Utilization of Chest Tube in Pediatric Caustic Injuries: A New Method for Esophageal Stenting

Abstract Background: The management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. Herein, along with describing the features of caustic injury, we described how to utilize a chest tube for esophageal stenting in pediatrics.Methods: Data regarding the etiology, treatment, and complications of caustic injury pediatrics during 10 years was collected retrospectively. Furthermore, data regarding the patient’s follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patients’ cheek.Results: Data from 57 patients with an average age of 2.5 years was collected. The most common cause of esophageal burn appertained to alkaline agents (89%). Twenty-nine patients (50.8%) recovered with dilatation alone, 16 ones needed esophageal repair, and ECT was inserted for 7 patients. None of the 7 ECT cases required gastrostomy or jejunostomy.Conclusion: The ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.

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Traumatic pancreatitis in children

Acta chirurgica iugoslavica ◽

10.2298/aci1701043s ◽

2017 ◽

Vol 64 (1) ◽

pp. 43-47

Author(s):

Danica Stanic ◽

Goran Rakic ◽

Biljana Draskovic ◽

Izabella Fabri ◽

Anna Uram-Benka

Keyword(s):

Practice Patterns ◽

Pediatric Population ◽

Diagnostic Procedures ◽

Physician Practice ◽

Physician Practice Patterns ◽

Optimal Management ◽

Significant Morbidity ◽

Multicenter Studies ◽

Traumatic Pancreatitis ◽

Guide Care

Traumatic pancreatitis is still a relative enigma, despite modern clinical practice, technology and modern diagnostic procedures. This condition is very specific and serious and is associated with significant morbidity, especially in pediatric population. Traumatic pancreatitis is also an emerging problem in pediatric population with its incidence rising in the last 20 years. Data regarding the optimal management and physician practice patterns are lacking. We present a literature review and updates on the management of pediatric pancreatitis due to trauma. Prospective multicenter studies are necessary to guide care and improve outcomes for this population.

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Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

Updates in Surgery ◽

10.1007/s13304-021-01094-4 ◽

2021 ◽

Author(s):

Ciro Esposito ◽

Ernesto Montaruli ◽

Giuseppe Autorino ◽

Mario Mendoza-Sagaon ◽

Maria Escolino

Keyword(s):

Patient Satisfaction ◽

Laser Therapy ◽

Pilonidal Sinus ◽

Pediatric Population ◽

Treatment Protocol ◽

Pilonidal Sinus Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Clavien Grade

AbstractThis paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

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Serum biomarkers confirming stable remission in inflammatory bowel disease

Scientific Reports ◽

10.1038/s41598-021-86251-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christoph Kessel ◽

Miha Lavric ◽

Toni Weinhage ◽

Markus Brueckner ◽

Sytze de Roock ◽

...

Keyword(s):

Disease Control ◽

Serum Biomarkers ◽

Treat To Target ◽

Optimal Management ◽

Tight Control ◽

Follow Up Study ◽

Number Of Patients ◽

Bowel Diseases ◽

Inflammatory Bowel

AbstractCrohn's disease (CD) and ulcerative colitis (UC) have a chronic-remittent course. Optimal management of inflammatory bowel diseases (IBD) relies on early intervention, treat-to-target strategies and a tight disease control. However, it is challenging to assess the risk of relapses in individual patients. We investigated blood-based biomarkers for the confirmation of disease remission in patients with IBD. We retrospectively analyzed samples of 40 IBD patients (30 UC, 10 CD) enrolled in a tight-control follow-up study. Half of the patients had a flare during follow up. Serum was analyzed for S100A12 as well as S100A8/A9 and for 50 further biomarkers in a bead-based multiplex assay. The concentrations of 9 cytokines/chemokines and S100A8/A9 significantly differed in IBD patients with unstable remission (before flares) when compared to IBD patients with stable remission. Although the number of patients was small, ROC curve analyses revealed a number of biomarkers (IL-1β, IL-1RA, IL-8, IL13, IL-15, IL-21, IL-25, IFN-β, CXCL9, CXCL10, CXCL11, Galectin-1, G-CSF and S100A8/A9) that were elevated in patients with later occurring relapses. While earlier studies on peripheral biomarkers in IBD are limited to only few analytes, our study using a broad screening approach identified serum biomarkers with the potential to indicate unstable disease control in IBD, which may help to steer individual therapies to maintain remission.

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Safety of growth hormone (GH) treatment in GH deficient children and adults treated for cancer and non-malignant intracranial tumors—a review of research and clinical practice

Pituitary ◽

10.1007/s11102-021-01173-0 ◽

2021 ◽

Author(s):

Margaret C. S. Boguszewski ◽

Adriane A. Cardoso-Demartini ◽

Cesar Luiz Boguszewski ◽

Wassim Chemaitilly ◽

Claire E. Higham ◽

...

Keyword(s):

Growth Hormone ◽

Clinical Practice ◽

Brain Tumors ◽

Cancer Recurrence ◽

Childhood Cancer Survivors ◽

Multicenter Studies ◽

Gh Treatment ◽

Secondary Neoplasms ◽

Gh Replacement

AbstractIndividuals surviving cancer and brain tumors may experience growth hormone (GH) deficiency as a result of tumor growth, surgical resection and/or radiotherapy involving the hypothalamic-pituitary region. Given the pro-mitogenic and anti-apoptotic properties of GH and insulin-like growth factor-I, the safety of GH replacement in this population has raised hypothetical safety concerns that have been debated for decades. Data from multicenter studies with extended follow-up have generally not found significant associations between GH replacement and cancer recurrence or mortality from cancer among childhood cancer survivors. Potential associations with secondary neoplasms, especially solid tumors, have been reported, although this risk appears to decline with longer follow-up. Data from survivors of pediatric or adult cancers who are treated with GH during adulthood are scarce, and the risk versus benefit profile of GH replacement of this population remains unclear. Studies pertaining to the safety of GH replacement in individuals treated for nonmalignant brain tumors, including craniopharyngioma and non-functioning pituitary adenoma, have generally been reassuring with regards to the risk of tumor recurrence. The present review offers a summary of the most current medical literature regarding GH treatment of patients who have survived cancer and brain tumors, with the emphasis on areas where active research is required and where consensus on clinical practice is lacking.

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Efficiency of modified Goldman’s technique in open pediatric septoplasty

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00074-0 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Omar Sabry ◽

Hazem Dewidar ◽

Mosaad abdel Aziz ◽

Amr Elemam ◽

Ahmed Nassar

Keyword(s):

Nasal Septum ◽

Pediatric Population ◽

Septal Deviation ◽

Nasal Resistance ◽

Deviated Nasal Septum ◽

Assessment Protocol ◽

Nose Scale ◽

Detailed Assessment

Abstract Background Performing nasal surgery on children has been the subject of controversy among surgeons. Specifically, the indications for and timing of septoplasty in children have been debated for the last several decades. In this study, we access the efficacy of the modified Goldman’s technique in dealing with caudal septal deviation in pediatric population suffering from severe nasal obstruction and its effect on nasal functions postoperatively. In this study, 30 pediatric patients suffering from deviated nasal septum who are candidate for septoplasty were included and underwent open septoplasty using modified Goldman’s technique. They were subjected to detailed assessment protocol preoperatively including NOSE scale, anterior rhinomanometry, and CT scans. Follow-up assessment was done at second week postoperative including anterior rhinoscopy and nasal endoscopy and 3 months postoperative including NOSE scale and anterior rhinomanometry. Results There was a statistically significant decrease of the NOSE scale severity to none in 90% of cases. Three months postoperative, all of the patients performed postoperative anterior active rhinomanometry with statistically significant decrease in the postoperative total nasal resistance values with inspiratory values ranging from 0.1 to 0.5 Pa/cm3/s with mean of 0.26 Pa/cm3/s and expiratory nasal resistance values ranging from 0.1 to 0.6 Pa/cm3/s with mean of 0.31 Pa/cm3/s. Conclusions Open septoplasty in children using the modified Goldman’s technique has enabled accurate and conservative approach for correction of nasal septal deviation especially those located in the caudal septal region. The technique also offers a significant reduction of the nasal symptoms postoperatively with marked improvement of the nasal resistance and quality of life in severe cases of deviated nasal septum.

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Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02336-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yu Liu ◽

Chunjie Liu ◽

Dongmei Guo ◽

Ning Wang ◽

Ying Zhao ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Conservative Treatment ◽

Closed Reduction ◽

Pediatric Population ◽

Normal Weight ◽

Medical Community ◽

Overweight Children ◽

Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

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Routine inguinal hernia repair in the pediatric population: Is office follow-up necessary?

Journal of Pediatric Surgery ◽

10.1016/0022-3468(93)90161-d ◽

1993 ◽

Vol 28 (9) ◽

pp. 1185-1187 ◽

Cited By ~ 15

Author(s):

J. Koulack ◽

P. Fitzgerald ◽

D.A. Gillis ◽

M. Giacomantonio

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Pediatric Population

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Recurrent schwannoma of the tongue in a pediatric patient—report of a rare case with an updated review of literature

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00101-0 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Anup Singh ◽

Vaisakh Kuzhikkali ◽

Arvind Kumar Kairo

Keyword(s):

Pediatric Population ◽

Surgical Excision ◽

Review Of Literature ◽

Case Presentation ◽

Nerve Sheath Tumors ◽

Peripheral Nerve Sheath Tumors ◽

Nerve Sheath ◽

Cervical Sympathetic ◽

Mobile Tongue

Abstract Background Head and neck is a relatively common site of occurrence for the peripheral nerve sheath tumors, and majority of these tumors are seen involving neck, involving vagus nerve, and cervical sympathetic chain. Schwannomas involving mobile tongue are rarely encountered, especially in the pediatric population Case presentation We present a case of recurrent tongue schwannoma in a 13-year-old female successfully managed with transoral excision. At a follow-up of 3 years, no recurrence is observed. Conclusion Surgical excision is the recommended modality of treatment for lingual schwannomas, and when excised adequately, recurrences are not expected. A clear margin of surrounding normal tissue should be aimed for to avoid possible recurrence.

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Pediatric Pituitary Adenoma: Case Series, Review of the Literature, and a Skull Base Treatment Paradigm

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625984 ◽

2018 ◽

Vol 79 (01) ◽

pp. 091-114 ◽

Cited By ~ 19

Author(s):

Avital Perry ◽

Christopher Graffeo ◽

Christopher Marcellino ◽

Bruce Pollock ◽

Nicholas Wetjen ◽

...

Keyword(s):

Systematic Review ◽

Pituitary Adenoma ◽

Skull Base ◽

Pituitary Adenomas ◽

Pediatric Population ◽

Csf Leak ◽

Persistent Disease ◽

Treatment Paradigm ◽

Surgical Cure

Background Pediatric pituitary adenoma is a rare skull base neoplasm, accounting for 3% of all intracranial neoplasms in children and 5% of pituitary adenomas. Compared with pituitary tumors in adults, secreting tumors predominate and longer disease trajectories are expected due to the patient age resulting in a natural history and treatment paradigm that is complex and controversial. Objectives The aims of this study were to describe a large, single-institution series of pediatric pituitary adenomas with extensive long-term follow-up and to conduct a systematic review examining outcomes after pituitary adenoma surgery in the pediatric population. Methods The study cohort was compiled by searching institutional pathology and operative reports using diagnosis and site codes for pituitary and sellar pathology, from 1956 to 2016. Systematic review of the English language literature since 1970 was conducted using PubMed, MEDLINE, Embase, and Google Scholar. Results Thirty-nine surgically managed pediatric pituitary adenomas were identified, including 15 prolactinomas, 14 corticotrophs, 7 somatotrophs, and 4 non-secreting adenomas. All patients underwent transsphenoidal resection (TSR) as the initial surgical treatment. Surgical cure was achieved in 18 (46%); 21 experienced recurrent/persistent disease, with secondary treatments including repeat surgery in 10, radiation in 14, adjuvant pharmacotherapy in 11, and bilateral adrenalectomy in 3. At the last follow-up (median 87 months, range 3–581), nine remained with recurrent/persistent disease (23%).Thirty-seven publications reporting surgical series of pediatric pituitary adenomas were included, containing 1,284 patients. Adrenocorticotropic hormone (ACTH)-secreting tumors were most prevalent (43%), followed by prolactin (PRL)-secreting (37%), growth hormone (GH)-secreting (12%), and nonsecreting (7%). Surgical cure was reported in 65%. Complications included pituitary insufficiency (23%), permanent visual dysfunction (6%), chronic diabetes insipidus (DI) (3%), and postoperative cerebrospinal fluid (CSF) leak (4%). Mean follow-up was 63 months (range 0–240), with recurrent/persistent disease reported in 18% at the time of last follow-up. Conclusion Pediatric pituitary adenomas are diverse and challenging tumors with complexities far beyond those encountered in the management of routine adult pituitary disease, including nuanced decision-making, a technically demanding operative environment, high propensity for recurrence, and the potentially serious consequences of hypopituitarism with respect to fertility and growth potential in a pediatric population. Optimal treatment requires a high degree of individualization, and patients are most likely to benefit from consolidated, multidisciplinary care in highly experienced centers.

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A Case Report of Pediatric Geniculate Neuralgia Treated with Sectioning of the Nervus Intermedius and Microvascular Decompression of Cranial Nerves IX and X

Pediatric Neurosurgery ◽

10.1159/000509760 ◽

2020 ◽

Vol 55 (6) ◽

pp. 439-443

Author(s):

Georgios Zenonos ◽

Michael M. McDowell ◽

Hussam Abou-Al-Shaar ◽

Kenan Alkhalili ◽

Paul A. Gardner

Keyword(s):

Microvascular Decompression ◽

Pediatric Population ◽

English Literature ◽

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Rare Condition ◽

Extensive Evaluation ◽

Patient Reported ◽

Nervus Intermedius

Background: Classic geniculate neuralgia (GN) is a rare condition characterized by lancinating pain centered in the ear and not involving the throat. To the best of our knowledge, no case of pediatric GN has been reported in the English literature. Case Presentation: We present the first reported case of successfully treated GN in a child via an endoscopic approach. The patient was a 9-year-old boy who presented with a 1-year history of lancinating right ear pain. Neuroleptics resulted in a short-lived improvement in symptoms, but with significant side effects. Extensive evaluation by multiple specialties did not reveal a cause for his pain. Imaging disclosed a tortuous loop of the right posterior inferior cerebellar artery abutting cranial nerves IX and X but no other abnormalities. The patient underwent an endoscopic microvascular decompression of cranial nerves IX and X, and sectioning of the nervus intermedius through a right retromastoid craniotomy. Postoperatively, the patient reported complete resolution of his symptoms that persisted at 3 months of follow-up. At the 5-year follow-up, the patient maintained pain relief and was developing normally. Conclusion: GN can affect the pediatric population. In carefully selected patients with consistent clinical and radiographic presentation, sectioning of the nervus intermedius and microvascular decompression of the lower cranial nerves can be an effective treatment.

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