Retrospective Review of Management and Outcomes of Pediatric Descending Mediastinitis

2016 ◽  
Vol 155 (1) ◽  
pp. 155-159 ◽  
Author(s):  
Caleb D. Wilson ◽  
Kenneth Kennedy ◽  
Joshua W. Wood ◽  
T. K. Susheel Kumar ◽  
Rose Mary S. Stocks ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Tertiary Care ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retropharyngeal Abscess ◽  
Surgical Drainage ◽  
Pediatric Hospital ◽  
Source Of Infection ◽  
Successful Approach ◽  
Descending Mediastinitis

Objectives To review the management and outcomes of pediatric patients treated for descending mediastinitis at a single institution and contribute to an updated mortality rate. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods This study is a 19-patient case series of all patients treated for descending mediastinitis at a tertiary pediatric hospital from 1997 to 2015, and it serves as an update to the case series published from this institution in 2008. Review of management included time to diagnosis, time to surgery, surgical procedures performed, and antibiotics administered. The primary outcomes measured were length of hospitalization and mortality. Results In addition to 8 previously reported patients, we identified 11 pediatric patients treated for descending mediastinitis in the period of review. All 19 patients were <18 months old, and all survived their hospitalization. Fourteen patients underwent surgical drainage at least twice. The median length of hospital stay was 15 days. Retropharyngeal abscess was the source of infection in 16 of 19 patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the isolated organism in 14 of 15 positive cultures. Conclusion This review represents the largest reported series of pediatric patients with descending mediastinitis. With 100% survival, our results suggest that pediatric descending mediastinitis can be safely managed by prompt surgical drainage. Broad-spectrum antibiotics covering MRSA and a low threshold for repeat surgical intervention have been an important part of our successful approach and may decrease length of stay.

scholarly journals Masses of the Sternoclavicular Area: Case Series and Review of the Literature

2021 ◽  
Vol 15 ◽  
pp. 117955652110216
Author(s):  
Parisa Oviedo ◽  
Morgan Bliss
Keyword(s):  
English Language ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Case Series ◽  
Review Of The Literature ◽  
Incision And Drainage ◽  
Surgical Interventions ◽  
Ganglion Cysts ◽  
Icd 10 ◽  
Bronchogenic Cysts

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

Outcomes In Pediatric Endoscopic Skull Base Surgery: A Systematic Review

2021 ◽  
Author(s):  
Erin Mamuyac Lopez ◽  
Zainab Farzal ◽  
Kelly Marie Dean ◽  
Craig Miller ◽  
Justin Cates Morse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Csf Leak ◽  
Inclusion Criteria ◽  
Endoscopic Skull Base Surgery ◽  
Tertiary Care Medical Center

Objectives: The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study’s aim is to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents ages 0-18 years. Design: A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000-2020 using PRISMA guidelines. Final inclusion criteria included: case series with 10+ patients with pediatric patients age ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting: Tertiary care medical center Participants: Children/adolescents ages 0-18 years who underwent endoscopic skull base surgery Main Outcome Measures: Patient demographics, pathology, reconstructive technique, intra-operative findings, intra-operative and post-operative surgical complications. Results: Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients age 0-18 years met inclusion criteria for final analysis. 7 of 12 studies discussed a single pathology. The most common pathology was a skull base defect causing CSF leak. The majority of skull base repairs were made with free tissue grafts. The most common post-operative complication was CSF leak (n=40). Twelve cases of meningitis occurred post-operatively with two of these episodes resulting in death. Conclusions: Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

scholarly journals Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anirban P. Mitra ◽  
Evalynn Vasquez ◽  
Paul Kokorowski ◽  
Andy Y. Chang
Keyword(s):  
Hospital Stay ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Operating Time ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Open Approach ◽  
Invasive Approach ◽  
Patients Âgés ◽  
Tertiary Center

Abstract Background Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.

Pediatric Tracheostomy Decannulation: 11-Year Experience

2019 ◽  
Vol 161 (3) ◽  
pp. 499-506 ◽  
Author(s):  
Kristen L. Seligman ◽  
Bryan J. Liming ◽  
Richard J. H. Smith
Keyword(s):  
Failure Rate ◽  
Chart Review ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Late Failure ◽  
Final Study ◽  
Study Population ◽  
Tertiary Care Institution

Objective To determine the successful decannulation rate with a published pediatric tracheostomy decannulation protocol. Study Design Case series with chart review. Setting A single tertiary care institution. Subjects and Methods A chart review was performed for patients aged ≤5 years who underwent tracheostomy. Extracted data included demographic data, indication for tracheostomy, age at tracheostomy and decannulation, comorbidities, and surgical complications. Records were searched for documentation of early decannulation failure (within 1 month of decannulation) or late failure (within 1 year). Results Forty patients with a tracheostomy aged ≤5 years underwent attempted decannulation during the 11-year study period. Seventeen patients were excluded from the study for documentation of nonprotocol decannulation. The final study population of 23 patients underwent a total of 27 decannulations, 26 of which were performed by protocol. Of the 26 protocol decannulations, 22 were successful, for a failure rate of 15%. Conclusion Twenty-six protocol decannulations were attempted among 23 patients, 4 of which were unsuccessful for an overall failure rate of 15%. This result is consistent with rates reported in other published decannulation protocols. We believe that our protocol minimizes resource utilization in its use of pulse oximetry over polysomnography, while maximizing patient safety and success through the use of capping trials for very young and very small pediatric patients.

scholarly journals A Conscious Sedation Protocol for Videolaryngostroboscopy in Pediatric Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Samantha Anne ◽  
Lawrence M. Borland ◽  
Laura Haibeck ◽  
Joseph E. Dohar
Keyword(s):  
Outcome Measures ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Case Series ◽  
Diagnostic Information ◽  
Secondary Outcome ◽  
Sedation Protocol

Objective. To determine best sedation protocol for videolaryngostroboscopy in children unable to tolerate non-sedated evaluation.Materials and Methods.Consecutive case series of 10 children with voice disturbances, unable to tolerate nonsedated videolaryngostroboscopy at an academic tertiary care children’s hospital. Flexible fiberoptic videolaryngostroboscopy was performed and interpreted by pediatric otolaryngologist and speech and language pathologist. Sedation was administered with newly described protocol that allowed functional portion of evaluation.Main Outcome Measures: ability to follow commands and tolerate flexible fiberoptic videolaryngostroboscopy.Secondary Outcome Measures: total phonation time, complications, need for subsequent videolaryngostroboscopic attempts, clinical outcomes, and follow-up.Results. 10 children underwent procedure under conscious sedation. 9/10 children were able to perform simple tasks and maintain adequate phonation time to complete stroboscopic exam. 1/10 patients failed to complete exam because of crying during entire exam. Mean exam time was 2 minutes 52 seconds (SD 86 seconds), phonation time is 1 minute 44 seconds (SD 60 seconds), and number of tasks completed was 10.5 (SD 8.6).Conclusions. Conscious sedation for videolaryngostroboscopy can be safely and effectively performed in children unable to comply with nonsedated examination. Such studies provide valuable diagnostic information to make a diagnosis and to devise a treatment plan.

scholarly journals A case series of brain abscesses: an eleven-year retrospective single center study

2021 ◽  
Vol 15 (06) ◽  
pp. 791-797
Author(s):  
Rami Waked ◽  
Hassan Tarhini ◽  
Hussein Mansour ◽  
Gebrael Saliba ◽  
Nabil Chehata ◽  
...  
Keyword(s):  
Stereotactic Biopsy ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Rare Condition ◽  
Source Of Infection ◽  
Single Center Study ◽  
Brain Abscesses ◽  
Worse Prognosis

Introduction: We lack data on the epidemiology and management of brain abscesses in the Middle East. The aim of this study is to report a case series of brain abscesses admitted at a tertiary care center in Lebanon, between January 2008 and December 2018. Methodology: This retrospective study aimed at determining the demographic data, treatment, and correlations between different studied variables with prognosis of patients that received treatment. Results: Forty-one patients (30 males) were included with a median age of 37 years (2-85). The analysis showed that the classic triad of fever, headache and neurologic deficit was only present in 12% of patients on admission. The source of infection was contiguous in 36.5%, post surgical in 32%, and distant in 17% of cases. Stereotactic biopsy was performed in 41.5% of patients, and craniotomy in 19.5%. A microorganism was isolated in 63% of patients (26 cases). The most used antibiotics were carbapenems (46%) and glycopeptides (66%). Eighty percent of patient (33) had a good outcome. A worse prognosis was significantly correlated with immunosuppression and multiple cerebral abscesses. Conclusions: Brain abscess remains a relatively rare condition.

Management Patterns in Pediatric Complicated Sinusitis

2020 ◽  
Vol 163 (4) ◽  
pp. 814-821
Author(s):  
Sean M. McDermott ◽  
Amanda Onwuka ◽  
Charles Elmaraghy ◽  
Patrick C. Walz
Keyword(s):  
Medical Therapy ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Early Stage ◽  
Tertiary Care ◽  
Case Series ◽  
Hospital Charges ◽  
Intracranial Extension ◽  
Disease Characteristics ◽  
Outcome Differences

Objectives Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed. Results The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens ( P = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients ( P < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS ( P = .92). Conclusion Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.

Profile of Patients with Completion Thyroidectomy and Assessment of Their Suitability for Outpatient Surgery

2011 ◽  
Vol 145 (5) ◽  
pp. 727-731 ◽  
Author(s):  
Gaosong Wu ◽  
Sara I. Pai ◽  
Nishant Agrawal ◽  
Jeremy Richmon ◽  
Alan Dackiw ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Vocal Fold ◽  
Outpatient Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Completion Thyroidectomy ◽  
Thyroid Lobectomy ◽  
Significant Difference ◽  
Symptomatic Hypocalcemia

Objective. Outpatient thyroid surgery for thyroid lobectomy has been shown to be safe and feasible. The safety of outpatient completion thyroidectomy in patients who have previously undergone thyroid lobectomy has not been extensively evaluated in the medical literature to date. The authors sought to evaluate postoperative complications associated with completion thyroidectomy in their institution to determine if it would be safe and feasible to perform as an outpatient procedure. Study Design. Case series with chart review. Setting. Tertiary care teaching hospital. Subjects and Methods. Two hundred four consecutive patients, who underwent completion thyroidectomy after previous thyroid lobectomy from January 2000 to June 2010, comprised the study population. Medical records were reviewed for preoperative and postoperative serum calcium levels, preoperative and postoperative fiber-optic laryngoscopic examination of vocal fold mobility, associated comorbidities, length of hospital stay, drain use, seroma or hematoma formation, final thyroid pathology, and postoperative follow-up. Results. Overall, 9 patients (4.4%) developed postoperative complications, including transient symptomatic hypocalcemia in 4 patients (2.0%), transient laboratory hypocalcemia in 3 patients (1.5%), seroma formation in 1 patient (0.5%), and hematoma development in 1 patient (0.5%). There were no cases with permanent or temporary vocal fold paralysis. No significant difference was found in the overall complication rate before and after 4 hours of observation ( P = .50). Conclusion. Selected patients who undergo completion thyroidectomy after previous thyroid lobectomy can be safely discharged after 4 hours of postoperative observation with appropriate instructions.

scholarly journals Differences between Two Methods to Stabilize Supramalleolar Osteotomies in Children—A Retrospective Case Series

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 86
Author(s):  
Thomas Schlemmer ◽  
Reinald Brunner ◽  
Bernhard Speth ◽  
Johannes Mayr ◽  
Erich Rutz
Keyword(s):  
Pediatric Patients ◽  
Muscle Power ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Retrospective Case ◽  
Functional Rehabilitation ◽  
Locking Compression Plates ◽  
Consolidation Rate ◽  
K Wires

Supramalleolar osteotomy (SMO) in pediatric patients can be fixed in various ways. We analyzed the records of 77 pediatric patients (124 SMOs) aged ≤16 years. In 56 patients (96 SMOs), K-wires were used to stabilize SMOs (WF group), while 21 patients (28 SMOs) were treated with locking compression plates (LCPs; PF group). We recorded time to radiographic consolidation, rate of complications, length of hospital stay (LOS), and time to implant removal. Mean time to radiographic consolidation of SMOs was 7.2 weeks in the WF group and 11.1 weeks in the PF group. Complication rate in the WF group was 10.7%. LOS was similar in the two groups (7.0 days in the WF group vs. 7.3 days in the PF group). K-wire stabilization resulted in a shortened interval until consolidation of osteotomies, but children were required to use a cast. Stabilization of SMOs with LCPs facilitated early mobilization and functional rehabilitation with no need to apply a cast. In conclusion, both methods provided safe fixation of SMOs with a low rate of complications. K-wire stabilization combined with a cast achieves fast consolidation of SMOs. We recommend SMO stabilization with angular stable LCPs in patients with muscular weakness or spasticity in whom early mobilization and physiotherapy are necessary to prevent loss of muscle power, muscle function, and bone mass.

scholarly journals RECENT INCREASE IN COLISTIN-RESISTANT EXTENSIVELY DRUG RESISTANT ACINETOBACTER INFECTIONS AT A TERTIARY CARE CENTER IN PAKISTAN

2019 ◽  
Author(s):  
Nosheen Nasir ◽  
Fatima Sharif ◽  
Rubab Mansoor ◽  
Shehryar Ahmed ◽  
Bushra Jamil ◽  
...  
Keyword(s):  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Antimicrobial Treatment ◽  
Common Diagnosis ◽  
Resistant Strains ◽  
Treat All

Abstract Background Acinetobacter is an important nosocomial pathogen and a major cause of morbidity and mortality in hospitalized patients. Recently, colistin resistant strains of Acinetobacter were reported from different parts of the world. We are describing a case series of 18 patients with colistin resistant Acinetobacter over a span of 4 years. Methods Patients with any clinical specimen positive for colistin resistant Acinetobacter from 2014 to 2017 were identified from the hospital records. Three cases were isolated between 2014 and 2015, six cases in 2016 and 9 cases in 2017. Data on patients’ demographics as well as clinical data was collected retrospectively on a structured proforma from the hospital medical records. Results Mean age of the patients was 50 ± 18 years. Fifteen (83.3%) out of the 18 patients were male. Acinetobacter Pneumonia was the most common diagnosis in n=13(72.2% of the patients). Nine (50%) of the patients developed sepsis. In addition to Colistin resistance, carbapenem and amikacin resistance was documented to be 94% and 61% respectively. Colistin and carbapenem based combinations were used to treat all patients with a mean antibiotic duration of 20 ± 10 days. Median length of hospital stay was 25 days (range 8 - 61), with 14 patients (77.8%) requiring ICU admission. Eight (44.4%) of the patients expired and only 6 (33.3%) achieved microbiological eradication. Conclusion Infections due to Colistin resistant strains of Acinetobacter are rapidly increasing, have limited antimicrobial treatment options and are associated with poor outcomes.

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