Outcomes and late complications after pulmonary resections in the pediatric population

Abstract Introduction Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. Aim The aim of this study was to report outcomes of therapeutic circumcision from our center. Methods Prospective registry of elective circumcisions was maintained and analyzed at a single institution in the United Kingdom. Data collected included information on complications (early and late), emergency presentations, and referrals back from primary care services. Results Between August 2015 and June 2019, 300 patients (mean age: 9 years; range: 3–16 years) underwent therapeutic circumcision. The average length of follow-up data available was 2.1 years (range: 6 months to 4 years). The overall complication rate was 4.7% (n = 16). There were no unplanned admissions and no cases returned to the operating room as emergency. Only 1% (n = 3) of patients presented with an early complication (minor bleeding, pain, urinary retention), and 3.7% (n = 11) suffered a late complication (meatal stenosis [2.7%]). All cases of meatal stenosis had lichen sclerosus confirmed on histology. Cosmetic satisfaction was 99%. Conclusion Therapeutic circumcision is an effective procedure in the pediatric population, which carries a low risk of early and late complications. Our study found that meatal stenosis only occurred in those patients with confirmed lichen sclerosus histology.

Download Full-text

Laparoscopic Ureteroureterostomy vs. Common Sheath Ureteral Reimplantation in Children With Duplex Kidney Anomalies

Frontiers in Pediatrics ◽

10.3389/fped.2021.637544 ◽

2021 ◽

Vol 9 ◽

Author(s):

Tim Gerwinn ◽

Ralph Gnannt ◽

Daniel M. Weber ◽

Rita Gobet ◽

Luca Mazzone

Keyword(s):

Pediatric Population ◽

Late Complications ◽

Pediatric Radiologist ◽

Ureteral Reimplantation ◽

Duplex Kidney ◽

Efficacious Treatment ◽

Parental Counseling ◽

Invasive Surgical Approach ◽

Duplex Kidneys ◽

Tract Infections

Purpose: Laparoscopic ureteroureterostomy (LUU) has been proposed as an alternative to common sheath ureteral reimplantation (CSUR) in children with symptomatic duplex kidneys. However, data is limited for LUU in the pediatric population. The aim of this study was to analyze our experience with LUU and to compare the results with those after CSUR to assess whether a less invasive surgical approach could be a valid alternative.Patients and methods: The data of all children with duplex kidneys who underwent either LUU or CSUR at our center from 2006 to 2018 were reviewed retrospectively. After parental counseling, the option of LUU was provided as an alternative to CSUR for unilateral procedures and in the absence of vesicoureteral reflux to the receiving ureter. Baseline characteristics, indication for surgery, hospitalization and operative times, and intraoperative, post-operative, and late complications were analyzed. Preoperative and 1-year post-operative sonographies were reviewed by a pediatric radiologist. Increasing renal pelvic diameter (Δ >5 mm) was regarded as a sign of ureteral obstruction.Results: Forty children were included in this study, with 16 children receiving LUU and 24 children receiving CSUR. The children had a mean age of 2.7 years (7 months−9.8 years) and were followed up in our outpatient clinic for an average of 3.9 years (3 months−10.6 years) after surgery. The median hospital stay was 2 days shorter after LUU. Initially, a considerably longer time was needed for LUU, but after more experience was gained, similar operative times were observed for both procedures. Complications were encountered in both groups. After LUU, two patients developed anastomotic leakage: one was managed conservatively, and one required temporary nephrostomy. In the CSUR group, one patient developed vesicoureteral obstruction during follow-up and required reoperation with LUU. The occurrence of post-operative urinary tract infections was similar in both groups. No complications related to the ureteral stump after LUU arose.Conclusion: LUU is a safe and efficacious treatment option for children with duplex kidney anomalies and can be used as an alternative to CSUR. All children receiving LUU showed a non-obstructive, patent anastomosis and no signs for stenotic compromise of the receiving ureter.

Download Full-text

Use of Vestibular Rehabilitation in the Pediatric Population

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig7-2019-0002 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1399-1405 ◽

Cited By ~ 1

Author(s):

Jennifer Christy

Keyword(s):

Pediatric Population ◽

Dynamic Balance ◽

Vestibular Rehabilitation ◽

Rehabilitation Program ◽

Gross Motor ◽

Gaze Stabilization ◽

Motor Delay ◽

Rehabilitation Programs ◽

Motor Practice ◽

Balance Exercises

Purpose The purpose of this article was to provide a perspective on vestibular rehabilitation for children. Conclusion The developing child with vestibular dysfunction may present with a progressive gross motor delay, sensory disorganization for postural control, gaze instability, and poor perception of motion and verticality. It is important that vestibular-related impairments be identified early in infancy or childhood so that evidence-based interventions can be initiated. A focused and custom vestibular rehabilitation program can improve vestibular-related impairments, enabling participation. Depending on the child's age, diagnosis, severity, and quality of impairments, vestibular rehabilitation programs may consist of gaze stabilization exercises, static and dynamic balance exercises, gross motor practice, and/or habituation exercises. Exercises must be modified for children, done daily at home, and incorporated into the daily life situation.

Download Full-text

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd18.2.76 ◽

2008 ◽

Vol 18 (2) ◽

pp. 76-86 ◽

Cited By ~ 2

Author(s):

Lauren Hofmann ◽

Joseph Bolton ◽

Susan Ferry

Keyword(s):

Tracheostomy Tube ◽

Pediatric Population ◽

Interdisciplinary Approach ◽

Extended Period ◽

Speech Development ◽

Tube Placement ◽

Background Information ◽

Speaking Valve ◽

Children's Hospital ◽

Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

Download Full-text