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Gastroesophageal reflux disease in pediatric esophageal atresia:Assessment of clinical symptoms and pH-impedance data

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World Journal of Clinical pediatrics 2020年第2期9卷 29-43页

作者： Marina Aksionchyk Kirill Marakhouski Aliaksandr Svirsky department of pediatric Gastroenterology Diagnostic DivisionRepublican Scientific and Practical Center for Pediatric SurgeryMinsk 220013Belarus department of Endoscopy Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus department of pediatric surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus

BACKGROUND Esophageal atresia(EA)is the most common congenital anomaly of the gastrointestinal tract.Gastroesophageal reflux disease(GERD)is a frequent and lifelong problem in these patients.GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia(Barrett’s esophagus)is increased in adults with EA compared with the general population.Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing.AIM To assess symptoms and pH-impedance data in children after EA,in order to identify their specific features of GERD.METHODS This study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair(51.35%boys,48.65%girls;age range:1-14 years,median:4.99 years).GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established:EA without GERD,n=17;EA with GERD,n=20.A control group was established with 66 children with proven GERD(68.18%boys,31.82%girls;median age:7.21 years),composed of a nonerosive reflux disease(referred to as NERD)group(n=41)and a reflux esophagitis group(n=25).Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients.RESULTS The most frequently observed symptom in EA patients with GERD and without GERD was cough(70%and 76.5%respectively).The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group(P=0.03).In the control reflux esophagitis group,prevalence of gastrointestinal symptoms was significantly higher than in the NERD group(P=0.017).For both EA groups,there was strong correlation with index of proximal events(IPE)and total proximal events(EA with GERD:0.96,P<0.001;EA without GERD:0.97,P<0.001)but level of IPE was significantly lower than in GERD patients without any surgical treatment(P<0.001).Data on distal mean nocturnal baseline impedance were significantly different between th

关键词： Esophageal atresia Gastroesophageal reflux disease pH-impedance testing Mean nocturnal baseline impedance Proximal reflux Reflux esophagitis Nonerosive reflux disease pediatric

Cardiac diagnostics before oral propranolol therapy in infantile hemangioma: retrospective evaluation of 234 infants

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World Journal of pediatrics 2018年第3期14卷 254-258页

作者： Giovanni Frongia Ji-Oun Byeon Raoul Arnold Arianeb Mehrabi Patrick Günther Division of pediatric surgery Department of GeneralVisceral and Transplantation SurgeryUniversity Hospital of HeidelbergIm Neuenheimer Feld 11069120 HeidelbergGermany department of pediatric Cardiology Center for Pediatrics and Adolescent MedicineUniversity Hospital of HeidelbergHeidelbergGermany department of General Visceral and Transplantation SurgeryUniversity Hospital of HeidelbergHeidelbergGermany

Background The indication and extent of cardiac screening before oral propranolol therapy (OPT) in patients with infantile hemangioma (IH) has been challenged. In this study, we evaluated pre-OPT cardiac diagnostics in a pediatric IH cohort in our department. Methods Retrospective chart review of infants ≤ 12 months old with IH undergoing OPT. The diagnostics prior to OPT, occurrence of complications, and outcome were recorded. Results A total of 234 patients were evaluated. The mean age at the onset of OPT was 4.2 ± 0.3 months, the average dura-tion of OPT was 6.1 ± 0.1 months, and the average follow-up was 12.3 ± 0.7 months. Echocardiograms and electrocardio-grams were performed prior to OPT in all patients. One hundred and three (44.0%) echocardiograms revealed pathological findings, 19 (8.1%) of which were minor (including atrial septal defects, pulmonary stenosis, and patent ductus arteriosus). Pathological findings were observed in 17 (7.3%) of electrocardiograms, only one (0.4%) of which was minor (suspected cardiac arrhythmia, subsequently excluded by long-term electrocardiogram analysis). These findings did not contraindicate OPT and no severe adverse events associated with OPT occurred during the follow-up period. Conclusions Routine cardiac screening by electrocardiogram and echocardiogram before OPT is debatable and not routinely indicated in children with IH. Further studies are necessary to draw definite conclusions on the reasonable indication and extent of this diagnostic approach.

关键词： Cardiac diagnostics Echocardiogram Electrocardiogram Hemangioma Propranolol

Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children aged<3 years:10-year experience with 1034 cases

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Asian Journal of Andrology 2020年第6期22卷 649-652页

作者： Liu Chen Wen-Hua Huang Yun-Jin Wang Qi-Liang Zhang Chao-Ming Zhou Xu Cui Jian-Qin Zhang department of pediatric surgery Fujian Maternity and Child Health HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou 350001China

This study was performed to summarize our clinical experience with testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children.This study included 1034 children with palpable cryptorchidism from March 2009 to March 2019.A scrotal stria incision was used to perform testicular descent and fixation.Overall,1020 children successfully underwent surgical testicular descent and fixation through a scrotal stria incision,and 14 patients underwent conversion to inguinal incision surgery.All patients were discharged 1-2 days after the operation.During hospitalization and follow-up,55 patients developed complicationsy including 10 patients with testicular retraction,7 with poor healing of the incision,and 38 with a scrotal hematoma.No patients developed testicular atrophy,an in direct ingui nal hernia,or a hydrocoele.Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children is safe and feasible in well-selected cases.This method has the advantages of no scarring and a good cosmetic effect.

关键词： children cosmetic effect palpable cryptorchidism scrotal stria incision testicular descending fixation

Is routine use of transanastomotic tube justified in the repair of esophageal atresia?

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World Journal of pediatrics 2017年第6期13卷 584-587页

作者： Sarath Kumar Narayanan Arun Preeth Vazhiyodan Prathap Somnath Arun Mohanan department of pediatric surgery Institute of Maternal and Child HealthGovernment Medical CollegeKozhikodeKeralaIndia

Background:Transanastomotic feeding tube (TAFT) is commonly used for post-operative enteral nutrition after esophageal atresia (EA)/tracheoesophageal fistula (TEF) repairs.The purpose of this study is to analyze the therapeutic implications of avoiding a TAFT and its impact on the outcomes post-operatively.Methods:The medical data of 33 inpatients with EA/TEF type C repair from 2009 to 2014 were retrospectively reviewed.Patients were divided into two groups for comparison based on the usage of TAFT during the repair:TAFT-(without) and TAFT+ (with) groups,without randomization.Both groups were compared statistically for post-operative complications and outcomes.Results:Eighteen neonates were males and 15 females,with an average birth weight of 2.43±0.43 kg and a mean gestational age of 36.15 weeks.Nineteen (57.5%) in the TAFT-group and 14 (42A%) were in the TAFF+ group.The post-operative complications,need for dilatations,duration of total parenteral nutrition (TPN) and length of hospital stay were similar in both groups.The incidence of pneumonitis was significantly higher in the TAFT+ group.Conclusions:By avoiding a TAFT,there is no increase in complication rates nor does it entail a prolonged period of TPN.Besides,not using a TAFT may have the advantage of reducing incidence of aspiration and consequent pneumonifis.

关键词： esophageal atresia tracheo-esophageal fistula transanastomotic tube

Repeat laparoscopic anatomical liver resection in a hepatocellular carcinoma patient:a case report

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Hepatoma Research 2022年第1期8卷 248-253页

作者： Kazuharu Igarashi Kohei Mishima Takahiro Ozaki Go Wakabayashi department of surgery Ageo Central General HospitalAgeoSaitama 362-8588Japan department of General-pediatric Hepatobiliary Pancreatic surgery Kitasato University School of MedicineSagamiharaKanagawa 252-0374Japan

Anatomical resection(AR)has been reported to achieve better long-term outcomes than non-anatomical resection for the treatment of hepatocellular carcinoma(HCC).The surgical feasibility and oncological significance of laparoscopic AR(LAR),especially“subsegment resection”,“cone unit resection”,and repeat LAR for HCC,remain unproven.We present a 67-year-old patient with alcoholic liver cirrhosis and HCC who underwent full LAR three times,focusing on the technical aspects of the Glissonean approach.Repeating LAR for recurrent HCC could be a safe and feasible procedure.However,HCC recurred in the neighboring segment twice,even though pathological vascular invasion and marginal remnants were not confirmed.We should investigate the oncological significance and advancements in subsegmentectomy and cone unit resection,in the future.

关键词： Repeat laparoscopic anatomical liver resection HCC Glissonean approach subsegmentectomy cone unit resection

Enteroenteroanastomosis near adjacent ileocecal valve in infants

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World Journal of Gastroenterology 2012年第48期18卷 7314-7318页

作者： Wei-Wei Jiang Xiao-Qun Xu Qi-Ming Geng Jie Zhang Huan Chen Xiao-Feng Lv Chang-Gui Lu Wei-Bing Tang department of pediatric surgery Nanjing Children's Hospital Affiliated to Nanjing Medical University

AIM:To investigate the feasibility and the effectiveness of ileoileostomy in the region adjacent to the ileocecal valve,which can retain the ileocecal valve in infants.METHODS:This is a retrospective review of 48 patients who underwent ileoileostomy in the region adjacent to the ileocecal valve(group 1) and 34 patients who underwent ileocecal resections and ileotransversanastomosis(group 2).Patients were monitored for the time to flatus,resumption of eating,length of hospital stay after surgery,serum total bile acid,vitamin B12 and postoperative complications.RESULTS:The time to flatus,time until resumption of eating and post-operative length of hospital stay showed no statistically significant differences between the two groups.Serum total bile acid and vitamin B12were not significantly different between the two groups at post-operative day 1 and day 3,but were significantly decreased at 1 wk after operation in group 2.None of the patients died or suffered from stomal leak in these two groups.However,the incidence of diarrhea,intestinal infection,disturbance of acid-base balance and water-electrolytes in group 1 was lower than in group 2.CONCLUSION:Ileoileostomy in the region adjacent to the ileocecal valve is safe and results in fewer complications than ileotransversanastomosis in infants.

关键词：婴幼儿维生素B12 显示时间肠道感染酸碱平衡胆汁酸并发症患者

Predictive factors for time to full enteral feeding after pyloromyotomy for infantile hypertrophic pyloric stenosis

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World Journal of pediatric surgery 2020年第1期3卷 12-17页

作者： David Eriksson Martin Salo department of Clinical Sciences PediatricsLund UniversityLundSweden department of pediatric surgery Skåne University HospitalLundSweden

Background The aim of the study was to evaluate how different parameters in the preoperative,perioperative,and postoperative period affect time to full enteral feeding(TFEF)in children undergoing pyloromyotomy.Methods A retrospective study of all children operated for infantile hypertrophic pyloric stenosis between 2001 and 2017 was conducted.Parameters in demographics and in the preoperative and postoperative period were evaluated against TFEF(hours)using linear regression models.Results In the whole cohort of 175 children,mean TFEF was 47 hours with Standard Deviation(SD)of±35.In the multivariate model,TFEF decreased with age[beta(B):−0.62;95%confidence interval(95%CI)−1.05 to−0.19;p=0.005)and increased with the presence of severe underlying disease(congenital heart defect or syndrome)(B:26.5;95%CI 3.3 to 49.7;p=0.026).Hence,for every day of age,the time to fully fed decreased by 0.6 hour,and the presence of an underlying disease increased the time to fully fed with over one day.TFEF did not seem to be affected by prematurity,weight loss,symptom duration,preoperative acid/base balance or electrolyte values,surgical method,or method of postoperative feeding.Conclusions TFEF decreased with higher age and increased in children with a severe underlying disease.These results may be useful in providing adequate parental information regarding what affects TFEF and the length of hospital stay.

关键词： stenosis infantile pylori

RRAS:A key regulator and an important prognostic biomarker in biliary atresia

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World Journal of Gastroenterology 2011年第6期17卷 796-803页

作者： Rui Zhao Hao Li Chun Shen Shan Zheng department of pediatric surgery Children's Hospital of Fudan University Shanghai 201102 China

AIM:To characterize the differentially expressed gene profiles in livers from biliary atresia (BA) patients including,ascertain genes,functional categories and pathways that play a central role in the pathogenesis of BA,and identify the novel prognostic markers for BA.METHODS:Liver tissue samples from control patients,neonatal cholestasis patients,and BA patients at the age of 90 d were pooled for DNA microarray analysis.Bioinformatics analysis was performed using,series test cluster of gene ontology,and Pathway-Finder software.Reverse-transcription polymerase chain reaction was performed to confirm changes in selected genes.Relation between RRAS gene expression and prognosis of 40 BA patients was analyzed in a 2-year follow-up study.RESULTS:The 4 identified significant gene expression profiles could confidently separate BA liver tissue from normal and other diseased liver tissues.The included genes were mainly involved in inflammation response and reconstruction of cellular matrix.The significant pathways associated with BA were primarily involved in autoimmune response,activation of T lymphocytes and its related cytokines.The RRAS,POMC,SLC26A6 and STX3 genes were important regulatory modules in pathogenesis of BA.The expression of RRAS was negatively correlated with the elimination rate of jaundice and positively correlated with the occurrence rate of cholangitis.CONCLUSION:Autoimmune response mediated by T lymphocytes may play a vital role in the pathogenesis of BA.The RRAS gene is an important regulatory module in the pathogenesis of BA,which may serve as a novel prognostic marker for BA.

关键词： RRAS 预后闭锁胆道差异表达基因标志物调节器反转录聚合酶链反应

Association of dissected ascending aorta diameter with preoperative adverse events in patients with acute type A aortic dissection

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World Journal of Cardiology 2022年第4期14卷 231-238页

作者： George Samanidis Meletios Kanakis Charalampos Georgiou Konstantinos Perreas department of Adult Cardiac surgery Onassis Cardiac Surgery CenterAthens 17674Greece department of pediatric and Congenital Heart surgery Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Acute type A aortic dissection(ATAAD)is a life-threatening disease associated with high morbidity and mortality.AIM To evaluate the diameter of dissected ascending aorta in patients diagnosed with ATAAD and whether the aortic diameter is associated with preoperative adverse events.METHODS A total of 108 patients diagnosed with ATAAD who underwent emergency operation under hypothermic circulatory arrest were enrolled in this study.Demographic characteristics and perioperative data were recorded.In all patients,preoperative chest and abdomen computed tomography(CT)scans were performed.RESULTS Median age of the patients was 61.5(52.5-70.5)years and median body mass index(BMI)was 28.2(25.1-32.6)cm^(2).The number of female patients was 37(25%).Median diameter of the ascending aorta was 5.0(4.5-6)cm and 53.8%of the patients had an aortic diameter5.5 cm,most of the patients with ATAAD had an aortic diameter of less than 5.5 cm.The diameter of the ascending aorta in patients diagnose with ATAAD is not associated with preoperative adverse events.

关键词： Acute Aortic dissection Type A Ascending aorta Diameter