Big and deep seated lipomatous tumours in children : results of surgical treatment

The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.

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Big and deep seated lipomatous tumours in children : results of surgical treatment

Acta Orthopaedica Belgica ◽

10.52628/87.1.25 ◽

2021 ◽

Vol 87 (1) ◽

pp. 197-200

Author(s):

Emin Özkul ◽

Serhat Elçi ◽

Muhsin Elçi ◽

Celil Alemdar

Keyword(s):

Surgical Treatment ◽

Local Recurrence ◽

Pediatric Patients ◽

Adult Patients ◽

Maximal Dimension ◽

Median Size ◽

Lower Complication ◽

The Mean ◽

Lipomatous Tumors

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Surgical Treatment of Pancreatic Insulinomas: A Series of 15 Years

10.47363/jcrr/2021(3)145 ◽

2021 ◽

Vol 3 (3) ◽

pp. 1-4

Author(s):

Vanessa Rebelo dos Santos ◽

◽

Carlota Ramos ◽

Rafael Cruz ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Local Recurrence ◽

Surgical Approach ◽

Medical Records ◽

Surgical Intervention ◽

Female Gender ◽

The Body ◽

Head Of The Pancreas ◽

The Mean

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

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Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

Journal of Robotic Surgery ◽

10.1007/s11701-021-01238-z ◽

2021 ◽

Author(s):

Tran Anh Quynh ◽

Pham Duy Hien ◽

Le Quang Du ◽

Le Hoang Long ◽

Nguyen Thi Ngoc Tran ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Pediatric Patients ◽

Three Dimensional ◽

Dentate Line ◽

Robotic Arms ◽

Robotic Assisted ◽

The Mean ◽

Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

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P3656Fontan operation performed in adult patients

European Heart Journal ◽

10.1093/eurheartj/ehz745.0513 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Santos Monteiro ◽

C Cruz Lamas ◽

M C Terra Cola ◽

A J Oliveira Monteiro ◽

M Machado Melo ◽

...

Keyword(s):

Pulmonary Artery ◽

Fontan Operation ◽

Cardiopulmonary Exercise Testing ◽

Adult Patients ◽

Venous Blood Flow ◽

Inhospital Mortality ◽

Vo2 Max ◽

Venae Cavae ◽

The Mean

Abstract Introduction Treatment of patients with univentricular physiology is based on a sequence of palliative surgeries which end with the Fontan operation, when all venous blood flow is diverted to the lungs, bypassing the heart. Most centers advise to complete this process around 4 years of age, and there are few data about the performance of the Fontan operation in adults. Purpose To describe the results of the Fontan surgery when performed in adult patients. Methods A retrospective review of patients submitted to the Fontan operation between 2014 and 2018, with data collection from charts, regarding their pre-operative state and follow up, including improvement in exercise capacity and hemoglobin levels. Results There were 12 patients submitted to the Fontan operation in the study period, with mean age 24±5 years, 8 female and 4 male. Two patients had no previous surgery, 2 only had bandage of the pulmonary artery, 7 had the Glenn surgery and 1 had the Damus and the Glenn surgery. Five patients had tricuspid atresia (TA) with valvular pulmonary stenosis (PS) or atresia, 1 patient had TA alone, 2 had TA with transposition of the great arteries, 1 patient had double inlet left ventricle (LV) with PS, 2 had double inlet LV with coarctation of the aorta, and 1 patient had hypoplastic right heart. One patient had suspected Noonan Syndrome. The patients who did not have Glenn surgery were submitted to connection of superior and inferior venae cavae with the pulmonary artery in the same procedure (4 patients). Seven patients had the fenestrated Fontan procedure. Six patients had a combined operation. Inhospital mortality was 0%. One patient died 4 months after the surgery due to bilateral subdural hematoma. The immediate post operative complications were tachyarrhythmia (2); important bleeding (2); pericardial effusion (4); pleural effusion (7); provisional pacemaker (1); junctional rhythmn (1); temporary hemodialysis (1); infection of the operative wound (1); fungal endocarditis (1); and mild stroke (1). The mean duration of hospitalization was 41.5±18.7 days. The length of hospital stay after surgery was 31.1±16.2 days. The exercise functional capacity improved in all patients. Before surgery there was 1 patient NYHA II that became NYHA I, 10 were NYHA III and became II or I, and 1 patient who was NYHA IV became II. The average oxygen saturation before surgery was 82% ± 8.2% and after was 91.7% ± 4.7%. The mean hemoglobin went from 17.8 g/dL to 13.9 g/dL. Eight patients performed cardiopulmonary exercise testing (CPX) before surgery, 1 patient was Weber B, 4 patients Weber C, 1 D and 1 E. Mean VO2 max was 11.7 ml/kg.min (± 3.69), and the mean slope was 71.8±35.0. Four patients performed CPX after surgery, mean VO2 max was 16.5±7.3, and mean slope was 39±16.6. Mean follow up was 20.3±17.7 months. Conclusions The Fontan operation is safe in adult patients and may still confer them significant benefits.

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Retroclival Epidural Hematomas

Neurosurgery ◽

10.1227/01.neu.0000372085.70895.e7 ◽

2010 ◽

Vol 67 (2) ◽

pp. 404-407 ◽

Cited By ~ 29

Author(s):

R. Shane Tubbs ◽

Christoph J. Griessenauer ◽

Todd Hankinson ◽

Curtis Rozzelle ◽

John C. Wellons ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Pediatric Patients ◽

Motor Vehicle ◽

Coma Scale ◽

Presenting Symptoms ◽

Cord Injury ◽

The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

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Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye

European Journal of Ophthalmology ◽

10.1177/11206721211020632 ◽

2021 ◽

pp. 112067212110206

Author(s):

Iliya Simantov ◽

Lior Or ◽

Inbal Gazit ◽

Biana Dubinsky-Pertzov ◽

David Zadok ◽

...

Keyword(s):

Visual Acuity ◽

Pediatric Patients ◽

Pediatric Population ◽

Corneal Thickness ◽

Cross Linking ◽

Uncorrected Distance Visual Acuity ◽

Mild Reduction ◽

Change In The Mean ◽

The Mean

Background: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. Methods: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. Results: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm ( p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D ( p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. Conclusion: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.

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Colonic carcinoid tumors: a clinicopathologic study of 23 patients from a single institution

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032009000400008 ◽

2009 ◽

Vol 46 (4) ◽

pp. 288-293 ◽

Cited By ~ 9

Author(s):

Daniel Reis Waisberg ◽

Antonio Sergio Fava ◽

Lourdes Conceição Martins ◽

Leandro Luongo Matos ◽

Maria Isete Fares Franco ◽

...

Keyword(s):

Surgical Treatment ◽

Abdominal Mass ◽

Survival Rates ◽

Muscularis Propria ◽

Venous Invasion ◽

Carcinoid Tumors ◽

Intestinal Bypass ◽

Curative Intent ◽

The Mean

CONTEXT: Colonic carcinoids, excluding those arising in the appendix, have proved to be extremely rare. Due to their rarity, the characteristics and behavior of this unusual malignancy remain unclear. OBJECTIVE: To review the clinicopathologic features of patients operated on carcinoid tumors of the colon. METHODS: Twenty-three patients (12 males and 11 females) were operated on colonic carcinoids. The mean age of the patients was 63.0 ± 12.9 years (42 to 85 years). The clinical and histopathological data of patients who were pathologically diagnosed as having carcinoid tumors and submitted to surgical treatment over a 30-year period (1977-2007) were gathered. Actuarial patient survival was estimated using the Kaplan-Meier method, with carcinoid-specific death as the outcome. RESULTS: The mean time elapsed between onset of symptoms and surgical treatment was 8.3 months (1.5 to 20 months). The most frequent symptoms or signs encountered were abdominal pain followed by anorexia or weight loss, diarrhea, abdominal tenderness, palpable abdominal mass, and rectal bleeding. No carcinoid syndrome was noted. The lesion was located in the cecum in 16 (69.6%) patients, in the sigmoid in 3 patients (13.0%), in the ascending colon in 3 patients (13.0%), and in the transverse colon in one patient (4.3%). Twenty-one (91.3%) patients were operated on curative intent. Spreading of the disease to the liver and peritoneum was found in two (8.7%) patients who submitted to intestinal bypass. The mean size of the largest mass was 3.7 ± 1.2 cm (1.5 to 6.2 cm). There were multiple (two or more) lesions in three cases (13.0%). In the resected cases, the lymph nodes were compromised in 10 patients (47.6%) and disease-free in 11 (52.4%). Venous invasion and neural infiltration were both present in five (23.8%) patients. The tumors had penetrated the muscularis propria in all resected cases. Four (17.4%) patients had a second non-carcinoid primary tumor. Three (13.0%) patients died due to postoperative complications and five (21.7%) patients died from metachronous metastases or local recurrence. Fifteen patients (65.2%) remain alive without evidence of active disease. The mean follow-up period was 12 years (1.2 to 18 years), whereas the mean global survival was 50.7 ± 34.2 months and the crude survival rate at 5 years was 62.7%. CONCLUSIONS: Carcinoid tumors of the colon are frequently right-sided and may be clinically occult until an advanced stage is reached. Based on the relatively poor survival rates reported, it is recommended that, in addition to standard surgical resection, vigorous surveillance for metastatic disease must be performed, particularly during the first 2 years after surgery. In addition, these patients require evaluation of the entire gastrointestinal tract for evidence of coexisting malignancy, along with an extended period of follow-up, because tumor recurrences after 5 years are not uncommon.

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Surgical Treatment in Bronchiectasis: Analysis of Our Patients.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v2i1.42 ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

Fadil Gradica ◽

Lutfi Lisha ◽

Dhimitraq Argjiri ◽

Fahri Kokici ◽

Alma Cani ◽

...

Keyword(s):

Surgical Treatment ◽

Pulmonary Resection ◽

Lower Lobe ◽

Lung Abscess ◽

Duration Of Symptoms ◽

Operative Morbidity ◽

Massive Haemoptysis ◽

Localized Disease ◽

The Mean

Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstructions. It is still a serious problem in developing countries, as our country. We reviewed the morbidity and mortal-ity rates and outcomes of bronchiectasis surgical treatment. Patients and methods: Between years 2000 and 2016, one hundred and seven (107) patients, sixty nine (69) of whom female and thirty eight (38) male underwent pulmonary resection for bronchiecta-sis. The mean age was 35years (range, 13–66 years). Mean duration of symptoms was 12 years. Results: Symptoms were copious amount of purulent sputum in 84 patients, expectoration of foul-smelling sputum in 72, haemoptysis in 21 and cough in all patients. The indications for pulmonary resection were: medical therapy failure in eighty two (82) patients, massive haemoptysis in eighteen and lung abscess in seven (7) patients. The disease was bilateral in twenty seven (27) patients and mainly confined in the lower lobe. Eighty six (86) patients had a lobectomy, 7 had a segmentectomy, two patients right pneumonectomy. Operative morbidity was seen in 47 patients (43.9 %) and mor-tality in two (2) patients. Follow-up was complete in 97 patients with a mean of 5 years. Overall, 78 patients were asymptomatic after surgical treatment; symptoms were improved in 24, and unchanged or worse in 5. Conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.

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Characteristics, Treatment Patterns, Healthcare Resource Use, and Costs among Pediatric Patients Diagnosed with Neurofibromatosis Type 1 and Plexiform Neurofibromas: A Retrospective Database Analysis of a Medicaid Population

10.21203/rs.3.rs-98302/v1 ◽

2020 ◽

Author(s):

Xiaoqin Yang ◽

Kaushal Desai ◽

Neha Agrawal ◽

Kirti Mirchandani ◽

Sagnik Chatterjee ◽

...

Keyword(s):

Resource Use ◽

Neurofibromatosis Type 1 ◽

Pediatric Patients ◽

Healthcare Resource ◽

Neurofibromatosis Type ◽

Treatment Patterns ◽

Healthcare Resource Use ◽

The Mean

Abstract Background: Neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN) can cause substantial morbidity by disfigurement and compression of vital structures. Real-world data on the burden and cost of disease among pediatric patients with NF1 and PN is limited. The objectives of this study were to describe the characteristics, treatment patterns, healthcare resource use (HCRU), and costs of these patients.Results: A total of 383 patients were included in the retrospective analysis of patients aged ≤18 with at least 1 ICD-10-CM diagnosis code for both NF1 and PN enrolled in the MarketScan® Multistate Medicaid database from October 1, 2014 to December 31, 2017. The mean follow-up was 448 days. The mean age was 11.4 years and 52.0% of patients were male. Most patients were diagnosed by a specialist (63.5%). During the follow-up period, pain medications were used by 58.5% of patients, 25.1% were treated with chemotherapy, 7.1% received surgery for PN, 1.6% received MEK inhibitors, and 0.8% received radiation. Mean per patient per year inpatient, outpatient, emergency room, pharmacy, and other visits were 1.4, 17.3, 1.6, 13.6, and 25.8, respectively. Mean ±SD (median) total per patient per year healthcare costs (2018 USD) were $17,275 ±$61,903 ($2,889), with total medical costs of $14,628 ±$56,203 ($2,334) and pharmacy costs of $2,646 ±$13,303 ($26). Inpatient costs were the largest drivers of medical cost, with a mean per patient per year cost of $6,739.Conclusions: This study showed that many pediatric patients diagnosed with NF1 and PN were treated with supportive care only, highlighting a substantial unmet medical need. This study also highlights the considerable economic burden among patients with NF1 and PN.

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