patients received acetaminophen (78% vs 53%, P = .03). This difference was significant. Mean postoperative length of stay was similar in both groups. CONCLUSION Our study suggests that UMBP infants might experience more postoperative pain in the ward, without any impact on various outcomes. A prospective study with a larger sample size should be undertaken to verify these findings.
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Affiliation(s)
- Caroline Lemoine
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Abstract
BACKGROUND A 29-year-old woman who presented with fatigue and jaundice was found to have an obstructing mass at the bifurcation of the bile duct. The patient underwent a successful left hepatectomy with resection of the bile duct bifurcation and a reconstruction with a right hepaticojejunostomy. Pathology revealed an atypical carcinoid tumour of the left extrahepatic bile duct, with perineural and lymphatic invasion. The patient subsequently developed multiple metastases in the remaining liver. METHODS In the absence of extrahepatic disease, the patient underwent a successful liver transplant. RESULTS Two years later she remains disease-free. DISCUSSION To our knowledge this is the first report of a biliary carcinoid treated with hepatectomy and finally with liver transplantation, with excellent results. The biological behaviour of these rare tumours mandates aggressive surgical management.
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Affiliation(s)
- G. N. Tzimas
- Division of General Surgery, Section of Transplantation and Hepatobiliary Surgery, McGill University Health CenterMontreal QuebecCanada
| | - K. Vali
- Division of General Surgery, Section of Transplantation and Hepatobiliary Surgery, McGill University Health CenterMontreal QuebecCanada
| | - M. Deschênes
- Department of Medicine, McGill University Health CenterMontreal QuebecCanada
| | - V. A. Marcus
- Department of Pathology, McGill University Health CenterMontreal QuebecCanada
| | - J. S. Barkun
- Division of General Surgery, Section of Transplantation and Hepatobiliary Surgery, McGill University Health CenterMontreal QuebecCanada
| | - J. I. Tchervenkov
- Division of General Surgery, Section of Transplantation and Hepatobiliary Surgery, McGill University Health CenterMontreal QuebecCanada
| | - P. P. Metrakos
- Division of General Surgery, Section of Transplantation and Hepatobiliary Surgery, McGill University Health CenterMontreal QuebecCanada
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Vali K, Gupta IR. The Effect of Cefotaxime on Kidney Development. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.26aa] [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: 11/13/2022] Open
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