DOZ047.100: Impact of fundoplication on pH-MII tracings in pediatric patients with esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
V Busoni ◽  
J C Sabban ◽  
P Lobos ◽  
F Ursino ◽  
M Urquizo ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Failure To Thrive ◽  
Type A ◽  
Mucosal Damage ◽  
Therapy Failure ◽  
Acid Clearance ◽  
Life Threatening ◽  
Type C ◽  
Group 2 ◽  
The Moment

Abstract Introduction Gastroesophageal reflux disease (GERD) is the most common long-term complication in esophageal atresia (EA) patients. Fundoplication in EA is controversial but may be an option in those with maximum GER therapy failure, acute life-threatening event, failure to thrive, persistent esophagitis, and recurrent anastomotic stenosis. Aim The aim of this study was to compare GERD characteristics according pH-MII parameters in EA patients with and without fundoplication. Materials and Methods Retrospective review of pH-MII tracings performed at a Gastroenterology Unit between 2011 and 2018 was carried out. Inclusion criteria were children under 18 years with history of EA, with and without fundoplication, with both pH-MII and endoscopy performed, histology of esophageal biopsies, and off antireflux medications at the moment of examination. GER therapy failure was the indication for surgery. The total number of reflux episodes (acid, nonacidic), bolus and acid clearance time (ACT), and baseline values in distal channels (5–6) were evaluated. Group 1 (G1): patients with EA and fundoplication. Group 2 (G2): patients with EA without fundoplication. T-test was performed to compare results between G1 and G2. Results Fifteen tracings in EA patients were evaluated. Out of 15, 8 (53%) underwent fundoplication (G1), median age 7.4 years, 87.5% EA type C, 12.5% type A (long gap). Esophagitis was observed in 100% postfundoplication: 2 macroscopic, 1 eosinophilic, 5 microscopic esophagitis. Out of 15, 7 (47%) were EA without fundoplication (G2), median age 3.25 years, 57% EA type C, 43% type A–B. Esophagitis was observed in 85% in G2, all of them microscopic. No statistical differences were observed in pH-MII parameters between both groups. Number of refluxes, ACT, and distal channels (ch-6) were pathological in both groups. Nevertheless better acid clearance and more mucosal damage were observed in G1. Conclusion In this pediatric series of EA patients, pH-MII data show persistence of GERD even postfundoplication. This observation could be due to severe esophageal dismotility. Even asymptomatic EA patients should undergo monitoring of GER with pH-MII and endoscopy.

DOZ047.19: Outcomes in the management of long-gap esophageal atresia: is the Foker technique superior?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A Wiseman ◽  
J Krishnan ◽  
D Wanaguru ◽  
C Langusch ◽  
V Varjavandi ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Type A ◽  
Small Sample ◽  
Type B ◽  
Repair Technique ◽  
Long Gap ◽  
Delayed Repair ◽  
Significant Difference ◽  
Long Gap Esophageal Atresia ◽  
Type C

Abstract Background Long-gap esophageal atresia (LGEA) has traditionally been managed by delayed anastamosis. However, over the last 10 years the Foker technique of esophageal growth elongation has been used. There is limited data evaluating outcomes using both techniques. Aims The aim of this study was to compare the outcomes in LGEA repair using the traditional delayed repair technique versus the Foker technique. Methods A retrospective chart review was done of LGEA patients at Sydney Children's Hospital between 1997 and 2016, comparing the Foker technique with the delayed repair technique. Results There were 9 children repaired using the Foker technique, and 10 by delayed repair. There were 7 patients with Type A, 1 with Type B, and 1 with Type C in the Foker group and in the delayed repair cohort, 5 were Type A, 2 Type B, 2 Type C, and 1 Type D esophageal atresia/tracheoesophageal fistula. There were 4 males in the Foker group and 5 in the non-Foker group. Median time to join was 59 days (15–117 days) for Foker repair and 173 days (16–433 days) for delayed repair. There was no significant difference in the incidence of post-operative leak, incidence of strictures needing dilation, presence of reflux symptoms, presence of reflux esophagitis on endoscopy, proton pump inhibitor use, need for fundoplication, incidence of cyanotic spells, occurrence of recurrent fistula, and symptoms of dysphagia when comparing both groups. Data on time to oral feeds and incidence of malnutrition was incomplete. Details are shown in Table 1. Conclusions Although the time to anastamosis was shorter in the Foker group and the incidence of post-operative leak, strictures needing dilation, need for fundoplication, and dysphagia were lower in the Foker group, the difference was not significant probably secondary to the small sample size. These results require validation in larger cohorts.

DOZ047.27: Esophageal atresia and polyhydramnios

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
T Arntzen ◽  
A Mikkelsen ◽  
G Haugen ◽  
R Emblem
Keyword(s):  
Prenatal Diagnosis ◽  
Esophageal Atresia ◽  
Detection Rate ◽  
Type A ◽  
Lower Esophagus ◽  
Type D ◽  
Perinatal Treatment ◽  
Type C ◽  
Regional Hospitals ◽  
Ultrasound Features

Abstract Background Prenatal diagnosis of esophageal atresia (EA) is difficult and the detection rate is only 20–35%. Ultrasound features of EA are nonspecific with polyhydramnios as the most reported finding. Polyhydramnios is reported in approximately 2% of all pregnancies and thus have low specificity. The aim of our retrospective study is to explore perinatal characteristics of EA patients with prenatal suspicion of EA. Methods Patients with EA born in the periods 1996–2002 and 2011–2017 were included after consent of the parents. Data regarding the pregnancy, birth, and perinatal treatment were obtained from medical records. Results We registered a total of 124 EA patients: 68 from 1996 to 2002, and 56 from 2011 to 2017. Among the 124 patients, 5(4%) had type Gross A or B, 108(87%) type C, 6(5%) type D, and 5(4%) type E. 73(59%) patients had an associated anomaly. 20/124(16%) patients had a prenatal suspicion of EA, and there were no significant differences between neonates with and without prenatal suspicion of EA in terms of birth weight, gestational age, and prematurity. Patients with prenatal suspicion of EA had more caesarean sections, were more frequently born at regional hospitals, and had more associated anomalies. Polyhydramnios was registered in 70 patients; in 18 of these (90% of all with prenatal diagnosis) a prenatal suspicion of EA had been raised. In 52 EA patients with polyhydramnios, no prenatal statement about anomaly was registered. Four of 5 patients (90%) with type A and B had a prenatal suspicion of EA. Corresponding number for type C was 15/108(14%) and 1/5(20%) with type E. Conclusion The detection rate for EA is low, and prenatal suspicion of EA implicates a more serious condition with higher morbidity than EA patients born without prenatal suspicion of malformation. Four of five patients without fistula to lower esophagus (type A and B) had a prenatal suspicion of EA, and polyhydramnios is the ‘signal sign’ for the possible presence of esophageal atresia.

scholarly journals Aspectos terapêuticos e nutricionais de neonatos submetidos a correção de atresia esofágica

2020 ◽  
Vol 10 (31) ◽  
pp. 35-44
Author(s):  
Karina Cristina Pinheiro Oliveira ◽  
Maria Victória Cravo Salustiano ◽  
Gilmara Lopes Vaz ◽  
Andressa Tavares Parente ◽  
Angeline Do Nascimento Parente ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Normal Weight ◽  
Sample Mean ◽  
Nutritional Conditions ◽  
Full Diet ◽  
Reference Hospital ◽  
Correction Surgery ◽  
Type C ◽  
The Moment

Descrever as variáveis neonatais, condições clínicas e nutricionais de recém-nascidos portadores de Atresia Esofágica submetidos a correção cirúrgica. Estudo documental, retrospectivo e quantitativo em 50 prontuários de neonatos portadores de atresia de esôfago, internados em um hospital de referência. Na amostra: 96% das genitoras realizaram o pré-natal, com 64% nascidos de parto cesáreo, sendo 62% do sexo feminino e 60% dos neonatos nasceram com peso normal. Sobre a classificação da Atresia Esogágica, 84% tipo C. A média da amostra foi de 10 dias de vida a submissão da cirurgia de correção e 20 dias de vida para introdução da dieta. A idade média no alcance da dieta plena foi de 30 dias, sendo em torno do 21º dia de pós-operatório. A amamentação foi informada em 44% da amostra. Predominou consonâncias entre as variáreis do estudo comparadas com publicações nacionais e internacionais sobre o tema.Descritores: Atresia Esofágica, Anormalidades Congênitas, Enfermagem Pediátrica. Therapeutic and nutritional aspects of neonates submitted to esophageal atresia correctionAbstract: To describe the neonatal variables, clinical and nutritional conditions of newborns with esophageal atresia who underwent surgical correction. This is a documentary, retrospective and quantitative study of 50 medical records of neonates with Esophageal Atresia, admitted in a reference hospital. In the sample: 96% of mothers received prenatal care, with 64% of infants born by cesarean delivery, 62% of whom were female and 60% of neonates were born with normal weight. Regarding the classification of Esophageal Atresia, 84% were classified as type C. The sample mean was being 10 days old until the moment that the newborn underwent correction surgery and 20 days old to introduce the diet. The average age to tolerate the full diet was 30 days, being around the 21st postoperative day. Breastfeeding was reported in 44% of the sample. There was a consonance between the study variables compared to national and international publications on the subject.Descriptors: Esophageal Atresia, Congenital Abnormalities, Pediatric Nursing. Aspectos terapéuticos y nutricionales de los neonatos sujetos a la corrección de la atresia esofágicaResumen: Describir las variables neonatales, las condiciones clínicas y nutricionales de los recién nacidos con atresia esofágica sometidos a corrección quirúrgica. Estudio documental, retrospectivo y cuantitativo de 50 registros médicos de recién nacidos con atresia esofágica, internados en un hospital de referencia. En la muestra: 96% de las madres realizaron atención prenatal, 64% nacieron por cesárea, 62% de las cuales eran del sexo feminino y 60% de los recién nacidos teníam peso normal. Con respecto a la clasificación de la Atresia de Esófago, 84% eran del tipo C. La media de la muestra fue de 10 días hasta el momento de la realización de la cirugía de corrección y de 20 días para introducir la dieta. La media de edad para alcanzar la dieta completa fue de 30 días, alrededor del día 21 de postoperatorio. La lactancia materna se informó en 44% de la muestra. Hubo una consonancia entre las variables de estudio en comparación con las publicaciones nacionales e internacionales sobre el tema.Descriptores: Atresia Esofágica, Anomalías Congénitas, Enfermería Pediátrica.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

2021 ◽  
pp. 175319342098321
Author(s):  
Anyuan Wang ◽  
Jian Ding ◽  
Long Wang ◽  
Tinggang Chu ◽  
Zhipeng Wu ◽  
...  
Keyword(s):  
Type A ◽  
Surgical Reconstruction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Type D ◽  
Type Iv ◽  
Secondary Operations ◽  
Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

MPTP delta, a putative murine homolog of HPTP delta, is expressed in specialized regions of the brain and in the B-cell lineage

1993 ◽  
Vol 13 (9) ◽  
pp. 5513-5523
Author(s):  
K Mizuno ◽  
K Hasegawa ◽  
T Katagiri ◽  
M Ogimoto ◽  
T Ichikawa ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lines ◽  
Type A ◽  
Extracellular Domain ◽  
Fine Tuning ◽  
Leader Peptide ◽  
Reticular Nucleus ◽  
Cdna Clones ◽  
Protein Tyrosine ◽  
Type C

Protein tyrosine phosphatases (PTPs), together with protein tyrosine kinases (PTKs), are involved in the regulation of cell activation, growth, and differentiation. To further elucidate the fine tuning of cell growth and differentiation through tyrosine phosphorylation, we tried to isolate mouse receptor-type PTP (RPTP) cDNA clones by screening mouse brain cDNA libraries with mouse CD45 PTP domain probes under reduced-stringency conditions. Characterization of isolated cDNA clones for RPTP showed that the cytoplasmic region contains two tandem repeats of PTP domain of about 230 amino acids with intrinsic phosphatase activity. The extracellular region was composed of immunoglobulin (Ig)-like domains and fibronectin type III (FN-III)-like domains. The gene was highly homologous to human PTP delta (HPTP delta) and thus was named MPTP delta (murine counterpart of HPTP delta). The MPTP delta gene appeared to generate at least three species of mRNA, which differ in the composition of the extracellular domain: type A, one Ig-like and four FN-III-like domains; type B, one Ig-like and eight FN-III-like domains; and type C, three Ig-like and eight FN-III-like domains. Interestingly, the 5' untranslated region and the leader peptide of types A and B were completely different from those of type C. Northern (RNA) blot analysis demonstrated that brain, kidney, and heart cells express three mRNA species of about 7 kb. Antibody directed against part of the extracellular domain of type A MPTP delta recognized a 210-kDa protein in brain and kidney lysates. In situ hybridization of brain samples revealed that MPTP delta mRNA is present in the hippocampus, thalamic reticular nucleus, and piriform cortex, where some Src family PTKs have been also demonstrated to exist. Although MPTP delta mRNA was not detected in lymphoid tissues, all of the pre-B-cell lines tested and one of three B-cell lines tested expressed MPTP delta mRNA, whereas antibody-producing B-cell hybridomas and T-cell and macrophage lines did not. Finally, the MPTP delta locus was tightly linked to the brown (b) locus on mouse chromosome 4.

Abstract 19622: Trans-apical Off-pump Mitral Valve Repair With Neochords Implantation: One Year Clinical and Echocardiographic Follow-up

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Andrea Colli ◽  
Laura Besola ◽  
Lorenzo Bagozzi ◽  
Erica Manzan ◽  
Eleonora Bizzotto ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Type A ◽  
Mitral Valve Regurgitation ◽  
Disease Type ◽  
Reverse Remodeling ◽  
Off Pump ◽  
Single Centre Study ◽  
Type C ◽  
One Year

Introduction: TOP-MINI is a new micro invasive surgical procedure to treat degenerative mitral valve regurgitation due to flail/prolapse. Hypothesis: This prospective single centre study sought to assess the safety and effectiveness of the TOP-MINI procedure up to one year follow-up. Methods: Clinical and Echocardiographic outcomes were evaluated at 1, 3, 6 months and 1 year follow-up for all patients underwent TOP-MINI procedure from November 2013 to March 2015. Procedural success was defined as residual MR≤2+ at any time. Results: Sixty-one patients were treated during study period. One year survival was 96.7±2.3%. Freedom from MR>2+ is shown in figure 1 Panel A, Freedom from MR>2+ according to valve anatomy (Type A isolated P2 disease, Type B posterior multisegment disease, Type C anterior or bileaflet and/or calcified disease) is shown in Figure 1 Panel B. Freedom from MR>2+ according to STS risk profile is shown in Figure 2. The trend of Echocardiographic parameters is shown in Figure 3. Conclusions: TOP-MINI is a safe and effective procedure at 1 year FU. Residual MR is influenced by valve anatomy showing good results in Type A and B patients. Future techniques refinements are needed in order to improve outcomes of Type C patients. The lack of annuloplasty procedure does not influence negatively left ventricle reverse remodeling.

scholarly journals A surveillance of enteropathogens in piglets from birth to seven days of age in Brazil

2013 ◽  
Vol 33 (8) ◽  
pp. 963-969 ◽  
Author(s):  
Eduardo C. Cruz Junior ◽  
Felipe M. Salvarani ◽  
Rodrigo O.S. Silva ◽  
Marcos X. Silva ◽  
Francisco C.F. Lobato ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Clostridium Difficile ◽  
Type A ◽  
Final Diagnosis ◽  
Enterotoxigenic Escherichia Coli ◽  
Microbiological Test ◽  
E Coli ◽  
Isospora Suis ◽  
Real Importance ◽  
Type C

The purpose of the study was to evaluate the real importance of anaerobic enteropathogens and rotavirus in contrast to more common agents as cause of diarrhea in piglets within the first week of life. Sixty 1- to 7-day-old piglets, 30 diarrheic and 30 non-diarrheic (control), from 15 different herds were selected, euthanized and necropsied. Samples of the jejunum, ileum, colon, cecum and feces were collected from the piglets and analyzed to determine the presence of the following enteropathogens: enterotoxigenic Escherichia coli (ETEC), Clostridium perfringens types A and C, Clostridium difficile, rotavirus and Isospora suis. Among diarrheic piglets, 23.3% were positive for C. difficile, 70% for C. perfringens type A cpb2+, 14.3% for rotavirus and 10% for ETEC. Among non-diarrheic control piglets, 10% were positive for C. difficile, 76.7% for C. perfringens type A cpb2+, 0% for rotavirus, 3.3% for ETEC and 3.3% for I. suis. C. perfringens type C was not detected in any of the animals. Histological lesions characteristic of C. difficile, E. coli and rotavirus were observed. However, no C. perfringens type A suggestive lesions were detected. There was a positive correlation between mesocolon edema and the presence of C. difficile toxins. Although C. perfringens type A cpb2+ was the most frequently detected enteropathogen, there was no association between its presence and diarrhea or macro or microscopic changes. C. difficile and Rotavirus were the most relevant pathogens involved with neonatal diarrhea in this study, and histopathology associated with microbiological test proved to be the key to reach a final diagnosis.

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