共查询到20条相似文献，搜索用时 46 毫秒
1.
Patrick C Bonasso M. Sidney Dassinger Mark L. Ryan Marie S. Gowen Jeffrey M. Burford Samuel D. Smith 《Journal of pediatric surgery》2019,54(4):628-630
Purpose
The low perioperative mortality rate in pediatric surgery precludes effective analysis of mortality at individual institutions. Therefore, analysis of multi-institutional data is essential to determine any patterns of perioperative death in children. The aim of this study was to determine diagnoses associated with 24-hour and 30-day perioperative mortality.Methods
A retrospective review of the 2012-2015 Pediatric Participant Use Data File (PUF) was performed. Statistical comparisons were made between survivors and nonsurvivors and between those with 24-hour and 30-day mortality using Fischer’s exact tests. P-values ≤ 0.05 were considered significant.Results
103,444 patients who underwent a pediatric surgical operation were evaluated. There were 732 deaths with a 30-day perioperative mortality of 0.7% (732/103,444). Necrotizing enterocolitis (NEC) was the diagnosis associated with the highest 30-day perioperative mortality (175/901, 19%). A significantly higher proportion NEC deaths occurred in the first 24 hours (67% (118/175) vs 33% (57/175) 30 day mortality, p < 0.001). Compared to patients who survived following operation for NEC, those who died were statistically more likely to require inotropic support (56% vs. 15%, p < 0.001), be diagnosed with sepsis (52% vs. 22%, p < 0.001), and undergo blood transfusion within 48 hours of operation (49% vs. 34%, p < 0.001).Conclusion
Although the overall pediatric surgical operative mortality rate is low, the largest proportion of perioperative deaths occur secondary to NEC. Based on the high immediate mortality, optimization of operative care for septic patients with NEC should be targeted.Type of Study
Prognosis StudyLevel of Evidence
Level II 相似文献2.
Michimasa Fujiogi Nobuaki Michihata Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga Jun Fujishiro 《Journal of pediatric surgery》2019,54(3):577-581
Background
This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database.Methods
Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence.Results
For 75,486 eligible patients (LS 20,186 vs. OS 55,300), the median follow-up was 815 (381–1350) days in LS and 1106 (576–1603) days in OS. The duration of anesthesia was significantly longer in LS than in OS for unilateral surgery (80 vs. 70 min, p < 0.001) but shorter for bilateral surgery (86 vs. 96 min, p < 0.001). LS had a lower proportion of MH than OS (0.3% vs. 3.4%, p < 0.001). There was no significant difference between LS and OS in complications (odds ratio: 0.55; 95% confidence interval: 0.22–1.38; p = 0.20) or recurrence (hazard ratio: 1.24; 95% confidence interval: 0.86–1.79; p = 0.89).Conclusions
LS patients had lower proportions of MH than OS patients. Complications and recurrence did not differ significantly between LS and OS.Type of study
Retrospective study.Levels of evidence
Level III. 相似文献3.
Simone Hildorf Erik Clasen-Linde Lihua Dong Dina Cortes Jorgen Thorup 《Journal of pediatric surgery》2019,54(4):809-814
Purpose
A meta-analysis including 11,900 cases showed that maternal gestational smoking was associated with increased risk of cryptorchidism. The aim of study was to investigate whether a hormone profile of cryptorchid boys and a supplementing histopathological evaluation of testicular biopsies could add detailed knowledge to the impact of maternal gestational smoking on pathogenesis of cryptorchidism.Methods
601 cryptorchid boys aged 4?months to 14?years old were included. Because normal hormones have a pronounced age dependency, we compared results from boys whose mothers had smoked heavily (> 10 cigarettes/day) during pregnancy with age matched cryptorchid controls of nonsmoking mothers (1:6). We studied: birthweight, germ-cell number/tubular cross section, frequency of germ cells positive for placental-like alkaline phosphatase (PLAP), gonadotropins and inhibin-B.Results
501 boys were sons of nonsmokers, 72 boys of intermittent smokers and 28 boys of heavy smokers. 39%, 44% and 61% respectively had bilateral cryptorchidism. Compared to age-matched cryptorchid controls of nonsmoking mothers, sons of heavy smokers had lower birthweight (p?=?0.006), germ-cell number/tubular cross section (p?=?0.009), frequency of germ cells positive for PLAP (p?=?0.037) and inhibin-B (p?=?0.042).Conclusions
All findings could be associated with placental dysfunction with altered human chorionic gonadotropin production well described in women smoking during pregnancy.Type of study
Prognosis study (prospective cohort study with > 80% follow-up).Level of evidence
Level 1. 相似文献4.
Seppo Taskinen Outi Leskinen Jouko Lohi Minna Koskenvuo Mervi Taskinen 《Journal of pediatric surgery》2019,54(4):771-774
Purpose
To evaluate the association between Wilms tumor histology at diagnosis and the change in Wilms' tumor volume during preoperative chemotherapy.Methods
We included all the 52 patients operated for Wilms tumor at 1988–2015, who had both pathology samples and either CT or MRI-images before and after preoperative chemotherapy, available for reevaluation.Results
The median tumor volume was 586?ml (IQR 323–903) at diagnosis. The median change in tumor volume was ? 68% (IQR ? 85 to ? 40, p?<?0.001) and the proportion of tumor necrosis 85% (IQR 24–97), after preoperative chemotherapy. There was a correlation between blastemal cell content in prechemotherapy cutting needle biopsy (CNB) sample and the reduction in tumor volume (Rho?=?? 0.452, p?=?0.002). High stromal and epithelial cell contents in CNB samples were associated with the lesser change in tumor volume (Rho?=?0.279, p? =0.053 and Rho?=?0.300, p?=?0.038 respectively). Reduction of tumor volume and the proportion of tumor necrosis after chemotherapy were associated (Rho?=?? 0.502, p?<?0.001). The actual viable tumor volume decreased in median by 97% (IQR 65–100), and the decrease could be seen in all cellular components. In three patients, the tumor volume increased more than 10% during the preoperative chemotherapy. Two of them had anaplastic tumor in the nephrectomy specimen.Conclusion
Wilms tumor total and viable tumor volumes were reduced by 68% and 97% with preoperative chemotherapy, respectively. High proportion of blastemal cells in CNB was associated with greatest decrease in Wilms tumor volume. Increase in tumor volume during preoperative chemotherapy may indicate anaplastic tumor and prolonging of preoperative therapy should be avoided.Type of study
Retrospective review.Level of evidence
Level III. 相似文献5.
Daniel K. Noland Nadja Apelt Cynthia Greenwell Jefferson Tweed David M. Notrica Nilda M. Garcia R. Todd Maxson James W. Eubanks Adam C. Alder 《Journal of pediatric surgery》2019,54(2):345-349
Background/Purpose
Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown.Methods
The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤ 18?years of age. Included were patients who either had the institutional MTP or received > 20?mL/kg or?>?2?units packed red blood cells (PRBCs).Results
110/202 qualified for inclusion. Median age was 5.9?years (3.0–11.4). 73% survived to discharge; median hospitalization was 10 (3.1–22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p?<?0.05). Logistic regression found increased mortality (OR 3.08 (1.10–8.57), 95% CI; p?=?0.031) per unit increase over a 1:1 ratio of pRBC:FFP.Conclusion
In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥ 3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion.Level of evidence
Level IV. 相似文献6.
Caroline Lemoine Annika Nilsen Katherine Brandt Saeed Mohammad Hector Melin-Aldana Riccardo Superina 《Journal of pediatric surgery》2019,54(2):266-271
Background/Purpose
The Abernethy malformation (AM) is a congenital venous malformation in which the splanchnic venous return bypasses the liver and drains directly into the systemic circulation. This deprives the liver of hepatotrophic growth factors and allows metabolic products of digestion to enter the systemic veins without the benefit of passing through the liver. The histologic features of liver biopsies in children with an AM were reviewed.Methods
A retrospective review of liver biopsies in patients with AM between 1997 and 2017 was performed. Patients were divided into two groups for comparison of histologic features: presence (M +) or absence (M ?) of a coexistent liver mass on imaging. Biopsies were reviewed by a pediatric pathologist. Chi-square test was used for statistical analysis between groups. Significance was assigned to p values < 0.05.Results
Eighteen liver biopsies were reviewed. Masses were present in only 6 patients who had a liver biopsy. Masses were observed with similar frequencies in either type of the Abernethy malformation (I or II). Nine of 12?M ? patients and 3/6?M + patients had the type I AM. Histologically, all patients were noted to have small or absent portal veins. Isolated capillaries were seen more frequently in patients with a known liver mass (p?=?0.045), while crowding of portal tracts was more commonly seen in patients without a liver mass (p?=?0.019).Conclusion
Liver biopsies in patients with AM demonstrate abnormal vascular and parenchymal histologic features. Livers with coexistent masses were more commonly found to have features suggesting an increased dependence on arterial blood supply.Level of evidence
III. 相似文献7.
Anne G.J.F. van Zoonen Christian V. Hulzebos Anneke C. Muller Kobold Elisabeth M.W. Kooi Arend F. Bos Jan B.F. Hulscher 《Journal of pediatric surgery》2019,54(3):455-459
Purpose
To investigate whether serial measurements of fecal calprotectin concentrations enable us to identify infants who will develop NEC prior to development of symptoms.Methods
Prospective matched case–control study including 100 high-risk neonates. High risk includes 1) gestational age (GA) ≤ 30?weeks, 2) birth-weight (BW) ≤ 1000?g, 3) GA 30–32?weeks and BW ≤ 1250?g, 4) born from a mother who received indomethacin for tocolysis. We matched every NEC subject with three controls for birth weight and gestational age. Fecal calprotectin was measured twice a week from day one until five weeks after birth or until NEC development. We analyzed differences in fecal calprotectin between NEC subjects and controls in the week preceding NEC onset and course of fecal calprotectin within subjects who developed NEC.Results
Of 100 included patients, ten (median GA 27.5?weeks [24.6–29.4], BW 1010?g [775–1630]) developed NEC. The median calprotectin concentration in all samples combined was 332?μg/g [< 40–8230] μg/g feces. There were no differences between NEC subjects and controls, with a wide variation in both groups. In NEC subjects, there was no intraindividual rise in calprotectin before clinical symptoms occurred.Conclusions
There are high concentrations and wide interindividual variations in calprotectin in preterm infants during the first weeks of life. Wide intraindividual variation further precludes the serial use of fecal calprotectin in the early detection or prediction of NEC in high risk infants.Level of Evidence
III 相似文献8.
Silvia Ceccanti Francesco Cozzi Alice Cervellone Augusto Zani Denis A. Cozzi 《Journal of pediatric surgery》2019,54(2):326-330
Aim
We sought to assess the magnitude of functional decline and the natural history of the operated kidney residual function after zero-ischemia nephron-sparing surgery (Z-NSS) in children with unilateral renal tumor (URT).Patients and methods
50 children were treated for URT at our surgical unit between 1992 and 2016. Of these 12 who underwent Z-NSS were available for the current analysis. Operated kidney function was assessed by 99mTc-dimercapto-succinic acid (DMSA) renal scintigraphy. Operated kidney volume was assessed by renal ultrasonography.Results
A positive correlation between split renal function and split renal volume was found (P?=?0.001). The subset of patients with ≥ 40% preservation of operated kidney function/volume (OKF/V) had no-time dependent changes during adolescence. The subset of patients with < 40% OKF/V preservation had a catch-up growth that after puberty reached values not much different from those with ≥ 40% OKF/V preservation. At 5?years of follow-up, 3 of 5 patients with baseline dysfunction (eGFR between 40.8 and 89.4?ml/min/1.73?m2) presented with a global renal function within normal range. After puberty, all patients presented with global renal function within normal values (eGFR between 95 and 151?ml/min/1.73 m2).Conclusions
In children with URT who underwent Z-NSS, the pattern of OKF/V recovery suggests that compensatory catch-up growth capacity during childhood minimizes OKF/V decline more than Z-NSS.Level of evidence
Level I prognosis study — prospective cohort study with > 80% follow-up and all patients enrolled at same time point in disease. 相似文献9.
Byung-Ki Cho Ji-Kang Park Seung-Myung Choi Nelson F. SooHoo 《Foot and Ankle Surgery》2019,25(2):127-131
Background
This study was performed to evaluate the intermediate-term clinical outcomes after proximal chevron osteotomy for hallux valgus in patients with generalized ligamentous laxity, and to determine the effect on postoperative recurrence of deformity.Methods
There were 23 cases in laxity group (Beighton score ≥5 points) and 175 in non-laxity group with a mean followup of 46.3 months. Clinical evaluation consisted of the AOFAS score, Foot and Ankle Ability Measure (FAAM), and radiographic measurement of hallux alignment. Risk factors associated with postoperative recurrence were evaluated using univariate analysis.Results
Recurrence rates were 21.7% in the laxity group and 17.1% in non-laxity group (P = .218). There were no significant differences in clinical and radiographic measurements at final followup between the 2 groups. Preoperative HVA and IMA were found to be predictive factors of recurrence (OR = 6.3, 4.2; P = .001, .018, respectively).Conclusion
There were no statistical differences in the clinical and radiographic outcomes between hallux valgus with and without generalized ligamentous laxity. Generalized ligamentous laxity demonstrated no definitive effects on postoperative recurrence of hallux valgus deformity. 相似文献10.
Young Mee Choi Kristen Campbell Kari Hayes Rebecca Jacobson Gregory Kobak Steven Moulton 《Journal of pediatric surgery》2019,54(4):707-711
Objectives
Abdominal wall thickness (AWT) is a key measurement when placing or replacing low profile gastrostomy devices. This measurement varies, depending on nutritional status and body habitus. We developed a mathematical model to estimate AWT using a compendium of body measurements.Methods
Ultrasonography was used to measure AWT at the initial gastrostomy site in subjects aged 22?days to 24?years old. Other body measurements (height, weight, waist circumference and distance from xiphisternum to pubis) were also obtained. Multiple linear regression was used to develop two separate models using age of 2?years to separate the groups. For analysis, AWT is log transformed.Results
Data from 97 subjects were used for analysis.The final model for those ≤ 24?months old is the following:ln(Estimated AWT)?=?? 1.255?+?0.082*(1 if age 3–24?months, 0 if <3?months)?+?0.022*(waist circumference in cm).The final model for those > 24 months old is the following:ln(Estimated AWT)?=?? 1.335?+?0.271*(1 if age >84?months, 0 if 24–84 months)?+?0.082*(BMI)Conclusion
This model to estimate AWT is useful for determining the length of a gastrostomy device at initial placement and with subsequent changes. More data are needed to refine and further validate the model.Level of evidence
Level IV, study of prognostic test. 相似文献11.
Madhavan Ramaswamy Pilar Anton-Martin Laura Garcia Martinez Nagarajan Muthialu 《Journal of pediatric surgery》2019,54(4):696-700
Objectives
Pediatric patients born with single functional lung can be associated with symptomatic airway abnormalities. Management of such patients is not only technically demanding but is also ethically challenging. This study reports our experience of managing symptomatic airway abnormalities in pediatric patients with congenital single functional lung.Methods
Observational retrospective cohort study performed at a tertiary children’s hospital from January 2001 to September 2017. All children (0 to 18 years old) with congenital single functional lung (agenesis and hypoplasia) presenting with symptomatic airway abnormalities (long segment congenital tracheal stenosis and tracheomalacia) and requiring surgical interventions were included in the study. Children with single functional lung secondary to non-congenital causes were excluded.Results
A total of 16 patients with single functional lung (agenesis = 8 and hypoplasia = 8) and airway abnormalities (long segment congenital tracheal stenosis = 12 and tracheomalacia = 4) were eligible for the study. Lung abnormalities were common on the right side (n = 10, 62.5%). Associated abnormalities (cardiac and non-cardiac) were seen in 11 patients (68.8%). Surgical interventions for airway abnormalities, alone or in combination, included slide tracheoplasty (n = 12), aortopexy with or without pericardiopexy (n = 7), excision of rudimentary lung (n = 4) and placement of intrathoracic tissue expanders to reposition the mediastinum (n = 3). Nine patients (56.3%) underwent a one-stage repair while staged repairs (airway and cardiac) were performed in 7 (43.7%). Fourteen patients (87.5%) survived to hospital discharge. Of the survivors, 9 (64.2%) had stable airways not requiring respiratory support at home.Conclusion
Management of pediatric patients with airway abnormalities in the setting of congenital single functional lung is feasible with acceptable surgical outcomes. This is facilitated by staged repairs and repositioning of mediastinum before a definitive airway repair in patients with significant comorbidities. Treatment should not be deferred to these patients if there are no obvious contraindications.Type of Study
Retrospective Case Control StudyLevel of Evidence
Level III. 相似文献12.
Annika Mutanen Meredith Barrett Yongjia Feng Jouko Lohi Raja Rabah Daniel H. Teitelbaum Mikko P. Pakarinen 《Journal of pediatric surgery》2019,54(3):511-516
Background
Although serial transverse enteroplasty (STEP) improves function of dilated short bowel, a significant proportion of patients require repeat surgery. To address underlying reasons for unsuccessful STEP, we compared small intestinal mucosal characteristics between initial and repeat STEP procedures in children with short bowel syndrome (SBS).Methods
Fifteen SBS children, who underwent 13 first and 7 repeat STEP procedures with full thickness small bowel samples at median age 1.5 years (IQR 0.7–3.7) were included. The specimens were analyzed histologically for mucosal morphology, inflammation and muscular thickness. Mucosal proliferation and apoptosis was analyzed with MIB1 and Tunel immunohistochemistry.Results
Median small bowel length increased 42% by initial STEP and 13% by repeat STEP (p = 0.05), while enteral caloric intake increased from 6% to 36% (p = 0.07) during 14 (12-42) months between the procedures. Abnormal mucosal inflammation was frequently observed both at initial (69%) and additional STEP (86%, p = 0.52) surgery. Villus height, crypt depth, enterocyte proliferation and apoptosis as well as muscular thickness were comparable at first and repeat STEP (p > 0.05 for all). Patients, who required repeat STEP tended to be younger (p = 0.057) with less apoptotic crypt cells (p = 0.031) at first STEP. Absence of ileocecal valve associated with increased intraepithelial leukocyte count and reduced crypt cell proliferation index (p < 0.05 for both).Conclusions
No adaptive mucosal hyperplasia or muscular alterations occurred between first and repeat STEP. Persistent inflammation and lacking mucosal growth may contribute to continuing bowel dysfunction in SBS children, who require repeat STEP procedure, especially after removal of the ileocecal valve.Level of evidence
Level IV, retrospective study. 相似文献13.
Colleen N. Bartley Kenisha Atwell Bruce Cairns Anthony Charles 《Burns : journal of the International Society for Burn Injuries》2019,45(2):322-327
Introduction
Discussions regarding withdrawal of life support after burn injury are challenging and complex. Often, providers may facilitate this discussion when the extent of injury makes survival highly unlikely or when the patient’s condition deteriorates during resuscitation. Few papers have evaluated withdrawal of life support in burn patients. We therefore sought to determine the predictor of withdrawal of life support (WLS) in a regional burn center.Methods
We conducted a retrospective analysis of all burn patients from 2002 to 2012. Patient characteristics included age, gender, burn mechanism, percentage total body surface area (%TBSA) burned, presence of inhalation injury, hospital length of stay, and pre-existing comorbidities. Patients <17 years of age and patients with unknown disposition were excluded. Patients were categorized into three cohorts: Alive till discharge (Alive), death by withdrawal of life support (WLS), or death despite ongoing life support (DLS). DLS patients were then excluded from the study population. Multivariate logistic regression was used to estimate predictors of WLS.Results
8,371 patients were included for analysis: 8134 Alive, 237 WLS. Females had an increased odd of WLS compared to males (OR 2.03, 95% CI 1.18–3.48; p = 0.010). Based on higher CCI, patients with pre-existing comorbidities had an increased odd of WLS (OR 1.28, 95% CI 1.08–1.52; p = 0.005). There was a significantly increased odds for WLS (OR 1.09, 95% CI 1.06–1.12; p < 0.001) with increasing age. Similarly, there was an increased odd for WLS (OR 1.08, 95% CI 1.07–1.51; p < 0.001) with increasing %TBSA. An increased odd of WLS (OR 2.47, 95% CI 1.05–5.78; p = 0.038) was also found in patients with inhalation injury.Conclusion
The decision to withdraw life support is a complex and difficult decision. Our current understanding of predictors of withdrawal of life support suggests that they mirror those factors which increase a patient’s risk of mortality. Further research is needed to fully explore end-of-life decision making in regards to burn patients. The role of patient’s sex, particularly women, in WLS decision making needs to be further explored. 相似文献14.
Peter Kayima David Kitya Maria Punchak Geoffrey A Anderson Martin Situma 《Journal of pediatric surgery》2019,54(4):838-844
Background/purpose
Anorectal malformation (ARM) is a common condition. Owing to scarcity of pediatric surgery services in Uganda, however, relatively little is known about this condition.Methods
This was a retrospective review of medical records of all patients admitted to Mbarara Regional Referral Hospital (MRRH) from January 2014 to May 2016. MRRH serves 3–8 million people in southwest Uganda. We also enrolled patients prospectively from June 2016 to December 2016.Results
78 patients were enrolled in the study. 63.38% had delayed diagnosis (presenting > 48?h after birth), and most of these were self-referrals from home. The most common malformation was a vestibular fistula. Associated congenital anomalies were seen in 20% of patients, and this was associated with increased mortality. These anomalies included limb, eye, ear and genitourinary anomalies as well as ventricular septal defects, patent ductus arteriosus, spina bifida and tracheoesophageal fistula. Posterior sagittal anorectoplasty (PSARP) was the definitive surgery used. It was performed in 58.97% of the patients. Median age of patients who underwent PSARP was 11?months. 73.91% of PSARP patients had their colostomies closed and 62.5% of these who were?≥ 3 years old had good continence outcomes. Overall mortality rate was 8.97%.Conclusion
The majority of patients are diagnosed late. Vestibular fistula is the overall most common type of ARM. In males, however, rectourethral fistula is the most common type. Definitive surgery at MRRH is performed late. Continence outcomes are good and comparable to other countries with more resources.Level of evidence
III. 相似文献15.
Chloe Xiaoyun Chan Jonathan Zhi-Wei Gan Hwei Chi Chong Inderjeet Rikhraj Singh Sean Yung Chuan Ng Kevin Koo 《Foot and Ankle Surgery》2019,25(2):119-126
Background
We report our experience with the Minimally Invasive Chevron Akin (MICA) technique for correcting hallux valgus, and evaluate its effectiveness and associated complications.Methods
Case series of 13 feet with mild to moderate symptomatic hallux valgus treated surgically from July 2013 to December 2014, with at least 48-months follow-up. Patients were assessed pre-operatively and post-operatively with radiographical measurements (Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA)) and clinical scores (American Orthopaedic Foot and Ankle Society (AOFAS), 36-Item Short Form Health Survery (SF-36), Visual Analog Scale (VAS)).Results
Mean HVA and IMA decreased from 30.4° and 13.9°–10.9° and 10.2° respectively (p < 0.05). The mean AOFAS score improved from an average of 59.0–93.7 (p < 0.05). All patients reported a VAS score of 0 post-operatively, and the 4 SF-36 domains improved significantly (p < 0.05).Conclusions
The MICA technique is a safe and effective method in the surgical correction of mild to moderate hallux valgus deformity, and continued use is justified. 相似文献16.
Surgical management of follicular thyroid carcinoma in children and adolescents: A study of 30 cases
Claudio Spinelli Leonardo Rallo Riccardo Morganti Valentina Mazzotti Alessandro Inserra Giovanni Cecchetto Maura Massimino Paola Collini Silvia Strambi 《Journal of pediatric surgery》2019,54(3):521-526
Background/Purpose
The purpose of the study is to describe the anatomoclinical, diagnostic, therapeutic and prognostic aspects of pediatric follicular thyroid carcinoma (FTC) in order to choose the best therapeutic strategy.Methods
Our study includes patients ≤ 18?years old surgically treated for FTC in four Italian Pediatric Surgery Centers from January 2000 to March 2017. The collected data were compared with those of 132 patients matched for age with a histological diagnosis of papillary thyroid carcinoma (PTC) surgically treated in the same institutions during the same period and with the data of patients diagnosed with FTC found in the literature; p-values < 0.05 were considered significant.Results
21 (70%) of the 30 patients with a histological diagnosis of FTC underwent hemithyroidectomy while 9 (30%) underwent total thyroidectomy. 11 (55%) out of 21 patients were subjected to a completion of thyroidectomy. All patients are alive (OS?=?100%) without recurrence or relapse of the disease. Compared with PTC, FTC is significant for capsule infiltration (p?<?0.0001), vascular invasion (p?=?0.0014) and T-stage T3-T4 (p?=?0.013). However, multifocality (p?<?0.001), extrathyroid extension (p?<?0.0001) and lymph node metastasis (p?<?0.0001) are more evident in PTC.Conclusion
The conservative approach seems to be a valid surgical treatment for pediatric patients diagnosed with MI-FTC. For patients with wide vascular invasion and/or a tumor > 4?cm, especially with high after-surgery Tg rate, a completion of thyroidectomy is recommended. In patients with multifocal neoplasia, and/or tumor size ≥ 4?cm, and/or extrathyroid extension, and/or lymph node metastasis, and/or distant metastasis, total thyroidectomy followed by radioiodine therapy is generally indicated.Levels of Evidence
II. 相似文献17.
Stan Janssen Kim Heiwegen Iris ALM van Rooij Janielle van Alfen-van der Velden Ivo de Blaauw Sanne MBI Botden 《Journal of pediatric surgery》2019,54(3):445-448
Background
Congenital diaphragmatic hernia (CDH) is a rare birth defect with a high mortality and morbidity. Nonscrotal testes (NST) are the most reported genital anomaly in boys. Both defects have known associated anomalies, but little is known about the association between CDH and NST. This study evaluates this association and the location of the NST in a large cohort of male CDH survivors. Moreover, we analyzed possible associative factors for NST in CDH patients.Methods
A cohort of CDH patients, born between January 2000 and March 2014 and treated in a high volume expertise center, was evaluated retrospectively. Boys with a minimum follow-up of 18 months were included. The patients were evaluated for testes location, performed orchidopexy, and possible associative factors such as birth weight, gestational age, other congenital anomalies and CDH characteristics (surgical treatment, approach and ECMO).Results
Seventy-five CDH patients were included. Twenty-seven (36%) were diagnosed with NST, of which 22 (29%) received orchidopexy. In 54 patients (72%) there were reports on testes location at birth and location was known for all patients at the age of 18 months, although side of NST was unknown in four. The location of the NST was mostly ipsilateral to the CDH (n = 20, 87%), of which eight (35%) had a bilateral NST with a unilateral CDH. There were no significant differences in birth weight, gestational age, and CDH specific characteristics in patients with or without NST.Conclusion
This study shows a strong association between CDH and NST, with a prevalence of 36%. However, no specific characteristics of the CDH were related to the NST. The testes of all male CDH patients should be thoroughly evaluated in the first year of their life, to ensure a proper and timely treatment.Level of evidence
Level IV; case series. 相似文献18.
Sami Hamid Ian A. Donaldson Yipeng Hu Rachael Rodell Barbara Villarini Ester Bonmati Pamela Tranter Shonit Punwani Harbir S. Sidhu Sarah Willis Jan van der Meulen David Hawkes Neil McCartan Ingrid Potyka Norman R. Williams Chris Brew-Graves Alex Freeman Caroline M. Moore Hashim U. Ahmed 《European urology》2019,75(5):733-740
Background
Multiparametric magnetic resonance imaging (mpMRI)-targeted prostate biopsies can improve detection of clinically significant prostate cancer and decrease the overdetection of insignificant cancers. It is unknown whether visual-registration targeting is sufficient or augmentation with image-fusion software is needed.Objective
To assess concordance between the two methods.Design, setting, and participants
We conducted a blinded, within-person randomised, paired validating clinical trial. From 2014 to 2016, 141 men who had undergone a prior (positive or negative) transrectal ultrasound biopsy and had a discrete lesion on mpMRI (score 3–5) requiring targeted transperineal biopsy were enrolled at a UK academic hospital; 129 underwent both biopsy strategies and completed the study.Intervention
The order of performing biopsies using visual registration and a computer-assisted MRI/ultrasound image-fusion system (SmartTarget) on each patient was randomised. The equipment was reset between biopsy strategies to mitigate incorporation bias.Outcome measurements and statistical analysis
The proportion of clinically significant prostate cancer (primary outcome: Gleason pattern ≥3 + 4 = 7, maximum cancer core length ≥4 mm; secondary outcome: Gleason pattern ≥4 + 3 = 7, maximum cancer core length ≥6 mm) detected by each method was compared using McNemar's test of paired proportions.Results and limitations
The two strategies combined detected 93 clinically significant prostate cancers (72% of the cohort). Each strategy detected 80/93 (86%) of these cancers; each strategy identified 13 cases missed by the other. Three patients experienced adverse events related to biopsy (urinary retention, urinary tract infection, nausea, and vomiting). No difference in urinary symptoms, erectile function, or quality of life between baseline and follow-up (median 10.5 wk) was observed. The key limitations were lack of parallel-group randomisation and a limit on the number of targeted cores.Conclusions
Visual-registration and image-fusion targeting strategies combined had the highest detection rate for clinically significant cancers. Targeted prostate biopsy should be performed using both strategies together.Patient summary
We compared two prostate cancer biopsy strategies: visual registration and image fusion. A combination of the two strategies found the most clinically important cancers and should be used together whenever targeted biopsy is being performed. 相似文献19.
Julien Dagenais Riccardo Bertolo Juan Garisto Matthew J. Maurice Pascal Mouracade Onder Kara Jaya Chavali Jianbo Li Ryan Nelson Amr Fergany Robert Abouassaly Jihad H. Kaouk 《European urology》2019,75(4):628-634
Background
Understanding physician-level discrepancies is increasingly a target of US healthcare reform for the delivery of quality-focused patient care.Objective
To estimate the relative contributions of patient and surgeon characteristics to the variability in key outcomes after partial nephrectomy (PN).Design, setting, and participants
Retrospective review of 1461 patients undergoing PN performed by 19 surgeons between 2011 and 2016 at a tertiary care referral center.Intervention
PN for a renal mass.Outcomes measurements and statistical analysis
Hierarchical linear and logistic regression models were built to determine the percentage variability contributed by fixed patient and surgeon factors on peri- and postoperative outcomes. Residual between- and within-surgeon variability was calculated while adjusting for fixed factors.Results and limitations
On null hierarchical models, there was significant between-surgeon variability in operative time, estimated blood loss (EBL), ischemia time, excisional volume loss, length of stay, positive margins, Clavien complications, and 30-d readmission rate (all p < 0.001), but not chronic kidney disease upstaging (p = 0.47) or percentage preservation of glomerular filtration rate (p = 0.49). Patient factors explained 82% of the variability in excisional volume loss and 0–32% of the variability in the remainder of outcomes. Quantifiable surgeon factors explained modest amounts (10–40%) of variability in intraoperative outcomes, and noteworthy amounts of variability (90–100%) in margin rates and patient morbidity outcomes. Immeasurable surgeon factors explained the residual variability in operative time (27%), EBL (6%), and ischemia time (31%).Conclusions
There is significant between-surgeon variability in outcomes after PN, even after adjusting for patient characteristics. While renal functional outcomes are consistent across surgeons, measured and unmeasured surgeon factors account for 18–100% of variability of the remaining peri- and postoperative variables. With the increasing utilization of value-based medicine, this has important implications for the goal of optimizing patient care.Patient summary
We reviewed our institutional database on partial nephrectomy performed for renal cancer. We found significant variability between surgeons for key outcomes after the intervention, even after adjusting for patient characteristics. 相似文献20.
Kerri Beckmann Hans Garmo Jan Adolfsson Cecilia Bosco Eva Johansson David Robinson Lars Holmberg Par Stattin Mieke Van Hemelrijck 《European urology》2019,75(4):676-683
