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Burnette C, Tashjian M, Cruz F, Mattei P. Correction of Facial Asymmetry After Skin Cancer Reconstruction Using Polydioxanone Lifting Threads. Dermatol Surg 2024; 50:480-481. [PMID: 38306438 DOI: 10.1097/dss.0000000000004096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Colin Burnette
- Nova Southeastern University College of Osteopathic Medicine, Davie, Florida
| | - Michelle Tashjian
- Nova Southeastern University College of Osteopathic Medicine, Davie, Florida
| | - Frainelys Cruz
- Dermatology Service, US Department of Veterans Affairs, Bay Pines Healthcare System, Cape Coral, Florida
| | - Peter Mattei
- Dermatology Service, US Department of Veterans Affairs, Bay Pines Healthcare System, Cape Coral, Florida
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Schoeman S, Bagatell R, Cahill AM, Maris J, Mattei P, Mosse Y, Pogoriler J, Srinivasan A, Acord M. Percutaneous biopsy for the diagnosis, risk stratification, and molecular profiling of neuroblastoma: A single-center retrospective study. Pediatr Blood Cancer 2024; 71:e30887. [PMID: 38291721 DOI: 10.1002/pbc.30887] [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] [Received: 10/06/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE To determine whether percutaneous core needle biopsy (PCNB) is adequate for the diagnosis and full molecular characterization of newly diagnosed neuroblastoma. MATERIALS AND METHODS Patients with newly diagnosed neuroblastoma who underwent PCNB in interventional radiology at a single center over a 5-year period were included. Pre-procedure imaging and procedure details were reviewed. Rates of diagnostic success and sufficiency for International Neuroblastoma Pathology Classification (INPC), risk stratification, and evaluation of genomic markers utilized in the Children's Oncology Group risk stratification, and status of the anaplastic lymphoma kinase (ALK) gene were assessed. RESULTS Thirty-five patients (13 females, median age 2.4 years [interquartile range, IQR: 0.9-4.4] and median weight 12.4 kg [IQR: 9.6-18]) were included. Most had International Neuroblastoma Risk Group Stage M disease (n = 22, 63%). Median longest axis of tumor target was 8.8 cm [IQR: 6.1-12]. A 16-gauge biopsy instrument was most often used (n = 20, 57%), with a median of 20 cores [IQR: 13-23] obtained. Twenty-five specimens were assessed for adequacy, and 14 procedures utilized contrast-enhanced ultrasound guidance. There were two post-procedure bleeds (5.7%). Thirty-four of 35 procedures (97%) were sufficient for histopathologic diagnosis and risk stratification, 94% (n = 32) were sufficient for INPC, and 85% (n = 29) were sufficient for complete molecular characterization, including ALK testing. Biologic information was otherwise obtained from bone marrow (4/34, 12%) or surgery (1/34, 2.9%). The number of cores did not differ between patients with sufficient versus insufficient biopsies. CONCLUSION In this study, obtaining multiple cores with PCNB resulted in a high rate of diagnosis and successful molecular profiling for neuroblastoma.
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Affiliation(s)
- Sean Schoeman
- Department of Radiology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Rochelle Bagatell
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Maris
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Peter Mattei
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Yael Mosse
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Jennifer Pogoriler
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Anatomical Pathology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Abhay Srinivasan
- Department of Radiology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Acord
- Department of Radiology, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Johnston WR, Hwang R, Mattei P. Ostomy Management for Pediatric Perianal Crohn's Disease. J Pediatr Surg 2023:S0022-3468(23)00693-0. [PMID: 38104035 DOI: 10.1016/j.jpedsurg.2023.11.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Pediatric patients with perianal Crohn's Disease (CD) suffer recalcitrant fistulas, abscesses, and strictures. Fecal diversion is a palliative last resort, but the expected clinical course and long-term management of the ostomy for this population is unclear. We sought to identify factors predictive of ostomy takedown and establish management recommendations for fistulizing and stenosing disease. METHODS We reviewed our institutional registry for patients aged 1-18 years with CD who received perianal surgery from 2011 to 2021. We analyzed medical therapy, examinations under anesthesia (EUA), fistula and stenosis response, and rates of fecal diversion and reversal. RESULTS There were 109 patients with fistulizing CD and 21 with stenosing CD. There were 8 diverted for fistula and 4 due to stricture [8/109 (7 %) vs 4/21 (19 %), p = 0.213]. Three patients with fistulizing disease had their ostomy reversed at an average of 1.46 years. Each demonstrated consistent CD control and with no additional perianal flares. The remainder have been diverted 3.15 ± 4.57 years with 2.1 ± 2.8 EUAs. Only one patient with stricture was durably reversed, but they still require serial anal dilation. Two were reversed but required re-diversion due to stricture progression. CONCLUSION Reversal rates after fecal diversion for pediatric perianal CD remain disappointingly low and diversion does not obviate the possibility of future EUAs. While reversal was successful for medically responsive patients with fistulizing disease, those with stenosing disease remained dependent on anal dilations and were more likely to fail reversal. Fecal diversion does nothing to reverse an established stricture and such patients will likely need to decide between indefinite dilations or permanent ostomy. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective review.
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Affiliation(s)
- William R Johnston
- General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rosa Hwang
- General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter Mattei
- General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; FAAP, USA
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Talbot LJ, Lautz TB, Aldrink JH, Ehrlich PF, Dasgupta R, Mattei P, Tracy ET, Glick RD, Grant CM, Brown EG, Christison-Lagay ER, Rodeberg DA. Implications of Immunotherapy for Pediatric Malignancies: A Summary from the APSA Cancer Committee. J Pediatr Surg 2023; 58:2119-2127. [PMID: 37550134 DOI: 10.1016/j.jpedsurg.2023.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/01/2023] [Accepted: 07/01/2023] [Indexed: 08/09/2023]
Abstract
Although survival for many pediatric cancers has improved with advances in conventional chemotherapeutic regimens and surgical techniques in the last several decades, it remains a leading cause of disease-related death in children. Outcomes in patients with recurrent, refractory, or metastatic disease are especially poor. Recently, the advent of alternative classes of therapies, including immunotherapies, have revolutionized systemic treatment for pediatric malignancies. Several classes of immunotherapies, including chimeric antigen receptor (CAR) T cell therapy, transgenic T-cell receptor (TCR)-T cell therapy, bispecific T-cell engagers, and monoclonal antibody checkpoint inhibitors have been FDA-approved or entered early-phase clinical trials in children and young adults. The pediatric surgeon is likely to encounter these therapies during the care of children with malignancies and should be familiar with the classes of therapy, indications, adverse events, and potential need for surgical intervention in these cases. This review from the APSA Cancer Committee offers a brief discussion of the three most encountered classes of immunotherapy in children and young adults and discusses surgical relevance. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa, USA
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Christa M Grant
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
| | - Erin G Brown
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale School of Medicine, Yale-New Haven Children's Hospital, New Haven, CT, USA
| | - David A Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC, USA
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Hill-Kayser CE, Li Y, Kurtz G, Mattei P, Balis F, Lustig RA, LaRiviere MJ, MacFarland S, Batra V, Mosse Y, Maris J, Balamuth N, Bagatell R. Survival and Local Recurrence Risk in Patients with High-Risk Neuroblastoma Treated with Proton Therapy over a 10 Year Interval. Int J Radiat Oncol Biol Phys 2023; 117:e516-e517. [PMID: 37785612 DOI: 10.1016/j.ijrobp.2023.06.1780] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients (pts) with high-risk neuroblastoma (HR-NBL) require radiation (RT) to the primary tumor site (PS); approach is standardized within North American paradigms but remains a subject of global study. Long-term experience using proton therapy (PRT) in this population is lacking. We hypothesized that PRT would be associated with low risk of local recurrence (LR) in a large population of pts with HR-NBL spanning > 10 years. MATERIALS/METHODS Sequential pts with HR-NBL at a single institution received RT to PS and persistent metastatic sites (MS). Dose to PS after subtotal resection (STR) was reduced from 36 Gy to 21.6 Gy in 2019 based on results from the Children's Oncology Group ANBL0532 trial (Liu K, 2019). Analysis using Kaplan Meier method and log rank test was performed with IRB approval. RESULTS From 9/2010 - 12/2021, 99 pts with HR-NBL received PS RT during first-line therapy; most [78, (79%)] had adrenal primary tumors and 26 (26%) received MS RT. Median age was 48m at RT (R 11m to 17.5y) and 52 (53%) were female. All pts had multi-agent induction chemotherapy (CT) [+ dinutuximab [12 (13%)] and/ or therapeutic 131MIBG [19 (19%)] and resection of primary tumor prior to RT; 34 (34%) patients had STR with residual disease (RD) on post-op imaging, 65 (66%) had gross total resection (GTR). Dose to PS was 21.6 Gy for 78 (79%) pts and 36 Gy for 21 (21%) based on RD and treatment era; PRT was pencil beam [78 (79%)] or double scattered [22 (22%)], combined with IMRT in 2 (2%). With median FU of 4.2 yrs (R 0.5y - 12y), 80 pts (81%) are alive [66 (67%) disease-free, 14 (14%) with disease], 19 (19%) have died. Progressive disease (PD) occurred in 33 (33%), with median time to PD 24m (R 8-116m); two pts (2%) had isolated LR, 25 (25%) distant PD, and 6 (6%) concurrent LR and distant PD. Risk of LR at 10 years was 8%; absolute risk of any LR was 8% (6/78) in 21.6 Gy cohort and 9% (2/21) in 36 Gy cohort (p = NS). After induction CT, 34 (34%) pts had STR with > 1cm3 RD on axial imaging; 18/ 34 (53%) also had MIBG uptake (MIBG+) at PS. Based on treatment era, 21 pts (62%) after STR received 21.6 Gy + boost to RD (36 Gy), and 13 (38%) 21.6 alone. Of those who received 36 Gy (median FU 5.7y), 2/21 (9.5%) had LR with concurrent distant PD; of those who received 21.6 Gy (median FU 3.2y) 4/13 (31%) had LR (2 with concurrent distant PD and 2 LR only) (p = 0.03). In the 21.6 Gy GTR cohort, 2/65 (3%) had LR + distant PD. Of 8 total patients who experienced LR, 5 had MIBG + RD, 1 MIBG- RD, and 2 GTR. CONCLUSION We observed excellent outcomes in 99 pts treated with proton radiotherapy for HR-NBL from 2010 through 2021, with 81% of patients alive and 92% free of LR. Our data suggest that LR is rare after GTR and 21.6 Gy, and uncommon among pts with STR treated with 36 Gy. A small number of pts received 21.6 Gy after STR, however, this experience suggests that a subset of pts with RD may require RT dose > 21.6 Gy. Further work is required to further characterize individual management of PS in pts with HR-NBL with regard to extent of RD and biologic disease features.
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Affiliation(s)
- C E Hill-Kayser
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA
| | - Y Li
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - G Kurtz
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - P Mattei
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - F Balis
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - R A Lustig
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - M J LaRiviere
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - S MacFarland
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - V Batra
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Y Mosse
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - J Maris
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - N Balamuth
- Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - R Bagatell
- Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
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Mittal S, Long C, El-Ali A, Talwar R, Lattanzio K, Lawton B, Hamdan D, Balis FM, Mattei P, Back SJ, Kolon TF. Utilizing RENAL nephrometry in pediatric patients undergoing nephron-sparing surgery for renal tumors: A single-institutional cohort. J Pediatr Urol 2023; 19:641.e1-641.e6. [PMID: 37453876 DOI: 10.1016/j.jpurol.2023.03.041] [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] [Received: 11/26/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION RENAL Nephrometry is a complexity score validated in adults with renal tumors and describes the likelihood of complication after partial nephrectomy (PN). Utilization in pediatrics has been limited. Thus, our goal is to quantify inter-rater agreement as well as determine how scores correlate with outcomes. We hypothesize that the RENAL Nephrometry Score is reproducible in children with renal tumors and is related to perioperative and post-operative complications. METHODS All pediatric patients who underwent PN for a renal mass from 2006 to 2019 were identified. Patient data, operative details, and outcomes were aggregated. Pre-operative CT/MR imaging was anonymized and scored by 2 pediatric radiologists and 2 pediatric urologists using RENAL Nephrometry metrics. Statistical analysis utilized Fleiss' kappa and the intraclass correlation coefficient (ICC). Comparative analyses were performed based on Nephrometry Score <9 and ≥ 9. RESULTS 28 patients undergoing 33 PN were identified. Median age at surgery was 3.2 years (IQR 1.8-4.0). There is moderate-good agreement across scorers on the domains of RENAL Nephrometry Score, with the lowest agreement noted for anterior vs posterior tumors. Comparing patients with scores <9 and ≥ 9, there was increased operative time (357 vs 267 min, p = 0.003) and LOS for those with a higher score, but no difference in the incidence of 30-day complications. CONCLUSION RENAL Nephrometry Score is an easily reproducible complexity score for renal tumors in pediatric patients. Higher scores are associated with increased length of stay and estimated blood loss but not complications. Reporting of nephrometry scores in future publications on pediatric renal tumors should become standard in the literature.
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Affiliation(s)
- Sameer Mittal
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Christopher Long
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Alexander El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 1st Ave, New York, NY 10016, USA.
| | - Ruchika Talwar
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Katherine Lattanzio
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Brendan Lawton
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Dawud Hamdan
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Frank M Balis
- Children's Hospital of Philadelphia, Division of Oncology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Peter Mattei
- Children's Hospital of Philadelphia, Division of General, Thoracic, and Fetal Surgery, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Susan J Back
- Children's Hospital of Philadelphia, Department of Radiology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Thomas F Kolon
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
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Rich BS, Brown EG, Rothstein DH, Baertschiger RM, Jackson GA, Roach JP, Naik-Mathuria B, Tracy ET, Mattei P, Glick RD, Ehrlich PF, Aldrink JH, Rodeberg D, Lautz TB. The Utility of Intraoperative Neuromonitoring in Pediatric Surgical Oncology. J Pediatr Surg 2023; 58:1708-1714. [PMID: 36907768 DOI: 10.1016/j.jpedsurg.2023.02.003] [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] [Received: 09/07/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Intraoperative nerve monitoring (IONM) is a technique used to decrease the possibility of nerve-associated morbidity and damage to nearby neural structures during complex surgical procedures. The use and potential benefits of IONM in pediatric surgical oncology are not well-described. METHODS An overview of the current literature was performed to elucidate the various techniques that may be useful to pediatric surgeons for resection of solid tumors in children. RESULTS The physiology and common types of IONM relevant to the pediatric surgeon are described. Important anesthetic considerations are reviewed. Specific applications for IONM that may be useful in pediatric surgical oncology are then summarized, including its use for monitoring the recurrent laryngeal nerve, the facial nerve, the brachial plexus, spinal nerves, and lower extremity nerves. Troubleshooting techniques regarding common pitfalls are then proposed. CONCLUSION IONM is a technique that may be beneficial in pediatric surgical oncology to minimize nerve injury during extensive tumor resections. This review aimed to elucidate the various techniques available. IONM should be considered as an adjunct for the safe resection of solid tumors in children in the proper setting with the appropriate level of expertise. A multidisciplinary approach is advised. Additional studies are necessary to further clarify the optimal use and outcomes in this patient population. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA.
| | - Erin G Brown
- Division of Pediatric Surgery, University of California, Davis Children's Hospital, Sacramento, CA, USA
| | - David H Rothstein
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - G Adam Jackson
- Division of Neurophysiology, BioTronic Neuro Network (BNN), St. Joseph's Hospital, Chicago, IL, USA
| | - Jonathan P Roach
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke Children's Hospital and Health Center, Durham NC, USA
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Rodeberg
- Division of Pediatric Surgery, Kentucky Children's Hospital, Lexington, KY, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, IL, USA
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Abstract
Background: After open or thoracoscopic lung biopsy, it is common to leave a chest tube as a postoperative drain that is typically removed on the first or second postoperative day. Standard technique is to apply an occlusive dressing at the site of chest tube removal using gauze and some form of tape. Methods: We reviewed the charts of children who underwent thoracoscopic lung biopsy at our institution for the past 9 years, many of whom left the operating room with a chest tube. When the tube was removed, the site was dressed, based on attending surgeon preference, with either cyanoacrylate tissue adhesive (Dermabond®; Ethicon, Cincinnati, OH) or a standard dressing with gauze and transparent occlusive adhesive dressing. Endpoints included wound complications and need for a secondary dressing. Results: Of 134 children who underwent thoracoscopic biopsy, 71 (53%) were given a chest tube. Chest tubes were removed at bedside in standard manner after a mean of 2.5 days. In 36 (50.7%) cyanoacrylate was used and in 35 (49.3%) a standard occlusive gauze dressing was used. No patient in either group suffered a wound dehiscence or needed a rescue dressing. There were no wound-related complications or surgical site infections in either group. Conclusion: Cyanoacrylate dressings are effective for closure of chest tube drain sites and appear to be safe. They might also save patients from having to deal with a bulky bandage and the discomfort of having a strong adhesive removed from their surgical site.
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Affiliation(s)
- Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Jen J, Hwang R, Mattei P. Post-discharge antibiotics do not prevent intra-abdominal abscesses after appendectomy in children. J Pediatr Surg 2023; 58:258-262. [PMID: 36428182 DOI: 10.1016/j.jpedsurg.2022.10.024] [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] [Received: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
AIM OF THE STUDY Perforated appendicitis is common in children, often associated with long hospital stays and high risk of complications. There has been much discussion regarding whether antibiotics prescribed after discharge might reduce the risk of intra-abdominal abscess. This study aims to evaluate whether giving post-discharge antibiotics after appendectomy for perforated appendicitis reduces the risk of abscess. METHOD After obtaining IRB approval, we reviewed the records of 363 patients who underwent appendectomy for perforated appendicitis at our tertiary pediatric institution from July 2015 to December 2021. Based on surgeon's preference, patients comprised two groups: those discharged with antibiotics (n = 86) or without antibiotics (n = 277). We compared post-discharge ED visits, 30-day readmissions, and SSI, analyzed with population proportion Z-tests with significance levels of 0.05. RESULTS Post-discharge organ-space infections occurred in 4/86 (4.7%) of those with antibiotics and 9/277 (3.2%) of those without (P = 0.54). Post-discharge ED visits occurred in 10/86 (11.6%) for those with antibiotics and 23/277 (8.3%) for those without (P = 0.35). Thirty-day readmissions occurred in 6/86 (7.0%) for those with antibiotics and 10/277 (3.6%) for those without (P = 0.18). Superficial and deep SSI occurred in 0/86 (0%) for those with antibiotics and 5/277 (1.8%) for those without (P = 0.21). CONCLUSION In children who underwent appendectomy for perforated appendicitis, antibiotics prescribed after discharge did not reduce the incidence of intra-abdominal abscess, ED visits, or SSI. Given appropriate clinical judgment, it is safe to discharge patients with perforated appendicitis home without antibiotics. LEVEL OF EVIDENCE Level III treatment study: retrospective comparative study.
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Affiliation(s)
- Jeremy Jen
- Department of Surgery, Mercy Catholic Medical Center, Mercy Fitzgerald Hospital, Darby, PA, United States.
| | - Rosa Hwang
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Peter Mattei
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Mattei P. Small-bowel plication prevents ileostomy prolapse in young children with inflammatory bowel disease. Pediatr Surg Int 2023; 39:88. [PMID: 36690789 DOI: 10.1007/s00383-023-05375-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE Young children with medically refractory very early-onset inflammatory bowel disease (VEO-IBD) sometimes benefit from ileostomy diversion alone or may be offered subtotal colectomy with ileostomy. Though generally well-tolerated, ileostomy complications are frequent. Prolapse is particularly frustrating as it can be difficult and painful to reduce, becomes a recurring problem is some patients, and often requires ostomy revision or bowel resection. METHODS Over the course of the past 6 months, eight consecutive children with VEO-IBD underwent 10 creation or revision of a diverting ileostomy (two underwent subsequent colectomy with ileostomy revision). In each of these 10 cases, we plicated the ileum just proximal to the ileostomy for a distance of approximately 3 cm using a running permanent monofilament suture. RESULTS No patient who underwent plication of bowel has developed ileostomy prolapse. There were no cases of ileostomy retraction, parastomal hernia or ostomy-level obstruction. One patient required a lysis of a single band adhesion for a more proximal small bowel obstruction. The stomas have functioned well and there have been no complications. CONCLUSION Simple bowel plication appears to be a quick and effective way to prevent ileostomy prolapse in young children with VEO-IBD with an ileostomy who are at high risk for prolapse.
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Affiliation(s)
- Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, HUB 2525, 34th Street & Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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11
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Sasso FC, Simeon V, Galiero R, Caturano A, De Nicola L, Chiodini P, Rinaldi L, Salvatore T, Lettieri M, Nevola R, Sardu C, Docimo G, Loffredo G, Marfella R, Adinolfi LE, Minutolo R, Amelia U, Acierno C, Calatola P, Carbonara O, Conte G, Corigliano G, Corigliano M, D’Urso R, De Matteo A, De Nicola L, De Rosa N, Del Vecchio E, Di Giovanni G, Gatti A, Gentile S, Gesuè L, Improta L, LampitellaJr A, Lampitella A, Lanzilli A, Lascar N, Masi S, Mattei P, Mastrilli V, Memoli P, Minutolo R, Nasti R, Pagano A, Pentangelo M, Pisa E, Rossi E, Sasso FC, Sorrentino S, Torella R, Troise R, Trucillo P, Turco AA, Turco S, Zibella F, Zirpoli L. The number of risk factors not at target is associated with cardiovascular risk in a type 2 diabetic population with albuminuria in primary cardiovascular prevention. Post-hoc analysis of the NID-2 trial. Cardiovasc Diabetol 2022; 21:235. [PMID: 36344978 PMCID: PMC9641842 DOI: 10.1186/s12933-022-01674-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background Nephropathy in Diabetes type 2 (NID-2) study is an open-label cluster randomized clinical trial that demonstrated that multifactorial intensive treatment reduces Major Adverse Cardiac Events (MACEs) and overall mortality versus standard of care in type 2 diabetic subjects with albuminuria and no history of cardiovascular disease. Aim of the present post-hoc analysis of NID- 2 study is to evaluate whether the number of risk factors on target associates with patient outcomes. Methods Intervention phase lasted four years and subsequent follow up for survival lasted 10 years. To the aim of this post-hoc analysis, the whole population has been divided into 3 risk groups: 0–1 risk factor (absent/low); 2–3 risk factors (intermediate); 4 risk factors (high). Primary endpoint was a composite of fatal and non-fatal MACEs, the secondary endpoint was all-cause death at the end of the follow-up phase. Results Absent/low risk group included 166 patients (52.4%), intermediate risk group 128 (40.4%) and high-risk group 23 (7.3%). Cox model showed a significant higher risk of MACE and death in the high-risk group after adjustment for confounding variables, including treatment arm (HR 1.91, 95% CI 1.04–3.52, P = 0.038 and 1.96, 95%CI 1.02–3.8, P = 0,045, respectively, vs absent/low risk group). Conclusions This post-hoc analysis of the NID-2 trial indicates that the increase in the number of risk factors at target correlates with better cardiovascular-free survival in patients with type 2 diabetes at high CV risk. Clinical Trial Registration ClinicalTrials.gov number, NCT00535925. https://clinicaltrials.gov/ct2/show/NCT00535925 Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01674-7.
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12
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Hill-Kayser C, Vogel J, Li Y, Lustig R, Kurtz G, LaRiviere M, Cummings E, Mattei P, Balamuth N, Bagatell R, MacFarland S, Evageliou N, Tochner Z, Balis F. Conformal Pencil Beam Scanning Proton Therapy for Delivery of Flank Radiation in Children with Renal Tumors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.466] [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: 10/31/2022]
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13
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Leibowitz MS, Zelley K, Adams D, Brodeur GM, Fox E, Li MM, Mattei P, Pogoriler J, MacFarland SP. Neuroblastoma and cutaneous angiosarcoma in a child with PTEN hamartoma tumor syndrome. Pediatr Blood Cancer 2022; 69:e29656. [PMID: 35278038 DOI: 10.1002/pbc.29656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/26/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Michael S Leibowitz
- Division of Oncology, Department of Pediatrics, Children's Hospital of Phialdelphia, Philadelphia, Pennsylvania, USA
| | - Kristin Zelley
- Division of Oncology, Department of Pediatrics, Children's Hospital of Phialdelphia, Philadelphia, Pennsylvania, USA
| | - Denise Adams
- Division of Oncology, Department of Pediatrics, Children's Hospital of Phialdelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Garrett M Brodeur
- Division of Oncology, Department of Pediatrics, Children's Hospital of Phialdelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth Fox
- Department of Oncology, St. Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Marilyn M Li
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelpiha, Philadelphia, Pennsylvania, USA
| | - Peter Mattei
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Pogoriler
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelpiha, Philadelphia, Pennsylvania, USA
| | - Suzanne P MacFarland
- Division of Oncology, Department of Pediatrics, Children's Hospital of Phialdelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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14
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Moon JK, Hwang R, Balis FM, Mattei P. An enhanced recovery after surgery protocol in children who undergo nephrectomy for Wilms tumor safely shortens hospital stay. J Pediatr Surg 2022; 57:259-265. [PMID: 35768311 DOI: 10.1016/j.jpedsurg.2022.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/26/2021] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric unilateral renal tumors in the US are treated with upfront nephrectomy and surgical staging. We applied enhanced recovery after surgery (ERAS) principles in care of children after Wilms nephrectomy. METHODS We reviewed records of pediatric unilateral nephrectomies for Wilms tumors, and analyzed tumor stage, surgical approach, length of operation, use of anesthesia adjuncts and catheters, diet advancement, hospital length of stay (LOS), and complications. Our ERAS protocol includes: parental education regarding discharge criteria and anticipated LOS, avoiding thoraco abdominal incisions, avoiding routine nasogastric tubes, clear liquids starting day of surgery, minimizing opiates, routine IV ketorolac use, and avoiding routine ICU stay. We examined the effects of our protocol on postoperative hospital LOS and complication rates. RESULTS Sixty six children (31 boys, mean age 3.8y, range 0-11.9) underwent unilateral total nephrectomy for Wilms tumor. Mean nephrectomy duration was 2.7 h. Post operatively, seven (11%) had temporary gastric tubes and 24 (36%) had epidural catheters. Ten (15%) recovered in the ICU. Patients were given regular diets mean of 1.9 days post op. Mean LOS was 3.7 days, with 56% of patients being discharged within 2-3 days. Presence of tumor thrombus, longer epidural catheter duration, delayed diet advancement, and total IV narcotic usage were associated with longer LOS. Routine use of IV ketorolac was associated with shorter LOS. CONCLUSIONS Use of an ERAS protocol in children undergoing nephrectomy for Wilms tumor is safe, resulting in rapid return to regular diet and compared to the published literature, shorter postoperative LOS without an increase in complications or return to ED/OR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- James K Moon
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of General Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Rosa Hwang
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Frank M Balis
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter Mattei
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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15
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Breton J, Tanes C, Tu V, Albenberg L, Rowley S, Devas N, Hwang R, Kachelries K, Wu GD, Baldassano RN, Bittinger K, Mattei P. A Microbial Signature for Paediatric Perianal Crohn's Disease. J Crohns Colitis 2022; 16:1281-1292. [PMID: 35211723 DOI: 10.1093/ecco-jcc/jjac032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/09/2021] [Accepted: 02/23/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Perianal fistulising disease can affect up to 25% of patients with Crohn's disease [CD] and lead to significant morbidity. Although the role of the gut microbiota in inflammatory bowel disease [IBD] has been increasingly recognised, its role in fistula development has scarcely been studied. Here, we aimed to define the microbial signature associated with perianal fistulising CD in children. METHODS A prospective observational study including children age 6-18 years with a diagnosis of perianal fistulising CD was conducted. Stool samples and rectal and perianal fistula swabs were collected. Stool samples and rectal swabs from children with CD without perianal disease and healthy children were included as comparison. Whole shotgun metagenomic sequencing was performed. RESULTS A total of 31 children [mean age 15.5 ± 3.5 years] with perianal CD were prospectively enrolled. The fistula-associated microbiome showed an increase in alpha diversity and alteration in the abundance of several taxa compared with the rectal- and faecal-associated microbiome with key taxa belonging to the Proteobacteria phylum. Genes conferring resistance to the clinically used antibiotic regimen ciprofloxacin and metronidazole were found in the three sample types. In comparison with children without the perianal phenotype [N = 36] and healthy controls [N = 41], the mucosally-associated microbiome of children with perianal CD harboured a reduced butyrogenic potential. Linear discriminant analysis identified key taxa distinguishing the rectal mucosally-associated microbiome of children with perianal CD from children without this phenotype. CONCLUSIONS The microbial community within CD-related anorectal fistula is compositionally and functionally unique. Taken together, these findings emphasise the need to better understand the ecosystem of the fistula milieu to guide development of novel microbiome-based strategies in this CD phenotype.
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Affiliation(s)
- Jessica Breton
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ceylan Tanes
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vincent Tu
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lindsey Albenberg
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah Rowley
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nina Devas
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rosa Hwang
- Division of General Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kelly Kachelries
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gary D Wu
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert N Baldassano
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kyle Bittinger
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter Mattei
- Division of General Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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16
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Devine KJ, Diorio C, Richman SA, Henderson AA, Oranges K, Armideo E, Kolb MS, Freedman JL, Aplenc R, Fisher MJ, Minturn JE, Olson T, Bagatell R, Barakat L, Croy C, Mauro J, Vitlip L, Acord MR, Mattei P, Johnson VK, Devine CM, Pasquariello C, Reilly AF. Guideline for Children With Cancer Receiving General Anesthesia for Procedures and Imaging. J Pediatr Hematol Oncol 2022; 44:e859-e865. [PMID: 35235547 DOI: 10.1097/mph.0000000000002430] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Children with cancer and those undergoing hematopoietic stem cell transplantation frequently require anesthesia for imaging as well as diagnostic and therapeutic procedures from diagnosis through follow-up. Due to their underlying disease and side effects of chemotherapy and radiation, they are at risk for complications during this time, yet no published guideline exists for preanesthesia preparation. A comprehensive literature review served as the basis for discussions among our multidisciplinary panel of oncologists, anesthesiologists, nurse practitioners, clinical pharmacists, pediatric psychologists, surgeons and child life specialists at the Children's Hospital of Philadelphia. Due to limited literature available, this panel created an expert consensus guideline addressing anesthesia preparation for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lamia Barakat
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Colleen Croy
- Division of Oncology
- Department of Pharmacy, Children's Hospital of Philadelphia
| | - Jane Mauro
- Division of Oncology
- Department of Pharmacy, Children's Hospital of Philadelphia
| | | | - Michael R Acord
- Division of Interventional Radiology
- Radiology, Perelman School of Medicine at the University of Pennsylvania
| | - Peter Mattei
- Surgery, The Children's Hospital of Philadelphia
| | - Victoria K Johnson
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia
| | - Conor M Devine
- Division of Otolaryngology
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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17
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Johnston WR, Hwang R, Mattei P. Intermittent boluses of balanced salt solution for post-operative intravenous hydration following elective major abdominal and thoracic surgery in children. Pediatr Surg Int 2022; 38:573-579. [PMID: 35226177 DOI: 10.1007/s00383-022-05081-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Maintenance fluids following major operations in children are typically administered with a continuous rate. We hypothesized that administering fluids as intermittent boluses is more physiologic and could limit post-operative fluid volume, thereby avoiding harmful effects of excess fluid. METHODS We retrospectively reviewed children aged 1-21 admitted after an elective major abdominal or thoracic operation from 2015 to 2021. We excluded non-elective operations and patients receiving peri-operative enteral or parenteral nutrition. We analyzed total fluid volume at 0-24, 24-48, 48-72, and 72-96 h, time to regular diet and discharge, and end-organ complications. RESULTS We identified 363 patients, of which 108 received intermittent boluses and 255 continuous fluids. Bolus group patients received significantly less fluid up to 72 h post-operatively with average rates of 0.49 mL/kg/h vs 0.86 mL/kg/h at 0-24 h (p << 0.01), 0.57 mL/kg/h vs 1.46 mL/kg/h at 24-48 h (p << 0.01), and 0.50 vs 0.92 mL/kg/h at 48-72 h (p << 0.01). Additionally, the bolus group maintained adequate urine output, tolerated a regular diet sooner (2.08 days vs 2.51 days; p = 0.0023) and averaged a shorter hospital stay (3.12 vs 4.14 days; p = 0.004). There was no difference in adverse effects between the two groups. CONCLUSION Utilizing intermittent boluses reduces the volume of maintenance fluids administered and may lead to a faster time to regular diet and discharge. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective review.
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Affiliation(s)
- William R Johnston
- General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rosa Hwang
- General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Peter Mattei
- General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA.
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18
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Aldrink JH, Glick RD, Baertschiger RM, Kulaylat AN, Lautz TB, Christison-Lagay E, Grant CN, Tracy E, Dasgupta R, Brown EG, Mattei P, Rothstein DH, Rodeberg DA, Ehrlich PF. Update on pediatric testicular germ cell tumors. J Pediatr Surg 2022; 57:690-699. [PMID: 33975708 DOI: 10.1016/j.jpedsurg.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/02/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Testicular germ cell tumors are uncommon tumors that are encountered by pediatric surgeons and urologists and require a knowledge of appropriate contemporary evaluation and surgical and medical management. METHOD A review of the recommended diagnostic evaluation and current surgical and medical management of children and adolescents with testicular germ cell tumors based upon recently completed clinical trials was performed and summarized in this article. RESULTS In this summary of childhood and adolescent testicular germ cell tumors, we review the initial clinical evaluation, surgical and medical management, risk stratification, results from recent prospective cooperative group studies, and clinical outcomes. A summary of recently completed clinical trials by pediatric oncology cooperative groups is provided, and best surgical practices are discussed. CONCLUSIONS Testicular germ cell tumors in children are rare tumors. International collaborations, data-sharing, and enrollment of patients at all stages and risk classifications into active clinical trials will enhance our knowledge of these rare tumors and most importantly improve outcomes of patients with testicular germ cell tumors. LEVEL OF EVIDENCE This is a review article of previously published and referenced level 1 and 2 studies, but also includes expert opinion level 5, represented by the American Pediatric Surgical Association Cancer Committee.
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Affiliation(s)
- Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States.
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Kids, University of Toronto, Toronto, Ontario, Canada
| | - Afif N Kulaylat
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States
| | - Emily Christison-Lagay
- Department of Surgery, Division of Pediatric Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Christa N Grant
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Elisabeth Tracy
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati OH, United States
| | - Erin G Brown
- Division of Pediatric Surgery, Department of Surgery, University of California Davis, Sacramento, CA, United States
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - David H Rothstein
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - David A Rodeberg
- Department of Surgery, Division of Pediatric Surgery, East Carolina University, Greenville, NC, United States
| | - Peter F Ehrlich
- Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
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19
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Patel A, Accord MR, Mattei P, Bhatti TR, Sande CM, Albenberg L. Angiographic Diagnosis of a Meckel's Diverticulum in a 26-month-old Boy. JPGN Rep 2022; 3:e143. [PMID: 37168739 PMCID: PMC10158349 DOI: 10.1097/pg9.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 05/13/2023]
Affiliation(s)
- Amit Patel
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | | | - Peter Mattei
- Department of General, Thoracic, and Fetal Surgery
| | - Tricia R. Bhatti
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher M. Sande
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsey Albenberg
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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20
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Johnston WR, Hwang R, Mattei P. Surgical considerations for neuroblastoma-associated opsoclonus-myoclonus-ataxia syndrome: a series of 14 patients from a single institution. Pediatr Surg Int 2022; 38:249-255. [PMID: 34549330 DOI: 10.1007/s00383-021-05014-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Neuroblastoma is a childhood cancer of neural crest cells occasionally associated with opsoclonus-myoclonus-ataxia syndrome (OMAS), a paraneoplastic process characterized by ataxia, rapid eye movements, and muscle twitching. OMAS treatment and outcomes are well studied, but prior reports do not detail how the presence of OMAS should impact surgical approach, particularly for tumors with image defined risk factors (IDRF). METHODS We reviewed patients with neuroblastoma and OMAS at our institution from January 2009 to December 2020 and recorded tumor characteristics, operative details, OMAS therapies, and outcomes. RESULTS We identified 14 patients with neuroblastoma and OMAS out of 212 patients referred for surgery. There were 11 gross total resections and three partial resections. Two patients with partial resections developed OMAS after initial resection. One patient with gross total resection developed tumor recurrence 10 years later with OMAS redevelopment signaling recurrence. Three patients were positive for IDRFs and the one receiving neoadjuvant therapy achieved a gross total resection. CONCLUSIONS OMAS development after partial resection and OMAS recurrence following tumor recurrence indicates a correlation between tumor bulk and the paraneoplastic process. This justifies an aggressive resection even for low-risk tumors. Neoadjuvant therapy should be considered for potentially unresectable tumors with image defined risk factors. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- William R Johnston
- General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Rosa Hwang
- General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Peter Mattei
- General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA.
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21
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Weiss BD, Yanik G, Naranjo A, Zhang FF, Fitzgerald W, Shulkin BL, Parisi MT, Russell H, Grupp S, Pater L, Mattei P, Mosse Y, Lai HA, Jarzembowski JA, Shimada H, Villablanca JG, Giller R, Bagatell R, Park JR, Matthay KK. A safety and feasibility trial of 131 I-MIBG in newly diagnosed high-risk neuroblastoma: A Children's Oncology Group study. Pediatr Blood Cancer 2021; 68:e29117. [PMID: 34028986 PMCID: PMC9150928 DOI: 10.1002/pbc.29117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/20/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION 131 I-meta-iodobenzylguanidine (131 I-MIBG) is effective in relapsed neuroblastoma. The Children's Oncology Group (COG) conducted a pilot study (NCT01175356) to assess tolerability and feasibility of induction chemotherapy followed by 131 I- MIBG therapy and myeloablative busulfan/melphalan (Bu/Mel) in patients with newly diagnosed high-risk neuroblastoma. METHODS Patients with MIBG-avid high-risk neuroblastoma were eligible. After the first two patients to receive protocol therapy developed severe sinusoidal obstruction syndrome (SOS), the trial was re-designed to include an 131 I-MIBG dose escalation (12, 15, and 18 mCi/kg), with a required 10-week gap before Bu/Mel administration. Patients who completed induction chemotherapy were evaluable for assessment of 131 I-MIBG feasibility; those who completed 131 I-MIBG therapy were evaluable for assessment of 131 I-MIBG + Bu/Mel feasibility. RESULTS Fifty-nine of 68 patients (86.8%) who completed induction chemotherapy received 131 I-MIBG. Thirty-seven of 45 patients (82.2%) evaluable for 131 I-MIBG + Bu/Mel received this combination. Among those who received 131 I-MIBG after revision of the study design, one patient per dose level developed severe SOS. Rates of moderate to severe SOS at 12, 15, and 18 mCi/kg were 33.3%, 23.5%, and 25.0%, respectively. There was one toxic death. The 131 I-MIBG and 131 I-MIBG+Bu/Mel feasibility rates at the 15 mCi/kg dose level designated for further study were 96.7% (95% CI: 83.3%-99.4%) and 81.0% (95% CI: 60.0%-92.3%). CONCLUSION This pilot trial demonstrated feasibility and tolerability of administering 131 I-MIBG followed by myeloablative therapy with Bu/Mel to newly diagnosed children with high-risk neuroblastoma in a cooperative group setting, laying the groundwork for a cooperative randomized trial (NCT03126916) testing the addition of 131 I-MIBG during induction therapy.
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Affiliation(s)
- Brian D. Weiss
- Cincinnati Children’s Hospital, University of Cincinnati School of Medicine
| | - Gregory Yanik
- CS Mott Children’s Hospital, University of Michgian School of Medicine
| | - Arlene Naranjo
- Children’s Oncology Group Statistics & Data Center, University of Florida, Gainesville, FL
| | - Fan F Zhang
- Children’s Oncology Group Statistics & Data Center, Monrovia, CA
| | | | - Barry L. Shulkin
- St. Jude Children’s Research Hospital; University of Tennessee Health Science Center
| | | | - Heidi Russell
- Texas Children’s Cancer and Hematology Centers,,Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Stephan Grupp
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Luke Pater
- Cincinnati Children’s Hospital, University of Cincinnati School of Medicine
| | - Peter Mattei
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Yael Mosse
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | | | | | | | - Judith G. Villablanca
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Roger Giller
- Children’s Hospital Colorado, University of Colorado School of Medicine
| | - Rochelle Bagatell
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Julie R. Park
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Katherine K Matthay
- UCSF Benioff Children’s Hospital, University of California San Francisco School of Medicine, San Francisco, CA
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22
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Mattei P. Commentary regarding evolving applications of fluorescence guided surgery in pediatric surgical oncology: A practical guide for surgeons. J Pediatr Surg 2021; 56:224-225. [PMID: 33190813 DOI: 10.1016/j.jpedsurg.2020.10.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022]
Abstract
This is an invited commentary on the manuscript by Goldstein S, Heaton T, Bondoc A, et al., titled Evolving Applications of Fluorescence Guided Surgery in Pediatric Surgical Oncology: A Practical Guide for Surgeons.
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Affiliation(s)
- Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.
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23
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Dewey J, Maxfield L, Shah M, Arida M, Mattei P. Man with recurrent necrotic papules. JAAD Case Rep 2020; 6:1170-1172. [PMID: 33145385 PMCID: PMC7591542 DOI: 10.1016/j.jdcr.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jesse Dewey
- Rocky Vista University College of Osteopathic Medicine, Ivins, Utah
| | - Luke Maxfield
- Campbell University at Sampson Regional Medical Center, Clinton, North Carolina
| | - Muneeb Shah
- Campbell University at Sampson Regional Medical Center, Clinton, North Carolina
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24
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Rossidis AC, Brown EG, Payton KJ, Mattei P. Implementation of an evidence-based protocol after appendectomy reduces unnecessary antibiotics. J Pediatr Surg 2020; 55:2379-2386. [PMID: 32753275 DOI: 10.1016/j.jpedsurg.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/20/2019] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Children with acute appendicitis have historically received intravenous antibiotics before and after appendectomy, yet recent literature supports minimizing postoperative antibiotics. In this study, we examined the impact of a standardized protocol that eliminates postoperative antibiotics for nonperforated appendicitis and discontinues antibiotics at discharge for perforated appendicitis. METHODS A retrospective review of all pediatric patients who underwent laparoscopic appendectomy for acute appendicitis between May 2013 and March 2017 was performed. Preprotocol patients (5/1/2013-3/31/2015) were compared to postprotocol patients (5/1/2015-3/31/2017), excluding those who underwent surgery during the month of protocol introduction (4/2015). Primary outcomes were postoperative antibiotic doses for nonperforated cases and antibiotics after discharge for perforated cases. Mann-Whitney and Fisher's exact tests were performed. RESULTS Laparoscopic appendectomy was performed in 748 children before (PRE) and in 814 children after (POST) protocol implementation. Perforation rates were similar (POST 21.5 vs. PRE 21.8%, p=0.90). For nonperforated appendicitis, postoperative antibiotics were reduced (median 0 [IQR 0-0] vs. 3 [0-5] doses, p<0.001), and more patients were discharged less than 24 h after surgery (65.7 vs. 40.9%, p<0.001). Fewer patients with perforated appendicitis underwent PICC placement (8.6 vs. 21.0%, p=0.002), and fewer patients were prescribed antibiotics on discharge (33.7 vs. 89.0%, p<0.001). There were no differences between groups for complication, readmission, or return to ED rates. CONCLUSION For children with acute appendicitis, a standardized protocol can safely reduce unnecessary antibiotics and decrease length of stay. Furthermore, the judicious use of antibiotics does not increase SSI, readmission, or overall complication rates. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Avery C Rossidis
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Erin G Brown
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - K Joy Payton
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Peter Mattei
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104.
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25
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Rhee DS, Rodeberg DA, Baertschiger RM, Aldrink JH, Lautz TB, Grant C, Meyers RL, Tracy ET, Christison-Lagay ER, Glick RD, Mattei P, Dasgupta R. Update on pediatric rhabdomyosarcoma: A report from the APSA Cancer Committee. J Pediatr Surg 2020; 55:1987-1995. [PMID: 32674846 DOI: 10.1016/j.jpedsurg.2020.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Rhabdomyosarcoma is the most common soft tissue sarcoma in children and young adults and requires multimodality treatment. The purpose of this review is to present an update on risk stratification as well as surgical and medical management strategies in pediatric rhabdomyosarcoma. METHODS A comprehensive review of the current literature on pediatric rhabdomyosarcoma, including the most recent Children's Oncology Group studies and several international collaboratives, was performed by the authors and key findings were summarized in the manuscript. RESULTS FOXO1 fusion status is a stronger prognostic factor than histology and is now used for risk stratification in treatment protocols. For assessment of regional nodal involvement, FDG-PET-CT shows poor sensitivity and specificity to detect histologically confirmed nodal metastasis. Thus, surgical assessment of regional lymph nodes is required for rhabdomyosarcoma of the extremities or trunk as well as paratesticular rhabdomyosarcoma in patients ≥10 years of age, although adherence to surgical guidelines remains poor. Hemiscrotectomy performed for scrotal violation in paratesticular rhabdomyosarcoma has not shown an improvement in event free survival and is not recommended. CONCLUSIONS Surgical and medical treatment strategies for rhabdomyosarcoma in children continue to evolve. This review provides current evidence-based treatment standards with an emphasis on surgical care. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel S Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - David A Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Christa Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, Yale New Haven Children's Hospital, New Haven, CT
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY
| | - Peter Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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26
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Affiliation(s)
- James K Moon
- Department of Surgery, The Mount Sinai Hospital, New York, NY
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia.
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27
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Mattei P, De Bonnecaze G, Chabrillac E. Necrotizing sinusitis. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:105-106. [PMID: 31982361 DOI: 10.1016/j.anorl.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Mattei
- Department of ENT-Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
| | - G De Bonnecaze
- Department of ENT-Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
| | - E Chabrillac
- Department of ENT-Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France.
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28
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Metjian TA, Gerber J, Watson A, Burlingame C, Gregory H, Rizzi M, Rodman A, Stow JN, Wertz A, Mattei P. 1096. Reducing Unnecessary Postoperative Antibiotic Prophylaxis. Open Forum Infect Dis 2019. [PMCID: PMC6810880 DOI: 10.1093/ofid/ofz360.960] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP).
Methods
We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression.
Results
Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36).
Conclusion
A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | - Jeffrey Gerber
- Children’s Hospital of Philadelphia, Media, Pennsylvania
| | - Adam Watson
- Children’s Hospital of Philadelphia, Media, Pennsylvania
| | | | - Heuer Gregory
- Children’s Hospital of Philadelphia, Media, Pennsylvania
| | - Mark Rizzi
- Children’s Hospital of Philadelphia, Media, Pennsylvania
| | - Allison Rodman
- Children’s Hospital of Philadelphia, Media, Pennsylvania
| | - Joanne N Stow
- The Children’s Hospital of Philadelphia, Thornton, Pennsylvania
| | - Aileen Wertz
- Children’s Hospital of Philadelphia, Media, Pennsylvania
| | - Peter Mattei
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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29
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Twist CJ, Schmidt ML, Naranjo A, London WB, Tenney SC, Marachelian A, Shimada H, Collins MH, Esiashvili N, Adkins ES, Mattei P, Handler M, Katzenstein H, Attiyeh E, Hogarty MD, Gastier-Foster J, Wagner E, Matthay KK, Park JR, Maris JM, Cohn SL. Maintaining Outstanding Outcomes Using Response- and Biology-Based Therapy for Intermediate-Risk Neuroblastoma: A Report From the Children's Oncology Group Study ANBL0531. J Clin Oncol 2019; 37:3243-3255. [PMID: 31386611 DOI: 10.1200/jco.19.00919] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The primary objective of the Children's Oncology Group study ANBL0531 (ClinicalTrials.gov identifier: NCT00499616) was to reduce therapy for subsets of patients with intermediate-risk neuroblastoma using a biology- and response-based algorithm to assign treatment duration while maintaining a 3-year overall survival (OS) of 95% or more for the entire cohort. PATIENTS AND METHODS Children younger than age 12 years with intermediate-risk stage 2A/2B or stage 3 tumors with favorable histology; infants younger than age 365 days with stage 3, 4 or 4S disease; and toddlers from 365 to younger than 547 days with favorable histology, hyperdiploid stage 4, or unfavorable histology stage 3 tumors were eligible. Patients with MYCN-amplified tumors were excluded. Patients were assigned to initially receive two (group 2), four (group 3), or eight (group 4) cycles of chemotherapy with or without surgery on the basis of prognostic markers, including allelic status of chromosomes 1p and 11q; ultimate duration of therapy was determined by overall response. RESULTS Between 2007 and 2011, 404 evaluable patients were enrolled. Compared with legacy Children's Oncology Group studies, subsets of patients had a reduction in treatment. The 3-year event-free survival and OS rates were 83.2% (95% CI, 79.4% to 87.0%) and 94.9% (95% CI, 92.7% to 97.2%), respectively. Infants with stage 4 tumors with favorable biology (n = 61) had superior 3-year event-free survival compared with patients with one or more unfavorable biologic features (n = 47; 86.9% [95% CI, 78.3% to 95.4%] v 66.8% [95% CI, 53.1% to 80.6%]; P = .02), with a trend toward OS advantage (95.0% [95% CI, 89.5% to 100%] v 86.7% [95% CI, 76.6% to 96.7%], respectively; P = .08). OS for patients with localized disease was 100%. CONCLUSION Excellent survival was achieved with this treatment algorithm, with reduction of therapy for subsets of patients. More-effective treatment strategies still are needed for infants with unfavorable biology stage 4 disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Peter Mattei
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Edward Attiyeh
- Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael D Hogarty
- Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Julie Gastier-Foster
- Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | | | - Katherine K Matthay
- University of California, San Francisco, School of Medicine, and UCSF Benioff Children's Hospital, San Francisco, CA
| | | | - John M Maris
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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30
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Hill-Kayser CE, Tochner Z, Li Y, Kurtz G, Lustig RA, James P, Balamuth N, Womer R, Mattei P, Grupp S, Mosse YP, Maris JM, Bagatell R. Outcomes After Proton Therapy for Treatment of Pediatric High-Risk Neuroblastoma. Int J Radiat Oncol Biol Phys 2019; 104:401-408. [PMID: 30738983 DOI: 10.1016/j.ijrobp.2019.01.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/04/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Patients with high-risk neuroblastoma (HR-NBL) require radiation to the primary tumor site and sites of persistent metastatic disease. Proton radiation therapy (PRT) may promote organ sparing, but long-term outcomes have not been studied. METHODS AND MATERIALS Sequential patients with HR-NBL received PRT: 2160 cGy (relative biological effectiveness) to primary tumor bed and persistent metastatic sites, with 3600 cGy (relative biological effectiveness) to gross residual disease. RESULTS From September 2010 through September 2015, 45 patients with HR-NBL received PRT after systemic therapy, primary tumor resection, and high-dose chemotherapy with stem cell rescue. Median age was 46 months at the time of PRT (range, 10 months to 12 years); 23 patients (51%) were male. Primary tumors were adrenal in 40 (89%); 11 (24%) received boost. Ten metastatic sites in 8 patients were radiated. Double scattered proton beams were used for 19 (42%) patients, in combination with x-rays for 2 (5%). The remaining 26 (58%) received pencil beam scanning, available since January 2013. We observed 97% freedom from primary site recurrence at 3, 4, and 5 years. Overall survival rates were 89%, 80%, and 80% and disease-free survival rates were 77%, 70%, and 70%, at 3, 4, and 5 years, respectively. With median follow-up of 48.7 months from diagnosis (range, 11-90 months) for all patients (57.4 months for those alive), 37 (82%) patients are alive, and 32 (71%) are without evidence of disease. One patient experienced locoregional recurrence; the remaining 12 (27%) experienced relapse at distant, nonradiated sites. Acute toxicities during treatment were mainly grade 1. No patient has experienced World Health Organization grade 3 or 4 long-term renal or hepatic toxicity. Pencil beam scanning plans required less planning time and resources than double scattered plans. CONCLUSIONS We observe excellent outcomes in patients treated with PRT for HR-NBL from 2010 through 2015, with 82% of patients alive and 97% free of primary site recurrence. No patient has experienced long-term renal or liver toxicity. This treatment maximizes normal tissue preservation and is appropriate for this patient population.
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Affiliation(s)
- Christine E Hill-Kayser
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Zelig Tochner
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yimei Li
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Goldie Kurtz
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Lustig
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul James
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naomi Balamuth
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard Womer
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Grupp
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yael P Mosse
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John M Maris
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rochelle Bagatell
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Twist CJ, Naranjo A, Schmidt ML, Tenney SC, Cohn SL, Meany HJ, Mattei P, Adkins ES, Shimada H, London WB, Park JR, Matthay KK, Maris JM. Defining Risk Factors for Chemotherapeutic Intervention in Infants With Stage 4S Neuroblastoma: A Report From Children's Oncology Group Study ANBL0531. J Clin Oncol 2018; 37:115-124. [PMID: 30444686 DOI: 10.1200/jco.18.00419] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Infants with stage 4S neuroblastoma usually have favorable outcomes with observation or minimal chemotherapy. However, young infants with symptoms secondary to massive hepatomegaly or with unfavorable tumor biology are at high risk of death. Our aim was to improve outcomes for patients with symptomatic and/or unfavorable biology 4S neuroblastoma with a uniform treatment approach using a biology- and response-based algorithm. PATIENTS AND METHODS The subset of patients with 4S disease with MYCN-not amplified tumors with impaired or impending organ dysfunction, or with unfavorable histology and/or diploid DNA index, were eligible. Patients were assigned to receive two, four, or eight cycles of chemotherapy on the basis of histology, diploid DNA index, chromosome arm 1p or 11q loss of heterozygosity (LOH) status, and symptoms. RESULTS Forty-nine eligible patients were enrolled: 41 were symptomatic and 28 had unfavorable biology. Seventeen patients (symptomatic, favorable biology) were assigned two cycles, 21 patients (any unfavorable biologic feature without 1p or 11q LOH) were assigned four cycles, and 11 patients (unfavorable biology including 1p and/or 11q LOH [n = 7] or symptomatic with unknown biology [n = 4]), were assigned eight cycles. The 3-year overall survival was 81.4% ± 5.8%. Eight of nine deaths were in patients younger than 2 months of age at diagnosis (median, 9 days [range, 1 to 68 days]): five acute deaths were a result of hepatomegaly and associated toxicities; two were a result of late relapse in patients with unfavorable biology; and two were a result of treatment complications. No deaths occurred after protocol-mandated pre-emptive treatment of infants younger than 2 months with hepatomegaly, regardless of symptoms. A new scoring algorithm for emergent chemotherapy in patients with 4S disease was developed on the basis of this experience. CONCLUSION The outcome for 4S neuroblastoma can be improved with pre-emptive chemotherapy for evolving hepatomegaly or other baseline comorbidities in infants younger than 2 months of age.
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Affiliation(s)
| | | | - Mary Lou Schmidt
- 3 University of Illinois at Chicago College of Medicine, Chicago, IL
| | | | | | - Holly J Meany
- 5 Children's National Medical Center, Washington, DC
| | - Peter Mattei
- 6 Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Wendy B London
- 9 Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | | | - Katherine K Matthay
- 11 University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, CA
| | - John M Maris
- 6 Children's Hospital of Philadelphia, Philadelphia, PA.,12 Perelman School of Medicine, Philadelphia, PA
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32
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Elgarten CW, Levy EM, Mattei P, Fisher BT, Olson TS, Freedman JL. Successful treatment of pulmonary mucormycosis in two pediatric hematopoietic stem cell transplant patients. Pediatr Transplant 2018; 22:e13270. [PMID: 30014584 DOI: 10.1111/petr.13270] [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] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
Pulmonary mucormycosis diagnosed immediately after hematopoietic stem cell transplantation frequently portends a poor prognosis. However, here we describe two cases in children that were treated successfully to highlight the efficacy of a multidisciplinary approach. Despite diagnosis in the immediate post-transplant period and requirement for ongoing immunosuppression to prevent or treat GVHD, both are long-term survivors due to early surgical debridement with transfusion support and prompt initiation of targeted antifungal therapy. In the absence of evidence-based treatment guidelines, survival of pulmonary mucormycosis is achievable even in high-risk patients with a multidisciplinary team to guide management.
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Affiliation(s)
- Caitlin W Elgarten
- Division of Oncology, Section of Cellular Therapy & Transplant, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen M Levy
- Division of Oncology, Section of Cellular Therapy & Transplant, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter Mattei
- Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian T Fisher
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Timothy S Olson
- Division of Oncology, Section of Cellular Therapy & Transplant, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason L Freedman
- Division of Oncology, Section of Cellular Therapy & Transplant, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Mattei P. Single-site robotic-assisted laparoscopic cholecystectomy in children and adolescents: a report of 20 cases. Surg Endosc 2017; 32:2402-2408. [PMID: 29218659 DOI: 10.1007/s00464-017-5939-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Single-site laparoscopy is increasingly popular for straightforward operations like appendectomy. Due to limited triangulation and maneuverability, single-site cholecystectomy is riskier and more difficult. Robotics offer to make it easier and safer. METHODS Twenty children and adolescents underwent robotic-assisted single-site cholecystectomy at a large academic children's hospital. Patients were not randomized; patients were offered the option of robotic-assisted single-site (SSR) or standard four-incision laparoscopic (LAP) cholecystectomy. Demographics and perioperative details were compared with those of a comparable cohort who underwent LAP during the same period. RESULTS The two groups were similar in physical characteristics and indications for operation. The robotic operations took longer but both groups received similar PRN doses of parenteral opiates. Patients in the SSR group were all discharged on the first postoperative day. There were no major complications in either group but a slightly higher incidence of minor wound complications in the SSR group. CONCLUSION Robotic-assisted single-site cholecystectomy appears to be a safe alternative to standard laparoscopy with a similar postoperative pain profile, short postoperative lengths of stay, and, for some, a superior cosmetic result. Nevertheless, it comes with longer set-up and operative times, a higher incidence of minor wound complications, an unknown but possibly higher risk of incisional hernia, and higher costs.
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Affiliation(s)
- Peter Mattei
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 34th Street & Civic Center Blvd., Philadelphia, PA, 19104-4399, USA.
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Carlson CA, Kolon TF, Mattei P, Hobbie W, Gracia CR, Ogle S, Ginsberg JP. Developing a Hospital-Wide Fertility Preservation Service for Pediatric and Young Adult Patients. J Adolesc Health 2017; 61:571-576. [PMID: 28917444 DOI: 10.1016/j.jadohealth.2017.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/25/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Gonadal damage is a common consequence of treatment for pediatric malignancies. Nononcologic conditions may also utilize treatments with potential impact on fertility. Models for oncology fertility preservation programs have emerged and demonstrate that a multidisciplinary team approach can have a positive impact on referral patterns, appropriate risk counseling, and access to fertility preservation options. Expansion of programmatic breadth is needed, providing improved care to nonmalignant conditions where the disease itself may impact reproductive health or treatment modalities. METHODS With support from the Department of Pediatrics Chair's Initiative, a multidisciplinary, hospital-wide Fertility Preservation Service was created at the Children's Hospital of Philadelphia. A centralized team provides fertility consults across the institution, allowing for risk-based counseling and facilitation of fertility preservation options (both standard care and experimental). RESULTS Team structure, consult process, and available fertility options for prepubertal and pubertal males and females are described. Preinitiative and postinitiative referral patterns were analyzed. Postinitiative referrals from divisions outside oncology more than doubled (34% vs. 15% at baseline). CONCLUSIONS A comprehensive model for fertility counseling provides accessible, high-value fertility preservation care to pediatric and young adult patients with a wide variety of diagnoses. A centralized point of contact ensures timely referrals and risk-based counseling and streamlines access to fertility preservation procedures.
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Affiliation(s)
- Claire A Carlson
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas F Kolon
- Department of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter Mattei
- Department of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wendy Hobbie
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue Ogle
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jill P Ginsberg
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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Affiliation(s)
- Seyed Ali Nabavizadeh
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Neuro-ophthalmology Service, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Maxwell EC, Dawany N, Baldassano RN, Mamula P, Mattei P, Albenberg L, Kelsen JR. Diverting Ileostomy for the Treatment of Severe, Refractory, Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2017; 65:299-305. [PMID: 28045769 DOI: 10.1097/mpg.0000000000001498] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Diverting ileostomy is used as a temporizing therapy in patients with perianal Crohn disease; however, little data exist regarding its use for colonic disease. The primary aim of the present study was to determine the role of diversion in severe refractory colonic inflammatory bowel disease (IBD) in a pediatric population. METHODS Retrospective study of patients who underwent diverting ileostomy at The Children's Hospital of Philadelphia from 2000 to 2014 for the management of severe, refractory colonic IBD. Clinical variables were compared in the 1 year before ileostomy and 1 year after diversion. Surgical and disease outcomes including changes in diagnosis were reviewed through 2015. RESULTS Twenty-four patients underwent diverting ileostomy for refractory colonic disease. Initial diagnoses were Crohn disease in 10 (42%), ulcerative colitis in 1 (4%), and IBD-unclassified in 13 patients (54%). Comparing data before and after surgery, there were statistically significant improvements in height and weight velocities, height velocity z score, blood transfusion requirement, hemoglobin, and hospitalization rates. Chronic steroid use decreased from 71% to 22%. At the conclusion of the study, 10 patients had undergone subsequent colectomy, 7 had successful bowel reanastomosis, and 7 remain diverted. Seven patients (29%) had a change in diagnosis. There were 13 surgical complications in 7 subjects, including prolapse reduction, stoma revision, and resection of ischemic bowel. CONCLUSIONS In pediatric patients with refractory colonic IBD, diverting ileostomy can be a successful intervention to induce clinical stability. Importantly, diversion is a steroid-sparing therapy and allows additional time to clarify the diagnosis.
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Affiliation(s)
- Elizabeth C Maxwell
- *Department of Pediatrics †Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia ‡Perelman School of Medicine, University of Pennsylvania §Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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Chu DI, Tan JM, Mattei P, Costarino AT, Rossano JW, Tasian GE. Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease. J Pediatr 2017; 185:88-93.e3. [PMID: 28410089 PMCID: PMC5529241 DOI: 10.1016/j.jpeds.2017.02.011] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/15/2016] [Accepted: 02/06/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine the risk of morbidity and mortality after laparoscopic surgery among children with congenital heart disease (CHD). STUDY DESIGN Cohort study using the 2013-2014 National Surgical Quality Improvement Program-Pediatrics, which prospectively collected data at 56 and 64 hospitals in 2013 and 2014, respectively. Primary exposure was CHD. Primary outcome was overall in-hospital postoperative mortality. Secondary outcomes included 30-day mortality and 30-day morbidity (any nondeath adverse event). Among 34?543 children who underwent laparoscopic surgery, 1349, 1106, and 266 had minor, major, and severe CHD, respectively. After propensity score matching within each stratum of CHD severity, morbidity and mortality were compared between children with and without CHD. RESULTS Children with severe CHD had higher overall mortality and 30-day morbidity (OR 12.31, 95% CI 1.59-95.01; OR 2.51, 95% CI 1.57-4.01, respectively), compared with matched controls. Overall mortality and 30-day morbidity were also higher among children with major CHD compared with children without CHD (OR 3.46, 95% CI 1.49-8.06; OR 2.07, 95% CI 1.65-2.61, respectively). Children with minor CHD had similar mortality outcomes, but had higher 30-day morbidity compared with children without CHD (OR 1.71, 95% CI 1.37-2.13). CONCLUSIONS Children with major or severe CHD have higher morbidity and mortality after laparoscopic surgery. Clinicians should consider the increased risks of laparoscopic surgery for these children during medical decision making.
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Affiliation(s)
- David I. Chu
- Department of Surgery, Division of Urology, The Children’s Hospital of Philadelphia Philadelphia, PA
| | - Jonathan M. Tan
- Department of Anesthesia and Critical Care Medicine, Division of General Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Peter Mattei
- Department of Surgery, Division of General, Thoracic, and Fetal Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Andrew T. Costarino
- Department of Anesthesia and Critical Care Medicine, Division of Cardiac Critical Care Medicine, The Children’s Hospital of Philadelphia Philadelphia, PA
| | - Joseph W. Rossano
- Department of Cardiology, Cardiac Center, The Children’s Hospital of Philadelphia, Philadelphia, PA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Gregory E. Tasian
- Department of Surgery, Division of Urology, The Children’s Hospital of Philadelphia Philadelphia, PA,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Wang KS, Tiao G, Bass LM, Hertel PM, Mogul D, Kerkar N, Clifton M, Azen C, Bull L, Rosenthal P, Stewart D, Superina R, Arnon R, Bozic M, Brandt ML, Dillon PA, Fecteau A, Iyer K, Kamath B, Karpen S, Karrer F, Loomes KM, Mack C, Mattei P, Miethke A, Soltys K, Turmelle YP, West K, Zagory J, Goodhue C, Shneider BL. Analysis of surgical interruption of the enterohepatic circulation as a treatment for pediatric cholestasis. Hepatology 2017; 65:1645-1654. [PMID: 28027587 PMCID: PMC5397365 DOI: 10.1002/hep.29019] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 07/08/2016] [Revised: 11/21/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED To evaluate the efficacy of nontransplant surgery for pediatric cholestasis, 58 clinically diagnosed children, including 20 with Alagille syndrome (ALGS), 16 with familial intrahepatic cholestasis-1 (FIC1), 18 with bile salt export pump (BSEP) disease, and 4 others with low γ-glutamyl transpeptidase disease (levels <100 U/L), were identified across 14 Childhood Liver Disease Research Network (ChiLDReN) centers. Data were collected retrospectively from individuals who collectively had 39 partial external biliary diversions (PEBDs), 11 ileal exclusions (IEs), and seven gallbladder-to-colon (GBC) diversions. Serum total bilirubin decreased after PEBD in FIC1 (8.1 ± 4.0 vs. 2.9 ± 4.1 mg/dL, preoperatively vs. 12-24 months postoperatively, respectively; P = 0.02), but not in ALGS or BSEP. Total serum cholesterol decreased after PEBD in ALGS patients (695 ± 465 vs. 457 ± 319 mg/dL, preoperatively vs. 12-24 months postoperatively, respectively; P = 0.0001). Alanine aminotransferase levels increased in ALGS after PEBD (182 ± 70 vs. 260 ± 73 IU/L, preoperatively vs. 24 months; P = 0.03), but not in FIC1 or BSEP. ALGS, FIC1, and BSEP patients experienced less severely scored pruritus after PEBD (ALGS, 100% vs. 9% severe; FIC1, 64% vs. 10%; BSEP, 50% vs. 20%, preoperatively vs. >24 months postoperatively, respectively; P < 0.001). ALGS patients experienced a trend toward greater freedom from xanthomata after PEBD. There was a trend toward decreased pruritus in FIC1 after IE and GBC. Vitamin K supplementation increased in ALGS after PEBD (33% vs. 77%; P = 0.03). Overall, there were 15 major complications after surgery. Twelve patients (3 ALGS, 3 FIC1, and 6 BSEP) subsequently underwent liver transplantation. CONCLUSION This was a multicenter analysis of nontransplant surgical approaches to intrahepatic cholestasis. Approaches vary, are well tolerated, and generally, although not uniformly, result in improvement of pruritus and cholestasis. (Hepatology 2017;65:1645-1654).
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Affiliation(s)
| | - Greg Tiao
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lee M. Bass
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | | | - Nanda Kerkar
- Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Colleen Azen
- Children’s Hospital Los Angeles, Los Angeles, CA
| | - Laura Bull
- University of California, San Francisco, CA
| | | | | | | | | | - Molly Bozic
- Riley Hospital for Children, Indianapolis, IN
| | | | | | | | | | | | - Saul Karpen
- Children’s Healthcare of Atlanta, Atlanta, GA
| | | | | | - Cara Mack
- Children’s Hospital Colorado, Aurora, CO
| | - Peter Mattei
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Kyle Soltys
- Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Karen West
- Riley Hospital for Children, Indianapolis, IN
| | | | - Cat Goodhue
- Children’s Hospital Los Angeles, Los Angeles, CA
| | - Benjamin L. Shneider
- Texas Children’s Hospital, Houston, TX,Children’s Hospital of Pittsburgh, Pittsburgh, PA
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Hwang TJ, Servaes S, Mattei P, Anupindi SA. Radiologist performance in the interpretation of contrast enemas performed for Hirschsprung's disease in children >1 year of age. Clin Radiol 2017; 72:519.e11-519.e19. [PMID: 28285706 DOI: 10.1016/j.crad.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/16/2016] [Revised: 09/19/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the diagnostic performance of contrast enemas (CEs) for the diagnosis of Hirschsprung's disease (HD). METHODS AND MATERIALS CE studies performed as part of an HD workup in patients 1-18 years of age over a 10-year period were identified. All abnormal CE studies and an equal number of age-matched controls were included in the final study group. Two radiologists independently and blindly reviewed all CE studies for quality (scale of 0-3) and the presence of large colon calibre, colon redundancy, transition zone, rectosigmoid ratio, and abnormal contractions. Readers also determined whether a rectal biopsy would be recommended to confirm an HD diagnosis. Discrepancies were resolved in consensus. Findings were correlated with surgery and biopsy data. RESULTS Out of 834 CE studies, 38 abnormal CE studies were identified (mean age 5.9 years) and included 38 matched controls. Seventeen of 76 patients were recommended for rectal biopsy, of which five were confirmed to have HD. Twelve of 70 (17.1%) were false positives, and were clinically confirmed not to have HD. The proportion of HD in the present population was 6/834 (0.72%). Of the 17 recommended for biopsy, CE studies showed 17/17 (100%) with an abnormal rectosigmoid ratio, 16/17 (94.1%) with redundant colon, and 15/17 (88%) with large colon. Of patients not recommended for biopsy, one was diagnosed with HD, (false negative, 16.7%). The diagnostic performance of CE was 83.3% sensitivity and 82.9% specificity. CONCLUSION Few children >1 year of age were found to have HD and the diagnostic performance of the CE is moderately high. The CE examination is a valuable non-invasive imaging study to help exclude older children who may not have HD, thereby obviating the need for invasive rectal biopsy and surgery.
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Affiliation(s)
- T J Hwang
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - S Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - P Mattei
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Amarilho-Silveira F, Vicente, S, Lemes J, Del Pino F, Esteves R, Halfen J, Tâmara J, Da Vara C, Dionello J, Mattei P. Relação entre os níveis de metabólitos sanguíneos e a qualidade de lã. ARCH ZOOTEC 2017. [DOI: 10.21071/az.v66i253.2137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
O tipo de alimentação altera diretamente os níveis dos metabólitos sanguíneos e as características da lã. Neste sentido o objetivo deste trabalho é relacionar os níveis de metabólitos sanguíneos com a qualidade da lã. Foram utilizadas 25 ovelhas com três anos de idade da raça Corriedale, em um período experimental de 98 dias, onde se avaliou os níveis dos metabolitos sanguíneos e os dados objetivos de qualidade de lã. Para as análises objetivas de qualidade de lã ocorreu uma diminuição no diâmetro médio das fibras (do inicio ao fim do experimento) e um crescimento diário médio da mecha de lã de 0,40 mm. Somente foi encontrada correlação entre os níveis séricos de glicose com a variação do diâmetro médio das fibras, a variação do comprimento da mecha de lã e com a variação do diâmetro no ponto em que apresentou maiores valores. As variáveis sanguíneas referentes à albumina e proteínas plasmáticas totais não tiveram correlação significativa com as aferições de qualidade de lã.
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Mattei P, Cincinelli A, Martellini T, Natalini R, Pascale E, Renella G. Reclamation of river dredged sediments polluted by PAHs by co-composting with green waste. Sci Total Environ 2016; 566-567:567-574. [PMID: 27236622 DOI: 10.1016/j.scitotenv.2016.05.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 05/15/2023]
Abstract
Polluted dredged sediments are classified as waste and cannot be re-used in civil and environmental engineering nor in agriculture, posing serious logistical, economic and environmental problems for their management. We tested co-composting of sediments (S) slightly polluted by PAHs with urban green waste (GW), as a sustainable technique to both degrade the organic pollutants and lend to sediments suitable properties to be reused as technosol. Four treatments were tested: sediments only (S), GW only (GW), 1:1 w:w S:GW (SGW1:1), and 3:1 w:w S:GW (SGW3:1) for a co-composting period of one year. The co-composting materials underwent to an initial short and moderate thermophilic phase. However, at the end of the co-composting process, SGW3:1 and SGW1:1 achieved suitable physical and chemical properties as plant substrate in terms of organic C, N and humic substances contents, electrical conductivity and bulk density. In the first six months of treatment, the PAHs concentration in SGW3:1 and SGW1:1 was reduced by 26% and 57%, respectively, reaching values below under 1mgg(-1), whereas such a reduction in S alone was observed only after nine months. We concluded that co-composting with green waste can be a suitable approach for reclamation of dredged sediments opening opportunities for their use as technosol or as plant growing substrate.
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Affiliation(s)
- P Mattei
- Department of Agrifood Production and Environmental Sciences, University of Florence, Florence, Italy.
| | - A Cincinelli
- Department of Chemistry "Ugo Schiff", University of Florence, Sesto Fiorentino (Fi), Italy
| | - T Martellini
- Department of Chemistry "Ugo Schiff", University of Florence, Sesto Fiorentino (Fi), Italy
| | - R Natalini
- Department of Chemistry "Ugo Schiff", University of Florence, Sesto Fiorentino (Fi), Italy
| | - E Pascale
- Department of Chemistry "Ugo Schiff", University of Florence, Sesto Fiorentino (Fi), Italy
| | - G Renella
- Department of Agrifood Production and Environmental Sciences, University of Florence, Florence, Italy
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Amarilho-Silveira F, Vicente IS, Lemes JS, Del Pino FAB, Esteves RM, Halfen J, Tâmara QJ, Da Vara CC, Mattei P. Ganho de peso, níveis de glicose sanguínea e qualidade da lã de ovelhas manejadas no terço final de gestação em pastagens hibernais. ARCH ZOOTEC 2016. [DOI: 10.21071/az.v65i250.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
O conhecimento acerca da produção de lã a nível internacional é sustentado por dois pilares. O mercado e aspectos produtivos. Assim devemos ser conhecedores das prospecções comerciais, porém não podemos negligenciar alguns fatores de produção, que podem refletir diretamente no aumento da quantidade e qualidade do produto lanoso. O objetivo deste trabalho é comparar as características de ganho de peso, níveis séricos de glicose sanguínea e características qualitativas da lã, em diferentes ofertas forrageiras de pastagens consorciadas de Avena strigosa Schreb. e Lolium multiflorum Lam. O experimento foi conduzido nas coordenadas 31º52’00”S, 52º 21’24”W, altitude 13,24 m. Foram utilizadas 29 ovelhas de seis dentes (estimativa de três anos de idade) prênhes, da raça Corriedale. Foi avaliado o ganho de peso no período e também, foram coletadas amostras de sangue e de lã. As amostras de sangue foram coletadas via punção da veia jugular em cinco momentos: uma coleta mensal, em que a primeira foi feita no mês que antecedeu o inicio do experimento e a ultima no final do mesmo. As amostras de lã foram tomadas na região do costilhar esquerdo nos dias 18 de junho e 24 de setembro. Somente foi encontrada diferença significativa (p
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Feijó JO, Mattei P, Oliviera AM, Jacometo CB, Tabeleão VC, Pereira RA, Schmitt E, Del Pino FAB, Corrêa MN. Parâmetros bioquímicos clínicos de vacas de alta e média produção de leite, criadas em sistema freestall. ACTA ACUST UNITED AC 2016. [DOI: 10.4322/rbcv.2016.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Sean Chen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter Mattei
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing You
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nara L. Sobreira
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ginette A. Hinds
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Latry P, Mattei P, Camacho A. Évaluation comparative entre l’ABTest Card® et la SAFETY CARD AB® de DIAGAST dans le cadre de greffe de cellules souches hématopoïétiques. Transfus Clin Biol 2014. [DOI: 10.1016/j.tracli.2014.08.098] [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: 11/28/2022]
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Ullmer C, Alvarez Sanchez R, Sprecher U, Raab S, Mattei P, Dehmlow H, Sewing S, Iglesias A, Beauchamp J, Conde-Knape K. Systemic bile acid sensing by G protein-coupled bile acid receptor 1 (GPBAR1) promotes PYY and GLP-1 release. Br J Pharmacol 2014; 169:671-84. [PMID: 23488746 DOI: 10.1111/bph.12158] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/18/2013] [Accepted: 02/07/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Nutrient sensing in the gut is believed to be accomplished through activation of GPCRs expressed on enteroendocrine cells. In particular, L-cells located predominantly in distal regions of the gut secrete glucagon-like peptide 1 (GLP-1) and peptide tyrosine-tyrosine (PYY) upon stimulation by nutrients and bile acids (BA). The study was designed to address the mechanism of hormone secretion in L-cells stimulated by the BA receptor G protein-coupled bile acid receptor 1 (GPBAR1). EXPERIMENTAL APPROACH A novel, selective, orally bioavailable, and potent GPBAR1 agonist, RO5527239, was synthesized in order to investigate L-cell secretion in vitro and in vivo in mice and monkey. In analogy to BA, RO5527239 was conjugated with taurine to reduce p.o. bioavailability yet retaining its potency. Using RO5527239 and tauro-RO5527239, the acute secretion effects on L-cells were addressed via different routes of administration. KEY RESULTS GPBAR1 signalling triggers the co-secretion of PYY and GLP-1, and leads to improved glucose tolerance. The strong correlation of plasma drug exposure and plasma PYY levels suggests activation of GPBAR1 from systemically accessible compartments. In contrast to the orally bioavailable agonist RO5527239, we show that tauro-RO5527239 triggers PYY release only when applied intravenously. Compared to mice, a slower and more sustained PYY secretion was observed in monkeys. CONCLUSION AND IMPLICATIONS Selective GPBAR1 activation elicits a strong secretagogue effect on L-cells, which primarily requires systemic exposure. We suggest that GPBAR1 is a key player in the intestinal proximal-distal loop that mediates the early phase of nutrient-evoked L-cell secretion effects.
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Affiliation(s)
- C Ullmer
- DTA CV & Metabolic Diseases, DTA CV and Metabolic Diseases, Pharma Research and Early Development, F. Hoffmann-La Roche AG, Basel, Switzerland.
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47
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Chen S, Mattei P, Berli JU, Shores J. Myxofibrosarcoma with associated Mycobacterium infection. Eplasty 2014; 14:ic18. [PMID: 24966999 PMCID: PMC4052792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Sean Chen
- aDepartment of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD,Correspondence:
| | - Peter Mattei
- aDepartment of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jens U Berli
- bDepartment of Plastic and Reconstructive Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jaimie Shores
- bDepartment of Plastic and Reconstructive Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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48
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Fox E, Amodei K, Mattei P, Kolon T, Johnson AM, Darge K, Balis FM. Prospective assessment of renal function using cystatin C and functional MRI in children with newly diagnosed renal tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Elizabeth Fox
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kate Amodei
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Peter Mattei
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Thomas Kolon
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ann M Johnson
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kassa Darge
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Frank M Balis
- The Children's Hospital of Philadelphia, Philadelphia, PA
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49
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Twist C, London WB, Naranjo A, Schmidt ML, Adkins ES, Mattei P, Cretella S, Cohn SL, Park JR, Maris JM. Maintaining outstanding outcomes using response- and biology-based therapy for intermediate-risk neuroblastoma: A report from the Children’s Oncology Group study ANBL0531. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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)
| | - Wendy B. London
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | | | | | - Peter Mattei
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - John M. Maris
- The Children's Hospital of Philadelphia, Philadelphia, PA
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50
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Sulkowski JP, Cooper JN, Lopez JJ, Jadcherla Y, Cuenot A, Mattei P, Deans KJ, Minneci PC. Morbidity and mortality in patients with esophageal atresia. Surgery 2014; 156:483-91. [PMID: 24947650 DOI: 10.1016/j.surg.2014.03.016] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/09/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study reports national estimates of population characteristics and outcomes for patients with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) and evaluates the relationships between hospital volume and outcomes. METHODS Patients admitted within 30 days of life who had International Classification of Diseases, 9th Edition, Clinical Modification diagnosis and procedure codes relevant to EA/TEF during 1999-2012 were identified with the Pediatric Health Information System database. Baseline demographics, comorbidities, and postoperative outcomes, including predictors of in-hospital mortality, were examined up to 2 years after EA/TEF repair. RESULTS We identified 3,479 patients with EA/TEF treated at 43 children's hospitals; 37% were premature and 83.5% had ≥1 additional congenital anomaly, with cardiac anomalies (69.6%) being the most prevalent. Within 2 years of discharge, 54.7% were readmitted, 5.2% had a repeat TEF ligation, 11.4% had a repeat operation for their esophageal reconstruction, and 11.7% underwent fundoplication. In-hospital mortality was 5.4%. Independent predictors of mortality included lower birth weight, congenital heart disease, other congenital anomalies, and preoperative mechanical ventilation. There was no relationship between hospital volume and mortality or repeat TEF ligation. CONCLUSION This study describes population characteristics and outcomes, including predictors of in-hospital mortality, in EA/TEF patients treated at children's hospitals across the United States. Across these hospitals, rates of mortality or repeat TEF ligation were not dependent on hospital volume.
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Affiliation(s)
- Jason P Sulkowski
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Joseph J Lopez
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Yamini Jadcherla
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Alissabeth Cuenot
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Peter Mattei
- Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
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