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Management of early appendicular lump in children-laparoscopic technique versus open surgery:a comparative study in low-middle income country perspective

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World Journal of pediatric surgery 2020年第2期3卷 24-28页

作者： Mohammad Zonaid Chowdhury Md Abdullah Al Farooq M A Mushfiqur Rahman Tanvir Kabir Chowdhury department of pediatric surgery Chittagong Medical CollegeChattogramBangladesh

Background In the pediatric population,appendectomy is one of the most common emergency operations.Laparoscopic appendectomy(LA)is an accepted way of dealing with suspected uncomplicated appendicitis in children.The role of laparoscopy in appendicular lump is more controversial and remains undefined and is not well practiced in low-middle income countries.The aim of this study was to determine a better surgical treatment plan for early appendicular lump in children.Methods This prospective observational study was performed in Pediatric Surgery Department of Chittagong Medical College and Hospital for a period of 1 year from April 2018 to March 2019.Sixty children with appendicular lump selected consecutively as per eligibility criteria underwent either LA or open appendectomy(OA),that is,30 children per group.They were followed up until hospital discharge to observe outcomes.Results There were no differences in terms of patient’s age,sex,clinical presentation and laboratory findings between the two groups.Postoperative pain severity was significantly less in the LA group than that in the OA group(p<0.01).The incidence of wound infection was significantly lower in the LA group than that in the OA group(6.7%in LA and 46.7%in OA;p<0.01).Children in the LA group had a shorter duration of hospital stay in comparison to the OA group[median(IQR)was 8(5.75-11.25)days and 12(7.75-18.00)days,respectively,in LA and OA groups;p=0.01].Conclusion The study findings suggest that LA is feasible and should replace OA in cases of early appendicular lump in children.

关键词： surgery wound income

Kids gone wild–Alcohol use and patient characteristics in pediatric trauma during the coronavirus disease 2019 pandemic

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pediatric Investigation 2023年第4期7卷 225-232页

作者： Neesha S Patel Brett H Waibel Bennett J Berning WT Hillman Terzian Charity H Evans Angela M Hanna Mark E Hamill department of surgery Division of AcuteCare SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA department of surgery Division of General and Thoracic Pediatric SugeryChildren’s Hospital and Medical CenterOmahaNebraskaUSA

Importance:Reported coronavirus disease 2019(COVID-19)pandemic effects on pediatric trauma have been variable.Objective:We investigated the characteristics of pediatric trauma including alcohol use during the pandemic at our urban trauma center.Methods:The trauma database of our adult level 1 trauma center was queried for all pediatric(age≤18 years)patients presenting between March 1,2020,and October 30,2020.Data from 2017 to 2019 served as a control.Variables analyzed included demographics,mechanisms,injury severity,hospitalization characteristics,and positive blood alcohol.Results:Pandemic pediatric trauma volumes increased by 67.5%(330/year vs.197/year).Pandemic patients were younger(median age 13 vs.14 years,P=0.011),but similar in gender,ethnicity,severity,hospital length of stay,mortality,and rates of penetrating injury.Falls doubled(79/year vs.34/year)and shifted away from high falls>6 meters(0%vs.7.9%)to moderate falls 1–6 meters(58.2%vs.51.5%)(P=0.028).Transportation injury rates were similar however mechanisms shifted from motor vehicle crashes(−13.5%)towards recreational vehicles including motorcycles(+2.1%),all-terrain vehicles(+8.6%),and bicycles(+3.8%)(P=0.018).pediatricpositive blood alcohol was significantly higher(11.2%vs.5.1%,Ppediatric trauma volumes during the COVID-19 pandemic increased.Pandemic patients had more recreational vehicle injuries and higher rates of positive blood alcohol.This suggests an increased need for alcohol assessment and targeted interventions in the pediatric population during pandemics or periods of school closures.

关键词： Alcohol COVID-19 pediatric trauma pediatrics

Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 343-349页

作者： Kirill Marakhouski Elena Malyshka Katsiaryna Nikalayeva Larysa Valiok Aleh Pataleta Kiryl Sanfirau Aliaksandr Svirsky Vasily Averin Division of Diagnostic Republican Scientific and Practical Centre of Paediatric SurgeryMinsk 220113Belarus department of Newborn surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus department of pediatric surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Division of Diagnostic Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus Academic Chair of pediatric surgery Belarusian State Medical UniversityMinsk 220116Belarus

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

关键词： Newborns Congenital duodenal obstruction Perforated duodenal membrane Endoscopy Balloon dilation

Infantile hemangiomas screening modalities for primary care physicians

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pediatric Investigation 2023年第3期7卷 199-205页

作者： Stylianos Roupakias Eirini Kostopoulou Despoina Gkentzi Sotirios Fouzas Xenophon Sinopidis department of pediatric surgery University of Patras School of MedicinePatrasGreece department of pediatrics University of Patras School of MedicinePatrasGreece

Infantile hemangiomas are the most common benign vascular tumors in children.They present a characteristic natural history of spontaneous involution after a phase of initial proliferation.A small but significant minority demonstrates incomplete regression or complications and requires prompt intervention.Prediction of the evolution of infantile hemangiomas is challenging because of their morphological and behavioral heterogeneity.The decision between referral for treatment and observation is sometimes difficult,especially among non-expert physicians,with the risk of missing the period for optimizing outcomes in case of delayed intervention.The aim of this review is to update our knowledge,especially of the primary care providers,regarding the ongoing difficulties of the early clinical evaluation of infantile hemangiomas,and to outline the importance of current practical scoring tools for the identification of the lesions which require expert consultation and referral.

关键词： Diagnosis Infantile hemangioma Scoring tool Screening Vascular tumor

One-Stage Correction with Intra- and Extraatrial Rerouting of Anomalous Systemic and Pulmonary Venous Return and Intraventricular Repair of Double Outlet Right Ventricle in a Patient with Heterotaxy Syndrome

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Congenital Heart Disease 2022年第1期17卷 25-30页

作者： Helena Staehler Carina Hopfner Masamichi Ono Jurgen Horer department of Congenital and pediatric Heart surgery German Heart Center MunichTechnische Universitat MünchenDivision of Congenital and Pediatric Heart SurgeryUniversity Hospital of MunichLudwig-Maximilians-UniversitatMunichGermany department of pediatric Cardiology and pediatric Intensive Care University Hospital of MunichLudwig-Maximilians-UniversitatMunichGermany

We report a very rare case of successful intracardiac correction in a patient with heterotaxy syndrome.The cardiac malformations included dextrocardia,double outlet right ventricle,pulmonary stenosis,interrupted inferior vena cava,hemiazygos continuation and total anomalous pulmonary venous return.One-stage correction was performed.The atrial procedure consisted of intra-and extraatrial rerouting of the anomalous systemic and pulmonary venous return.The hepatic veins were detached and diverted to the left atrium via an extracardiac conduit.The correction of the double outlet right ventricle was accomplished by intraventricular redirection of the blood flow from the left ventricle to the aorta.The right ventricular outflow was ultimately remodeled using a valved conduit.For better perception of the complex morphology,a three-dimensional model was designed,using CT scan images.This proved to be very useful for surgical planning,especially with regard to the intraatrial reconstruction of the systemic and pulmonary venous rerouting.

关键词： Heterotaxy syndrome anomalous systemic venous return anomalous pulmonary venous return azygos continuation double outlet right ventricle 3D modeling

How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

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World Journal of pediatric surgery 2018年第1期1卷 3-8页

作者： Jianghua Zhan Yajun Chen Kenneth K Y Wong department of pediatric surgery Tianjin Children’s HospitalTianjinChina department of pediatric surgery Beijing Children’s HospitalBeijingChina department of pediatric surgery Queen Mary HospitalHong KongChina

background Biliary atresia(BA)is one of the most challenging hepatobiliary diseases in children.Notwithstanding the reasonable outcome of liver transplantation(LT),portoenteral anastomosis(Kasai operation)is still the first choice of treatment for patients with BA.How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sources Based on recent original publications and the experience with the BA in China,we review many factors that influence BA survival situation,including early diagnosis and screen plan,defects of early treatment,Kasai operation,and LT and indicate present questions about BA diagnosis and treatment in China.results BA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China.Further education of the physicians at smaller city hospitals about BA,neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA.Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.Conclusions In the era of LT,especially in China,Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.

关键词： diagnosis treatment guarantee

Textbook outcome in gallbladder carcinoma after curative-intent resection:a 10-year retrospective single-center study

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Chinese Medical Journal 2023年第14期136卷 1680-1689页

作者： Qi Li Hengchao Liu Qi Gao Feng Xue Jialu Fu Mengke Li Jiawei Yuan Chen Chen Dong Zhang Zhimin Geng department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710061China department of pediatric surgery The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710004China

Background:Textbook outcome(TO)can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement.We explored the factors associated with achieving a TO for gallbladder carcinoma(GBC)after curative-intent resection and analyzed the effect of adjuvant chemotherapy(ACT)on TO and non-TO patients.Methods:A total of 540 patients who underwent curative-intent resection for GBC at the department of Hepatobiliary surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed.Multivariable logistic regression was used to investigate the factors associated with TO.Results:Among 540 patients with GBC who underwent curative-intent resection,223 patients(41.3%)achieved a TO.The incidence of TO ranged from 19.0%to 51.0%across the study period,with a slightly increasing trend over the study period.The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection(P=0.003).Age≤60 years(P=0.016),total bilirubin(TBIL)level≤34.1 mmol/L(P<0.001),well-differentiated tumor(P=0.008),no liver involvement(P<0.001),and T1-2 stage disease(P=0.006)were independently associated with achieving a TO for GBC after resection.Before and after propensity score matching(PSM),the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant;ACT improved the prognosis of patients in the non-TO group(P<0.05).Conclusion:Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection,and ACT can improve the prognosis of those with non-TO.

关键词： Gallbladder neoplasms Textbook outcome Curative-intent resection Adjuvant chemotherapy Prognosis Nomogram

Polarization of M1 tumor associated macrophage promoted by the activation of TLR3 signal pathway

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Asian Pacific Journal of Tropical Medicine 2016年第5期9卷 470-474页

作者： Bo Liu Xia Wang Tai-Zhong Chen Guang-Liang Li Chang-Chun Tan Yong Chen Shao-Qiang Duan department of pediatric surgery Yongchuan hospital of chongqing medical university

Objective: To investigate the correlation between activation of toll-like receptors 3(TLR3) signaling pathway and tumor-associated macrophage and its effect on the tumor growth. Methods: The mice Lewis lung cancer cell lines 3LL and melanoma B16H10 were used to construct the subcutaneous transplantation tumor models and then they were treated with Poly-ICLC. The curative effect was observed and then the T cell and macrophage phenotypes infiltrated in local tumor were detected by flow cytometry. After the in vitro culture of mouse bone marrow-derived macrophage, the real-time PCR and western blot were applied to detect the expression of macrophage activation markers and the activation of intracellular signaling pathways. Results: The survival time of mice with brown tumor treated with Poly-ICLC significantly increased and the tumor growth was inhibited. The ratio of local tumor-infiltrated Treg decreased, while the ratio of CD8+ T cell increased significantly. The macrophages surface CD206 expression was down-regulated while the expression of i NOS increased. The Poly-ICLC could promote the expression of M1 markers(IL-1毬, TNF-α毩 and i NOS) in bone marrow-derived macrophage and inhibited the expression of M2 molecules(Arg-1, YM-1 and CD206). The phosphorylation level of downstream p65, TBK1 and IRF3 increased significantly. Conclusions: The Poly-ICLC can activate the TLR3 downstream signaling pathway to induce a M1 polarization of tumor associated macrophage, thereby inhibiting the tumor growth.

关键词： Tumor-associated macrophage TLR3 Poly-ICLC M1

Early relaparotomy following pediatric living-donor liver transplantation:experience in an Indonesian national referral hospital

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World Journal of pediatric surgery 2023年第1期6卷 42-47页

作者： Tri Hening Rahayatri Alif Rizqy Soeratman Rusdah Binti Muhammad Amin Dalia Benchamas Margiadi Riana Pauline Tamba Mureo Kasahara Division of pediatric surgery Department of SurgeryRumah Sakit Umum Pusat Nasional Dr Cipto MangunkusumoCentral JakartaIndonesia Division of pediatric surgery Department of SurgeryUniversitas Indonesia Fakultas KedokteranCentral JakartaIndonesia department of surgery Rumah Sakit Umum Pusat Nasional Dr Cipto MangunkusumoCentral JakartaIndonesia Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo Central JakartaIndonesia department of Transplantation National Center for Child Health and DevelopmentSetagaya-kuJapan

Background Living donor liver transplantation(LDLT)remains the only curative treatment for children with end-stage liver disease;however,complications of the procedure are associated with indications for early relaparotomy.Several risk factors associated with early relaparotomy after liver transplantation include pediatric end-stage liver disease(PELD)score,warm ischemia time(WIT),and cold ischemia time(CIT).Our study investigated the incidence and indications of early relaparotomy in postoperative pediatric LDLT recipients and compared the outcomes with patients who did not require relaparotomy.Methods A retrospective cohort study of pediatric LDLT recipients from Cipto Mangunkusumo Hospital,Jakarta,Indonesia,was collected from 2010 to August 2022.Indications for early relaparotomy were investigated.Factors analyzed in the early relaparotomy group compared with the nonrelaparotomy group included intraoperative blood loss,surgery duration,CIT,WIT,and PELD score.Results The highest indication for early relaparotomy was biliary leakage.Most patients who underwent early relaparotomy only had one incidence of relaparotomy(60%).The surgery duration in subjects with early relaparotomy was longer by a median of 3 hours compared with those without early relaparotomy(p=0.289).Intraoperative blood loss was greater in early relaparotomy subjects than in subjects without early relaparotomy(95 vs 77mL/kg,p=0.552).Other factors,such as PELD score,CIT,and WIT,also showed no significant difference between the two groups.Conclusion Biliary leakage was the most common indication for early relaparotomy in our center.There were no preoperative or intraoperative factors that significantly influenced the incidence of early relaparotomy due to the limited sample size and the early advancement of our liver transplant center.

关键词： laparotomy pediatric donor