scholarly journals Erudition after neonatal gastric transposition for esophageal atresia at 10 years of follow-up

2021 ◽  
Vol 10 ◽  
pp. 37
Author(s):  
Kanika Sharma ◽  
Shilpa Sharma ◽  
Devendra Kumar Gupta
Keyword(s):  
Esophageal Atresia ◽  
Primary Anastomosis ◽  
Esophageal Replacement ◽  
Contrast Study ◽  
Hepatobiliary Scintigraphy ◽  
Oral Contrast ◽  
Cross Sectional ◽  
Gastric Transposition ◽  
The Mean

Background: Gastric transposition (GT) is a well-established procedure of esophageal re­placement (ER) for children with esophageal atresia. ER in the neonatal period is sparsely reported. We report characteristics of children who have undergone neonatal GT and have completed ten years of follow-up. Methods: The cross-sectional study was conducted which included all children who under­went neonatal GT at the institute and have completed a follow-up of at least 10-years. An­thropometry, oral contrast study, Hepatobiliary Scintigraphy, Gastroesophageal reflux study, Gastric emptying test, spirometry, and blood investigations were done for all the children. Results: Four children (three male and one female) were included in the study. The mean age at ER was 5.3 ±2.2 days with a mean birth-weight of 2.43 ±0.13 kg. Two children had prima­ry GT, while the other two had GT following a leak in primary anastomosis. During the mean follow-up of 180.25 ±43.5 months, none of the children required esophageal dilatation or other surgical intervention or procedures. All children were below 3rd centile for weight-for-age while all except one were below 50th centile for height-for-age. There was no stricture on oral contrast study, however, one child had grade III reflux on GER scan. Persistent duode­nogastric reflux on HIDA scan was seen in one child. Three children had restrictive parame­ters on spirometry. Symptomatically, all reported poor weight gain, one had left vocal cord palsy with hoarseness, and one had chest-wall protuberance.     Conclusions: Neonatal gastric transposition is a feasible alternative to delayed esophageal replacement for neonates with esophageal atresia with limited complications.

DOZ047.47: Flourish device for treatment of esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
Bethany J Slater ◽  
Mario Zaritzky
Keyword(s):  
Esophageal Atresia ◽  
Primary Anastomosis ◽  
Distal Portion ◽  
Contrast Study ◽  
Anastomotic Leaks ◽  
Magnetic Device ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia ◽  
Cook Medical

Abstract Esophageal atresia (EA) is usually repaired soon after birth. However, there are conditions in which early repair is not possible including prematurity, a large distance between the ends, failed attempt at primary anastomosis, and postoperative complications. Cases in which the ends of the esophagus are not able to be brought together without significant tension, or long-gap esophageal atresia (LGEA), remain a challenge to manage. A variety of techniques have been used to establish esophageal continuity consisting of extensive mobilization, myotomies, esophageal flaps, and traction of the segments. The use of magnets is a nonsurgical alternative for esophageal anastomosis. There have been a few series demonstrating initial success and accomplishment of magnamosis in EA patients. A prospective, single-arm, observational study is currently enrolling patients to evaluate the safety and benefit of the Flourish Device (Cook Medical), a catheter-based, magnetic device used to lengthen the atretic esophageal ends and create an anastomosis. The primary outcomes include stricture requiring dilation or surgery, anastomotic leaks or other adverse events with follow-up for two years. The distance of the esophageal gap is measured with metal probes. All patients require a mature gastrostomy and atretic segments < 4 cm apart. The proximal catheter has a suction port and the distal portion has a channel for feeds. Placement is done under fluoroscopy with anesthesia or sedation. Daily chest radiographs are obtained until union of the magnets occur. Successful anastomosis is identified by saliva in the gastrostomy catheter, feeds in the esophageal catheter, or with a contrast study. One day after confirmation, the magnets may be removed. When the catheters are aligned, the magnets attract. Once the magnets have connected, the tissue between them sloughs off while the outer rim heals establishing the anastomosis. The Flourish device may be particularly useful in patients in whom additional operations are not ideal such as those with congenital anomalies or who have undergone previous operations or complications.

DOZ047.60: Evaluation of gastroesophageal reflux in children born with esophageal atresia using pH and impedance monitoring

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
F W T Vergouwe ◽  
M P van Wijk ◽  
C A ten Kate ◽  
M C W Spaander ◽  
M J Bruno ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Measurement Data ◽  
Tube Feeding ◽  
Impedance Analysis ◽  
Esophageal Replacement ◽  
Acid Therapy ◽  
School Aged Children ◽  
The Mean

Abstract Aim of the Study The ESPHGAN-NASPGHAN guideline (Krishnan, 2016) recommends routine prescription of proton pump inhibitors in the first year of life after esophageal atresia (EA) repair, and to monitor gastroesophageal reflux (GER) using pH-impedance (pH-MII) monitoring and/or endoscopy at time of discontinuation and during long term follow up of these patients. This study aimed to evaluate acid and non-acid GER in infants and school-aged children with EA using pH-MII monitoring. Methods Children born with EA between 2011–2017, who underwent a 24-hour pH-MII study during infancy (≤18 months) or at 8 years old as part of a standardized longitudinal follow-up program, were included. Exclusion criteria were: isolated tracheoesophageal fistula, esophageal replacement therapy, tube feeding and monitoring < 18 hours. Anti-acid therapy was discontinued before pH-MII measurement. Data was collected on reflux index (RI; exposure to pH < 4 in %, >7% considered abnormal), retrograde bolus movements (RBM) and bolus clearance time (BCT). Automatically detected RBM were manually reviewed and modified/deleted if necessary. Results We included 57 children (51% male, 2% isolated EA, 44% thoracoscopic repair): 24 infants (median age 0.6 years) and 33 school-aged children (median age 8.2 years). In infants, median RI was 2.6% (abnormal in n = 2), median RBM was 61 (62% non-acid, 58% mixed) and median of the mean BCT was 11 seconds. In school-aged children, median RI was 0.3% (abnormal in n = 4), median RBM was 21 (64% non-acid, 75% mixed) and median of the mean BCT was 13 seconds. Of the automatically detected 3,313 RBM, 1,292 were manually deleted from the tracings: 52% of non-acid RBM and 8% of acid RBM (mainly misinterpreted swallows or one event recognized as several events). Conclusions Most children with EA off medication have a normal RI, yet experience a significant number of non-acid RBM. After manual revision of the tracings a high percentage of RBM was deleted. Our data show that automated impedance analysis software needs refinement for use in infants and children with EA, and question the need for standard anti-acid therapy in these patients.

scholarly journals Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

Urolithiasis ◽  
2021 ◽  
Author(s):  
R. A. Kingma ◽  
M. J. H. Voskamp ◽  
B. H. J. Doornweerd ◽  
I. J. de Jong ◽  
S. Roemeling
Keyword(s):  
Computed Tomography ◽  
Percutaneous Nephrolithotomy ◽  
Cone Beam Computed Tomography ◽  
University Hospital ◽  
Cone Beam ◽  
Cross Sectional ◽  
The Mean ◽  
Residual Stones ◽  
Residual Fragments

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

Longitudinal Assessment of Industrial Workers

2000 ◽  
Vol 44 (30) ◽  
pp. 5-557-5-560
Author(s):  
Alfred Franzblau ◽  
Robert A. Werner ◽  
Thomas J. Armstrong ◽  
Sheryl S. Ulin
Keyword(s):  
Upper Extremity ◽  
Musculoskeletal Disorders ◽  
Prospective Studies ◽  
Industrial Workers ◽  
Cross Sectional ◽  
Comparison Of Results ◽  
Body Regions ◽  
Upper Extremity Musculoskeletal Disorders ◽  
The Mean

Numerous investigators have performed cross-sectional studies of upper extremity musculoskeletal disorders (UEMSDs) among industrial workers, and modeled the prevalence of these conditions in relation to potential ergonomic exposures and other covariates. However, prospective studies have been rare for a variety of reasons. Results of a cross-sectional study of UEMSDs based on data collected approximately 5 years ago were published in 1999 (Latko et al., 1999). A subset of the workers from this study were available for re-examination approximately 5 years after the first investigation. The survey tools and clinical examination protocols used in the follow-up examinations were largely identical to the baseline procedures, thus permitting direct comparison of results between rounds. Workers from 2 of the 3 employers in the original study were available for the follow-up investigation. Just over 50% of available and eligible workers participated in the follow-up examinations (152 out of 267, or 57%). The mean age at follow-up was almost 48 years (standard deviation = 9.5 years). The mean body mass index (BMI) was 28.9 at follow-up, and just over half of the study participants were male (53%). Most subjects were still employed by the same employer, and most were still in the same jobs. The prevalence and severity of upper extremity symptoms declined significantly in most body regions between baseline and follow-up. In contrast, the prevalence of most upper extremity diagnoses (tendinitis and carpal tunnel syndrome based on symptoms, standardized physical examinations, and/or nerve conduction tests) increased slightly, though not significantly. Relative median-minus-ulnar peak latency differences increased slightly, and significantly, between rounds. There are almost no studies for comparison of results. More prospective studies are needed to better understand the natural history of upper extremity musculoskeletal disorders among workers.

scholarly journals Lag screw cutout in intertrochanteric fractures fixed with DHS.

2020 ◽  
Vol 27 (09) ◽  
pp. 1862-1866
Author(s):  
Muhammad Nasir Ali ◽  
Muhammad Khalid Chishti ◽  
Kashif Siddiq ◽  
Muhammad Hamayun Hameed ◽  
Muhammad Tayyab Waheed ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Intertrochanteric Fractures ◽  
Cross Sectional ◽  
Middle Position ◽  
Lag Screw ◽  
Screw Position ◽  
Hip Screw ◽  
The Mean ◽  
Study Setting

Objectives: To determine the failure of DHS (dynamic hip screw) in terms of lag screw cutout. Study Design: Hospital Based Cross Sectional study. Setting: BVH and Civil Hospital Bahawalpur. Period: From 2013 to 2018. Material & Methods: 273 patients of both genders with age more than 50 years having stable intertrochanteric fractures were included in this study. With the help of C arm, the best possible anatomical reduction and rigid internal fixation was done with 135 degree DHS. Lag screw position and TAD determined on first postoperative day on radiographs (Anteroposterior & Lateral). Failure of fixation was determined on the radiographs during follow up. Lag screw cut-out was the projection of the screw from the femoral head by more than 1mm. Results: The mean age of the patients was 68.6 years (50-88). There were 132 (51.1 %) males and 126 (48.8%) females. Overall lag screw cutout rate was 11.2%. 21(30.8%) had screw cutout while 47 (69.1%) healed successfully among 68 patients with TAD ≥ 25mm. On the other hand 8(4.2%) had screw cutout while 182 (95.7%) healed successfully among 190 patients with TAD < 25mm. Middle middle and inferior middle position had highest success rate (˃ 92%) while inferior posterior position had highest cutout rate (36.2%). Among different age categories high failure rate (17.8%) seen in patients more than 70 years. Conclusion: The incidence of lag screw cutout is 11.2 % and risk of cutout can be minimized by placing lag screw in middle middle or inferior middle position and keeping the TAD < 25mm. More attention during follow up should be paid to patients with age ˃ 70 years.

Delayed primary anastomosis for esophageal atresia: 18 Months' to 11 years' follow-up

1992 ◽  
Vol 27 (8) ◽  
pp. 1127-1130 ◽  
Author(s):  
Prem Puri ◽  
George K. Ninan ◽  
Noel S. Blake ◽  
Raymond J. Fitzgerald ◽  
Edward J. Guiney ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Primary Anastomosis

Evaluate the delay in the management of acute abdomen at the Yaounde central hospital: a prospective cohort study

2021 ◽  
Vol 11 (6) ◽  
pp. 155-158
Author(s):  
Joseph Cyrille Chopkeng Ngoumfe
Keyword(s):  
Cross Sectional Study ◽  
Good Prognosis ◽  
Central Hospital ◽  
Indication For Surgery ◽  
Continuous Training ◽  
Cross Sectional ◽  
Generalized Peritonitis ◽  
Common Diagnosis ◽  
The Mean

Background: Early surgical treatment remains the first factor of good prognosis for the management of acute abdominal diseases. The aim of this study was to evaluate the delay in the management of these pathologies in our context. Material and methods: We conducted a prospective cross-sectional study at the Yaoundé Central Hospital (HCY) over 7 months. All patients over 15 years of age presenting with an acute non-traumatic digestive surgical abdomen were included. The follow-up was done during the entire hospital stay of the patients. The dates and times of the different stages of management were recorded. Results: We collected 63 patients, 37 men, with a sex ratio M/F of 1.42. The mean age was 41.06±18 years. The mean time between arrival in the emergency room and the indication for surgery was 16.9 hours. Acute generalized peritonitis (n=26) was the most common diagnosis with 41.3% of cases. The average time between the indication for surgery and the availability of the surgical kit was 19 hours. The average time between the availability of the operating kit and the start of the surgical procedure was 6.2 hours. The complication rate was 33.3%. The mortality rate was 15.9%. Conclusion: Our delays in the management of acute abdomens are relatively long. A better organisation of the system and continuous training of the medical staff of peripheral hospitals would improve the prognosis of our patients.

DOZ047.82: Outcome of thoracoscopic repair of type C esophageal atresia: single-center experience from North Africa

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Elbarbary ◽  
A Shalaby ◽  
M Elseoudi ◽  
M Ragab ◽  
A E Fares ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Esophageal Atresia ◽  
Operative Time ◽  
Primary Anastomosis ◽  
Single Center Experience ◽  
Resource Setting ◽  
Thoracoscopic Repair ◽  
Type C ◽  
The Mean ◽  
A Prospective Study

Abstract Background and Aim Thoracoscopic repair of esophageal atresia is gaining popularity worldwide owing to the availability of and advances in minimally invasive instruments. This report presents our early experience of thoracoscopic esophageal atresia repair (EA/TEF) in a single institute. Methods A prospective study on short-gap type C EA/TEF was conducted at Cairo University Specialized Pediatric Hospital from April 2016. The technique was standardized in all cases: patients placed in the fully prone position, and using a 5 mm 30° scope with 3 mm instruments and carried out by four experts in minimally invasive surgery. Data was collected to include patient demographics and operative time. The main outcome was survival. Secondary outcomes were leak rate and postoperative stricture. Results Over a period of 24 months (April 2016–April 2018) 136 cases of EA/TEF were admitted. Thoracoscopy was attempted in 76 cases. Thirty cases with pure atresia or long-gap anomaly were excluded from this study for gap length, leaving 46 (60%) nonconsecutive neonates who underwent thoracoscopic repair of their short-gap EA/TEF. Five cases (10.8%) were converted to open surgery via right thoracotomy. A primary anastomosis was possible in all cases, leaving the azygos intact. The mean age at operation was 8.7 days (range 2–32), the mean weight was 2.6 kg (range 1.8–3.6), and the mean operative time was 108.3 minutes (range 80–180). In the fully thoracoscopic patients the survival was 85.4% (n = 35). An anastomotic leak occurred in 17% (n = 7); it was managed conservatively in 2 and with esophagostomy and gastrostomy in 5 cases. Followup was at one week, one and three months postdischarge. A stricture developed in 5 (16.6%) of the 30 surviving patients who kept their native esophagus. Conclusions Thoracoscopic repair is a feasible alternative even in a low-resource setting. The better outcome compared to traditional open repair in our center may be due to patient selection bias.

scholarly journals Change in Depression Symptomatology and Cognitive Function in Twins: A 10-Year Follow-Up Study

2016 ◽  
Vol 19 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Inge Petersen ◽  
Matt McGue ◽  
Qihua Tan ◽  
Kaare Christensen ◽  
Lene Christiansen
Keyword(s):  
Cognitive Decline ◽  
Cognitive Abilities ◽  
Depressive Symptomatology ◽  
Twin Studies ◽  
Cognitive Change ◽  
Depression Symptoms ◽  
Cross Sectional ◽  
The Mean ◽  
Depression Symptomatology

A complex interrelation exists between change in depression symptomatology and cognitive decline. Studies indicate either that depression is a direct risk factor for cognitive change over time, or vice versa. Longitudinal twin studies provide the possibility to unravel cause and effect of correlated traits. Here, we have applied twin modeling approaches to shed light on the genetic correlation between both level and change of depression symptomatology and cognitive functioning, and to further explore the bidirectionality of any such correlation using assessments of both phenotypes at two occasions 10 years apart. The study included 2,866 Danish twins with a mean age of 56.8 years at intake (range: 45–68 years). Of these, 1,267 were intact pairs. A total number of 1,582 twins (55%), of whom 557 were intact pairs, participated in the follow-up survey. We found stable cross-sectional heritability estimates of approximately 60% for general cognitive abilities and 30% for affective depressive symptoms. There was a considerable decline in the mean cognitive performance over 10 years, whereas the mean affective depression symptoms score was stable and with no genetic contribution to any individual change. Additionally, we saw a small but significant cross-trait correlation at both occasions (-0.11 and -0.09, respectively), but cross-trait cross-occasion analysis revealed no evidence that either of the two traits predicts the other over a 10-year interval. Thus, our study was not able to detect any causal association between change in depressive symptomatology and cognitive decline in middle-aged and elderly people over a 10-year interval.

Survey of Waiting Time for Examination at the Medical Examination Department 2 of the National Children’s Hospital in 2018

2018 ◽  
Vol 2 (5) ◽  
Author(s):  
Dang Thi Hong Khanh ◽  
Nguyen Thi Ut ◽  
Nguyen Thi Chien ◽  
Giang Thi Thanh Ha ◽  
Vu Thi Thuy Linh
Keyword(s):  
Median Time ◽  
Waiting Time ◽  
Blood Test ◽  
Medical Consultation ◽  
Medical Examination ◽  
Medical Visit ◽  
Cross Sectional ◽  
The Mean ◽  
Cross Sectional Design

Objectives: To measure the waiting time for medical visit at the Outpatient Department 2, NationalChildren’s Hospital in 2018.Study method: Cross sectional design combines quantitative study.Result:The study on waiting time for medical visit of2060 patients showed that: the mean follow- up time was 32.5minutes. Average time for 01 technique was 137 minutes. The median time for medical consultation and 2techniques implemented was 162 minutes. The median time for the medical consultation and 03 techniquesimplemented was 208 minutes. Among sub- clinical techniques, blood test took the maximum time (137minutes).Conclusion: The waiting time for medical consultation was standardized according to the Decision 1313 /QĐ-BYT in 2013; Approximately 70 patients per visit / 8 hours.

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