Preoperative symptom duration predicts success in relieving abdominal pain caused by biliary dyskinesia in a pediatric population

2013 ◽  
Vol 48 (4) ◽  
pp. 796-800 ◽  
Author(s):  
Jeremy J. Johnson ◽  
Tabitha Garwe ◽  
Nicholas Katseres ◽  
David W. Tuggle
Keyword(s):  
Abdominal Pain ◽  
Pediatric Population ◽  
Biliary Dyskinesia ◽  
Symptom Duration ◽  
Preoperative Symptom

Laparoscopic Cholecystectomy for Biliary Dyskinesia in Children: Report of 100 Cases from a Single Institution

2008 ◽  
Vol 74 (7) ◽  
pp. 587-593 ◽  
Author(s):  
Constantinos Constantinou ◽  
Iswanto Sucandy ◽  
Max Ramenofsky
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
Pediatric Population ◽  
Biliary Dyskinesia ◽  
Successful Outcome ◽  
Symptom Duration ◽  
Functional Abdominal Pain ◽  
Biliary Stones ◽  
Persistent Symptoms

Laparoscopic cholecystectomy (LC) is increasingly performed in the pediatric population. Biliary dyskinesia (BD) is largely responsible for this increase and is presently the most common indication for LC in this age group. In our institution the diagnosis of BD is made in patients with biliary symptoms, absence of biliary stones, and an ejection fraction <35 per cent on hydroxy iminoadiacetic acid (HIDA) scan. We reviewed our experience of 100 children with BD that underwent LC. Data that was prospectively collected and entered into electronic medical records by gastroenterologists, primary care physicians, and pediatric surgeons was reviewed and analyzed. Patients were symptomatic for an average of 15 months before undergoing surgery. Seventy-seven per cent reported resolution of symptoms from 6 months to 5 years following LC, whereas the rest complained of persistent symptomatology. When the two groups were compared, patients with persistent symptoms were more likely to be female and to have longer symptom duration. An ejection fraction <35 per cent reliably predicts successful outcome of LC in patients with BD. The diagnosis of BD should be entertained early in the differential of functional abdominal pain in children and referred to Pediatric Surgery when its presence is confirmed.

scholarly journals Microvascular decompression for tinnitus: systematic review

2017 ◽  
Vol 126 (4) ◽  
pp. 1148-1157 ◽  
Author(s):  
Brenton Nash ◽  
Matthew L. Carlson ◽  
Jamie J. Van Gompel
Keyword(s):  
Systematic Review ◽  
Microvascular Decompression ◽  
English Language ◽  
Positive Outcome ◽  
Future Research ◽  
Symptom Duration ◽  
Review Of The Literature ◽  
Preoperative Symptom ◽  
Operative Outcomes ◽  
Review Reports

OBJECTIVE The objective of this study was to examine operative outcomes in cases of microvascular decompression (MVD) of cranial nerve (CN) VIII for tinnitus through a critical review of the literature. METHODS Forty-three English-language articles were gathered from PubMed and analyzed. In this review, two different case types were distinguished: 1) tinnitus-only symptomatology, which was defined as a patient with tinnitus with or without sensorineural hearing loss; and 2) mixed symptomatology, which was defined as tinnitus with symptoms of other CN dysfunction. This review reports outcomes of those with tinnitus-only symptoms. RESULTS Forty-three tinnitus-only cases were found in the literature with a 60% positive outcome rate following MVD. Analysis revealed a 5-year cutoff of preoperative symptom duration before which a good outcome can be predicted with 78.6% sensitivity, and after which a poor outcome can be predicted with 80% specificity. CONCLUSIONS As the 60% success rate is more promising than several other therapeutic options open to the chronic tinnitus sufferer, future research into this field is warranted.

The Effect of Preoperative Symptom Duration on Postoperative Outcomes After a Tubular Lumbar Microdiscectomy

2019 ◽  
Vol 32 (1) ◽  
pp. E27-E30
Author(s):  
Bryce A. Basques ◽  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Philip K. Louie ◽  
Dil V. Patel ◽  
...  
Keyword(s):  
Postoperative Outcomes ◽  
Symptom Duration ◽  
Preoperative Symptom ◽  
Lumbar Microdiscectomy

Early Surgical Repair of Medial Meniscus Posterior Root Tear Minimizes the Progression of Meniscal Extrusion: 2-Year Follow-up of Clinical and Radiographic Parameters After Arthroscopic Transtibial Pull-out Repair

2020 ◽  
Vol 48 (11) ◽  
pp. 2692-2702 ◽  
Author(s):  
Hyun-Soo Moon ◽  
Chong-Hyuk Choi ◽  
Min Jung ◽  
Dae-Young Lee ◽  
Seung-Pyo Hong ◽  
...  
Keyword(s):  
Symptom Duration ◽  
Root Tear ◽  
Meniscal Extrusion ◽  
Factors Affecting ◽  
Preoperative Symptom ◽  
Pull Out ◽  
Radiographic Parameters ◽  
Group 2 ◽  
Relevant Factors ◽  
Group 1

Background: Conflicting results have been reported concerning the progression of medial meniscal extrusion (MME) after arthroscopic transtibial pull-out repair of medial meniscus posterior root tear (MMRT), and no study has evaluated the relevant factors affecting the progression of MME. Purpose: To (1) evaluate the subjective and objective surgical outcomes of arthroscopic transtibial pull-out repair of MMRT and (2) identify relevant factors affecting the progression of MME after surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 63 patients who underwent isolated arthroscopic transtibial pull-out repair of MMRT between January 2010 and June 2017 were evaluated retrospectively. Clinical scores and various radiographic parameters were evaluated to assess the surgical outcomes. The patients were classified into 2 groups according to the change in medial meniscal extrusion ratio (MMER) at 1 year after surgery compared with before surgery (group 1 consisted of 21 patients with reduced or maintained MMER; group 2 consisted of 42 patients with increased MMER). Variables including baseline demographics, radiographic parameters, and arthroscopic findings were compared to identify relevant factors affecting the progression of MME after surgery. Results: In the overall cohort, clinical outcomes at postoperative 2 years improved significantly ( P < .001 for visual analog scale score, International Knee Documentation Committee subjective score, and Lysholm score), whereas radiographic parameters showed an overall deterioration compared with the preoperative level. In subgroup comparisons, a significant difference was seen in the time from the onset of symptoms until surgery ( P < .001), defined as preoperative symptom duration, which a subsequent logistic regression analysis revealed to be a relevant factor associated with the progression of MMER ( P = .015). Both groups showed progression of radiographic osteoarthritis, but the progression was significantly higher in group 2 compared with group 1 at postoperative 2 years ( P = .032). On receiver operating characteristic curve analysis, the cutoff point for preoperative symptom duration associated with the progression of MMER was 13 weeks (sensitivity, 52.4%; specificity, 76.2%; accuracy, 72.4%). Conclusion: The arthroscopic transtibial pull-out repair of MMRT showed clinical improvement but did not prevent the progression of knee osteoarthritis, MME, or MMER. Although the preservation of MMER was not capable of completely preventing the progression of knee degeneration, MMER still has a potential clinical value in delaying the rate of progression of knee degeneration. Early surgical repair of MMRT, within 13 weeks from the onset of symptoms, might be helpful to prevent the progression of MME.

Chronic Abdominal Pain in Children

2018 ◽  
Author(s):  
Alina Lazar
Keyword(s):  
Abdominal Pain ◽  
Parent Education ◽  
Behavioral Therapy ◽  
Pediatric Population ◽  
Multimodal Analgesia ◽  
Chronic Abdominal Pain ◽  
Relaxation Techniques ◽  
Visceral Hyperalgesia ◽  
Young Females ◽  
Comprehensive Plan

Abdominal pain in the pediatric population is mostly functional. Patients with chronic abdominal pain (typically young females) have a high risk of anxiety, depression, and dysfunctional coping, which are also risk factors for postoperative pain and persistent postsurgical pain. In these patients, peripheral and central sensitization contribute to possible visceral hyperalgesia. When patients with chronic abdominal pain and visceral hyperalgesia undergo surgical procedures, perioperative pain can be difficult to treat. To manage the chronic pain of such patients, their complex biopsychosocial make-up should be considered. A comprehensive plan includes preventive and aggressive multimodal analgesia, adequate patient and parent education, realistic expectations, cognitive-behavioral therapy, and distraction and relaxation techniques.

scholarly journals Isolated fallopian tube torsion associated with hydrosalpinx in a 12-year-old girl: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Javier Martín-Vallejo ◽  
Enrique E. Garrigós-Llabata ◽  
Patricia Molina-Bellido ◽  
Pedro A. Clemente-Pérez
Keyword(s):  
Abdominal Pain ◽  
Fallopian Tube ◽  
Acute Abdominal Pain ◽  
Pediatric Population ◽  
Rare Condition ◽  
Case Presentation ◽  
Reactive Protein ◽  
Clinical Case Study ◽  
Caucasian Girl

Abstract Background Isolated fallopian tube torsion associated with hydrosalpinx is a rare condition in the pediatric population. We present this unusual clinical case study in a sexually inactive girl. Case presentation a12-year-old Caucasian girl presented symptoms of acute abdominal pain. Pelvic ultrasound revealed a normal looking uterus and ovaries and next to left ovary a imaging compatible with hydrosalpinx. She was discharged 48 hours later after clinical monitoring with oral analgesia and normal blood workup. At 3 weeks, she was readmitted for acute abdominal pain. Leukocytosis with left shift and raised C-reactive protein were observed. Her clinical condition worsened, and complication of the preexisting hydrosalpinx was suspected. Exploratory laparoscopy confirmed torsion of the fallopian tube. Left salpingectomy was performed. Histopathologic study confirmed a fallopian tube with hemorrhagic infarct. Conclusion Torsion of the fallopian tube must be considered in the event of acute abdominal pain. Early diagnosis and trying conservative management with a view to preserving fertility in this group of patients are essential.

Laparoscopic Cholecystectomy for Treatment of Biliary Dyskinesia is Safe and Effective in the Pediatric Population

2008 ◽  
Vol 74 (11) ◽  
pp. 1069-1072 ◽  
Author(s):  
Matthew Hofeldt ◽  
Bryan Richmond ◽  
Kristy Huffman ◽  
Jennings Nestor ◽  
Damian Maxwell
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Perioperative Complications ◽  
Pediatric Population ◽  
Biliary Dyskinesia ◽  
Quadrant Pain ◽  
Gallbladder Ejection Fraction ◽  
Patients Âgés ◽  
History Of

Experience with laparoscopic cholecystectomy for biliary dyskinesia in children remains limited. The aim of this study was to examine the results of a single institution's experience with laparoscopic cholecystectomy for the treatment biliary dyskinesia in the pediatric population. Medical records were reviewed on all patients younger than age 18 who underwent laparoscopic cholecystectomy at our institution from July 2004 to December 2006. Patients undergoing surgery for biliary dyskinesia, as evidenced by a preoperative gallbladder ejection fraction of 40 per cent or less, comprised the study group. Of the 51 pediatric laparoscopic cholecystectomies, 30 (58.8%) were performed for biliary dyskinesia. The patients’ ages ranged from 7 to 17 (mean, 12.67 years; SD, 2.75). Symptoms consisted of chronic right upper quadrant pain (96.67%), nausea/vomiting (73.33%), back pain (30.0%), weight loss (13.33%), and a history of pancreatitis (6.66%). The amount of time between onset of symptoms and surgery was as follows: 1 to 3 months (34.62%), 4 to 6 months (30.77%), 7 to 12 months (7.69%), and greater than 1 year (26.92%). Gallbladder ejection fraction ranged from 1 to 36 per cent (mean, 14.7%). Seven of the 30 (26.67%) underwent endoscopic evaluation as part of their preoperative workup (six upper endoscopy, one colonoscopy), all of which were noncontributory. Pathology revealed chronic cholecystitis in 26 of 30 (93.3%), no abnormalities in three of 30 (10.0%), and unexpected cholelithiasis in one of 30 (3.33%). No perioperative complications were encountered. Twenty-nine of the 30 patients were available for follow up and all but one reported relief of symptoms (96.55%). This study supports the use of laparoscopic cholecystectomy as a safe and effective treatment for biliary dyskinesia in the pediatric population. The success rate in our study was substantially higher than that reported in previous series. Routine preoperative endoscopy was not used and was reserved for investigation of ambiguous or unrelated complaints.

scholarly journals Acute pancreatitis prevalence in children with cystic fibrosis and PIP score prediction applicability

2021 ◽  
Vol 16 (2) ◽  
pp. 248-253
Author(s):  
Valentina-Daniela COMĂNICI ◽  
◽  
Ioana Florentina CODREANU ◽  
Anca BĂLĂNESCU ◽  
Alina Angelica BELIVACĂ ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Retrospective Study ◽  
Pediatric Population ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Substitution Therapy ◽  
Imaging Evaluation ◽  
Female Predominance

One of the affected organs in cystic fibrosis (CF) is the pancreas, mainly translated into exocrine pancreatic insufficiency. Although rare, acute pancreatitis (AP) has been described, mostly in pancreatic sufficient patients. Objectives. Estimating AP prevalence in CF pediatric population of the I.N.S.M.C. „AlessandrescuRusescu” CF centre. Material and methods. 5 year retrospective study (2011-2016) including INSMC CF centre pediatric population aged 3-18 years. PA diagnosis was established on the presence of minimum 2 criteria between: characteristic abdominal pain, x3 normal value for age elevation of amylase/lipase, medical imaging evaluation suggestive for AP. Patients were evaluated with different criteria including PIP score of predicting AP risk. Outcomes. 48 patients were included with a slight female predominance (54%). 3 of them presented diagnostic criteria for AP (6,25%), all heaving pancreatic insufficiency and high PIP score (low risk of developing AP); 2 of them have low compliance with pancreatic enzymes substitution therapy; one of them presented recurrent episodes of AP. Conclusions. AP is a rare CF complication. It can be easily missed due to a large number of abdominal pain and emesis causes in CF patients. Although it is usually associated with pancreatic sufficiency, all our patients were pancreatic insufficient.

scholarly journals My tummy hurts – a case report of abdominal pain and macrocytic anemia caused by hypothyroidism

2018 ◽  
Vol 2018 ◽  
Author(s):  
Kewan Hamid ◽  
Neha Dayalani ◽  
Muhammad Jabbar ◽  
Elna Saah
Keyword(s):  
Abdominal Pain ◽  
Pediatric Population ◽  
Financial Burden ◽  
Macrocytic Anemia ◽  
Chronic Abdominal Pain ◽  
List Type ◽  
Thyroid Disorder ◽  
Significant Morbidity ◽  
Delay In Diagnosis ◽  
Wide Range

Summary A 6-year-old female presented with chronic intermittent abdominal pain for 1 year. She underwent extensive investigation, imaging and invasive procedures with multiple emergency room visits. It caused a significant distress to the patient and the family with multiple missing days at school in addition to financial burden and emotional stress the child endured. When clinical picture was combined with laboratory finding of macrocytic anemia, a diagnosis of hypothyroidism was made. Although chronic abdominal pain in pediatric population is usually due to functional causes such as irritable bowel syndrome, abdominal migraine and functional abdominal pain. Hypothyroidism can have unusual presentation including abdominal pain. The literature on abdominal pain as the main presentation of thyroid disorder is limited. Pediatricians should exclude hypothyroidism in a patient who presents with chronic abdominal pain. Contrast to its treatment, clinical presentation of hypothyroidism can be diverse and challenging, leading to a delay in diagnosis and causing significant morbidity. Learning points: Hypothyroidism can have a wide range of clinical presentations that are often nonspecific, which can cause difficulty in diagnosis. In pediatric patients presenting with chronic abdominal pain as only symptom, hypothyroidism should be considered by the pediatricians and ruled out. In pediatric population, treatment of hypothyroidism varies depending on patients’ weight and age. Delay in diagnosis of hypothyroidism can cause significant morbidity and distress in pediatrics population.

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