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Nuss S, Majyambere JP, Ntaganda E, Forbes C, Nkurunziza J, Mugabo C, Cubaka V, Hedt-Gauthier B. Adaptation and validation of the Children's Surgical Assessment Tool for Rwandan district hospitals. Glob Health Action 2024; 17:2297870. [PMID: 38193438 PMCID: PMC10778412 DOI: 10.1080/16549716.2023.2297870] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND/AIMS Paediatric surgical care is a critical component of child health and basic universal health coverage and therefore should be included in comprehensive evaluations of surgical capacity. This study adapted and validated the Children's Surgical Assessment Tool (CSAT), a tool developed for district and tertiary hospitals in Nigeria to evaluate hospital infrastructure, workforce, service delivery, financing, and training capacity for paediatric surgery, for use in district hospitals in Rwanda. METHODS We used a three-round modified Delphi process to adapt the CSAT to the Rwandan context. An expert panel of surgeons, anaesthesiologists, paediatricians, and health systems strengthening experts were invited to participate based on their experience with paediatric surgical or anaesthetic care at district hospitals or with health systems strengthening in the Rwandan context. We used the Content Validity Index to validate the final tool. RESULTS The adapted tool had a final score of 0.84 on the Content Validity Index, indicating a high level of agreement among the expert panel. The final tool comprised 171 items across five domains: facility characteristics, service delivery, workforce, financing, and training/research. CONCLUSION The adapted CSAT is appropriate for use in district hospitals in Rwanda to evaluate the capacity for paediatric surgery. This study provides a framework for adapting and validating a comprehensive paediatric surgical assessment tool to local contexts in LMICs and used in similar settings in sub-Saharan Africa.
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Affiliation(s)
- Sarah Nuss
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Jean Paul Majyambere
- Department of Surgery, Partners in Health Rwanda/Inshuti Mu Buzima, Butaro, Rwanda
| | - Edmond Ntaganda
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Butaro, Rwanda
| | - Jonathan Nkurunziza
- Department of Surgery, Partners in Health Rwanda/Inshuti Mu Buzima, Butaro, Rwanda
| | - Carol Mugabo
- Department of Surgery, Partners in Health Rwanda/Inshuti Mu Buzima, Butaro, Rwanda
| | - Vincent Cubaka
- Department of Surgery, Partners in Health Rwanda/Inshuti Mu Buzima, Butaro, Rwanda
| | - Bethany Hedt-Gauthier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Shah NR, Weadock WJ, Williams KM, Moreci R, Stoll T, Joshi A, Petroze R, Newman EA. Use of modern three-dimensional imaging models to guide surgical planning for local control of pediatric extracranial solid tumors. Pediatr Blood Cancer 2024; 71:e30933. [PMID: 38430473 DOI: 10.1002/pbc.30933] [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: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In complex pediatric surgical oncology, surgical planning is contingent upon data gathered from preoperative imaging. Three-dimensional (3D) modeling and printing has been shown to be beneficial for adult presurgical planning, though pediatric literature is less robust. The study reviews our institutional experience with the use of 3D image segmentation and printed models in approaching resection of extracranial solid tumors in children. METHODS This is a single institutional series from 2021 to 2023. Models were based on computed tomography and magnetic resonance imaging studies, optimized for 3D imaging. The feasibility and creation of the models is reviewed, including specific techniques, software, and printing materials from our institution. Clinical implications for surgical planning are also described, along with detailed preoperative and intraoperative images. RESULTS 3D modeling and printing was performed for four pediatric patients diagnosed with extracranial solid tumors. Diagnoses included Ewing sarcoma, hepatoblastoma, synovial sarcoma, and osteosarcoma. No intraoperative complications or discrepancies with the preoperative 3D-printed model were noted. No evidence of local recurrence was identified in any patient thus far. CONCLUSION Our institutional series demonstrates a wide spectrum of clinical application for 3D modeling and printing technology within pediatric surgical oncology. This technology may aid in surgical planning for both resection and reconstruction, can be applied to a diverse breadth of diagnoses, and may potentially augment patient and/or family education about their condition.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William J Weadock
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Keyonna M Williams
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rebecca Moreci
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tammy Stoll
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aparna Joshi
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robin Petroze
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Erika A Newman
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Arredondo Montero J, Bardají Pascual C. From Aviation to Pediatric Surgery. Clin Pediatr (Phila) 2024; 63:557-559. [PMID: 37246755 DOI: 10.1177/00099228231176631] [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] [Indexed: 05/30/2023]
Abstract
Aviation is a tremendously complex process involving multiple factors that can be subsidiary to human error. The implementation of checklists, tools that reduce this risk, has often been extrapolated to other fields, especially medicine. Through this reflection, we comment on the critical and relevant aspects of pediatric surgical patient safety, briefly discussing the existing literature and analyzing potential areas for improvement.
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Affiliation(s)
| | - Carlos Bardají Pascual
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Ragheb DK, Healan S, Frischhertz B, Nicholson G, Janssen D, Bichell D, Doyle T, Weingarten A. Hybrid Stenting of Pulmonary Venous Baffle Stenosis: Subxiphoid Approach in Transposition of the Great Arteries. JACC Case Rep 2024; 29:102294. [PMID: 38576773 PMCID: PMC10992688 DOI: 10.1016/j.jaccas.2024.102294] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/06/2024]
Abstract
A 31-year-old woman with transposition of the great arteries status post-Senning operation presents with severe pulmonary venous baffle obstruction. Both standards of care (percutaneous stenting or open repair) were deemed suboptimal and/or high risk. A multidisciplinary, hybrid approach via subxiphoid incision, guided by 3-dimensional modeling, provided a lower risk and minimally invasive intervention.
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Affiliation(s)
- Daniel Kyrillos Ragheb
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Healan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Benjamin Frischhertz
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - George Nicholson
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Dana Janssen
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - David Bichell
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Thomas Doyle
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Angela Weingarten
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Martino AM, Yeates EO, Grigorian A, Chinn J, Young H, Colin Escobar J, Glavis-Bloom J, Anavim A, Yaghmai V, Nguyen NT, Dolich M, Schubl SD, Goodman LF, Guner YS, Nahmias J. Comparing Accuracy of Night Radiology Interpretations for Pediatric Trauma: Radiology Residents Versus Attending Teleradiologists. Am Surg 2024:31348241248794. [PMID: 38655777 DOI: 10.1177/00031348241248794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Overnight radiology coverage for pediatric trauma patients (PTPs) is addressed with a combination of on-call radiology residents (RRs) and/or attending teleradiologists (ATs); however, the accuracy of these two groups has not been investigated for PTPs. We aimed to compare the accuracy of RRs vs AT interpretations of computed tomography (CT) scans for PTPs. Methods: Pediatric trauma patients (<18 years old) at a single level-I adult/level-II pediatric trauma center were studied in a retrospective analysis (3/2019-5/2020). Computed tomography scans interpreted by both RRs and ATs were included. Radiology residents were compared to ATs for time to interpretation (TTI) and accuracy compared to faculty attending radiologist interpretation, using the validated RADPEER scoring system. Additionally, RR and AT accuracies were compared to a previously studied adult cohort during the same time-period. Results: 42 PTPs (270 interpretations) and 1053 adults (8226 interpretations) were included. Radiology residents had similar rates of discrepancy (13.3% vs 13.3%), major discrepancy (4.4% vs 4.4%), missed findings (9.6% vs 12.6%), and overcalls (3.7% vs .7%) vs ATs (all P > .05). Mean TTI was shorter for RRs (55.9 vs 90.4 minutes, P < .001). Radiology residents had a higher discrepancy rate for PTPs (13.3% vs 7.5%, P = .01) than adults. Attending teleradiologists had a similar discrepancy rate for PTPs and adults (13.3% vs 8.9%, P = .07). Discussion: When interpreting PTP CT imaging, RRs had similar discrepancy rates but faster TTI than ATs. Radiology residents had a higher discrepancy rate for PTP CTs than RR interpretation of adult patients, indicating both RRs and ATs need more focused training in the interpretation of PTP studies.
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Affiliation(s)
- Alice M Martino
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Hayley Young
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Jessica Colin Escobar
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Justin Glavis-Bloom
- Department of Radiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Arash Anavim
- Department of Radiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Vahid Yaghmai
- Department of Radiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Matthew Dolich
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Sebastian D Schubl
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Laura F Goodman
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
- Department of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Yigit S Guner
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
- Department of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
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Lehane A, Wood E, Pranikoff S, Avery M, Pranikoff T. Pediatric and Young Adult Trauma Recidivism. Am Surg 2024:31348241248698. [PMID: 38653577 DOI: 10.1177/00031348241248698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Unintentional injury is the leading cause of death among children. Much can be gleaned from the adult literature in understanding the characteristics that lead to recidivism in efforts to establish interventions for prevention. Our study aims to evaluate the rates, demographics, and features of pediatric trauma recidivism. METHODS This was a retrospective single-institution review at a level-1 pediatric trauma center of children and young adults (ages 0-28) with traumatic injuries from January 2008 to April 2023. Patients with 1 or more prior visits to our institution's trauma center (recidivists) were identified and compared with those with single admissions. Chi-square tests were used to statistically analyze the two groups. RESULTS Pediatric/young adult trauma recidivists were 4.4% of the total trauma population captured (n = 14,613). Of the total trauma group, 55% were under 18 years old. Recidivists had higher percentages of patients who were male (82% vs 69%, P < .01), African American (36% vs 24%, P < .01), involved in penetrating trauma (33% vs 17%, P < .01), self-pay/uninsured (17% vs 12%, P < .01), and have abuse reported (5% vs 4%, P = .04). The primary county for recidivism patients was Forsyth with most patients from a specific zip code in an urban area of the county. The average time between visits for recidivists was 1,066 days. CONCLUSIONS Pediatric/young adult trauma recidivism is associated with specific characteristics including male, African American race, penetrating trauma, and uninsured status. Recidivists are primarily presenting from a zip code with low socioeconomic status. It is critical to develop targeted interventions to help this population in trauma prevention.
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Affiliation(s)
- Alison Lehane
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Elizabeth Wood
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Sarah Pranikoff
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Martin Avery
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Thomas Pranikoff
- Division of Pediatric Surgery, Department of Surgery, Brenner Children's Hospital, Winston-Salem, NC, USA
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Motta M, Garapaty N, Savage M, Segarra J, Samuels S, Parreco JP, Levene T. The Impact of Redosing Antibiotics for Pediatric Patients Undergoing Appendectomy for Complicated Appendicitis. Am Surg 2024:31348241248815. [PMID: 38634883 DOI: 10.1177/00031348241248815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Currently, there is no universally accepted, standardized protocol for pre-operative antibiotic administration in the setting of appendectomy for complicated appendicitis among pediatric patients. Strategies to mitigate surgical site infections (SSIs) must be balanced with optimal antibiotic use and exposure. We conducted a retrospective chart review to compare outcomes between patients treated pre-operatively with a single pre-operative dose of antibiotics with those who received additional antibiotics prior to laparoscopic appendectomy for complicated appendicitis between 2020 and 2022. Of 124 pediatric patients, 18% received an additional dose of pre-operative antibiotics after initial treatment dose. Surgical site infection rates between the two groups were not statistically significant (P-value = .352), thereby suggesting that redosing antibiotics closer to the time of incision may not impact SSI rates. Additional studies are necessary to make clinical recommendations.
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Affiliation(s)
- Monique Motta
- Department of Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Nikitha Garapaty
- Nova Southeastern College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Margaret Savage
- Nova Southeastern College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Joann Segarra
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Tamar Levene
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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8
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Verhoeven R, Hulscher JBF. Editorial: Artificial intelligence and machine learning in pediatric surgery. Front Pediatr 2024; 12:1404600. [PMID: 38659697 PMCID: PMC11042026 DOI: 10.3389/fped.2024.1404600] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Rosa Verhoeven
- Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jan B. F. Hulscher
- Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Motta M, Siretskiy R, Avila A, Samuels S, Levene T. Efficacy of Landmark-Guided Transverse Abdominis Plane (LTAP) Block in Pediatric Patients Undergoing Laparoscopic Appendectomy. Am Surg 2024:31348241241711. [PMID: 38569662 DOI: 10.1177/00031348241241711] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Optimizing perioperative analgesia in patients undergoing abdominal surgery remains a challenge given the side effects of narcotics and the potential for abuse. While transversus abdominis plane block has been shown to improve clinical outcomes, such as decreased opioid consumption and pain scores among adult patients, there is limited data regarding its efficacy for pediatric patients. This study evaluates efficacy amongst pediatric patients undergoing landmark-guided transversus abdominis plane (LTAP) during laparoscopic appendectomy. METHODS A retrospective chart review of patients, ages 0-18 years old, who underwent laparoscopic appendectomy for uncomplicated appendicitis at a single institution from January 2021 to December 2022 was conducted. Pearson's chi-square test or Fisher's exact test and Welch's t test were used to assess differences between the two cohorts for categorical and continuous variables, respectively. Results are statistically significant at P < .05. RESULTS Of the 90 patients who met inclusion criteria, 40% (n = 36) underwent LTAP block. Those with LTAP block had a shorter average operative time than those without LTAP block (.6 vs .7 hours; P = .009). Similarly, patients with LTAP block had a shorter average time to discharge (4.1 vs 11.0 h; P = .039). There were no other statistically significant differences in postoperative outcomes including narcotic use between both cohorts. DISCUSSION Landmark-guided transversus abdominis plane blocks did not increase operative times yet reduced time to discharge for pediatric patients who underwent laparoscopic appendectomy at our institution. Larger studies are needed to evaluate the relationship between LTAP administration and postoperative narcotic consumption to make clinical recommendations.
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Affiliation(s)
- Monique Motta
- Department of Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Rachel Siretskiy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Azalia Avila
- Department of Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA
| | - Tamar Levene
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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Hernandez J, Quintero LA, Shatawi Z, Ngo L, Romero D, Heath R, Redden A, Levene T, Lao O, Parreco JP. Venous Thromboembolism in Children and Teenagers Admitted for Trauma: A 5-Year Nationwide Perspective. Am Surg 2024:31348241241687. [PMID: 38565168 DOI: 10.1177/00031348241241687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitted for trauma. 276 670 patients were identified; 2063 (.8%) were diagnosed with VTE. Among those with VTE, 300 (15%) were identified during a readmission. Higher rates of VTE were seen in ages 15-17 years (n = 1,294, 1.3%, P < .001), penetrating injuries (n = 478, .9%, P < .001), and assault (n = 271, 2.7%, P < .001). The strongest risk factor for VTE was prolonged mechanical ventilation (OR 5.5 [4.9-6.3] P < .001). Our study found that a significant portion of post-traumatic VTE in children and teenagers occur during readmissions. A deeper understanding of the risk factors outlined here can guide enhanced clinical protocols, ensuring early detection and prevention of this complication.
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Affiliation(s)
- Jennifer Hernandez
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Luis A Quintero
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Zaineb Shatawi
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Lisa Ngo
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Dino Romero
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Rainya Heath
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Anna Redden
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Tamar Levene
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Oliver Lao
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, Memorial Healthcare System, Hollywood, FL, USA
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11
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Avila A, Motta M, Schechter D, Samuels S, Jaramillo I, Whitehouse J, Neville HL, Levene T. Ovarian Salvage With Prompt Surgical Intervention for Adnexal Torsion: Does Timing Matter? Am Surg 2024:31348241241678. [PMID: 38566270 DOI: 10.1177/00031348241241678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adnexal torsion requires treatment to limit ischemic injury and tissue loss. Optimal time to surgical intervention has not been established. We compared outcomes of ovarian loss amongst pediatric patients. METHODS We conducted a retrospective review of 88 patients with adnexal torsion from March 2014 through April 2021. Rates of ovarian loss were compared for patients who underwent surgery within and beyond 60 minutes from diagnosis. RESULTS Most patients underwent surgery more than 60 minutes from the time of diagnosis (83%; median time 116 minutes). Comparing patients with and without ovarian loss, there was no statistically significant difference in time to surgery from time of diagnosis (P = .618). Patients with ovarian loss had a longer duration of symptoms (24 vs 96 hours; P = .017). CONCLUSIONS While surgical repair of adnexal torsion may be urgent, this study suggests that duration of symptoms should be considered when assessing a patient's likelihood of ovarian loss.
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Affiliation(s)
- Azalia Avila
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Monique Motta
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - David Schechter
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA
| | - Ingry Jaramillo
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Jill Whitehouse
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Holly L Neville
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Tamar Levene
- Memorial Healthcare System, Division of Pediatric General Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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12
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Ngo LC, Carroll HM, Massimilian SS, Garapaty N, Palladino K, Samuels SK, Lao OB, Parreco JP, Levene T. Optimizing Triage Practice in Pediatric Trauma: Lessons From Under-triage and Over-triage Rates and Risk Factors. Am Surg 2024:31348241241693. [PMID: 38532308 DOI: 10.1177/00031348241241693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Triage accuracy is essential for delivering effective trauma care, especially in the pediatric population where unique challenges exist. The purpose of this study was to investigate risk factors contributing to under-triage and over-triage in an urban pediatric trauma center. METHODS This retrospective cohort study included all trauma activations at an urban level 1 trauma center between January 1, 2021, and July 31, 2023 (patients <18 years old.) Patients who were under- or over-triaged were identified based on the level of trauma activation and injury severity score. RESULTS There were 1094 trauma activations included in this study. The rate of under-triage was 3.8% (n = 42) and over-triage was 13.6% (n = 149). Infants aged 0-1 years had the highest rate of under-triage (10.9%, n = 19, P < .001), while those aged 11-17 had the highest rate of over-triage (17.0%, n = 82, P = .003). Non-accidental trauma was the strongest risk factor for under-triage (OR 30.2 [6.4-142.8] P < .001). Penetrating mechanism was the strongest risk factor for over-triage (OR 12.2 [5.6-26.2] P < .001). DISCUSSION This study reveals the complexity of trauma triage in the pediatric population. We identified key predictive factors, such as age, comorbidities, and mechanism of injury, that can be used to refine triage practices and improve the care of pediatric trauma patients.
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Affiliation(s)
- Lisa C Ngo
- Memorial Regional Hospital, Hollywood, FL, USA
| | | | | | - Nikitha Garapaty
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | | | - Shenae K Samuels
- Memorial Healthcare System Office of Human Research, Hollywood, FL, USA
| | - Oliver B Lao
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Tamar Levene
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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Gigena C, Díaz I, Valverde S, Portu AM, Fortunato AC, Kaller R, Bosich M, Bellía Munzon G, Millán C. Results of a Novel Long-Term Method for Laparoscopic Skills Online Training. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38526573 DOI: 10.1089/lap.2023.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Introduction: Ensuring patient safety in minimally invasive surgery (MIS) within the field of pediatric surgery requires systematic and extensive practice. Many groups have proposed mastery learning programs encompassing a range of training methods. However, short courses often have a narrow focus on specific objectives, limiting opportunities for sustained training. Our aim was to analyze our results with an online long-term competency-based and supervised training. Methods: This is a retrospective cohort study with prospective data collection of scores and performance of trainees during online courses from October 2020 to April 2023. Results: All participants (n = 76) were able to set up their personal training gym and complete the intensive stage of the course. The total score evolved from 2.60 ± 0.56 at the first meeting to 3.67 ± 0.61 at the fourth meeting, exhibiting a significant difference (P < .013). A considerable drop out was observed in the follow-up stage, with only 53.8% of the participants completing the course. When compared with the first meeting, they also showed a significant improvement with a mean general score of 3.85 ± 0.25 (P < .013) Conclusion: We have presented a novel online training program, based on continuous training that demonstrated that the unlimited access to a personal training gym allows surgeons to improve and maintain MIS skills.
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Affiliation(s)
- Cecilia Gigena
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
- Deparment of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ignacio Díaz
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Soledad Valverde
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Agustina Mariana Portu
- School of Science and Technology, National University of San Martín (UNSAM), Buenos Aires, Argentina
- National Research Council (CONICET), Buenos Aires, Argentina
| | - Ana Clara Fortunato
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Ruth Kaller
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Mariano Bosich
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Gastón Bellía Munzon
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Carolina Millán
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
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Bašković M, Markanović M, Ivanović S, Boričević Z, Alavuk Kundović S, Pogorelić Z. Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients. Children (Basel) 2024; 11:382. [PMID: 38671599 PMCID: PMC11049595 DOI: 10.3390/children11040382] [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] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Same-day surgery implies patient discharge on the same day after the surgery. The main aim of the research was to determine which predisposing factors lead to children treated with same-day surgery not being able to be discharged on the same day. METHODS For the purposes of this research, the electronic records of patients in the hospital information system were reviewed retrospectively. The search included patients who were surgically treated through the Day Surgery Unit at the Children's Hospital Zagreb with various diagnoses from 1 January 2021 to 31 December 2023. The target group consisted of patients who could not be discharged on the same day (n = 68), while for the purposes of the control group (n = 68), patients were randomly selected, comparable by age and gender, who were discharged from the hospital on the same day in accordance with the principles of same-day surgery. RESULTS In relation to the parameters of interest between the groups, statistically significant differences were observed in the type of general anesthesia (p = 0.027), the use of analgesics (p = 0.016), the time of entering the operating room (p = 0.000), the time of leaving the operating room (p < 0.0001) and the duration of surgery (76.81 ± 37.21 min vs. 46.51 ± 22.46 min, p < 0.0001). When explanatory variables were included in the regression model, they explained 38% of the variability in the dependent variable. Only the variable "duration of surgery" provided significant information to explain the variability in the dependent variable (p = 0.004). CONCLUSIONS Although the duration of surgery was imposed as the main predictor of hospitalization after same-day surgery, and considering the extremely small number of studies on the mentioned topic, especially in the pediatric population, further, preferably multicenter research on the mentioned topic is needed.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Martina Markanović
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
- Day Surgery Unit, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Sanja Ivanović
- Department of Pediatric Surgery, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
- Day Surgery Unit, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Zrinka Boričević
- Department of Surgery, General Hospital Karlovac, Ulica Andrije Štampara 3, 47000 Karlovac, Croatia
| | - Sandra Alavuk Kundović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Children's Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva Ulica 1, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, Šoltanska Ulica 2a, 21000 Split, Croatia
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15
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Perelli F, Grimaldi C, Candiani M, Masieri L, Mantovani A. Editorial: Update in pediatric gynecology. Front Surg 2024; 11:1391435. [PMID: 38577254 PMCID: PMC10991820 DOI: 10.3389/fsurg.2024.1391435] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Federica Perelli
- Department of Gynecology and Pediatrics, Azienda USL Toscana Centro, Florence, Italy
| | - Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Masieri
- Pediatric Urology Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alberto Mantovani
- Pediatric Urology Department, Meyer Children's Hospital IRCCS, Florence, Italy
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16
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Ghezzi M, Abbattista L, Dighera A, Silvestri AD, Farolfi A, Pelizzo G, Riccipetitoni G, Costanzo S, Calcaterra V, Zuccotti GV. Lung Function Evaluated By Structured Light Plethysmography in Children After Lung Surgery: A Preliminary Analysis. Pediatr Allergy Immunol Pulmonol 2024; 37:7-12. [PMID: 38484265 DOI: 10.1089/ped.2023.0069] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background: Structured light plethysmography (SLP) is a novel light-based method that captures chest wall movements to evaluate tidal breathing. Methods: Thirty-two children who underwent lung surgery were enrolled. Their clinical history was collected along with spirometry and SLP. Results: Median age of surgery was 9 months (interquartile range 4-30). Most frequent diagnosis was congenital pulmonary airway malformation (14/32), then pulmonary sequestration (9/32), tumor (5/32), and bronchogenic cyst (4/32). The most frequent surgical approach was lobectomy (59%), segmentectomy (38%), and complete resection (3%). More than 80% had surgery when younger than 3 years of age. Eight patients had short-term complications (pleural effusion was the most frequent), while long-term effects were reported in 15 patients (19% recurrent cough, 13% thoracic deformities, 13% airway infections, 9% wheezing, 6% reduced exercise tolerance, and 3% columnar deformities). Spirometry was normal in 9/22 patients. Nine patients had a restrictive pattern, while 4 showed a mild bronco-reactivity. Ten patients did not perform spirometry because of young age. SLP revealed the presence of obstructive pattern in 10% of patients (IE50 > 1.88) and showed a significant difference between the two hemithorax in 29% of patients. Discussion: SLP may be a new method to evaluate lung function, without collaboration and radiation exposure, in children who underwent lung resection, also in preschool age.
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Affiliation(s)
- Michele Ghezzi
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Luisa Abbattista
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Anna Dighera
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Annalisa De Silvestri
- Department of Biometry and Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Farolfi
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, Milano, Italy
- Department of Biomedical and Clinical Science "L. Sacco," University of Milano, Milano, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - Sara Costanzo
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
- Department of Biomedical and Clinical Science "L. Sacco," University of Milano, Milano, Italy
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17
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Alghenaim M, Awadh M, Alshafai A, Darwish A. Intestinal Intussusception Complicating an Undiagnosed Burkitt Lymphoma in a Pediatric Arab Patient. Cureus 2024; 16:e55949. [PMID: 38601415 PMCID: PMC11005805 DOI: 10.7759/cureus.55949] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Burkitt's lymphoma (BL) is considered an aggressive form of a non-Hodgkin B-cell lymphoma, representing less than 5% of all pediatric malignancies and 30% of pediatric lymphomas. However, intestinal BL may present as a lead point, causing intussusception. Surgery continues to be the gold standard for the treatment and identification of localized tumors to ensure complete removal with proper margin. In this report, we describe a hidden BL presenting as intestinal intussusception in an eight-year-old Arab boy. A computed tomography (CT) scan of the abdomen revealed an ileoileal intussusception with multiple enlarged lymph nodes. The report discusses the role of histopathology, supported by immunohistochemistry studies, in establishing the diagnosis. It also covers the significance of proper laparoscopic surgery and chemotherapy in the management of this child.
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Affiliation(s)
- Marwa Alghenaim
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Mohamed Awadh
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Abdulrahman Alshafai
- Department of Pediatric Surgery, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Abdulla Darwish
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
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18
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Mustafa MS, Shafique MA, Zaidi SDEZ, Qamber A, Rangwala BS, Ahmed A, Zaidi SMF, Rangwala HS, Uddin MMN, Ali M, Siddiq MA, Haseeb A. Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques. Front Pediatr 2024; 12:1353508. [PMID: 38440185 PMCID: PMC10909818 DOI: 10.3389/fped.2024.1353508] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
Background This study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients. Methods Following the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979). Results This meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias. Conclusion Our study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979].
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Affiliation(s)
| | | | | | - Amna Qamber
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Aftab Ahmed
- Department of Paediatrics, National Institute of Child Health, Karachi, Pakistan
| | | | | | | | - Mirha Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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19
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Schmoke N, Porigow C, Wu YS, Alexander M, Chalphin AV, Rothenberg S, Duron V. Thoracoscopic Excision of Mediastinal Bronchogenic Cysts in Children: A Case Series. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38354292 DOI: 10.1089/lap.2023.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background: Bronchogenic cysts result from a congenital anomalous budding of the tracheobronchial tree. Resection is usually recommended to avoid complications. Mediastinal bronchogenic cysts present a unique challenge due to their proximity to vital structures. The purpose of this study is to review our experience with mediastinal bronchogenic cysts. Methods: A single-institution retrospective review evaluated all mediastinal bronchogenic cyst excisions between January 2012 and November 2022. Patient demographics were assessed, including age at diagnosis, presenting symptoms, imaging workup, and cyst characteristics. Operative approach, complications, and surgical pathology were reported. Results: Five patients were identified. Age at diagnosis ranged from 18 to 27 months. No patient was diagnosed prenatally. All patients had symptoms at the time of diagnosis, including cough, wheezing, and respiratory distress. Three cysts were paratracheal, and two were paraesophageal. Age at surgery ranged from 26 to 30 months. All bronchogenic cysts were successfully resected thoracoscopically. Individual technical challenges included narrowing of the mainstem bronchus preventing lung isolation, significant mediastinal inflammation, the necessity for cyst evacuation to delineate the extent of the cyst, adherence of cyst wall to bronchus or trachea requiring cold dissection, and a stalk of tissue with an intimate connection to the carina that was amputated. No intraoperative or postoperative complication occurred. Surgical pathology was consistent with a bronchogenic cyst in all cases. Median length of hospital stay was two days. Conclusion: Thoracoscopy is a safe and effective procedure for mediastinal bronchogenic cyst excision in children. Certain technical maneuvers are highlighted, which may facilitate resection.
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Affiliation(s)
- Nicholas Schmoke
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Chloe Porigow
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Yeu Sanz Wu
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Matthew Alexander
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Alexander V Chalphin
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Steven Rothenberg
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
- Division of Pediatric Surgery, Department of Surgery. Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Vincent Duron
- Division of Pediatric Surgery, Department of Surgery. Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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20
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Jock A, Neunhoeffer F, Rörden A, Schuhmann MU, Zipfel J, Hofbeck M, Dietzel M, Scherer S, Urla C, Fuchs J, Michel J, Fideler F. The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study. Paediatr Anaesth 2024; 34:138-144. [PMID: 37933584 DOI: 10.1111/pan.14789] [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: 04/24/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Cerebral oxygen desaturation during pediatric surgery has been associated with adverse perioperative outcomes. The aim of this pilot study was to analyze the frequency and severity of intraoperative cerebral oxygen desaturations and their impact on postoperative cerebral oxygen metabolism in neonates and infants undergoing pediatric surgery. METHODS In a prospective pilot study, intra- and postoperative regional cerebral oxygen saturation and blood flow were measured noninvasively using a device combining laser Doppler flowmetry and white-light-spectrometry. Thirty-seven consecutive neonates and infants undergoing noncardiac surgery under general anesthesia for more than 30 min and necessity for invasive arterial blood pressure monitoring were included. Patients with pre-known congenital structural heart disease or cerebral disease were excluded. Continuously brain monitor recording was started in sedated patients before induction of anesthesia (preoperative baseline) and was completed 1 h postoperatively in the PICU in sedated, intubated, and mechanically ventilated states at the PICU (postoperative state). Baseline and postoperative state for cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated. RESULTS Seventeen (46%) of the 37 studied neonates and infants suffered from intraoperative periods of regional cerebral oxygen desaturation below 20% of the baseline (event group). Severity of cerebral desaturations was median 4.0%min/h [range 0.1-58.7; interquartile range [IQR] 0.99-21.29]. In the event group, the duration of surgery was significantly longer (median 135 min [range 11-260; IQR 113.5-167.0] vs median 46.5 min [range 11-180; IQR 30.5-159.3]; difference of -62.94; 95% confidence interval [CI] -105.17 to -20.71; p = .021). In the event group, cerebral fractional tissue oxygen extraction (median 0.41 [range 0.20-0.55; IQR 0.26-0.44] vs. median 0.27 [range 0.11-0.41; IQR 0.20-0.31]; difference of -0.11; 95% CI -0.17 to -0.05; p = .001) and approximated cerebral metabolic rate of oxygen (median 6.15 arbitrary unit [range 2.69-12.07; IQR 5.12-7.21] vs. median 4.14 arbitrary unit [range 1.78-7.86; IQR 3.82-6.31]; difference of -1.76; 95% CI -3.03 to -0.49; p = .009) were significantly higher and the cerebral regional oxygen saturation (median 58.99% [range 44.87-79.1; IQR 54.26-72.61] vs median 70.94% [range 57.9-86.13; IQR 67.07-76.59]; difference of 10.01; 95% CI 4.13-15.90; p = .002) significantly lower after surgery compared to the nonevent group. DISCUSSION The increase of approximated cerebral metabolic rate of oxygen could indicate an elevated oxidative energy metabolism in the "stressed" brain, due to repair processes. The increased cerebral fractional tissue oxygen extraction fits with the decreased NIRS cerebral oxygenation. Our data suggest that an increase in cerebral oxygen metabolism was the cause. CONCLUSION Cerebral oxygen desaturation during major surgery in neonates and infants is associated with early postoperative increased cerebral oxygen extraction and possibly increased cerebral oxygen metabolism.
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Affiliation(s)
- Anna Jock
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | - Alisa Rörden
- Department of Dermatology, University Hospital, Tuebingen, Germany
| | - Martin U Schuhmann
- Department of Pediatric Neurosurgery, University Hospital, Tuebingen, Germany
| | - Julian Zipfel
- Department of Pediatric Neurosurgery, University Hospital, Tuebingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | - Markus Dietzel
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
| | - Simon Scherer
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
| | - Cristian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | - Frank Fideler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tuebingen, Germany
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Mashlah Q, Al Laham O, Odah Bashi H, Sharaf Aldeen R, Alashi S, Abdulkader M. Thoracoabdominal duplication accompanied by intestinal malrotation: a case report and literature review of a rare congenital anomaly in an infant. Ann Med Surg (Lond) 2024; 86:1166-1172. [PMID: 38333278 PMCID: PMC10849408 DOI: 10.1097/ms9.0000000000001654] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Thoracoabdominal duplication and intestinal malrotation are extremely rare congenital alimentary tract anomalies that can manifest in any segment of the gastrointestinal tract. Still, tubular duplications are an even rarer subset of alimentary tract duplications. Misdiagnosis could occur and this will yield devastating ramifications. Therefore, consideration in the clinical settings is warranted to aid in conducting timely therapeutic interventions. Case presentation In this article, we illustrate the overwhelmingly rare occurrence of thoracoabdominal duplication coexistent with intestinal malrotation in a 7-month-old male whose primary complaint was chronic dyspnoea since birth that progressed to involve cough and fever. Imaging analysis revealed a significant intrathoracic fluid-filled cyst. Clinical discussion The intestinal malrotation was treated through Ladd's procedure, and surgical excision of the duplicated segments was accomplished. The subsequent analysis of the resected specimens via means of histopathology utilizing Hematoxylin and Eosin dyes established the definitive diagnosis of a foregut duplication cyst. Conclusion Thoracoabdominal duplication is one of the most crucial topics in the field of Paediatric Surgery. It is exceptionally rare in occurrence, and the scarcity of available resources that document and describe this topic is evident in the published literature. The authors must opt to document, study, and broaden awareness regarding this life-threatening pathology so that they can circumvent the resultant complications by means of early detection and the performance of apt surgical interventions. Upon careful review of the available literature, we can state that ours is the first-ever case documented from their country regarding this topic and this co-incidence.
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Affiliation(s)
- Qusai Mashlah
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital
| | | | - Hajar Odah Bashi
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital
| | - Rahaf Sharaf Aldeen
- Faculty of Medicine
- Department of Surgery, Al-Mouwasat University Hospital
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | | | - Mohammd Abdulkader
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital
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22
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Williamson KA. Nurse-led Preoperative Education With Home-based Internet Resources for Pediatric Patients and Their Parents. J Perianesth Nurs 2024; 39:6-9. [PMID: 37656107 DOI: 10.1016/j.jopan.2023.05.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/18/2022] [Accepted: 05/02/2023] [Indexed: 09/02/2023]
Abstract
The majority of pediatric patients and their parents experience fear and anxiety related to their surgical experience. Traditionally, anesthesia providers addressed this anxiety with pharmacologic therapy, such as benzodiazepines, to provide amnesia and anxiolysis. However, this approach has been questioned due to the potential for developmental neurotoxicity, among other drawbacks. Further, the pharmacological approach does not remove preexisting anxiety that the child and parent experience before arrival and during check-in. Pediatric and parental preparation before surgery is an important step that continues to be inconsistently addressed, particularly in lower-resource community hospitals where the majority of routine pediatric outpatient procedures occur. This care gap provides an opportunity for preanesthesia nurses to intervene with valid, evidence-based preoperative education tools aimed at pediatric patients and their parents. Providing these resources before the day of surgery allows time for child-directed, at-home practice as often as the parent(s) and patient choose. Use of available resources from a leading children's hospital, nurses can create a tailored, developmentally appropriate preoperative education plan for pediatric patients and their parents, providing families with the power to create a positive surgical experience.
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23
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Pendem S, Bhuvan Chandra R, Selvarasu K, Krishnan M, M R M, J P. Analysis of Different Facets of the Rule of 10 for Cleft Lip Repair for Their Application in the Current Era. Cureus 2024; 16:e53832. [PMID: 38465130 PMCID: PMC10924625 DOI: 10.7759/cureus.53832] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE To evaluate the relevance of the "rule of 10" as a deciding factor preoperatively for patients undergoing cleft lip repair in the Indian sub-continent. DESIGN A questionnaire survey was conducted. SETTING All tertiary cleft care centers in the Indian subcontinent participated in an online questionnaire survey with anesthetic and surgical professionals. MAIN OUTCOME The primary goal of this survey was to determine the relevance and applicability of various aspects of the rule of 10 as a preoperative guideline for determining the timing of cleft lip repair in ASA I infants. The survey also aids in understanding the systemic factors that need to be prioritized and factors that are no longer of primary relevance in defining the timeline to undertake cleft lip repair in infants in the current era. RESULTS Surgeons and anesthetists from 31 tertiary cleft centers in India responded to the questionnaire. Specifically, 64.5% do not apply the "rule of 10" for deciding the timing of cleft lip repair, and 77% of the centers reported that cleft lip repair can be taken up in infants with hemoglobin levels in the range of 9-10 g/dL and an average weight of 4.5 kg. The average blood loss in unilateral lip repair ranged between 5 and 10 mL and 10 and 40 mL in children with bilateral lip repair. Three to six months was the average age at which cleft lip repair was undertaken at most of the centers in India. CONCLUSION The rule of 10 is not considered a gold standard by most of the centers in India, and the decision-making was based on the overall physiological status of the patients, the experience of the surgeon, and the anesthetic and post-operative care facilities available at the center.
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Affiliation(s)
- Sneha Pendem
- Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, IND
| | - Raparthi Bhuvan Chandra
- Oral Surgery, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, IND
| | - Kathiravan Selvarasu
- Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, IND
| | - Muthusekhar M R
- Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, IND
| | - Preethi J
- Anaesthesiology, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, IND
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Sapkale B, Shinde RK, Kakde U. Overcoming Challenges in Hemihyperplasia Through Surgical Innovation and Genetic Diagnosis: A Case Report. Cureus 2024; 16:e54445. [PMID: 38510879 PMCID: PMC10951678 DOI: 10.7759/cureus.54445] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
This case report sheds light on the complex management of hemihyperplasia (HHP), highlighting the difficulties associated with diagnosis and the critical importance of a multimodal approach to treatment. The story of Acharya Vinoba Bhave Rural Hospital's (AVBRH) successful resolution following a misdiagnosis at another clinic emphasizes the value of expert care. The successful outcome resulted from the fusion of surgical innovation, genetic insights, and psychosocial factors through genetic testing, liposuction, and postoperative rehabilitation. This example emphasizes the need to treat congenital illnesses holistically and the transforming power of individualized, multidisciplinary treatment to improve the functional and esthetic elements of life for patients with HHP.
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Affiliation(s)
- Bhagyesh Sapkale
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Umesh Kakde
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Groszman L, McCook KM, Xiang L, Parker L, Villamor LL, Koganti D, Smith RN, Sola R. Understanding Chest CT Scan Usage Among Adolescent Blunt Trauma Patients at Adult Trauma Centers. Am Surg 2024; 90:220-224. [PMID: 37619987 DOI: 10.1177/00031348231198121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE The utility of chest computed tomography (CCT) is not well established in the diagnostic algorithm of adolescent blunt trauma patients. Our study's aim was to review CCT usage in the initial evaluation of adolescent blunt trauma. METHODS We retrospectively reviewed adolescent blunt trauma patients treated at our urban level 1 adult trauma center from 2015 to 2019. Our primary outcome was the rate of positive CCT findings. Univariate and multivariate logistic regression analyses were performed. RESULTS There were 288 patients that met our inclusion criteria and 153 positive CCT and 135 negative CCT. There was no statistically significant difference between both groups in terms of age, gender, and race. Those with a positive CCT were found to have a statistically significant higher ISS than the negative CCT group (20.6 ± 12.3 vs 12.3 ± 7.6; P < .01). Those with a positive CCT were more likely to have a GCS <15 (40% vs 25%), have a positive CXR (38% vs 2%), have chest pain (16% vs 7%), and have an abnormal chest exam (27% vs 7%) than those with a negative CCT (P < .01). On multivariate analysis, positive CXR (P < .05, OR = 13.96) and ISS (P < .05, OR = 3.10) were independently associated with a positive CCT. CONCLUSION While CCT may provide valuable information, clinical exam coupled with low-ionizing radiographic imaging (i.e., CXR) may sufficiently identify chest trauma after blunt mechanisms. This shift in management can potentially reduce the risk of radiation without compromising the care of adolescent trauma patients at adult trauma centers.
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Affiliation(s)
- Lilly Groszman
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Kem-Maria McCook
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Laurel Xiang
- Center for Data Science, New York University, New York, NY, USA
| | - Laurel Parker
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Deepika Koganti
- Department of Surgery, Emory School of Medicine, Atlanta, GA, USA
| | | | - Richard Sola
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
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Mejia M, Royero Arias M, Pimiento Figueroa J, Romero Espitia W. Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome: A Case Report of an Uncommon Condition. Cureus 2024; 16:e54255. [PMID: 38496087 PMCID: PMC10944333 DOI: 10.7759/cureus.54255] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
The megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS), also known as Berdon syndrome, is a rare congenital condition that falls within the spectrum of visceral myopathies. It is characterized by the presence of megacystis, microcolon, and hypoperistalsis, which are secondary to gastrointestinal and urinary system dysmotility. It is frequently associated with other alterations in the gastrointestinal and genitourinary tracts. Although it is possible to make the diagnosis in the prenatal period, most cases are diagnosed after birth through genetic and imaging studies. Advances in treatment have led to a progressive increase in survival rates. We present the case of a newborn with congenital alterations described prenatally and with imaging findings characteristic of the syndrome.
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Affiliation(s)
- Marcia Mejia
- Radiology, Universidad de Antioquia, Medellín, COL
| | - Mónica Royero Arias
- Pediatric Radiology, Hospital Universitario San Vicente Fundación, Medellín, COL
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Nemeh C, Hassan IN, Walsh A, Iyer S, Gitzelmann CA. Pediatric Ultrasound Appendicitis Score for the Diagnosis of Acute Appendicitis to Reduce Computed Tomography Scan Utilization. Am Surg 2024; 90:245-251. [PMID: 37651539 DOI: 10.1177/00031348231199172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Acute appendicitis is one of the most common reasons for pediatric surgical consultation in the emergency room. Although acute appendicitis is a clinical diagnosis, the use of imaging in the emergency department to assist with the diagnosis is very common. Ultrasound is frequently utilized in pediatrics because of the radiation risks associated with computed tomography (CT) scan. The risks of radiation in the pediatric population are much more significant than in adults. Reasons for this include smaller size so there is a relative higher radiation dose than for larger adults, radiosensitive organs such as thyroid, bone marrow, and gonads, and radiation exposure earlier in life allows for more time that a radiation induced cancer could develop. The risks of radiation from imaging are increased with cumulative dosing. METHODS The purpose of this study was to incorporate the pediatric appendicitis score (PAS) and standardized ultrasound scoring system to provide a combined score that would assist with the clinical diagnosis of acute appendicitis and avoid the need for a CT scan. RESULTS The presented data shows that for scores of 7 or more, the specificity and sensitivity is 90% and 90.2%, respectively for the diagnosis of acute appendicitis. DISCUSSION This study validates the combined score, shows the specific cutoffs, and initiates the discussion that CT scan may not always be required for diagnosing acute appendicitis if this scoring system is used.
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Affiliation(s)
- Christopher Nemeh
- Department of General Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Irfan N Hassan
- Department of Radiology, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | - Abigail Walsh
- Division of Pediatric Surgery, Robert Wood Johnson Medical School, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | - Sekhar Iyer
- Department of Radiology, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | - Christopher A Gitzelmann
- Division of Pediatric Surgery, Robert Wood Johnson Medical School, Cooperman Barnabas Medical Center, Livingston, NJ, USA
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Scoville SD, Bergus K, Diefenbach KA, Dajusta DG, Fuchs ME, Michalsky MP, Aldrink JH. Robotic-Assisted Surgery in Patients Less than 15 kg: A Single Center Review. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38294893 DOI: 10.1089/lap.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Introduction: Robotic-assisted surgery (RAS) is an increasingly utilized tool in children. However, utilization of RAS among infants and small children has not been well established. The purpose of this study was to review and characterize RAS procedures for children ≤15 kg. Methods: We performed a single institution retrospective descriptive analysis including all patients ≤15 kg undergoing RAS between January 2013 and July 2021. Data collection included procedure type, age, weight, gender, and surgical complications. Cases were further categorized according to surgical specialty: pediatric urology (PU), pediatric surgery (PS), and multiple specialties (MS). t-Tests were used for statistical analyses. Results: Since 2013, a total of 976 RAS were identified: 492 (50.4%) were performed by PU, 466 (47.8%) by PS, and 18 (1.8%) by MS. One hundred eighteen (12.1%) were performed on children ≤15 kg, consisting of 110 (93.2%) PU cases, 6 (5.1%) PS cases, and 2 (1.7%) MS cases. Procedures were significantly more common in the PU subgroup, mean of 12 cases/year, compared to PS subgroup, mean of 0.63 cases/year, (P < .01). The mean weight of PU patients (10.5 kg) was significantly less than PS patients (13.9 kg) (P < .01). Mean age was also significantly lower among PU patients (18.6 months) compared to PS (34.2 months) (P < .01). Conclusion: RAS among patients ≤15 kg is safe and feasible across pediatric surgical subspecialties. RAS was performed significantly more frequently by pediatric urologists in younger and smaller patients compared to pediatric surgeons. Further refinement of robotic technology and instrumentation should enhance the applicability of these procedures in this young group.
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Affiliation(s)
- Steven D Scoville
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katherine Bergus
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Daniel G Dajusta
- Divisions of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Molly E Fuchs
- Divisions of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marc P Michalsky
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer H Aldrink
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Salim A, Ali S, Sheikh MA, Latif T, Din IU. Emergency Angioembolization for Life-Threatening Hemorrhage in Wilms Tumor. J Cancer Allied Spec 2024; 10:603. [PMID: 38259681 PMCID: PMC10793714 DOI: 10.37029/jcas.v10i1.603] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
Introduction Renal artery embolization has been used in a palliative fashion for symptomatic relief of hematuria or flank pain in unresectable renal cell carcinoma in adults. There is limited data on the use of embolization for actively bleeding and unresectable tumors in the oncological pediatric population. Case Description A previously healthy 5-year-old boy with no significant past medical or surgical history presented to the clinic with gradually worsening abdominal distension associated with occasional abdominal pain, gross hematuria, and lethargy for four months. Diagnostic investigations showed an 18-cm left-sided metastatic (pulmonary) renal tumor (Wilms), which was deemed unresectable on imaging. Treatment was planned according to the SIOP-RTSG protocol. However, he became hemodynamically and vitally unstable with acute, sudden distension of the abdomen on the left side after the first cycle of chemotherapy. Imaging showed active bleeding from an inferior branch of the left renal artery. Selective angioembolization was done, and chemotherapy was reinitiated with a patent left main renal artery. Following the fourth cycle of chemotherapy, he developed hemodynamic instability and abdominal pain; imaging revealed the resolution of pulmonary nodules and bleeding from the left renal artery (main); this was again embolized, and the patient was stabilized. The patient was operated on after optimization, and a complete resection of the mass was done with negative margins. On six months follow-up, he is well. Practical Implications To the best of our knowledge, this is the first case where angioembolization has been done in conjunction with neoadjuvant chemotherapy to downsize a Wilms tumor to achieve favorable outcomes. Continued research efforts are necessary to optimize strategies and improve the prognosis for pediatric patients, and this case is one of the prime examples.
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Affiliation(s)
- Areej Salim
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Sajid Ali
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Muhammad Ali Sheikh
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Tariq Latif
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Islah Ud Din
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
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Zhang L, Zhang R, Zhang J, Hu H, Chen Z, Fu Y, Li S. To use a simple hernia needle for single-port laparoscopic percutaneous inguinal hernia repair in children: a 5-year experience study. Front Pediatr 2024; 11:1298643. [PMID: 38259601 PMCID: PMC10801725 DOI: 10.3389/fped.2023.1298643] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The aim of this study is to investigate the technique and practical significance of using a simple hernia needle in single-port laparoscopic herniorrhaphy in pediatric patients. Methods The study conducted a retrospective analysis of all pediatric patients who underwent treatment for inguinal hernia using single-port laparoscopic herniorrhaphy with a simple hernia needle at Yellow River Sanmenxia Hospital from June 2018 to May 2023. The medical records of all the children were collected, and clinical characteristics, procedural information, and follow-up data were carefully reviewed. Results A total of 848 patients underwent inguinal hernia repair, with ages ranging from 7 months to 13 years (2.99 ± 2.49 years), including 756 males and 92 females. A total of 528 cases of unilateral hernia and 310 cases of bilateral hernia were reported, with intra-operative findings revealing contralateral occult hernia in 253 cases. Single-port laparoscopic herniorrhaphy was successfully completed in all patients, with no instances of conversion to open surgery. The mean operation time for unilateral hernia repair was (7.50 ± 4.80) min, while for bilateral hernia repair it was (11.55 ± 7.27) min. Five patients presented with subcutaneous emphysema, while two patients experienced a recurrence of inguinal hernia. No complications, such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, were observed. The duration of the follow-up period ranged from 3 to 24 months. Conclusion The promotion and utilization of single-port laparoscopy combined with a simple hernia needle in clinical practice are justified. Our initial investigation indicates that this surgical approach is both safe and dependable for the management of pediatric inguinal hernia. The procedure presents numerous benefits, including the utilization of uncomplicated instruments, straightforward operation, a clear curative impact, minimal tissue damage, rapid recovery, and the absence of scarring.
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Affiliation(s)
- Li Zhang
- Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, China
| | - Rui Zhang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Jianfa Zhang
- Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, China
| | - Hailong Hu
- Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, China
| | - Zihan Chen
- Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, China
| | - Yanxiang Fu
- Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, China
| | - Saihua Li
- Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, China
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Trembath HE, Caruso DM, McLean SE, Akinkuotu AC, Hayes Dixon AA, Phillips MR. Central Line-Associated Bloodstream Infection Risk Factors in a Pediatric Population. Am Surg 2024; 90:69-74. [PMID: 37571962 DOI: 10.1177/00031348231192070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates. METHODS This is a single-institution case-control study of pediatric patients (≤18 years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed. RESULTS We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors. DISCUSSION Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates.
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Affiliation(s)
- Hannah E Trembath
- Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Deanna M Caruso
- Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea A Hayes Dixon
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Phillips
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
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Khokar DS. Presidential Speech IAPSCON 2023. J Indian Assoc Pediatr Surg 2024; 29:1-3. [PMID: 38405256 PMCID: PMC10883170 DOI: 10.4103/jiaps.jiaps_243_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 02/27/2024] Open
Abstract
Respected Chief Guest, guests from overseas, esteemed colleagues, dear students, and friends, I am deeply honoured to address you at this prestigious gathering at the Indian Association of Paediatric Surgeons (IAPS) Conference. I take this opportunity to remind all members that our responsibility extends far beyond our operating theatres. The Incidence of congenital anomalies in India is still 18.2/1000 live births with a high mortality of about 6.78/1000 live births, with a vast majority of these children with congenital anomalies being born into poor families, resulting in a large proportion of children being left untreated or incompletely treated. To address these problems, the IAPS makes the following suggestions: (1) Urgent instructions from the government to insurance providers to launch affordable and easily accessible insurance policies that address the needs of newborns, infants, and children. (2) To ensure the appointment of at least one pediatric surgeon for every pediatric intensive care unit/neonatal intensive care unit being set up in district hospitals. (3) To make pediatric surgery an essential subject in the undergraduate curriculum at MBBS level and ensure that medical colleges and district hospitals have at least one full-time pediatric surgeon on their faculty. (4) To ensure that newborns and children (up to the age of 18 years) have access to a pediatric surgeon or specialist who is well trained in surgery on children, much like medical problems in this age group are treated by pediatricians, surgical problems should be entrusted to pediatric surgeons. Someday, a pediatric surgeon for every child's operation may become a reality. Hope that day is not too far away.
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Affiliation(s)
- Dasmit Singh Khokar
- Department of Paediatric Surgery, B. J. Government Medical College, Pune, Maharashtra, India
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Reiter AJ, Huang L, Tian Y, Sullivan GA, Hu A, Raval MV. National Trends in Interventions for Pediatric Gallstone Pancreatitis. J Laparoendosc Adv Surg Tech A 2024; 34:82-87. [PMID: 37682559 PMCID: PMC10794827 DOI: 10.1089/lap.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Introduction: Laparoscopic cholecystectomy (LC) during index hospitalization for gallstone pancreatitis is standard in adult populations. The objective of this study was to evaluate trends in use of LC and endoscopic retrograde cholangiopancreatography (ERCP) for children with gallstone pancreatitis. Materials and Methods: This retrospective cohort study used the Kids' Inpatient Database, spanning 2000-2019, to identify patients aged 18 years or younger with a principal diagnosis of gallstone pancreatitis. The Mann-Kendall trend test was used to assess trends over time. Results: Gallstone pancreatitis occurred in 5028 patients. The rate of LC during index hospitalization ranged from 55.4% to 63.8% (P = .76). Trends demonstrate that LC occurred on average hospital day 4.6 in 2000 and decreased to 3.4 in 2019 (P < .01). Among those undergoing LC, average length of stay (LOS) decreased from 6.8 days in 2000 to 5.1 days in 2019 (P < .01). The rate of ERCP alone decreased from 24.8% in 2000 to 14.0% in 2019 (P = .23). For those undergoing ERCP, average hospital day of ERCP decreased from 3.3 in 2000 to 2.3 in 2019 (P = .07). The rate of undergoing both an ERCP and LC decreased from 19.0% in 2000 to 8.5% in 2019 (P = .13). For patients who underwent either LC or ERCP, average LOS decreased from 7.0 days in 2000 to 5.1 days in 2019 (P < .01). For patients who did not undergo a procedure, average LOS decreased from 5.7 days in 2000 to 4.0 days in 2019 (P = .13). Conclusion: The proportion of LC performed during index hospitalizations for children with gallstone pancreatitis has been stable for two decades. However, trends indicate that interventions are occurring earlier, and LOS is becoming shorter.
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Affiliation(s)
- Audra J. Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn Huang
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yao Tian
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gwyneth A. Sullivan
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Parrado RH, Patel KJ, Allen DP, Feuvrier A, Mansfield JH, Cina RA. Opioid Use, Disposition, and Parent Satisfaction Following Common Pediatric Surgical Procedures. Am Surg 2024; 90:63-68. [PMID: 37555374 DOI: 10.1177/00031348231191239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
INTRODUCTION There is wide variability in prescribing practices among providers, even for patients undergoing the same operations. Our study aims to analyze the variation in opioid prescription practices using a patient-centered approach to establish more appropriate prescribing guidelines for health care providers. METHODS We conducted phone surveys 30 days after surgery to assess patient-reported opioid use. Over a two-year collection period, we identified patients that had undergone common outpatient pediatric surgery procedures in our 4-surgeon group. Included in the survey tool was the narcotic prescribed (if any), the amount used, and patient/family rating of pain control. RESULTS We collected data for 189 separate procedures (88 umbilical hernias, 30 laparoscopic inguinal hernias, 2 open inguinal hernias, 41 appendectomies, 15 laparoscopic cholecystectomies, and 13 pectus bar removals). Patient age ranged from less than 1 month to 246 months. 83.5% of patients had a narcotic prescribed. The average number of doses used was 4, ranging from 0 (11.3%) to 30 (1.5%). 72.6% of families surveyed felt pain control was appropriate. However, 19.6% did feel they received too much pain medication. 10.6% reported completing their entire prescription; however, only 13.6% of families with excess narcotics reported proper disposal. CONCLUSIONS Despite heightened awareness of the opioid epidemic, there is still a poor understanding of appropriate pain control regimens in the pediatric surgical population. We demonstrate that most patients are discharged home with excess opioids and that many families save the leftover pills/liquid. Further research and education are encouraged to limit the use of opioids in standard pediatric surgical procedures.
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Affiliation(s)
- Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, Cincinnati Children's Hospital, Charleston, SC, USA
| | - Kunal J Patel
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel P Allen
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ariana Feuvrier
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Julie H Mansfield
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Cina
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Reinig BA, Silva BM, Fernandes M, Onofre AL, Veruska Paiva Ortolan E. A Single-System Ectopic Ureter in a Child: A Challenge for Early Diagnosis. Cureus 2024; 16:e51834. [PMID: 38327937 PMCID: PMC10848177 DOI: 10.7759/cureus.51834] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
An ectopic ureter is an uncommon anomaly, usually associated with a duplicated urinary system. Up to 20% of ectopic ureters occur in a single system. In females, only 25% of ectopic ureters insert into the vagina and usually cause urinary incontinence, which can be confused with vaginal discharge. The diagnostic investigation includes urinary tract ultrasound, DMSA, and urethrocystography, which evaluate renal morphology and function, determining factors for surgical treatment decision that aims to preserve renal function, prevent the recurrence of infections, and reestablish urinary continence. The rarity of this anomaly and the delay in recognizing symptoms are factors related to late diagnosis.
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Affiliation(s)
- Barbara A Reinig
- General Surgery, Hospital das Clinicas de Botucatu, Botucatu, BRA
| | - Bianca M Silva
- General Surgery, Hospital das Clínicas de Botucatu, Botucatu, BRA
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Kankoç A, Sayan M, Çelik A. Videothoracoscopic surgery in children. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S43-S54. [PMID: 38584793 PMCID: PMC10995678 DOI: 10.5606/tgkdc.dergisi.2024.25710] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024]
Abstract
Video-assisted thoracic surgery (VATS) is now being used with increasing frequency for a wide variety of indications in pediatric patients. Although there is no high level of evidence for the advantages of VATS in the pediatric patient group, the proven benefits of this method in the adult patient group have encouraged thoracic surgeons to perform VATS in this patient population. In this study, the procedures performed in pediatric patients under 18 years of age and their results were reviewed with the help of articles obtained as a result of searches using relevant keywords in the English literature (PubMed, Web of Science, EMBASE, and Cochrane). The frequency, indications, and results of the procedures performed differed according to age groups.
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Affiliation(s)
- Aykut Kankoç
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Muhammet Sayan
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ali Çelik
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
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Knowlin LT, Laskay NMB, Jules NP, Godzik J, Chang TP, Spurrier RG. Advances in Pediatric Surgery Simulation-Based Training. Children (Basel) 2023; 11:34. [PMID: 38255348 PMCID: PMC10813955 DOI: 10.3390/children11010034] [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] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Pediatric surgery is the diagnostic, operative, and postoperative surgical care of children with congenital and acquired anomalies and diseases. The early history of the specialty followed the classic "see one, do one, teach one" philosophy of training but has since evolved to modern methods including simulation-based training (SBT). Current trainees in pediatric surgery face numerous challenges, such as the decreasing incidence of congenital disease and reduced work hours. SBT consists of several modalities that together assist in the acquisition of technical skills and improve performance in the operating room. SBT has evolved to incorporate simulator models and video gaming technology, in parallel with the development of simulation in other surgical and non-surgical pediatric fields. SBT has advanced to a level of sophistication that means that it can improve the skills of not only pediatric surgery trainees but also practicing attending surgeons. In this review, we will discuss the history of pediatric surgery, simulation in pediatric surgery training, and the potential direction of pediatric surgical simulation training in the future.
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Affiliation(s)
- Laquanda T. Knowlin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #175, Los Angeles, CA 90027, USA
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Nicholas M. B. Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Nehemie P. Jules
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Todd P. Chang
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Ryan G. Spurrier
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #175, Los Angeles, CA 90027, USA
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Vinit N, Sarnacki S, Blanc T. Robotic-assisted laparoscopy in pediatric surgical oncology: a narrative review. Transl Pediatr 2023; 12:2256-2266. [PMID: 38197107 PMCID: PMC10772838 DOI: 10.21037/tp-23-251] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Objective Robotic surgical oncology in children calls for experienced surgeons in minimally invasive surgery (MIS) and a solid oncological background. The aim of this review was to analyze the current state of robotic-assisted laparoscopy in pediatric tumor resection, assess the necessary framework of minimally invasive surgical oncology and describe future developments of the robotic technology. Methods A literature search of the MEDLINE/PubMed database was conducted, using the terms "robotic surgery", "pediatric" or "children" and "oncology" or "tumor". All relevant English-language studies published between 2008 and 2022 were reviewed. Key Content and Findings Although concerns have been raised regarding the use of MIS in surgical oncology, current literature reports similar oncological outcome if surgeons comply with the oncologic principles. The benefits of MIS have been established for robotic surgery in adult studies, including a shorter time to adjuvant chemotherapy. Surgical feasibility should be assessed based on tumor characteristics, preoperative imaging focusing on vascular involvement and surgeon's experience until clear guidelines are issued. The difficulties in establishing eligibility criteria for robotic resection of pediatric tumors lie in the great variability of indications, heterogeneity in tumor histology with their own surgical specificities, and wide range of age and weight, as shown by the literature review we performed. Between 2008 and 2022, 31 studies reported 171 cases with three studies including at least ten patients. The most reported procedure was adrenalectomy (41 cases). Current research in pediatric surgical oncology focuses on intraoperative locoregional treatment, improved vision with fluorescence and dyed-loaded specific probes and the many possibilities of enhancement software using the robotic console. Conclusions The robotic technology allows the surgeon to push the boundaries of conventional laparoscopy. Specific surgical guidelines are necessary.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
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Franconi I, Faragalli A, Palego G, Canonici S, Gatti L, Simonini A, Bindi E, Cobellis G, Carle F. Preoperative anxiety management in children. Benefits of humanoid robots: an experimental study. Front Surg 2023; 10:1322085. [PMID: 38145215 PMCID: PMC10739395 DOI: 10.3389/fsurg.2023.1322085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The purpose of this study was to determine whether the use of a humanoid robot (Estrabot) could reduce preoperative anxiety levels in children. Methods An experimental study was conducted at Azienda Ospedaliero Universitaria delle Marche Hospital, involving the Pediatric Surgery ward and the Operating Room (OR). Patients aged between 2 and 14 years who underwent minor surgery were included. The Instruments used were the Children's Emotional Manifestation Scale to evaluate anxiety levels, and Estrabot, a humanoid robot that interacts with people. Medical records between April and May 2023 were analyzed and the data was anonymous. The level of anxiety is extrapolated in Pediatric Surgery during the administration of oral pre-medication, and in the Operating Room, during the induction of anesthesia. Patients were divided into an intervention group treated with Estrabot, and a control group without a robot. Results The population consists of 60 patients (86.7% male) with a median (IQR) age of 6 (4-8) years. The median (IQR) anxiety score during premedication was 7 (5-11), while the median (IQR) anxiety score during anesthesia was 6 (5-10). A significantly lower level of anxiety was reported in the Estrabot group. Patients in the Estrabot group had significantly lower anxiety levels in different age groups. Conclusion A humanoid robot can reduce preoperative anxiety levels in children during premedication and the induction of anesthesia.
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Affiliation(s)
- Ilaria Franconi
- Operating Room, Salesi Children’s Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Andrea Faragalli
- Department of Biomedical Sciences and Public Health, Center of Epidemiology, Biostatistics and Medical Information Technology, Marche Polytechnic University, Ancona, Italy
| | - Giulia Palego
- AOU delle Marche, Salesi Hospital Foundation Onlus, Ancona, Italy
| | - Samuele Canonici
- AOU delle Marche, Salesi Hospital Foundation Onlus, Ancona, Italy
| | - Ludovica Gatti
- Operating Room, Salesi Children’s Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Alessandro Simonini
- Pediatric Intensive Care Unit, Salesi Children’s Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children’s Hospital, Ancona, Italy
- Department of Clinical Specialty Sciences and Odontostomatology, Università Politecnica of Marche, Ancona, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children’s Hospital, Ancona, Italy
- Department of Clinical Specialty Sciences and Odontostomatology, Università Politecnica of Marche, Ancona, Italy
| | - Flavia Carle
- Department of Biomedical Sciences and Public Health, Center of Epidemiology, Biostatistics and Medical Information Technology, Marche Polytechnic University, Ancona, Italy
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Moturu A, Mehl SC, Miranda J, Mills J, Rosenfeld E, Naik-Mathuria B. Management of Concurrent Pediatric Blunt Aortic and Traumatic Brain Injury. Am Surg 2023; 89:6235-6237. [PMID: 35969423 DOI: 10.1177/00031348221121541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is the case of a pediatric blunt trauma patient who presented with a concurrent blunt traumatic aortic and severe brain injury. We describe successful simultaneous management of the aortic and brain injury with delayed endovascular repair of the aorta. This report details the importance of multidisciplinary discussion in definitive management of children with these concurrent injuries and the endovascular technical considerations in children.
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Affiliation(s)
- Anoosha Moturu
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Steven C Mehl
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX
| | - Jorge Miranda
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Surgery, Division of Vascular Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Mills
- Department of Surgery, Division of Vascular Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eric Rosenfeld
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bindi Naik-Mathuria
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX
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Griffin KL, Richardson C, Brierley S, Stullich RM, Gates RL. Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury. Am Surg 2023; 89:5921-5926. [PMID: 37257502 DOI: 10.1177/00031348231180935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND In 2000, the American Pediatric Surgical Association (APSA) published guidelines for the management of pediatric solid organ injury, recommending a hospital length of stay (LOS) of grade of injury plus 1 day. Since the publication of these guidelines, several studies have suggested that it is safe to discharge patients sooner based upon hemodynamic and clinical factors. The results of several of these studies have been confounded by the existence of other injuries. The aim of this study was to examine LOS and outcomes in children with strictly isolated solid organ injuries. MATERIALS AND METHODS This is a 12-year retrospective review of pediatric patients with isolated trauma to the kidney, liver, or spleen to determine LOS. Patients were excluded for associated intracranial, neurologic, orthopedic, or pulmonary injuries which would impact length of stay. Documented hemodynamic parameters were reviewed as determinants of patient stability. RESULTS A total of 156 patients were included in the study. The projected average LOS for all patients based on the 2000 APSA guidelines would have been 3.71 ± 0.98 days. The actual average LOS for all patients 2.85 ± 3.32 days. Need for operation, ICU stay, and transfusion all contributed to increased LOS. The number of episodes of abnormal vitals positively correlated with increased LOS. DISCUSSION This study validates that management of isolated solid organ injuries based upon hemodynamic parameters and clinical status is safe and decreases hospital length of stay. Consistently normal vital signs indicate these children can be safely discharged sooner.
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Affiliation(s)
| | | | | | - Renee M Stullich
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Robert L Gates
- Prisma Health Upstate, Greenville, SC, USA
- School of Medicine, University of South Carolina, Greenville, SC, USA
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McCauley CJ, Purcell LN, Schiro SE, Nakayama DK, McLean SE. Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children. Am Surg 2023; 89:5858-5864. [PMID: 37220878 DOI: 10.1177/00031348231175455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC. METHODS A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8 years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint. RESULTS Inappropriately restrained patients were older (5.1 years v. 3.6 yrs, P < .001) and weighed more (44.1 lbs v. 35.3 lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different. DISCUSSION African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences.
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Affiliation(s)
| | - Laura N Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon E Schiro
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Don K Nakayama
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA
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Golubkova AA, Liebe HL, Leiva TD, Stewart KE, Sarwar Z, Hunter CJ, Johnson JJ. Blunt Cerebrovascular Injury in Pediatric Hanging Victims. Am Surg 2023; 89:5897-5903. [PMID: 37253687 DOI: 10.1177/00031348231180929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Incidence of blunt cerebrovascular injury (BCVI) following hanging in the pediatric population is ill-defined. Current guidelines recommend screening imaging during the initial trauma evaluation. Necessity of screening is questioned given BCVI is considered rare after hanging, especially when asymptomatic. This study aims to elucidate the incidence of BCVI in pediatric hangings and determine the value of radiographic work-up. METHODS A retrospective cohort study was performed of pediatric hangings reported to the National Trauma Data Bank (NTDB), 2017-2019. Imaging, diagnoses, and findings suggestive of BCVI, such as Glasgow Coma Scale (GCS) ≤8, presence of cervical injury, and soft tissue injury were considered. Statistical analysis was carried out to compare incidence. RESULTS 197 patients met study criteria, with 179 arriving in the trauma bay with signs of life. BCVI incidence was 5.6% (10 of 179). Computed Tomography Angiography (CTA) of the neck was the only reported screening modality in this data set. A CTA was completed in 46% of the cases. DISCUSSION BCVI incidence following pediatric hanging is more common than previously thought. Less than half of patients had a CTA reported in this cohort. This may result in an underestimate. Given the potentially devastating consequences of a missed BCVI, the addition of CTA to initial work-up may be worthwhile to evaluate for cervical vascular injury, but further studies into the outcomes of children who do receive prophylactic therapy are needed.
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Affiliation(s)
- Alena A Golubkova
- Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Heather L Liebe
- Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tyler D Leiva
- Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kenneth E Stewart
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoona Sarwar
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Catherine J Hunter
- Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jeremy J Johnson
- Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Jamil OK, Shanmugarajah K, Azzam RK, Slidell MB. Improved Kasai Hepatoportoenterostomy Outcomes After Implementation of a Dedicated Biliary Atresia Team. Am Surg 2023; 89:6270-6272. [PMID: 36268550 DOI: 10.1177/00031348221135781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It can be difficult or impractical to refer all biliary atresia (BA) patients to high-volume centers. Our hypothesis was that a low volume center could improve outcomes with implementation of a dedicated multidisciplinary BA team. We conducted a retrospective study of patients with BA who underwent hepatic portoenterostomy at our institution from 2003 to 2020, before and after the development of a dedicated BA team. Ten consecutive patients with BA were identified following the establishment of a dedicated BA team. Since the establishment of the BA team, total bilirubin (TB) clearance (TB < 2 mg/dL) achieved by 3 and 6 months has been 60% and 60%, respectively, and survival of the native liver (SNL) at 1 and 2 years post HPE at 90% and 86%, respectively. Outcomes were markedly improved after the team was established. A dedicated BA team prioritizing communication and expeditious workup can improve outcomes at a low volume center.
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Affiliation(s)
- Omar K Jamil
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA
| | | | - Ruba K Azzam
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago, Chicago, IL, USA
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Chicago Comer Children's Hospital, Chicago, IL, USA
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Mayan D, Melton CS, Sanderford VL, Camps JI, Tomlin KV. Surgical Treatment of Bilateral Tubo-Ovarian Abscess in a Pre-Coitarchal Female. Am Surg 2023; 89:6206-6208. [PMID: 35768199 DOI: 10.1177/00031348221112264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease that is most commonly seen in sexually active females and seldom in pre-coitarchal adolescents. Initial treatment is generally parenteral antibiotics but often requires more invasive surgical procedures. We present the case of a 12-year-old, non-sexually active adolescent, with bilateral TOA who ultimately underwent a sterilizing bilateral salpingectomy and appendectomy for treatment.
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Affiliation(s)
- Danel Mayan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | | | | | - Juan I Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital Midlands, Columbia, SC, USA
| | - Kristl V Tomlin
- Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Prisma Health Midlands, Columbia, SC, USA
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Roby K, Barkach C, Studzinski D, Novotny N, Akay B, Brahmamdam P. Spontaneous Pneumomediastinum is Not Associated With Esophageal Perforation: Results From a Retrospective, Case-Control Study in a Pediatric Population. Clin Pediatr (Phila) 2023; 62:1568-1574. [PMID: 37089060 DOI: 10.1177/00099228231166997] [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] [Indexed: 04/25/2023]
Abstract
What is the optimal management of spontaneous pneumomediastinum (SPM) and is there a risk of esophageal perforation in patients with SPM? We performed a retrospective case-control study of children through age 21, diagnosed with SPM in one hospital system over 10 years with the primary aim of describing the diagnostic workup, treatment patterns, and clinical outcomes. We hypothesized that SPM is a self-limited disease and is not associated with esophageal injury. Cases were identified using International Classification of Disease codes and excluded for trauma or severe infections. Median age was 16 years, 66% were male (n = 179). Chest radiography was performed in 97%, chest computed tomography (CT) in 33%, and esophagrams in 26%. Follow-up imaging showed resolution in 83% (mean = 17.2 days). SPM was not associated with esophageal perforation. We recommend avoiding CT scans and esophagrams unless there is discrete esophageal concern. Management of SPM should be guided by symptomatology.
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Affiliation(s)
- Kevin Roby
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Catherine Barkach
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Diane Studzinski
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
| | - Nathan Novotny
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
| | - Begum Akay
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
| | - Pavan Brahmamdam
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
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Ramos-Gonzalez G, Williams S, Miller A, Mosha M, Irby I, Chang HL, Danielson PD, Gonzalez R, Snyder CW, Chandler NM. Language Differences by Race on Letters of Recommendation for the Pediatric Surgery Match. J Surg Educ 2023; 80:1789-1798. [PMID: 37749001 DOI: 10.1016/j.jsurg.2023.08.016] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/31/2023] [Accepted: 08/27/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aims to evaluate if there is any significant linguistic difference in LoR based on applicant's race/ethnicity. DESIGN Retrospective review of applications to pediatric surgery fellowship at a single institution (2016-2020). Race was self-reported by applicants. LoR were analyzed via the Linguistic Inquiry and Word Count (LIWC) software program. SETTING Johns Hopkins All Children's Hospital, St. Petersburg, Florida USA. A free-standing tertiary pediatric hospital. PARTICIPANTS Pediatric surgery fellowship applicants from 2016 to 2020. RESULTS A total of 1086 LoR from 280 applicants (52% female) were analyzed. Racial distribution was Caucasians 62.1%, Asian 12.1%, Hispanics 7.1%, multiracial 6.4% African Americans 5%, and other/unknown 7.1%. Letter writers were largely male (84%), pediatric surgeons (63%) and professors (57%). There was no difference in LoR word count across races. LoR for female multiracial candidates contained higher use of affiliation and negative emotion terms compared to Hispanic females (p = 0.002 and 0.048, respectively), and past focus terms when compared to Caucasian and Asian female applicants (p < 0.001 and p = 0.003, respectively). Religion terms were more common in LoR for Asian females when compared to Caucasian females (p < 0.001). CONCLUSION This study demonstrates linguistic differences in LoR for pediatric surgery training programs based on applicant race/ethnicity. While differences are present, these do not suggest overt bias based on applicants race or ethnicity.
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Affiliation(s)
- Gabriel Ramos-Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Sacha Williams
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Alexandra Miller
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Maua Mosha
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Iris Irby
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Henry L Chang
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
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Arthur L, Schiro S, Tumin D, Nakayama D, Toschlog E, Greene E, Waddell M, Longshore S. Shelter in Place and an Alarming Increase in Penetrating Trauma in Children and Concerning Decrease in Child Abuse. Am Surg 2023; 89:5386-5390. [PMID: 36583224 DOI: 10.1177/00031348221148361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND On March 14, 2020, schools across North Carolina (NC) closed in response to Covid-19, forcing completion of the school year at home. Most pediatric trauma occurs at home with a higher prevalence when children are out of school. We queried the state trauma database to assess if the 2020 "shelter in place" was associated with an increase in pediatric trauma statewide. METHODS The NC trauma database was queried for injuries in children (age < 18 yrs) from 13 March-1 August 2020, and the corresponding months of 2018 and 2019. The number and type of injuries were compared. We also queried the NC death certificate and child welfare databases. Data were analyzed by standard statistical methods using chi-squared or Kruskal-Wallis test. RESULTS Total pediatric trauma cases were lower during 2020 (71.6 per 100,000) compared to 2018 (92.4 per 100,000) and 2019 (80 per 100,000) (P < .001); however, average injury severity score (ISS) was higher (P = .001). A significant increase in firearm injuries were seen in 2020 (P = .016), with an increase in mortality (P = .08) and ISS (P = .013). The rate of child abuse trauma decreased in 2020 (P = .005) as did the number of child abuse and neglect reports (P < .001). There were also significant decreases in trauma due to sports, burns, falls, and motor vehicle accidents. CONCLUSION While overall pediatric trauma decreased during the Covid-19 pandemic, there was an alarming increase in penetrating injuries in children. Child abuse trauma and reports decreased, which is concerning for lower identification of abuse.
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Affiliation(s)
- Lauren Arthur
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
| | - Sharon Schiro
- UNC Department of Surgery, North Carolina Office of Emergency Medical Services, Chapel Hill, NC, USA
- UNC Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Don Nakayama
- UNC Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Eric Toschlog
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
| | - Erika Greene
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
| | - Megan Waddell
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | - Shannon Longshore
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
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Cruz-Centeno N, Fraser JA, Stewart S, Marlor DR, Rentea RM, Aguayo P, Juang D, Hendrickson RJ, Snyder CL, St Peter SD, Fraser JD, Oyetunji TA. Hypertrophic Pyloric Stenosis Protocol: A Single Center Study. Am Surg 2023; 89:5697-5701. [PMID: 37132378 DOI: 10.1177/00031348231175126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Initial treatment of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Our aim was to describe the protocol and subsequent outcomes. METHODS We conducted a single-center retrospective review of patients diagnosed with HPS from 2016 to 2023. All patients were given ad libitum feeds postoperatively and discharged home after tolerating three consecutive feeds. The primary outcome was the postoperative hospital length of stay (LOS). Secondary outcomes included the number of preoperative labs drawn, time from arrival to surgery, time from surgery to initiation of feeds, time from surgery to full feeds, and re-admission rate. RESULTS The study included 333 patients. A total of 142 patients (42.6%) had electrolytic disturbances that required fluid boluses in addition to 1.5x maintenance fluids. The median number of lab draws was 1 (IQR 1,2), with a median time from arrival to surgery of 19.5 hours (IQR 15.3,24.9). The median time from surgery to first and full feed was 1.9 hours (IQR 1.2,2.7) and 11.2 hours (IQR 6.4,18.3), respectively. Patients had a median postoperative LOS of 21.8 hours (IQR 9.7,28.9). Re-admission rate within the first 30 postoperative days was 3.6% (n = 12) with 2.7% of re-admissions occurring within 72 hours of discharge. One patient required re-operation due to an incomplete pyloromyotomy. DISCUSSION This protocol is a valuable tool for perioperative and postoperative management of patients with HPS while minimizing uncomfortable intervention.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - James A Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Charles L Snyder
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
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Filip F, Avramia R, Terteliu-Baitan M, Cocuz ME, Filip R. COVID-19 positive cases in a pediatric surgery department from Romania: Case series from 2 years of pandemics. Medicine (Baltimore) 2023; 102:e36235. [PMID: 38050253 PMCID: PMC10695600 DOI: 10.1097/md.0000000000036235] [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: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE The COVID-19 pandemic had a dramatic effect on various health systems in terms of admissions and outcomes, including pediatric surgery activity. The aim of this paper was to analyze the outcome of SARS-CoV-2-positive patients admitted to our department during the regional COVID-19 pandemic in North-Eastern Romania. We also evaluated the changes generated in our daily practice by the COVID-19 pandemic and the dynamic response to this major challenge. PATIENT CONCERNS The patients presented with symptoms related to their primary diagnosis: local pain and deformity in case of fractures; pain, swelling, and erythema in case of abscess; pain and decreased range of motion (ROM) in case of intolerance to metal implants. Other specific concerns are mentioned on an individual basis. DIAGNOSES Eighteen patients (of which 4 had acute appendicitis and were included in a previous article), representing 1.18% of the total number of admissions, tested positive for SARS-CoV-2. There were 4 patients with fractures, 3 patients with soft tissue abscess or cellulitis, 2 patients with intolerance to metal implants, 1 patient with facial burn, 1 patient with thumb laceration, 1 patient with liver trauma, 1 patient with undescende testis, and 1 patient with symptomatic inguinal hernia, respectively. Boys represented 11/ 14 (78.57%) of the cases. The mean age of the patients was 9 years 11 months. There were only mild COVID-19 cases. INTERVENTIONS Surgery was performed in 13/ 14 (95.71%) of cases. The fractures were treated with open reduction internal fixation (ORIF); incision and drainage (I & D) were performed in case of soft tissue abscess; the metal implants were removed in case of local intolerance. Other conditions (burn, inguinal hernia, undescended testis, skin laceration) were treated specifically. Only 1 patient with liver laceration was treated conservatively under close hemodynamic monitoring. OUTCOMES The mean length of stay (LoS) was 2.71 days. The infection with the SARS-CoV-2 virus had no deleterious effect on the surgical outcome among the 14 patients included in the study. There were no surgical complications during admission and no patient returned for late complications related to their primary disease or SARS-CoV-2 infection. LESSONS The SARS-CoV-2 infection had no significant influence on the outcome of pediatric surgical cases included in the study. We noticed a significant (31.54%) decrease in the number of admissions compared to the previous 2-year interval before the COVID-19 pandemic. Fast and adequate adjustment of the daily activity imposed by the COVID-19 pandemic was feasible and may be used in the future should similar epidemiological emergencies occur.
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Affiliation(s)
- Florin Filip
- College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | | | - Monica Terteliu-Baitan
- College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | - Maria - Elena Cocuz
- Fundamental Prophylactic and Clinical Disciplines Department, Faculty of Medicine, Transilvania University of Brasov, Brașov, Romania
- Clinical Infectious Diseases Hospital of Brasov, Brasov, Romania
| | - Roxana Filip
- College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
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