MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Pediatric Surgery' source. Sat, 20 Mar 2010 15:02:41 +0100 http://www.medworm.com/index.php?rid=3131933&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000699%2Fabstract%3Frss%3Dyes The multivisceral liver-intestine-pancreas-stomach allograft was first described by Starzl nearly 50 years ago. Since then, over 1000 children have received small bowel transplantation (SBTx), alone or with the liver and other organs, for refractory short gut syndrome (SGS) because of a variety of congenital conditions. In 2001, SBTx was approved as definitive therapy for SGS by Medicare. Currently, 1- and 5-year graft survival routinely exceeds 90% and 80%, respectively. The expected outcomes also include freedom from parenteral nutrition, normalization of growth parameters, and quality of life. However, recurrent rejection, complications of high-dose immunosuppression, or chronic rejection, which is more likely to occur after SBTx without a liver graft, account for differences between ea... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131933 Thu, 31 Dec 2009 14:54:02 +0100 3131933 http://www.medworm.com/index.php?rid=3131932&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000675%2Fabstract%3Frss%3Dyes Multidisciplinary management of intestinal failure has progressed over the last 30 years, facilitating the transition to enteral autonomy in many pediatric patients. However, there remains a select group of patients who reach a plateau in advancement of their enteral nutrition. Numerous surgical options have been pursued to attempt to slow intestinal transit, taper dilated bowel, and promote intestinal adaptation. The purpose of this chapter is to review the current literature on autologous intestinal reconstruction surgery, including a brief historical perspective, descriptions of procedures, and reported surgical outcomes. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131932 Thu, 31 Dec 2009 14:54:02 +0100 3131932 http://www.medworm.com/index.php?rid=3131931&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000663%2Fabstract%3Frss%3Dyes Gastrointestinal motility disorders in their most severe forms may directly lead to intestinal failure. Abnormal motor function may also contribute to the overall gut dysfunction of children who have other underlying gastrointestinal diseases, such as Hirschsprung disease or gastroschisis. Understanding the extent and the severity of the dysmotile segments has direct therapeutic and prognostic implications. Our ability to study gastrointestinal motility has greatly improved in the past few years, with the development of less-invasive diagnostic tests. Optimal treatment of children with intestinal motility disorders relies on a multidisciplinary approach, which focuses on optimizing nutrition, improving gastrointestinal motility, and reducing psychosocial disability. Patient education is im... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131931 Thu, 31 Dec 2009 14:54:02 +0100 3131931 http://www.medworm.com/index.php?rid=3131930&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000651%2Fabstract%3Frss%3Dyes This article reviews our evolving understanding of the role of glucagon-like peptide 2 (GLP-2) in controlling the adaptive process. The ability of the remnant intestine to produce GLP-2 appears to be predictive of the adaptive process; exogenous GLP-2 may be a therapy to augment adaptation. Strategies for monitoring patients, including conventional means, such as anthropomorphic measurements, plasma levels of specific nutrients, and vitamins and radiological contrast studies are reviewed. Investigational methods, such as nutrient balance studies, plasma citrulline levels, and the absorption of inert sugars (3-0 methyl glucose, mannitol, and lactulose) are discussed with the evidence to support their use. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131930 Thu, 31 Dec 2009 14:54:02 +0100 3131930 http://www.medworm.com/index.php?rid=3131929&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000705%2Fabstract%3Frss%3Dyes The structural and functional changes during intestinal adaptation are necessary to compensate for the sudden loss of digestive and absorptive capacity after massive intestinal resection. When the adaptive response is inadequate, short bowel syndrome (SBS) ensues and patients are left with the requirement for parenteral nutrition and its associated morbidities. Several hormones have been studied as potential enhancers of the adaptation process. The effects of growth hormone, insulin-like growth factor-1, epidermal growth factor, and glucagon-like peptide 2 on adaptation have been studied extensively in animal models. In addition, growth hormone and glucagon-like peptide 2 have shown promise for the treatment of SBS in clinical trials in human beings. Several lesser studied hormones, includ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131929 Thu, 31 Dec 2009 14:54:02 +0100 3131929 http://www.medworm.com/index.php?rid=3131928&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS105585860900064X%2Fabstract%3Frss%3Dyes Children with intestinal failure (IF) suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PN-associated liver disease, which is also called intestinal failure-associated liver disease (IFALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effec... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131928 Thu, 31 Dec 2009 14:54:02 +0100 3131928 http://www.medworm.com/index.php?rid=3131927&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000638%2Fabstract%3Frss%3Dyes The outcome for children with congenital enteropathies or massive surgical resections has improved significantly over the past two decades. Advances in understanding of the pathophysiology of intractable diarrhea and of the mutations causing many of the congenital enteropathies have enabled initiation of preventive measures for intractable diarrhea, and have enabled clinicians to provide focused treatment of immune-mediated congenital diarrheal illnesses. Children with surgical short bowel syndrome also face an improved outcome because of improvements in the composition of parenteral nutrition (TPN) and in enteral alimentation strategies. It is now recognized that, through adaptation, small intestinal surface area and absorptive function may improve over time to facilitate emancipation fro... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131927 Thu, 31 Dec 2009 14:54:01 +0100 3131927 http://www.medworm.com/index.php?rid=3131926&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000626%2Fabstract%3Frss%3Dyes The management of the child with intestinal failure is complex, and it is developing into a multispecialty field of its own led by expert teams of both transplant and nontransplant surgeons, gastroenterologists, and dieticians. Patients are at risk for medical, surgical, and nutritional complications that should be anticipated so that they can be prevented or managed appropriately. Catheter associated infections and intestinal failure associated liver diseases are important complications that impact the likelihood of bowel adaptation and long-term survival. The clinical assessment of a pediatric intestinal failure patient should include evaluation of the child within the context of recognized prognostic factors. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131926 Thu, 31 Dec 2009 14:54:01 +0100 3131926 http://www.medworm.com/index.php?rid=3131925&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000614%2Fabstract%3Frss%3Dyes Pediatric short bowel syndrome (SBS) is most commonly caused by congenital or acquired conditions of the newborn. SBS is associated with an inability of the bowel to adequately absorb water and nutrients in sufficient quantities to meet caloric, fluid, and electrolyte demands, thus necessitating dependence on parenteral nutrition (PN). It is this dependence on PN, that is responsible for the majority of morbidity and mortality associated with SBS, including central venous catheter infections and PN-induced cholestatic liver dysfunction. There are very few estimates of SBS incidence and mortality in the literature. The epidemiology of SBS is reviewed and the limitations of the published literature are discussed. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131925 Thu, 31 Dec 2009 14:54:01 +0100 3131925 http://www.medworm.com/index.php?rid=3131924&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000687%2Fabstract%3Frss%3Dyes The understanding and management of pediatric intestinal failure is undergoing an exciting transformation. Recent innovations in medical and surgical therapy, coupled with the evolution of specialized multidisciplinary intestinal failure treatment centers, have been associated with significant improvements in patient survival. Although intestinal failure remains a major cause of pediatric morbidity and mortality, current research offers reason for continued optimism. This issue of the Seminars in Pediatric Surgery attempts to summarize recent progress in a logical manner, with contributions from groups that are leaders in the treatment and investigation of intestinal failure. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131924 Thu, 31 Dec 2009 14:54:01 +0100 3131924 http://www.medworm.com/index.php?rid=3131923&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000845%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=3131923 Thu, 31 Dec 2009 14:54:01 +0100 3131923 http://www.medworm.com/index.php?rid=2837738&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS105585860900047X%2Fabstract%3Frss%3Dyes Gastrointestinal motility disorders can develop in neurologically impaired children and those with congenital malformations of the gut. It is characterized by moderate to severe abdominal pain, vomiting, and failure to thrive. Antral dysmotility after fundoplication and increased sympathetic over activity are 2 factors associated with this condition that make it difficult to treat. This paper proposes a management strategy using metoclopramide, celiac plexus blockade, and thoracic splanchnectomy. It reviews our experience with 11 patients. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837738 Mon, 28 Sep 2009 17:21:50 +0100 2837738 http://www.medworm.com/index.php?rid=2837737&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000468%2Fabstract%3Frss%3Dyes Gut motility disorders represent a significant challenge in clinical management with current palliative approaches failing to overcome disease and treatment-related morbidity. The recent progress with stem cells to restore missing or defective elements of the gut neuromusculature offers new hope for potential cure. Focusing on enteric neuropathies such as Hirschsprung's disease, the review discusses the progress that has been made in the sourcing of putative stem cells and the studies into their biology and therapeutic potential. It also explores the practical challenges that must be overcome before stem cell-based therapies can be applied in the clinical arena. Although many obstacles remain, the speed of advancement of the enteric stem cell field suggests that such therapies are on the h... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837737 Mon, 28 Sep 2009 17:21:50 +0100 2837737 http://www.medworm.com/index.php?rid=2837736&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000456%2Fabstract%3Frss%3Dyes Intestinal transplantation (ITx) has now become an accepted form of replacement therapy for intestinal failure (IF) and its complications. Disorders of bowel motility may represent up to 25% of patients on waiting lists for ITx. Some patients with short bowel as a cause for IF may also have dysmotile bowel. Underlying pathology of the intestine is heterogenous and may be due to abnormalities in the nerve supply, intestinal smooth muscle, or may be regarded as idiopathic (chronic intestinal pseudo-obstruction). Outcome after ITx for dysmotility has previously been guarded, but providing the appropriate graft is used and taking into account the functional motility of residual bowel, it should not be different from other indications. The subject is reviewed emphasizing the potential pitfalls ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837736 Mon, 28 Sep 2009 17:21:50 +0100 2837736 http://www.medworm.com/index.php?rid=2837735&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000481%2Fabstract%3Frss%3Dyes The gastrointestinal tract responds to significant mechanical or functional obstruction by dilatation and hypertrophy of the segment proximal to the obstruction. Excessive dilatation compromises motility, and absorption and is associated with considerable morbidity (intraluminal stasis, sepsis) such that bowel dilatation represents a major liability that predisposes the patient to intestinal failure. The dilated bowel proximal to an obstruction provides valuable autologous material for reconstruction with “tissue appropriate to the part.” Bowel elongation and dilatation are integral to the natural intestinal adaptation response to loss of small bowel and can also be induced through a structured “Bowel Expansion” program. The additional absorptive tissue that is progressively genera... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837735 Mon, 28 Sep 2009 17:21:50 +0100 2837735 http://www.medworm.com/index.php?rid=2837734&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000444%2Fabstract%3Frss%3Dyes Internal anal sphincter (IAS) achalasia is a clinical condition with presentation similar to Hirschsprung's disease, but with the presence of ganglion cells on rectal suction biopsy. The diagnosis is made by anorectal manometry, which demonstrates the absence of the rectosphincteric reflex on rectal balloon inflation. The IAS is regulated by several neurogenic mechanisms, and so its pathogenesis is thought to be multifactorial, including the absence of nitrergic innervations, defective innervation of the neuromuscular junction, and altered distribution of interstitial cells of Cajal. The recommended treatment of choice is posterior IAS myectomy. Recently, however, the use of intrasphincteric botulinum toxin has been used to treat this condition, but further long-term studies are needed to ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837734 Mon, 28 Sep 2009 17:21:49 +0100 2837734 http://www.medworm.com/index.php?rid=2837733&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000432%2Fabstract%3Frss%3Dyes Intestinal failure associated liver disease (IFALD) is one of the most common and devastating complications in infants with intestinal failure. Although multifactorial, its pathophysiology is clearly related to the administration of parenteral nutrition (PN), with a recent focus on the role of PN lipid emulsions. This paper will review the evidence for the use of omega-3 fatty acid PN lipid emulsions, which are proposed to have efficacy in the treatment of IFALD. Mechanisms explaining their effects will be considered as will future research directions. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837733 Mon, 28 Sep 2009 17:21:49 +0100 2837733 http://www.medworm.com/index.php?rid=2837732&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000420%2Fabstract%3Frss%3Dyes We review the current clinical evaluation and management of the most common esophageal and gastrointestinal motility disorders in children based on the literature and our experience in a pediatric motility center in the United States. The disorders discussed include esophageal achalasia, pre- and post-fundoplication motility disorders, gastroparesis, motility disorders occurring after repair of congenital atresias, motility disorders associated with gastroschisis, chronic intestinal pseudo-obstruction, motility after intestinal transplantation, motility disorders after colonic resection for Hirschsprung's disease, chronic functional constipation, and motility disorders associated with imperforate anus. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837732 Mon, 28 Sep 2009 17:21:49 +0100 2837732 http://www.medworm.com/index.php?rid=2837731&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000419%2Fabstract%3Frss%3Dyes Diagnosis and management of Hirschsprung's disease (HSCR) requires understanding of the malformation's anatomic features and multigenic nature. Rectal biopsies, intraoperative frozen sections, and resection specimens provide invaluable information. Extraction of these data requires thoughtful biopsy technique, adequate histologic sections, histochemistry, and collaboration of surgeon and pathologist. Critical consideration of transition zone anatomy and published studies of “transition zone pull through” indicate that more research is needed to determine how much ganglionic bowel should be resected from HSCR patients. Many HSCR-susceptibility genes have been identified, but mutational analysis has limited practical value unless family history or clinical findings suggest syndromic HSCR... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837731 Mon, 28 Sep 2009 17:21:49 +0100 2837731 http://www.medworm.com/index.php?rid=2837730&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000407%2Fabstract%3Frss%3Dyes Gastrointestinal motility disorders and chronic constipation are common pediatric problems. Symptoms of abdominal discomfort are frequently encountered in the daily practice of pediatricians and pediatric surgeons. Normal peristalsis depends on the interaction between muscles, nerve cells, and tendinous connective tissue of muscularis propria. Malfunction of any of these components results in a motility disorder. Aganglionosis, typically of the left distal colon, is the cause of Hirschsprung disease. Hypoganglionosis constitutes another gastrointestinal motility disorder. In hypoplastic hypoganglionosis, the number of nerve cells and the size of ganglia of the enteric nervous system are reduced, resulting in symptoms similar to aganglionosis. In intestinal neuronal dysplasia type B, submuc... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837730 Mon, 28 Sep 2009 17:21:49 +0100 2837730 http://www.medworm.com/index.php?rid=2837729&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000390%2Fabstract%3Frss%3Dyes Motility patterns in the mature intestine require the coordinated interaction of enteric neurons, gastrointestinal smooth muscle, and interstitial cells of Cajal. In Hirschsprung's disease, the aganglionic segment causes functional obstruction, and thus the enteric nervous system (ENS) is essential for gastrointestinal motility after birth. Here we review the development of the ENS. We then focus on motility patterns in the small intestine and colon of fetal mice and larval zebrafish, where recent studies have shown that the first intestinal motility patterns are not neurally mediated. Finally, we review the development of gastrointestinal motility in humans. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837729 Mon, 28 Sep 2009 17:21:49 +0100 2837729 http://www.medworm.com/index.php?rid=2837728&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000493%2Fabstract%3Frss%3Dyes Two years ago, I corresponded with Professor Jay Grosfeld about the lack of evidence-based medicine concerning gastrointestinal motility disorders. In a prompt reply, he described it as one of the “black box” areas in surgery and how little is known about this spectrum of disorders. A lot of experimental work has unravelled the mysteries of the “enteric nervous system (ENS),” and there is a growing interest in the management of these disorders by pediatricians, gastroenterologists, and neurogastroenterologists that seems very far removed from the realms of the general pediatric surgeon. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837728 Mon, 28 Sep 2009 17:21:49 +0100 2837728 http://www.medworm.com/index.php?rid=2837727&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000535%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837727 Mon, 28 Sep 2009 17:21:49 +0100 2837727 http://www.medworm.com/index.php?rid=2837726&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000523%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2837726 Mon, 28 Sep 2009 17:21:49 +0100 2837726 http://www.medworm.com/index.php?rid=2624086&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS105585860900033X%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2624086 Wed, 22 Jul 2009 11:28:45 +0100 2624086 http://www.medworm.com/index.php?rid=2558566&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000298%2Fabstract%3Frss%3Dyes Performance of bariatric surgery in pediatric patients carries profound ethical burdens for all stakeholders: morbidly obese children and adolescents, their parents and families, pediatric physicians and surgeons, pediatric health care institutions, and society. The decision to proceed with a bariatric intervention should be made only after it is established that the patient's comorbidities could not be treated with less invasive means, the patient has a favorable risk/benefit profile, the patient and her/his family have received extensive preoperative counseling and given informed consent, and the pediatric bariatric team has a comprehensive system of short- and long-term care. The patient and her/his family should be counseled about the innovative aspects of the bariatric intervention, i... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558566 Wed, 01 Jul 2009 15:51:32 +0100 2558566 http://www.medworm.com/index.php?rid=2558565&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000286%2Fabstract%3Frss%3Dyes This article discusses the problems obesity presents to children and their families, highlights the unique aspects of treating obesity in children, reviews the currently utilized bariatric surgical procedures, and introduces those bariatric procedures that are under development. When considering whether to use bariatric surgical procedures in a multidisciplinary weight management program for children, the special needs and characteristics of children with a severe weight problem must be considered. Development of bariatric surgical techniques and devices and implementation of these tools in multidisciplinary weight management programs need greater attention. This will require the combined efforts of the pediatric health care providers from many specialties and partnerships with industry to... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558565 Wed, 01 Jul 2009 15:51:32 +0100 2558565 http://www.medworm.com/index.php?rid=2558564&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000274%2Fabstract%3Frss%3Dyes The global epidemic of obesity has not spared children. Although prevention of obesity is commendable, we cannot hide from the pressing need to identify, assess, and actively manage children seriously afflicted by obesity and its associated conditions. Sustained weight loss (or, for children, lowering of body mass index standard deviation score) delivers major health benefit, but in children has been difficult to achieve. In adults, the success of the diabetes prevention programs using practical lifestyle interventions is indisputable. Medical therapy, although currently limited in it scope, provides some promise for older children. There is now accumulating evidence, generally of poor quality that surgical interventions (laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558564 Wed, 01 Jul 2009 15:51:32 +0100 2558564 http://www.medworm.com/index.php?rid=2558563&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000262%2Fabstract%3Frss%3Dyes This article reviews recommendations on assessment of BMI, nutrition and activity, and obesity-related comorbidities. Principles of obesity prevention and treatment are discussed and high-risk eating and activity behaviors are addressed. Prevention and treatment of obesity are reviewed as set in the context of the Medical Home using the principles of the chronic disease model. The stepwise approach to obesity treatment and prevention is reviewed along with specific evidence-based/informed strategies. The skills needed to implement the recommendations, such as integration of the care team, roles and training, links to the health care system, connection to the community, and the role of the subspecialist, are discussed. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558563 Wed, 01 Jul 2009 15:51:31 +0100 2558563 http://www.medworm.com/index.php?rid=2558562&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000250%2Fabstract%3Frss%3Dyes The prevalent surge in childhood and adolescent obesity within the past 3 decades poses a significant challenge for many pediatric clinicians who are charged with treating this condition. Comprehensive, research-based pediatric obesity treatment programs are essential to addressing this problem and preventing the transition of obesity and its many comorbidities into adulthood. This paper will identify dietary, physical activity, and behavioral approaches to lifestyle change and describe how they are incorporated as part of multidisciplinary treatment interventions in youth. Specific tailoring of treatment programs to address age and varying degrees of overweight and obesity will also be presented along with recommendations for future research. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558562 Wed, 01 Jul 2009 15:51:31 +0100 2558562 http://www.medworm.com/index.php?rid=2558561&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000249%2Fabstract%3Frss%3Dyes This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH and children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress; however, clinical trials focusing on NASH are needed. Heightened physician awareness of NAFLD, NASH, and associated risk factors is important to identify and treat affected child... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558561 Wed, 01 Jul 2009 15:51:31 +0100 2558561 http://www.medworm.com/index.php?rid=2558560&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000237%2Fabstract%3Frss%3Dyes The clustering of traditional cardiovascular disease risk factors is known as the metabolic syndrome. The metabolic syndrome was first characterized as a distinct entity by Dr. Gerald Reaven in 1988. The intent was to identify individuals at greatest risk for cardiovascular disease mortality and those in urgent need of lifestyle intervention. Since then the metabolic syndrome has evolved into a diagnosable entity recognized by the National Cholesterol Education Program, Adult Treatment Panel III, World Health Organization, and the International Diabetes Foundation. However, the metabolic syndrome as a diagnosis faces considerable controversy, particularly when applied to the pediatric population. Due to the changes in growth and development, the adult criteria for the metabolic syndrome ca... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558560 Wed, 01 Jul 2009 15:51:31 +0100 2558560 http://www.medworm.com/index.php?rid=2558559&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000225%2Fabstract%3Frss%3Dyes Obesity has reached epidemic proportions in the USA with a nearly fourfold rise in the prevalence of childhood obesity. There are many possible etiologies of obesity as the adipose tissue plays a significant, complex role in the physiology of fuel metabolism and hormone regulation. The development of obesity represents a pathophysiologic increase in fat mass in which multiple metabolic pathways are deranged. The consequences of these metabolic derangements, including insulin resistance and inflammation, are reflected in obesity-related comorbidities and can be seen in the setting of pediatric obesity. Obese adolescents demonstrate increased rates of early maturation, orthopedic growth abnormalities, diabetes mellitus, obstructive sleep apnea, hypertension, steatosis, and polycystic ovarian... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558559 Wed, 01 Jul 2009 15:51:31 +0100 2558559 http://www.medworm.com/index.php?rid=2558558&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000213%2Fabstract%3Frss%3Dyes Although the overall health status of the pediatric population in the United States has improved, the last quarter century has witnessed a dramatic rise in the prevalence of childhood obesity and its associated comorbid conditions. Specifically, the medical community is witnessing a steady and alarming rise in the prevalence of chronic diseases among obese children, including diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, and cardiovascular disease. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558558 Wed, 01 Jul 2009 15:51:31 +0100 2558558 http://www.medworm.com/index.php?rid=2558557&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000328%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2558557 Wed, 01 Jul 2009 15:51:31 +0100 2558557 http://www.medworm.com/index.php?rid=2481750&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000146%2Fabstract%3Frss%3Dyes Adverse medical events occurring in the context of care of children undergoing elective surgical procedures are usually truly unexpected occurrences with the potential for long-term consequences. Such events, when they occur, are obviously devastating to the patient and family, but frequently also to the pediatric surgeon and his/her team. When such events occur, it is important to ensure uninterrupted care of the patient, a full disclosure of events leading to harm, and an ongoing accessibility to the family for disclosure of new information as it becomes available. Finally, it is important that the adverse event be systematically reviewed as a “critical incident,” so that opportunities for practice improvement leading to enhanced patient safety can be realized and compliance with new... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481750 Fri, 01 May 2009 04:00:00 +0100 2481750 http://www.medworm.com/index.php?rid=2481749&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000134%2Fabstract%3Frss%3Dyes We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 × 5.9 × 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of malrotation. Postoperatively, after discussion with the parents, support was withdrawn and the child died. We should not rely solely on ultrasonographic features and flui... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481749 Fri, 01 May 2009 04:00:00 +0100 2481749 http://www.medworm.com/index.php?rid=2481748&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000122%2Fabstract%3Frss%3Dyes The intraoperative management of a neonate with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) is a true anesthetic challenge. Pediatric anesthesia textbooks recommend a distal tracheal intubation beyond the fistula and spontaneous ventilation, if possible, until surgical control of the fistula is achieved to minimize gastric distention. A full-term neonate with Trisomy 21 presented with an EATEF and was transferred to the operating theater for repair after appropriate evaluation. After induction of anesthesia, a size 3.0 endotracheal tube was inserted orally with confirmation of its position by good air entry and chest movement bilaterally. After positioning for thoracotomy, the patient desaturated and became bradycardic with abdominal distention. Despite reintubation,... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481748 Fri, 01 May 2009 04:00:00 +0100 2481748 http://www.medworm.com/index.php?rid=2481747&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000110%2Fabstract%3Frss%3Dyes We present a patient who became paraplegic after resection of a chest wall tumor. After neoadjuvant radio- and chemotherapy, a 10-year-old girl with primitive neuroectodermal tumor (PNET) of the right chest underwent a right chest wall resection. Ribs #3, 4, 5, and 6 were resected en masse with a pulmonary wedge resection of right upper and middle lobes. To obtain clear margins, the ribs were disarticulated from the vertebral column. Significant bleeding arose when the fourth rib was detached. Presuming an intercostal vessel bleed, the area was packed with surgicel with resolution of the bleeding. The patient was kept sedated and ventilated in the PICU. The next day, she complained of paresis of her lower extremities. MRI revealed compression of the spinal cord at the T4 level. Emergency d... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481747 Fri, 01 May 2009 04:00:00 +0100 2481747 http://www.medworm.com/index.php?rid=2481746&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000109%2Fabstract%3Frss%3Dyes Use of a spring-loaded silastic silo has been advocated as a means of gentle reduction of the herniated bowel, while avoiding the possible complications of primary closure of gastroschisis. We recently encountered intestinal venous congestion during elective silo reduction of gastroschisis. Two babies with gastroschisis were treated postdelivery with a spring-loaded silo placed under the fascial defect and the eviscerated bowel suspended within the silo. Patient #1 had no bowel matting. On day of life 2, the bowel within the silo was noted to be dusky. The silo was removed, and the bowel was indeed congested, but viable. Complete reduction with a modified Bianchi closure was performed at the bedside. Patient #2 had severe matting of the bowel and did not require intubation for silo placeme... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481746 Fri, 01 May 2009 04:00:00 +0100 2481746 http://www.medworm.com/index.php?rid=2481745&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000092%2Fabstract%3Frss%3Dyes We present two patients who developed delayed fistulisation following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent chest pain for 6 months. He developed a tension pneumopericardial tamponade caused by a fistula between gastric tube and pericardium. He recovered after sternotomy. The second was born prematurely with type C esophageal atresia and other malformations. After esophageal anastomosis, he developed a refractory stricture that was resected at 10 months. Despite a fundoplication at 4 years, the recurre... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481745 Fri, 01 May 2009 04:00:00 +0100 2481745 http://www.medworm.com/index.php?rid=2481744&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000080%2Fabstract%3Frss%3Dyes Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity and/or mortality. These cases are combined with larger case series to arrive at a list of relatively specific clinical and radiologic findings that can alert the clinician to t... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481744 Fri, 01 May 2009 04:00:00 +0100 2481744 http://www.medworm.com/index.php?rid=2481743&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000079%2Fabstract%3Frss%3Dyes Percutaneous endoscopic gastrostomy (PEG) provides for enteral nutrition in children with feeding problems. PEG, however, is not without complications. The present study has a twofold aim: (1) comparing our incidence of major complications after PEG with the incidence in other centers, and (2) identifying risk factors for major complications. All patients receiving a PEG or laparoscopic-assisted PEG (lap PEG) in the period 1992-2008 were reviewed. Primary outcome was the occurrence of major complications, defined as the need for surgery, nonprophylactic antibiotics, or blood transfusion, and procedure-related death. Potential risk factors, eg, age under 1 year, mental retardation, scoliosis, constipation, hepatomegaly, upper abdominal surgery, ventriculoperitoneal shunt, peritoneal dialysi... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481743 Fri, 01 May 2009 04:00:00 +0100 2481743 http://www.medworm.com/index.php?rid=2481742&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000067%2Fabstract%3Frss%3Dyes Gastrostomy tubes are used in the pediatric population when long-term enteral feeding is needed. A common method of placement is percutaneously with endoscopy (PEG, percutaneous endoscopic gastrostomy). Although PEG placement is a straightforward procedure most of the time, it can be associated with a significant rate of minor complications and a smaller but significantly important rate of major complications. Some of these complications may also occur after any type of gastrostomy. We will present representative case studies outlining major complications and discuss how we may be able to prevent them at the time of PEG insertion or during PEG to low-profile button gastrostomy exchange. The proposed guidelines apply to all types of gastrostomies. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481742 Fri, 01 May 2009 04:00:00 +0100 2481742 http://www.medworm.com/index.php?rid=2481741&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000055%2Fabstract%3Frss%3Dyes Erosion of the skin over a totally implanted vascular access device (TIVAD) is a rare event that may lead to life-threatening sequelae. From 1994 to 2007, we reviewed the medical records and central line database of 960 central line insertions for the complication of skin erosion over the TIVAD. Outcome measures included age, gender, and nutritional status, number of days until complication, insertion site, and attending surgeon. A total of 540 of the 960 central lines were TIVAD. Skin erosion occurred in 9 patients for an incidence of 1.67%. Average age at insertion was 51 months (range 25-116.5 months). The average catheter duration use in days was 335 with a range of 39-1575 days. Malnutrition defined as BMI (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481741 Fri, 01 May 2009 04:00:00 +0100 2481741 http://www.medworm.com/index.php?rid=2481740&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000043%2Fabstract%3Frss%3Dyes Discussions on the complications of central venous catheterization in children typically focus on infectious and the more common mechanical complications of pneumothorax, hemothorax, or thrombosis. Rare complications are often more life-threatening, and inexperience may compound the problem. Central venous catheter complications can be broken down into early or late, depending on when they occur. The more serious complications are typically mechanical and occur early, but delayed presentations of pericardial effusions, cardiac tamponade, and pleural effusions may be of equal severity, and delay in diagnosis can be catastrophic. Careful insertion techniques, as well as continued vigilance in the correct position and function of central venous catheters, are imperative to help prevent seriou... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481740 Fri, 01 May 2009 04:00:00 +0100 2481740 http://www.medworm.com/index.php?rid=2481739&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000031%2Fabstract%3Frss%3Dyes This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future. (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481739 Fri, 01 May 2009 04:00:00 +0100 2481739 http://www.medworm.com/index.php?rid=2481738&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS105585860900002X%2Fabstract%3Frss%3Dyes Complications are part of the life as a surgeon, hence the popular saying, “The only surgeons who don't have surgical complications are those who don't operate.” Many complications are unavoidable. For example, a small percentage of wound infections will always occur in patients with perforated appendicitis, despite meticulous technique and the use of properly timed preoperative antibiotics. Those who leave all contaminated wounds open may never have to report a wound infection, but is it worth submitting all children to the discomfort of an open wound and dressing changes to avoid a 5-10% rate of wound infection? Personally, I don't think so, and I accept the fact that I will have to report a certain number of these complications. However, other than these predictable and, to a certai... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481738 Fri, 01 May 2009 04:00:00 +0100 2481738 http://www.medworm.com/index.php?rid=2481737&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000183%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481737 Fri, 01 May 2009 04:00:00 +0100 2481737 http://www.medworm.com/index.php?rid=2481736&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS1055858609000171%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481736 Fri, 01 May 2009 04:00:00 +0100 2481736 http://www.medworm.com/index.php?rid=2481735&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.sempedsurg.org%2Farticle%2FPIIS105585860900016X%2Fabstract%3Frss%3Dyes (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2481735 Fri, 01 May 2009 04:00:00 +0100 2481735 http://www.medworm.com/index.php?rid=2315166&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348993%26dopt%3DAbstract Authors: Laberge JM PMID: 19348993 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315166 Thu, 09 Apr 2009 13:46:24 +0100 2315166 http://www.medworm.com/index.php?rid=2315157&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348994%26dopt%3DAbstract Authors: Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future. PMID: 19348994 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315157 Thu, 09 Apr 2009 13:46:18 +0100 2315157 http://www.medworm.com/index.php?rid=2315147&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348995%26dopt%3DAbstract Discussions on the complications of central venous catheterization in children typically focus on infectious and the more common mechanical complications of pneumothorax, hemothorax, or thrombosis. Rare complications are often more life-threatening, and inexperience may compound the problem. Central venous catheter complications can be broken down into early or late, depending on when they occur. The more serious complications are typically mechanical and occur early, but delayed presentations of pericardial effusions, cardiac tamponade, and pleural effusions may be of equal severity, and delay in diagnosis can be catastrophic. Careful insertion techniques, as well as continued vigilance in the correct position and function of central venous catheters, are imperative to help prevent seriou... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315147 Thu, 09 Apr 2009 13:46:11 +0100 2315147 http://www.medworm.com/index.php?rid=2315133&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348996%26dopt%3DAbstract Authors: Bass J, Halton JM Erosion of the skin over a totally implanted vascular access device (TIVAD) is a rare event that may lead to life-threatening sequelae. From 1994 to 2007, we reviewed the medical records and central line database of 960 central line insertions for the complication of skin erosion over the TIVAD. Outcome measures included age, gender, and nutritional status, number of days until complication, insertion site, and attending surgeon. A total of 540 of the 960 central lines were TIVAD. Skin erosion occurred in 9 patients for an incidence of 1.67%. Average age at insertion was 51 months (range 25-116.5 months). The average catheter duration use in days was 335 with a range of 39-1575 days. Malnutrition defined as BMI <5% or a decrease in BMI percentiles occurred... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315133 Thu, 09 Apr 2009 13:46:04 +0100 2315133 http://www.medworm.com/index.php?rid=2315121&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348997%26dopt%3DAbstract Authors: Beres A, Bratu I, Laberge JM Gastrostomy tubes are used in the pediatric population when long-term enteral feeding is needed. A common method of placement is percutaneously with endoscopy (PEG, percutaneous endoscopic gastrostomy). Although PEG placement is a straightforward procedure most of the time, it can be associated with a significant rate of minor complications and a smaller but significantly important rate of major complications. Some of these complications may also occur after any type of gastrostomy. We will present representative case studies outlining major complications and discuss how we may be able to prevent them at the time of PEG insertion or during PEG to low-profile button gastrostomy exchange. The proposed guidelines apply to all types of gastrostomies. ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315121 Thu, 09 Apr 2009 13:45:55 +0100 2315121 http://www.medworm.com/index.php?rid=2315116&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348998%26dopt%3DAbstract Authors: Vervloessem D, van Leersum F, Boer D, Hop WC, Escher JC, Madern GC, de Ridder L, Bax KN Percutaneous endoscopic gastrostomy (PEG) provides for enteral nutrition in children with feeding problems. PEG, however, is not without complications. The present study has a twofold aim: (1) comparing our incidence of major complications after PEG with the incidence in other centers, and (2) identifying risk factors for major complications. All patients receiving a PEG or laparoscopic-assisted PEG (lap PEG) in the period 1992-2008 were reviewed. Primary outcome was the occurrence of major complications, defined as the need for surgery, nonprophylactic antibiotics, or blood transfusion, and procedure-related death. Potential risk factors, eg, age under 1 year, mental retardation, scoliosis... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315116 Thu, 09 Apr 2009 13:45:48 +0100 2315116 http://www.medworm.com/index.php?rid=2315108&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19348999%26dopt%3DAbstract Authors: Gerstle JT, Chiu P, Emil S Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity and/or mortality. These cases are combined with larger case series to arrive at a list of relatively specific clinical and radiologic fi... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315108 Thu, 09 Apr 2009 13:45:38 +0100 2315108 http://www.medworm.com/index.php?rid=2315089&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19349000%26dopt%3DAbstract We present two patients who developed delayed fistulisation following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent chest pain for 6 months. He developed a tension pneumopericardial tamponade caused by a fistula between gastric tube and pericardium. He recovered after sternotomy. The second was born prematurely with type C esophageal atresia and other malformations. After esophageal anastomosis, he developed a refractory stricture that was resected at 10 months. Despite a fundoplication at 4 years, the recurre... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315089 Thu, 09 Apr 2009 13:45:28 +0100 2315089 http://www.medworm.com/index.php?rid=2315077&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19349001%26dopt%3DAbstract Authors: Ryckman J, Aspirot A, Laberge JM, Shaw K Use of a spring-loaded silastic silo has been advocated as a means of gentle reduction of the herniated bowel, while avoiding the possible complications of primary closure of gastroschisis. We recently encountered intestinal venous congestion during elective silo reduction of gastroschisis. Two babies with gastroschisis were treated postdelivery with a spring-loaded silo placed under the fascial defect and the eviscerated bowel suspended within the silo. Patient #1 had no bowel matting. On day of life 2, the bowel within the silo was noted to be dusky. The silo was removed, and the bowel was indeed congested, but viable. Complete reduction with a modified Bianchi closure was performed at the bedside. Patient #2 had severe matting of the... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315077 Thu, 09 Apr 2009 13:45:18 +0100 2315077 http://www.medworm.com/index.php?rid=2315058&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19349002%26dopt%3DAbstract We present a patient who became paraplegic after resection of a chest wall tumor. After neoadjuvant radio- and chemotherapy, a 10-year-old girl with primitive neuroectodermal tumor (PNET) of the right chest underwent a right chest wall resection. Ribs #3, 4, 5, and 6 were resected en masse with a pulmonary wedge resection of right upper and middle lobes. To obtain clear margins, the ribs were disarticulated from the vertebral column. Significant bleeding arose when the fourth rib was detached. Presuming an intercostal vessel bleed, the area was packed with surgicel with resolution of the bleeding. The patient was kept sedated and ventilated in the PICU. The next day, she complained of paresis of her lower extremities. MRI revealed compression of the spinal cord at the T4 level. Emergency d... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315058 Thu, 09 Apr 2009 13:45:06 +0100 2315058 http://www.medworm.com/index.php?rid=2315042&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19349003%26dopt%3DAbstract Authors: Alabbad SI, Shaw K, Puligandla PS, Carranza R, Bernard C, Laberge JM The intraoperative management of a neonate with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) is a true anesthetic challenge. Pediatric anesthesia textbooks recommend a distal tracheal intubation beyond the fistula and spontaneous ventilation, if possible, until surgical control of the fistula is achieved to minimize gastric distention. A full-term neonate with Trisomy 21 presented with an EATEF and was transferred to the operating theater for repair after appropriate evaluation. After induction of anesthesia, a size 3.0 endotracheal tube was inserted orally with confirmation of its position by good air entry and chest movement bilaterally. After positioning for thoracotomy, the patient d... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315042 Thu, 09 Apr 2009 13:44:52 +0100 2315042 http://www.medworm.com/index.php?rid=2315033&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19349004%26dopt%3DAbstract We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 x 5.9 x 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of malrotation. Postoperatively, after discussion with the parents, support was withdrawn and the child died. We should not rely solely on ultrasonographic features and fluid ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315033 Thu, 09 Apr 2009 13:44:48 +0100 2315033 http://www.medworm.com/index.php?rid=2315017&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19349005%26dopt%3DAbstract Authors: Skarsgard ED Adverse medical events occurring in the context of care of children undergoing elective surgical procedures are usually truly unexpected occurrences with the potential for long-term consequences. Such events, when they occur, are obviously devastating to the patient and family, but frequently also to the pediatric surgeon and his/her team. When such events occur, it is important to ensure uninterrupted care of the patient, a full disclosure of events leading to harm, and an ongoing accessibility to the family for disclosure of new information as it becomes available. Finally, it is important that the adverse event be systematically reviewed as a "critical incident," so that opportunities for practice improvement leading to enhanced patient safety can be realized a... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2315017 Thu, 09 Apr 2009 13:44:35 +0100 2315017 http://www.medworm.com/index.php?rid=2063801&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103414%26dopt%3DAbstract Authors: Pierro A PMID: 19103414 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063801 Fri, 26 Dec 2008 03:54:09 +0100 2063801 http://www.medworm.com/index.php?rid=2063800&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103415%26dopt%3DAbstract Authors: Ioannides AS, Copp AJ Esophageal atresia (OA) and tracheoesophageal fistula (TOF) are important human birth defects of unknown etiology. The embryogenesis of OA/TOF remains poorly understood, mirroring the lack of clarity of the mechanisms of normal tracheoesophageal development. The development of rat and mouse models of OA/TOF has allowed the parallel study of both normal and abnormal embryogenesis. Although controversies persist, the fundamental morphogenetic process appears to be a rearrangement of the proximal foregut into separate respiratory (ventral) and gastrointestinal (dorsal) tubes. This process depends on the precise temporal and spatial pattern of expression of a number of foregut patterning genes. Disturbance of this pattern disrupts foregut separation and under... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063800 Fri, 26 Dec 2008 03:54:03 +0100 2063800 http://www.medworm.com/index.php?rid=2063799&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103416%26dopt%3DAbstract Authors: Mortell AE, Azizkhan RG Esophageal atresia/tracheoesophageal fistula (EA/TEF) repair using an open muscle-sparing thoracotomy has been the standard approach used in our institution. Whereas perioperative mortality is now very uncommon, short- and long-term morbidity is very common in these patients. However, the complexity of the esophageal anatomy and significant comorbidities appear to be important contributors to significant complications in these patients. At least 30% of the EA/TEF patients required esophageal dilatations for anastomotic stricture; this increased to 50% for patients with pure EA. Gastroesophageal reflux requiring an antireflux procedure was performed 23% of the time for EA/TEF and 30% for EA patients. In addition, there were a few complications, such as w... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063799 Fri, 26 Dec 2008 03:53:58 +0100 2063799 http://www.medworm.com/index.php?rid=2063798&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103417%26dopt%3DAbstract Authors: Mackinlay GA The results of thoracoscopic repair of oesophageal atresia with or without tracheo-oesophageal fistula are presented. Twenty-six children had the repair perfomed thoracoscopically (22 in Edinburgh and 4 by Edinburgh surgeons in other institutions). Twenty infants had oesophageal atresia with tracheo-oesophageal fistula and 6 had isolated oesophageal atresia without fistula. Details of the technique are presented. Birth weights ranged from 1.4 to 3.9 kg and children were operated between 1 day and three months of age. There were 7 minor anastomotic leaks all managed conservatively, 1 recurrent fistula managed thoracoscopically and 9 anastomotic strictures. One child had a tracheo-bronchial fistula not seen at original thoracoscopy. There were 3 deaths (one child wi... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063798 Fri, 26 Dec 2008 03:53:52 +0100 2063798 http://www.medworm.com/index.php?rid=2063797&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103418%26dopt%3DAbstract This study had two purposes. The first was to determine whether the growth procedure would allow true primary repairs of the most severe end of the esophageal atresia (EA) spectrum with the longest gaps (LG) and most rudimentary lower esophageal segments. The second goal was to provide the first short- to mid-term (3-12 years) follow-up data on the esophageal function and quality of life (QOL) data on the patients in this series. From our series of 60 LG-EA patients who underwent a growth procedure, 42 had the true primary esophageal repair completed 3 years ago. Among these, 18 had gaps over 6 cm, and for 6, only a rudimentary lower esophagus existed well below the diaphragm. No patient was turned down and all had primary repairs. These results suggest that even the most rudimentary segme... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063797 Fri, 26 Dec 2008 03:53:41 +0100 2063797 http://www.medworm.com/index.php?rid=2063796&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103419%26dopt%3DAbstract CONCLUSIONS: Gastric transposition for esophageal substitution is an acceptable procedure. It is attended by 4.6% mortality and a 12% leak rate. A total of 20% of the patients needed anastomotic dilation for stricture. In the long term, good function has been maintained. Gastric transposition compares favorably with other methods of esophageal replacement. PMID: 19103419 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063796 Fri, 26 Dec 2008 03:53:21 +0100 2063796 http://www.medworm.com/index.php?rid=2063795&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103420%26dopt%3DAbstract CONCLUSION: Orthotopic jejunal pedicle graft reconstruction of the esophagus in children is a demanding operation with considerably early morbidity but good long-term results. It should be part of the pediatric surgical armamentarium for reconstruction of the esophagus. PMID: 19103420 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063795 Fri, 26 Dec 2008 03:53:06 +0100 2063795 http://www.medworm.com/index.php?rid=2063794&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103421%26dopt%3DAbstract Authors: Hamza AF Replacement of the esophagus in children is still a challenging problem; one of the major indications is failed esophageal atresia repair or long-gap ones. The colon is one of the best alternatives for replacement; long-term follow up has shown satisfactory results. In cases of complicated repair receiving frequent dilation and multiple operations, colon could be an alternative choice for these children to achieve normal swallowing. PMID: 19103421 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063794 Fri, 26 Dec 2008 03:53:00 +0100 2063794 http://www.medworm.com/index.php?rid=2063793&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103422%26dopt%3DAbstract Authors: Ron O, De Coppi P, Pierro A The optimal approach for esophageal atresia (OA) repair and technique used for long-gap OA repair are controversial. There are few data comparing the outcomes of the different approaches and techniques. We performed a survey of current practice of 88 pediatric surgeons and asked experts to provide us with definitions and rationales behind their management strategies. There were no differences between UK and non-UK surgeons. Although the majority of pediatric surgeons perform minimally invasive surgery (68%), only 16% have performed thoracoscopic OA repair; however, 46% are planning to carry out thoracoscopic OA repair. Gastric interposition is the most preferred technique for long-gap OA when primary anastomosis is not possible, with 94% of those su... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063793 Fri, 26 Dec 2008 03:52:51 +0100 2063793 http://www.medworm.com/index.php?rid=2063792&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103423%26dopt%3DAbstract Authors: Rintala RJ, Sistonen S, Pakarinen MP Survivors of esophageal atresia are reaching their adulthood in large numbers for the first time enabling assessment of true long-term outcome among this group of patients. This review summarizes the current knowledge on the subject focusing on late symptoms and complications, esophageal pathology and pulmonary function. Relationships between esophageal dysmotility, gastroesophageal reflux, esophagitis and epithelial metaplastic changes including esophageal cancer are outlined. In addition to pertinent literature, institutional experience, and follow-up of patients with esophageal atresia for more than 60 years is included. PMID: 19103423 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063792 Fri, 26 Dec 2008 03:52:43 +0100 2063792 http://www.medworm.com/index.php?rid=2063791&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19103424%26dopt%3DAbstract Authors: Zani A, Pierro A, Elvassore N, De Coppi P Esophageal replacement is required in several pediatric surgical conditions, like long-gap esophageal atresia. Although several techniques have been described to bridge the gap, all of them could be followed by postoperative complications. Esophageal tissue engineering could represent a valid alternative thanks to the recent advances in biomaterial science and cellular biology. Numerous attempts to shape a new esophagus in vitro have been described in the last decade. Herein, we review the main studies on the experimental use of nonabsorbable and absorbable materials as well as the development of cellularized patches. Furthermore, we describe the future perspectives of esophageal tissue engineering characterized by the use of stem cell... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=2063791 Fri, 26 Dec 2008 03:52:22 +0100 2063791 http://www.medworm.com/index.php?rid=1994623&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019294%26dopt%3DAbstract This article examines recent data regarding surgical treatment options for NEC as well as emerging treatment modalities. PMID: 19019294 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1994623 Sat, 01 Nov 2008 04:00:00 +0100 1994623 http://www.medworm.com/index.php?rid=1978208&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019290%26dopt%3DAbstract Authors: Carachi R, Hajivassiliou CA PMID: 19019290 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978208 Sat, 01 Nov 2008 04:00:00 +0100 1978208 http://www.medworm.com/index.php?rid=1978207&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019291%26dopt%3DAbstract Authors: Marven S, Owen A Early definitive closure of abdominal wall defects is possible in most cases. Staged reduction does offer distinct advantages, and mortality and morbidity may be better. Risk stratification may produce outcome and tailor management of difficult cases in the form of a clinical pathway. Stem cell technology may, in the future, offer the ideal allogenic prosthesis in complex cases. PMID: 19019291 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978207 Sat, 01 Nov 2008 04:00:00 +0100 1978207 http://www.medworm.com/index.php?rid=1978206&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019292%26dopt%3DAbstract Authors: Gupta DK, Sharma S The outcome of cases of esophageal atresia depends on many factors that affect the prognosis. These factors have been identified since Waterston aimed to classify the anomaly according to the risk factors. There are other factors that affect the outcome, and these differ in different parts of the globe. This comprehensive review attempts to incorporate all the factors-preoperative, operative, and postoperative-that can pose risks to the ultimate survival of the baby. Early detection for proper management of these cases is essential. Feasibility to perform early esophageal replacement has come as a boom for these high-risk cases. Total care in a high-risk population of esophageal atresia depends on the investigative modalities adopted, available neonatal ICU ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978206 Sat, 01 Nov 2008 04:00:00 +0100 1978206 http://www.medworm.com/index.php?rid=1978205&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019293%26dopt%3DAbstract Authors: Waag KL, Loff S, Zahn K, Ali M, Hien S, Kratz M, Neff W, Schaffelder R, Schaible T Centralization of all complicated congenital diaphragmatic hernias (CDH) was organized in Germany from 1998, collecting 325 consecutive patients with striking increasing survival rates. This series report 244 patients from 2002 to 2007. Today, large defects are detected early in pregnancy by ultrasound and magnetic resonance imaging (MRI). In extracorporeal membrane oxygenation (ECMO) patients, prenatal lung head ratio (LHR) was 1.2 (median) at the 34th week of gestation or less than 25 ml lung tissue in MRI. This means that all patients below LHR of 1.4 should be transferred prenatally in a tertiary center. High risk group for survival was defined as LHR below 0.9, ie, 10 ml in MRI planimetry. ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978205 Sat, 01 Nov 2008 04:00:00 +0100 1978205 http://www.medworm.com/index.php?rid=1978204&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019294%26dopt%3DAbstract This article examines recent data regarding surgical treatment options for NEC as well as emerging treatment modalities. PMID: 19019294 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978204 Sat, 01 Nov 2008 04:00:00 +0100 1978204 http://www.medworm.com/index.php?rid=1978203&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019295%26dopt%3DAbstract Authors: Haricharan RN, Georgeson KE Hirschsprung disease is a relatively common condition managed by pediatric surgeons. Significant advances have been made in understanding its etiologies in the last decade, especially with the explosion of molecular genetic techniques and early diagnosis. The surgical management has progressed from a two- or three-stage procedure to a primary operation. More recently, definitive surgery for Hirschsprung disease through minimally invasive techniques has gained popularity. In neonates, the advancement of treatment strategies for Hirschsprung disease continues with reduced patient morbidity and improved outcomes. PMID: 19019295 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978203 Sat, 01 Nov 2008 04:00:00 +0100 1978203 http://www.medworm.com/index.php?rid=1978202&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019296%26dopt%3DAbstract Authors: Pierro A, Eaton S Considerable improvements have been achieved in pediatric surgery during the last two decades: the mortality rate of neonates undergoing major operations has declined to less than 10%, and the morbidity of major operations has become negligible. This considerable improvement can be partly ascribed to a better understanding of the physiological changes that occur after an operation and to more appropriate management and nutrition of the critically ill and "stressed" neonates and children. The metabolic response to an operation is different in neonates from adults: there is a small increase in oxygen consumption and resting energy expenditure immediately after surgery with return to normal by 12-24 hours. The increase in resting energy expenditure is significan... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978202 Sat, 01 Nov 2008 04:00:00 +0100 1978202 http://www.medworm.com/index.php?rid=1978201&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019297%26dopt%3DAbstract Authors: Currie JM In recent years, there has been a major change in our thinking about the way neonates experience stress. This understanding has led to advances in anesthetic technique and the pre- and postoperative care of the surgical neonate. Stress can develop before birth due to placental insufficiency. This can lead to preterm delivery, and the preterm infant is much more vulnerable to stressful stimulus. Stress is detrimental to the neonate in the short term and can also have adverse effects on the future wellbeing of the child. Limiting stress is not just about good pain control. The nursing environment is vitally important. Much can be achieved with good attention to detail in this respect. The effects of stress and the ways they can be minimized are discussed. PMID: 190... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978201 Sat, 01 Nov 2008 04:00:00 +0100 1978201 http://www.medworm.com/index.php?rid=1978200&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19019298%26dopt%3DAbstract Authors: Kelly A, Liddell M, Davis C In the last two decades, advancement in neonatal surgery, anesthesia, and intensive care have improved the outcome not only for neonates with complex surgical conditions but also for those preterm infants with combined medical and surgical issues. Infants with surgical problems may remain in the neonatal care setting for weeks or months, and providing ongoing nursing care can be challenging but rewarding. In this article, the authors outline the immediate preoperative management, stabilization, and subsequent postoperative nursing care of the surgical neonate. PMID: 19019298 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1978200 Sat, 01 Nov 2008 04:00:00 +0100 1978200 http://www.medworm.com/index.php?rid=1644281&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582819%26dopt%3DAbstract Authors: Nuss D, Kelly RE PMID: 18582819 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1644281 Wed, 23 Jul 2008 06:29:24 +0100 1644281 http://www.medworm.com/index.php?rid=1548873&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582819%26dopt%3DAbstract Authors: Nuss D, Kelly RE PMID: 18582819 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548873 Sat, 28 Jun 2008 15:24:50 +0100 1548873 http://www.medworm.com/index.php?rid=1548872&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582820%26dopt%3DAbstract This article reviews the embryological development of the chest wall, specific sternal defect anomalies, along with available methods of treatment. PMID: 18582820 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548872 Sat, 28 Jun 2008 15:24:48 +0100 1548872 http://www.medworm.com/index.php?rid=1548871&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582821%26dopt%3DAbstract Authors: Moir CR, Johnson CH The main purpose of surgical correction in Poland's syndrome is to improve chest wall symmetry and correct breast hypoplasia. Creation of an anterior axillary fold and smoothing out the infraclavicular defect greatly improves the final result. Cardiorespiratory function may be impaired, but serious conditions requiring early operative correction are rare. When present, unilateral costochondral agenesis involves one to three segments in the mid-anterior chest and sternal depression to that side. Operative planning in such cases includes a multi-layered approach to provide a solid base for soft tissue reconstruction of the more superficial layers. PMID: 18582821 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548871 Sat, 28 Jun 2008 15:24:46 +0100 1548871 http://www.medworm.com/index.php?rid=1548870&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582822%26dopt%3DAbstract Authors: Phillips JD, van Aalst JA Familial asphyxiating thoracic dystrophy (ATD), also known as Jeune's syndrome, is a rare autosomal recessive disorder with variable severity and multiple musculo-skeletal manifestations. Respiratory distress may be severe, resulting in death during infancy. Surgical repair techniques have typically involved median sternotomy (with graft interposition), resulting in poor outcomes. Acquired ATD may rarely result from impairment of chest wall growth following "open" (Ravitch-type) repair of pectus excavatum or carinatum deformities. Symptomatic patients may have profound restriction of pulmonary function. Repair techniques typically involve re-do Ravitch-type procedures or median sternotomy with rib graft interposition. Mild to moderate improvements in ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548870 Sat, 28 Jun 2008 15:24:43 +0100 1548870 http://www.medworm.com/index.php?rid=1548869&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582823%26dopt%3DAbstract Authors: La Quaglia MP Chest wall tumors in childhood and adolescence can be very heterogeneous and may appear at any age from infancy to late adolescence. They can be benign or malignant and secondary or primary. A careful history and physical examination should be followed by adequate imaging studies to delineate the primary tumor and identify possible sites of dissemination. Diagnosis usually requires either a needle or open biopsy which minimizes dissection so that a complete resection can be done later. Most neoplastic lesions require a complete resection, whereas secondary and infectious processes are treated with chemotherapy or antibiotics. Rigid chest wall re-construction has the advantage of eliminating paradoxical respiration and obviating the need for postoperative ventilat... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548869 Sat, 28 Jun 2008 15:24:41 +0100 1548869 http://www.medworm.com/index.php?rid=1548868&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582824%26dopt%3DAbstract Authors: Kelly RE Pectus excavatum is a depression of the sternum and costal cartilages which may present at birth, or more commonly during the teenage growth spurt. Symptoms of lack of endurance, shortness of breath with exercise, or chest pain are frequent. Although pectus excavatum may be a component of some uncommon syndromes, patients usually are healthy. Evaluation should include careful anatomic description with photographs, radiography to demonstrate the depth of the depression, extent of cardiac compression, or displacement, measurement of pulmonary function, and echocardiography to look for mitral valve prolapse (in 15%) or diminished right ventricular volume. Indications for surgical treatment include two or more of the following: a severe, symptomatic deformity; progression... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548868 Sat, 28 Jun 2008 15:24:38 +0100 1548868 http://www.medworm.com/index.php?rid=1548867&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582825%26dopt%3DAbstract Authors: Martinez-Ferro M, Fraire C, Bernard S Between April 2001 and 2007, we treated 208 patients with pectus carinatum by using a specially designed dynamic compression system (DCS) that uses a custom-made aluminum brace. Recently, an electronic pressure measuring device was added to the brace. Results were evaluated by using a double-blinded subjective scale (1 to 10). A total of 208 patients were treated over 6 years; 154 were males (74%) and the mean age was 12.5 years (range 3 to 18 years). Mean utilization time was 7.2 hours daily for 7 months (range 3 to 20 months). A total of 28 (13.4%) patients abandoned treatment and were not evaluated for final results. Of the 180 remaining patients, 112 completed treatment. A total of 99 of 112 (88.4%) had good to excellent results scorin... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548867 Sat, 28 Jun 2008 15:24:36 +0100 1548867 http://www.medworm.com/index.php?rid=1548866&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582826%26dopt%3DAbstract Authors: Lopushinsky SR, Fecteau AH Pectus deformities represent a spectrum of relatively common congenital chest malformations. The adoption of less invasive techniques has renewed interest in surgical repair by both patients and clinicians. The aim of this review is to identify current management, outcomes, and controversy in the treatment of pectus excavatum and pectus carinatum. PMID: 18582826 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548866 Sat, 28 Jun 2008 15:24:34 +0100 1548866 http://www.medworm.com/index.php?rid=1548865&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18582827%26dopt%3DAbstract Authors: Nuss D The minimally invasive repair of pectus excavatum has become widely accepted. The number of patients presenting for repair has increased dramatically. There have been many technical improvements over 20 years that have made the procedure much safer and more successful. The complications have been identified and preventative measures instituted. The long-term results have shown a 95% good to excellent outcome, and patient satisfaction studies have shown similar results. PMID: 18582827 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1548865 Sat, 28 Jun 2008 15:24:32 +0100 1548865 http://www.medworm.com/index.php?rid=1359001&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395655%26dopt%3DAbstract Authors: Oldham KT PMID: 18395655 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1359001 Wed, 09 Apr 2008 19:02:26 +0100 1359001 http://www.medworm.com/index.php?rid=1359000&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395656%26dopt%3DAbstract Authors: Calkins CM Outcomes are, simply put, why a surgeon comes to work each day. For decades, surgeons have insisted on a regular self-examination of outcomes to ensure the optimal treatment of our patients. Clinical research in pediatric surgery has largely subsisted on outcome analysis as it relates to the rudimentary end-result of an operation, utilizing variables such as mortality, operative time, specific complication rates, and hospital length of stay to name a few. Recently, outcomes research has become a more complex endeavor. This issue of Seminars in Pediatric Surgery addresses a wide array of these newfound complexities in contemporary outcomes research. The purpose of this review is to assist the pediatric surgeon in understanding the tools that are used in contemporary ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1359000 Wed, 09 Apr 2008 19:02:22 +0100 1359000 http://www.medworm.com/index.php?rid=1358999&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395657%26dopt%3DAbstract Authors: Rintala RJ, Pakarinen MP Anorectal malformations are common anomalies observed in neonates. Survival of these babies is currently achieved in most cases and improvements in operative technique, patient care, and better follow-up have led to improved functional results. A new, simplified classification system (Krickenbeck classification) and method of functional assessment has led to an improved understanding of these anomalies and has allowed for a better comparison of outcomes. Following successful anatomical repair and appropriate programs of bowel care, socially acceptable continence can be achieved in a majority of patients, especially those with an intact sacrum. PMID: 18395657 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358999 Wed, 09 Apr 2008 19:02:18 +0100 1358999 http://www.medworm.com/index.php?rid=1358998&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395658%26dopt%3DAbstract Authors: Tsao K, Lally KP The Congenital Diaphragmatic Hernia Registry (CDHR) was established to collect data on all infants treated at participating institutions with congenital diaphragmatic hernia (CDH) to assess therapy and improve outcome. Since 1995, the CDHR has accumulated data on over 4000 infants. The collective efforts of the CDH Study Group have provided valuable information regarding the efficacy of various therapeutic interventions and have tried to establish predictors of outcome. Because CDH is an uncommon, heterogeneous structural anomaly with a wide spectrum of severity, individual institutions may vary significantly in their experiences and treatment approaches. International multicenter registries, like the CDHR, are useful to provide clinically relevant direction b... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358998 Wed, 09 Apr 2008 19:02:14 +0100 1358998 http://www.medworm.com/index.php?rid=1358997&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395659%26dopt%3DAbstract Authors: Henry MC, Moss RL Necrotizing enterocolitis (NEC) remains a major cause of morbidity and death in neonates. The 30% to 50% mortality rate for NEC with perforation has not changed appreciably in the past 30 years. The critical relevant outcomes following NEC include survival, gastrointestinal function, and neurodevelopmental status. In each of these areas, initial anecdotal and case-series analysis has been followed by studies using more sophisticated methods of analysis. The single most important predictor of outcome, besides gestational age, is whether or not the disease has progressed to the point requiring surgical intervention. Patients with NEC requiring operation have a high mortality. Moreover, the vast majority of morbidity following NEC occurs in the patients who surv... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358997 Wed, 09 Apr 2008 19:02:08 +0100 1358997 http://www.medworm.com/index.php?rid=1358996&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395660%26dopt%3DAbstract This report will highlight outcomes studies in pediatric trauma care, often comparing outcomes by physician and hospital expertise. We will discuss pediatric trauma mortality and outcomes in abdominal, closed head, and orthopedic injuries with an emphasis on functional outcomes. Much of the data are derived from large regional and national databases, which are increasingly available and useful in the analysis of specific aspects of our health care delivery system. PMID: 18395660 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358996 Wed, 09 Apr 2008 19:02:04 +0100 1358996 http://www.medworm.com/index.php?rid=1358995&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395661%26dopt%3DAbstract Authors: Stringer MD Biliary atresia is a complex disorder dependent on multidisciplinary management. A series of comprehensive national audits in the United Kingdom and France exposed a clear relationship between center volume and clinical outcomes. Different models were adopted in each country in an attempt to improve results. In the United Kingdom, the management of biliary atresia was centralized to three specialist units in 1999, whereas in France, a strategy of decentralized management with closer inter-unit cooperation was adopted in 1997. Both policy changes led to improved outcomes for infants with biliary atresia, but only centralization improved the overall results of Kasai portoenterostomy. Other countries have adopted alternative systems of audit based on voluntary registr... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358995 Wed, 09 Apr 2008 19:02:01 +0100 1358995 http://www.medworm.com/index.php?rid=1358994&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395662%26dopt%3DAbstract Authors: Ryckman FC, Bucuvalas JC, Nathan J, Alonso M, Tiao G, Balistreri WF As the field of Liver Transplantation has matured, survival alone is no longer an acceptable single metric of success. This chapter explores the impact of the PELD system for donor organ allocation, surgical modification of donor organs, living donation, and long-term transplant-related complications on overall quality of life and outcome. Strategies to improve survival, overall outcome, and health-related quality of life in long-term recipients are outlined. PMID: 18395662 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358994 Wed, 09 Apr 2008 19:01:59 +0100 1358994 http://www.medworm.com/index.php?rid=1358993&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395663%26dopt%3DAbstract Authors: Dillon P, Hammermeister K, Morrato E, Kempe A, Oldham K, Moss L, Marchildon M, Ziegler M, Steeger J, Rowell K, Shiloach M, Henderson W Under the guidance of the American College of Surgeons (ACS) and in partnership with the US Department of Veterans Affairs (VA), the National Surgical Quality Improvement Program (NSQIP) has been developed to improve the quality of surgical care in adults on a national level. Its purpose is to provide reliable, risk-adjusted outcomes data so that surgical quality can be assessed and compared between institutions. Data analysis consists of reporting observed to expected ratios (O/E) for 30-day postoperative mortality and morbidity measurements. A surgical clinical nurse reviewer is assigned at each medical center to collect information on 97 var... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358993 Wed, 09 Apr 2008 19:01:55 +0100 1358993 http://www.medworm.com/index.php?rid=1358992&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395664%26dopt%3DAbstract Authors: Hoffman GM Improvement in anesthesia outcomes has derived from advances in safety science related to equipment, drugs, human factors analysis, professional standardization and organization, subspecialty care, and regionalization. Outcomes of pediatric anesthesia have improved, but universal outcome measures are lacking. Because of the limitations of small numbers, future improvement efforts will necessarily involve multiple disciplines, institutions, and regions, and will require sophisticated systems approaches. PMID: 18395664 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1358992 Wed, 09 Apr 2008 19:01:53 +0100 1358992 http://www.medworm.com/index.php?rid=1116949&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158135%26dopt%3DAbstract Authors: Klein MD PMID: 18158135 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116949 Thu, 27 Dec 2007 00:39:51 +0100 1116949 http://www.medworm.com/index.php?rid=1116948&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158136%26dopt%3DAbstract Authors: Shanti CM, Klein MD Cystic lung disease is divided into congenital and acquired lesions. Congenital cystic lung disease includes several malformations with distinct anatomical and histological features. There is significant overlap between these lesions to suggest a common pathologic mechanism for their occurrence. Congenital cystic lung lesions include cystic adenomatoid malformations, pulmonary sequestrations, congenital lobar emphysema, and peripheral bronchogenic cysts. These lesions are commonly diagnosed prenatally with high accuracy. Prenatal imaging has allowed us to better understand their natural history and devise strategies for prenatal and postnatal management. Some lesions warrant resection (even prenatally), whereas others can be managed expectantly. PMID: 1... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116948 Thu, 27 Dec 2007 00:39:50 +0100 1116948 http://www.medworm.com/index.php?rid=1116947&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158137%26dopt%3DAbstract Authors: Liechty KW, Flake AW Pulmonary vascular malformations have historically been diagnosed in a wide range of age groups, but the extensive use of prenatal imaging studies has resulted in the majority of lesions being diagnosed in utero. Among this group of lesions, bronchopulmonary sequestrations (BPS), hybrid lesions with both congenital cystic adenomatoid malformation (CCAM) and BPS, aberrant systemic vascular anastomoses, and pulmonary arteriovenous malformations (PAVM), are the most common. The biologic behavior of these lesions and the subsequent therapy is, in large part, determined by the age of the patient at diagnosis. In the fetus, large BPS or hybrid lesions can result in fetal hydrops and in utero fetal demise. In the perinatal period, pulmonary hypoplasia from the ma... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116947 Thu, 27 Dec 2007 00:39:47 +0100 1116947 http://www.medworm.com/index.php?rid=1116946&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158138%26dopt%3DAbstract Authors: Weldon CB, Shamberger RC Pediatric pulmonary tumors are rare. There is often a significant delay in diagnosis of pulmonary tumors secondary to their rarity and nonspecific presenting physiologic and radiographic findings. A high index of suspicion in pediatric patients with recurrent or persistent pulmonary symptoms is of paramount importance in diagnosing pulmonary tumors at an early stage. Malignant pulmonary tumors are more frequently diagnosed than benign lesions, with metastatic cancers being the most common. Complete surgical resection remains the basis of therapy for primary lesions, and its role in secondary cancers is becoming more established. Adjuvant therapies are frequently employed depending on the precise tumor involved. Mortality rates vary greatly depending on... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116946 Thu, 27 Dec 2007 00:39:45 +0100 1116946 http://www.medworm.com/index.php?rid=1116945&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158139%26dopt%3DAbstract Authors: Langenburg SE, Lelli JL Thoracoscopy of pediatric patients has evolved from diagnostic lung biopsy to a myriad of both diagnostic and therapeutic procedures. In this chapter, we discuss those procedures related to the child's lung which are most commonly performed: lung biopsy; resection of bronchogenic cysts, pulmonary sequestrations, and pulmonary lobes; and the treatment of spontaneous pneumothorax. PMID: 18158139 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116945 Thu, 27 Dec 2007 00:39:43 +0100 1116945 http://www.medworm.com/index.php?rid=1116944&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158140%26dopt%3DAbstract Authors: Frenckner B, Radell P Conventional treatment of respiratory failure involves positive pressure ventilation with high concentrations of inspired oxygen. If adequate gas exchange still cannot be achieved extracorporeal membrane oxygenation (ECMO) may be an option. The general indication for ECMO for respiratory insufficiency is a reversible pulmonary disease, which cannot be managed by conventional means. ECMO is a modified heart-lung machine. Blood is withdrawn from a central vein in the patient and pumped through an artificial oxygenator back to the patient, either to a central artery (veno-arterial ECMO) or to a central vein (veno-venous ECMO). Total gas exchange can be achieved through the extracorporeal system, and the lungs do not have to be subjected to high-pressure vent... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116944 Thu, 27 Dec 2007 00:39:40 +0100 1116944 http://www.medworm.com/index.php?rid=1116943&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158141%26dopt%3DAbstract This article focuses on the clinical presentation, etiology, and treatment of childhood pneumonia, with special consideration given to the immunocompromised child. Two specific complications of pneumonia, lung abscess and empyema, are discussed. PMID: 18158141 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116943 Thu, 27 Dec 2007 00:39:38 +0100 1116943 http://www.medworm.com/index.php?rid=1116942&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158142%26dopt%3DAbstract Authors: Tovar JA Thoracic trauma is relatively frequent in children and causes considerable mortality. This is mainly due to the multiorganic nature of the trauma. The lung is more often affected even in the absence of rib fractures because of the considerable pliability of the chest wall that allows direct transfer of energy to this organ. Injuries to the heart, the aorta, the esophagus, and the diaphragm are rare. Lung contusion and laceration cause parenchymal hemorrhage and consolidation sometimes accompanied by pneumothorax and/or hemothorax. Tracheobronchial disruption is rare but life-threatening. Most traumatic lung injuries may be treated with rest, respiratory support, and eventually intercostal drainage. Large hemorrhage may require thoracotomy, and persistent pneumothorax ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116942 Thu, 27 Dec 2007 00:39:36 +0100 1116942 http://www.medworm.com/index.php?rid=1116941&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18158143%26dopt%3DAbstract Authors: Cuenca AG, Beierle EA Cystic fibrosis (CF) has a variety of pulmonary manifestations that include pneumonia, pulmonary abscess, bronchiectasis, hemoptysis, and pneumothorax. Although newer therapies have greatly improved survival of patients with CF, surgical interventions for definitive treatment of these sequelae are often required. Several reports have illustrated that, with the current advances in the perioperative treatment and care of CF patients, surgical interventions for these pulmonary manifestations may be performed safely, resulting in a greatly improved quality of life. Also, although improvements in lung transplantation offer new hope for definitive treatment of those patients with cystic fibrosis, special considerations regarding other surgical issues, such as t... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=1116941 Thu, 27 Dec 2007 00:39:34 +0100 1116941 http://www.medworm.com/index.php?rid=954918&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933661%26dopt%3DAbstract Authors: Bax KN PMID: 17933661 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954918 Tue, 16 Oct 2007 23:39:38 +0100 954918 http://www.medworm.com/index.php?rid=954917&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933662%26dopt%3DAbstract Authors: Ure BM, Suempelmann R, Metzelder MM, Kuebler J The knowledge on the physiological impact of endoscopic surgery in infants and children is limited. Cardiovascular effects of pneumoperitoneum are mainly the result of an increase in intraabdominal pressure, absorption of carbon dioxide, and a stimulation of the neurohumoral vasoactive system. In infants, pneumoperitoneum alters the heart rate, mean arterial pressure, left ventricular endsystolic and end-diastolic volume, and meridional wall stress. Urine production is significantly reduced, and cerebral oxygenation and blood flow are altered. However, postoperative immune function is preserved or restored faster, and specific physiological responses to endoscopic surgery are well tolerated by otherwise healthy infants and childre... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954917 Tue, 16 Oct 2007 23:39:37 +0100 954917 http://www.medworm.com/index.php?rid=954916&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933663%26dopt%3DAbstract Authors: van der Zee DC, Bax KN Single center experience with thoracoscopic repair of esophageal atresia with distal fistula and of tracheomalacia. Between May 2000 and December 2006, 51 neonates with an esophageal atresia were presented for thoracoscopic repair. Gestational age varied from 31 3/7 to 42 2/7 weeks (M = 37 2/7). Birth weight was between 1025 g and 4030 g (mean 2620 g). Concomitant anomalies or VACTERL asociation were encoutered in 31 patients (61%). Duration of the operation was from 90 minutes to 390 minutes (mean 178 minutes). All but 1 patient had an esophageal atresia with a distal fistula. Six patients had tracheomalacia requiring aortopexia, which was performed thoracoscopically. In 2 patients the thoracoscopic procedure had to be converted to a thoracotomy. All ot... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954916 Tue, 16 Oct 2007 23:39:34 +0100 954916 http://www.medworm.com/index.php?rid=954915&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933664%26dopt%3DAbstract Authors: Rothenberg SS Thoracoscopy in infants and children has undergone a dramatic evolution in the last 30 years. From its infancy in the mid-1970s, limited procedures such as biopsy and pleural lysis, were pioneered by Rogers and others, and in the late 1990s, the most delicate of procedures, a tracheo-esophageal fistula repair, was performed thoracoscopically for the first time. During the last 20 years, it has become clear that the most commonly performed thoracic procedures in the pediatric age group, lung biopsy and resection, are clearly best performed using these advanced thoracoscopic techniques. New instrumentation and advanced skills now make thoracoscopic lung resection the preferred approach and help avoid the significant morbidity associated with thoracotomy in the pedi... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954915 Tue, 16 Oct 2007 23:39:32 +0100 954915 http://www.medworm.com/index.php?rid=954914&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933665%26dopt%3DAbstract Authors: Becmeur F, Reinberg O, Dimitriu C, Moog R, Philippe P Minimal invasive surgery (MIS) has been first proposed in case of delayed congenital diaphragmatic hernia (CDH). Since then, about 32 cases of thoracoscopic CDH approach in newborns have been published. Conditions of thoracoscopy are reviewed and enlightened with our preliminary series. The advantages of thoracoscopy versus a laparoscopic approach are detailed. Since 1999, all children presenting with CDH after the immediate neonatal period were offered a MIS approach. We started treating stable newborns suffering a CDH by thoracoscopic procedures in 2003. In cases of late presentations, 10 thoracoscopies and 1 laparoscopy were performed. Among them, 4 patients suffered from an incarcerated hernia. One conversion to a thora... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954914 Tue, 16 Oct 2007 23:39:30 +0100 954914 http://www.medworm.com/index.php?rid=954913&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933666%26dopt%3DAbstract Authors: Bax KN, van der Zee DC Hyperinsulinemic hypoglycemia (HH) in children requiring surgery is rare. Early HH can be the result of focal or diffuse pancreatic pathology. A number of genetic abnormalities in early HH have been identified, but in the majority of patients no abnormality is found. The sporadic focal and diffuse forms as well the autosomal recessive form are particularly therapy-resistant and demand for early surgery. Preoperative discrimination between focal and diffuse disease in early HH is difficult. 18 F DOPA PET in combination with CT is promising as is laparoscopic exploration of the pancreas. Frozen section biopsy analysis has not been uniformly beneficial. If macroscopically no focal lesion is found, limited laparoscopic distal pancreatectomy provides tissue f... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954913 Tue, 16 Oct 2007 23:39:28 +0100 954913 http://www.medworm.com/index.php?rid=954912&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933667%26dopt%3DAbstract This article outlines the etiology for recurrent gastroesophageal reflux disease, presentation of the patient with wrap failure or transmigration, steps which the authors have taken to help prevent these complications from developing, and our approach for those patients who require re-operation. PMID: 17933667 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954912 Tue, 16 Oct 2007 23:39:26 +0100 954912 http://www.medworm.com/index.php?rid=954911&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933668%26dopt%3DAbstract Authors: Iwanaka T, Kawashima H, Uchida H Neuroblastoma is one of the most common solid tumors, and the biopsy and excision of this tumor are often required as part of a planned multimodal treatment. In 1995, Holcomb and coworkers first reported endosurgical procedures for the diagnosis and treatment of pediatric malignancies; however, the usefulness of laparoscopic procedures for abdominal neuroblastoma is still unclear. Twenty-five laparoscopic biopsies for advanced abdominal neuroblastoma and nine laparoscopic excisions for localized abdominal neuroblastoma performed at Saitama Children's Medical Center were evaluated. The laparoscopic procedures significantly reduce the time to start postoperative feeding as well as the time to start postoperative chemotherapy and the duration of h... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954911 Tue, 16 Oct 2007 23:39:24 +0100 954911 http://www.medworm.com/index.php?rid=954910&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933669%26dopt%3DAbstract Authors: Georgeson K Posterior sagittal anorectoplasty (PSARP) is the procedure most commonly employed to repair high and intermediate anorectal malformations. Many patients repaired by PSARP subsequently require bowel management to avoid the physiologic and social problems associated with fecal incontinence. Laparoscopic assisted anorectal pull-through (LAARP) is a recently developed technique which positions the neorectum accurately inside the sphincter complex without dividing any of these muscles. Some physiologic measurements after LAARP indicate that outcomes are at least equivalent to PSARP. Long-term outcomes have not been reported after LAARP. PMID: 17933669 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954910 Tue, 16 Oct 2007 23:39:22 +0100 954910 http://www.medworm.com/index.php?rid=954909&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933670%26dopt%3DAbstract Authors: Valla JS Even if no large comparative studies enable us to definitely confirm the potential advantages of minimal retroperitoneoscopic access surgery, this new technique is now expanding in pediatric urology and considered today as feasible and safe in well-trained hands. The technique is described in detail; the main indications are presented from the classical ablative surgery, like total or partial nephrectomy, to more advanced reconstructive surgery, like pyeloplasty, retrocaval ureter, and stone disease. The success rate is similar to open surgery. However, the advanced laparoscopic skills needed for reconstructive surgery in children may limit its widespread application. PMID: 17933670 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954909 Tue, 16 Oct 2007 23:39:21 +0100 954909 http://www.medworm.com/index.php?rid=954908&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17933671%26dopt%3DAbstract This article details the technique and reports the results of the use of operative laparoscopy for the treatment of uterovaginal anomalies in children and adolescents. The author's experience demonstrates some"nonclassical" applications of endosurgery in the management of these anomalies in the pediatric age. PMID: 17933671 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=954908 Tue, 16 Oct 2007 23:39:19 +0100 954908 http://www.medworm.com/index.php?rid=710613&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602968%26dopt%3DAbstract Authors: Alexander F PMID: 17602968 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710613 Tue, 03 Jul 2007 15:18:10 +0100 710613 http://www.medworm.com/index.php?rid=710612&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602969%26dopt%3DAbstract Authors: Kugathasan S, Fiocchi C A modern approach to inflammatory bowel disease (IBD) research has been under way for little over one-half century, but only during the last two decades has progress accelerated and finally generated tangible results that have been translated into practical and better therapeutic strategies. The areas where progress has been more evident are those currently believed to be the key components of IBD pathogenesis, and include the environment, genetics, enteric microbiology, and immune reactivity. Progress in these different areas has been somewhat uneven, yielding a better understanding of the mechanisms behind gut inflammation and tissue injury rather than of specific etiological agents or predisposing factors. However, with the rapidly increasing utiliza... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710612 Tue, 03 Jul 2007 15:18:08 +0100 710612 http://www.medworm.com/index.php?rid=710611&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602970%26dopt%3DAbstract Authors: Gramlich T, Petras RE Inflammatory bowel disease in childhood refers to ulcerative colitis, Crohn's disease, and colitis of an indeterminate type. Their gross and microscopic features are discussed along with the differential diagnosis from other childhood conditions associated with bloody diarrhea. PMID: 17602970 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710611 Tue, 03 Jul 2007 15:18:07 +0100 710611 http://www.medworm.com/index.php?rid=710610&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602971%26dopt%3DAbstract Authors: Carvalho R, Hyams JS Upwards of 100,000 children and adolescents are affected by inflammatory bowel disease (IBD) in the United States, and the incidence of IBD appears to be increasing worldwide. Although the diagnosis and differentiation of Crohn's disease or ulcerative colitis is still based on clinical, radiographic, endoscopic, and histological findings, newer less invasive serological tests are being employed to help distinguish these disorders and provide prognostic information to possibly guide therapy. Videocapsule endoscopy has increased our ability to detect previously unrecognized small bowel inflammation in selected patients. Whereas initial therapy has historically included aminosalicylates and corticosteroids, recent data suggest the limited efficacy of aminosal... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710610 Tue, 03 Jul 2007 15:18:05 +0100 710610 http://www.medworm.com/index.php?rid=710609&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602972%26dopt%3DAbstract Authors: Dolgin SE Burill Crohn's convincing description of the disease that now carries his name conceived of the illness as arising exclusively from the terminal ileum, involving other sites only secondarily. As a result, he took the condition to be curable by an adequate operative resection. The current concept is that Crohn's disease may affect any segment of the gastrointestinal tract. The practical implication of this change in thinking is the need to conserve bowel when weighing medical and surgical options for each child. Operations should be used to treat complications of the disease. Absolute indications for the surgery are uncommon and include perforation, bleeding, and refractory obstruction. The margins of resection need only include a short amount of grossly normal intest... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710609 Tue, 03 Jul 2007 15:18:04 +0100 710609 http://www.medworm.com/index.php?rid=710608&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602973%26dopt%3DAbstract Authors: Moir CR Crohn's disease in childhood is changing. The incidence is increasing, colonic disease is becoming more prevalent in younger children, and colon reconstruction is more acceptable. Genetic phenotypes are influencing decisions for surgery, and targeted immunotherapy has renewed hope for more durable remissions following less extensive resections. The tasks facing the surgeon evaluating a child with Crohn's colitis include confirming the specific diagnostic subtype and selecting the correct procedure. This chapter will review the unique aspects of pediatric Crohn's colitis and the increased complexity of surgical choice for this most challenging presentation. Recent success with less extensive surgery offers renewed hope for children with intractable colonic disease. ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710608 Tue, 03 Jul 2007 15:18:03 +0100 710608 http://www.medworm.com/index.php?rid=710607&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602974%26dopt%3DAbstract Authors: Strong SA Perianal Crohn's disease in children is a potentially debilitating condition that can precede or follow the intestinal disease component. The perianal abnormalities are varied and can include lesions of the perianal skin or anal canal, abscesses or fistulas, and malignancies. The appropriate management of these problems is predicated on a thorough evaluation of the perineum and anus as well as the remainder of the alimentary tract. Therapy usually includes a combination of antibiotics, immunomodulators, and biologic agents as well as conservative operative procedures. The surgical options are intended to safely ameliorate disease-related symptoms without compromising function or continence. PMID: 17602974 [PubMed - in process] (Source: Seminars in Pediatric Surge... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710607 Tue, 03 Jul 2007 15:18:02 +0100 710607 http://www.medworm.com/index.php?rid=710606&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602975%26dopt%3DAbstract Authors: Lillehei CW Total colectomy with ileal pouch-anal anastomosis has emerged as the preferred surgical treatment for ulcerative colitis. The operation has evolved over the last few decades. Various technical issues are discussed, including types of reservoir, options for mesenteric lengthening, method and level of ileoanal anastomosis (hand-sewn versus stapled), and rationale for staging. Anticipated postoperative problems and strategies for management are discussed. PMID: 17602975 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710606 Tue, 03 Jul 2007 15:18:01 +0100 710606 http://www.medworm.com/index.php?rid=710605&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602976%26dopt%3DAbstract Authors: Alexander F Ileal pouch anal anastomosis (IPAA) is associated with complications in a significant number of patients, including ileal-anal separation, anal stricture, pouchitis, pelvic sepsis, and small bowel obstruction. In most cases, these complications may be successfully treated using either medical or surgical therapy and do not result in long-term pouch dysfunction. Important preventative measures include accrual of experience or creation of a team with experienced surgical leadership and scrupulous selection of patients who have no features of Crohn's disease. Despite these precautions, 5% to 15% of patients will develop chronic pouch dysfunction and pouch failure requiring diversion with or without excision of the pouch. Medical measures, such as antibiotics, immunomo... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710605 Tue, 03 Jul 2007 15:17:59 +0100 710605 http://www.medworm.com/index.php?rid=710604&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17602977%26dopt%3DAbstract Authors: Kayton ML Cancer in children may be mistakenly diagnosed as inflammatory bowel disease (IBD), and specific cancers may develop in patients who truly have IBD. Ulcerative colitis patients historically carry an increased risk of colorectal adenocarcinoma, but current practices of surveillance and early surgery may have an impact on this. Crohn's disease patients require surveillance for colon cancer, but are also likely to be at increased risk for small bowel tumors and lymphoma. Some malignancies affecting IBD patients are sequelae of immunomanipulation, performed in the interest of IBD therapy itself. Knowing the cancer risks associated with IBD and those associated with agents used for IBD treatment, and practicing long-term surveillance for these tumors, are central componen... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=710604 Tue, 03 Jul 2007 15:17:58 +0100 710604 http://www.medworm.com/index.php?rid=598240&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462558%26dopt%3DAbstract Authors: Lally KP PMID: 17462558 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598240 Tue, 01 May 2007 04:00:00 +0100 598240 http://www.medworm.com/index.php?rid=598239&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462559%26dopt%3DAbstract Authors: Miniati D The maladaptive response of the pulmonary vasculature that occurs in patients with congenital diaphragmatic hernia significantly impacts outcome. Muscularized distal pulmonary arterioles inhibit the ability of the neonate to adjust to extrauterine circulation, resulting in severe pulmonary hypertension. This review summarizes the current state of knowledge regarding normal and abnormal development of the lung vascular system and identifies current and potential therapies directed toward preserving or restoring proper pulmonary vascular function. PMID: 17462559 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598239 Tue, 01 May 2007 04:00:00 +0100 598239 http://www.medworm.com/index.php?rid=598238&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462560%26dopt%3DAbstract Authors: Scott DA Congenital diaphragmatic hernia (CDH) is a common structural birth defect that affects approximately 1 in 2500 live births. Although the exact etiology of most cases of CDH remains unknown, it is becoming increasingly clear that genetic factors play an important role in many cases of CDH. In this paper, we review critical findings in the areas of clinical and basic research that highlight the importance of genetics in the development of CDH. We also provide practical information that can aid physicians and surgeons as they evaluate and care for patients with isolated, nonisolated, and syndromic forms of CDH and their families. PMID: 17462560 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598238 Tue, 01 May 2007 04:00:00 +0100 598238 http://www.medworm.com/index.php?rid=598237&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462561%26dopt%3DAbstract Authors: Clugston RD, Greer JJ Advances in the understanding of normal diaphragm embryogenesis have provided the necessary foundation for novel insights into the pathogenesis of congenital diaphragmatic hernia (CDH). Although diaphragm formation is still not completely understood, we have identified key structures and periods of development that are clearly abnormal in animal models of CDH. The pleuroperitoneal fold (PPF) is a transient structure which is the target for the neuromuscular component of the diaphragm. The PPF has been shown to be abnormal in multiple animal models of Bochdalek CDH; specifically, a malformation of the nonmuscular component of this tissue is thought to underlie the later defect in the complete diaphragm. Based on data from animal models and the examination ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598237 Tue, 01 May 2007 04:00:00 +0100 598237 http://www.medworm.com/index.php?rid=598236&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462562%26dopt%3DAbstract Authors: Kitano Y Advances in prenatal ultrasound have revealed the poor natural history of fetal congenital diaphragmatic hernia (CDH) and its hidden mortality during gestation and immediately after birth. Attempts to improve this poor outcome led to the development of prenatal surgical intervention for severe CDH by Harrison and his colleagues at the University of California San Francisco. Prenatal surgical intervention for CDH has seen four phases: open fetal surgical repair, open surgical tracheal occlusion, endoscopic external tracheal occlusion, and endoscopic endoluminal tracheal occlusion. After extensive work in the laboratory, prenatal intervention has been applied in humans since 1984. With the most recent techniques, maternal risk is significantly reduced as is the incidenc... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598236 Tue, 01 May 2007 04:00:00 +0100 598236 http://www.medworm.com/index.php?rid=598235&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462563%26dopt%3DAbstract Authors: Harting MT, Lally KP Congenital diaphragmatic hernia (CDH) is one of the most challenging and complex pediatric abnormalities to manage, both medically and surgically. The care of these neonates has seen significant evolution, from previous aggressive ventilation and emergent operation to current permissive hypercapnea, physiologic stabilization, and elective surgical repair, all in less than two decades. These changes have led to many centers reporting survival rates near 80%, a dramatic improvement from the 50% survival reported in the 1970s. This review covers the current principles guiding the surgical management of CDH in the neonate, including preoperative stabilization, operative timing, extracorporeal membrane oxygenation, surgical approach, and management of recurrenc... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598235 Tue, 01 May 2007 04:00:00 +0100 598235 http://www.medworm.com/index.php?rid=598234&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462564%26dopt%3DAbstract Authors: Logan JW, Cotten CM, Goldberg RN, Clark RH Most infants with congenital diaphragmatic hernia (CDH) require respiratory support. The goal of this report is to present an overview of mechanical ventilation strategies in the management of infants with CDH. The anatomic and physiologic limitations in the lungs of infants with diaphragmatic hernia make decisions on the best strategy and use of mechanical ventilation challenging. We will briefly review lung development in infants with CDH, identifying factors that provide a basis for lung protection strategies. Background on the use of specific mechanical ventilation modes and the rationale for each are provided. Finally, we review mechanical ventilation practices described in published case series of successful CDH management, with... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598234 Tue, 01 May 2007 04:00:00 +0100 598234 http://www.medworm.com/index.php?rid=598233&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462565%26dopt%3DAbstract Authors: Mohseni-Bod H, Bohn D Clinically significant pulmonary hypertension (PHTN) is a common finding in newborn infants with congenital diaphragmatic hernia (CDH) resulting in right to left shunting at pre- and postductal level, hypoxemia, and acute right heart failure in those most severely affected. Even in those without clinical manifestations of ductal shunting, cardiac echo studies would suggest that increased pulmonary vascular resistance and right ventricular pressures are almost a universal finding in this disease, and in some instances, may persist well into the postnatal period. The lung is small and structurally abnormal, and the pulmonary vascular bed is not only reduced in size, but responds abnormally to vasodilators. During the last 20 years, "gentle" ventilation, del... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598233 Tue, 01 May 2007 04:00:00 +0100 598233 http://www.medworm.com/index.php?rid=598232&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17462566%26dopt%3DAbstract Authors: Bagolan P, Morini F With improving treatment strategies for congenital diaphragmatic hernia (CDH) infants, an increase in survival of more severely affected patients can be expected. Consequently, more attention is now focused on long-term follow up of these patients. Many reports have emphasized associated morbidity, including pulmonary sequelae, neurodevelopmental deficits, gastrointestinal disorders, and other abnormalities. Therefore, survivors of CDH remain a complex patient population to care for throughout infancy and childhood, thus requiring long-term follow up. Much information has been provided from many centers regarding individual institutional improvements in overall survival. Few of these, however, have reported long-term follow up. The aim of this review is to ... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=598232 Tue, 01 May 2007 04:00:00 +0100 598232 http://www.medworm.com/index.php?rid=351331&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17210477%26dopt%3DAbstract Authors: Snyder CL PMID: 17210477 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=351331 Fri, 12 Jan 2007 13:46:02 +0100 351331 http://www.medworm.com/index.php?rid=351330&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17210478%26dopt%3DAbstract Authors: Tracy TF, Muratore CS Head and neck masses are a common clinical concern in infants, children, and adolescents. The differential diagnosis for a head or neck mass includes congenital, inflammatory, and neoplastic lesions. An orderly and thorough examination of the head and neck with an appropriate directed workup will facilitate the diagnosis. The most common entities occur repeatedly within the various age groups and can be differentiated with a clear understanding of embryology and anatomy of the region, and an understanding of the natural history of a specific lesion. Congenital lesions most commonly found in the pediatric population include the thyroglossal duct cyst and the branchial cleft and arch anomalies. The inflammatory masses are secondary to local or systemic infe... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=351330 Fri, 12 Jan 2007 13:46:02 +0100 351330 http://www.medworm.com/index.php?rid=351329&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17210479%26dopt%3DAbstract Authors: Engum SA Thoracoscopy was initially described for use in children to obtain pulmonary biopsy samples in the immunocompromised patient. With refinements in technique, development of better instrumentation, and advances in pediatric anesthesia, there are now many diagnostic and therapeutic indications for the use of thoracoscopy in children. One of the most common indications includes pleural debridement for empyema. Many centers consider this the optimal approach for biopsy of mediastinal lesions and excision of bronchogenic or duplication cysts. The technique is useful for pleural disorders, such as spontaneous pneumothorax and chylothorax. Thoracoscopy has been used to achieve exposure for spinal diskectomy in children with thoracic scoliosis, and newer techniques are being d... Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=351329 Fri, 12 Jan 2007 13:46:02 +0100 351329 http://www.medworm.com/index.php?rid=351328&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17210480%26dopt%3DAbstract This article reviews the diagnostic work up and imaging, preoperative resuscitation, the various surgical approaches used, and the effect of subspecialty training on outcomes after pyloromyotomy. Postoperative care and the variety of postoperative feeding regimens applied after pyloromyotomy are reviewed, as well as intra- and postoperative complications. Finally, medical management, in lieu of surgery, is discussed. PMID: 17210480 [PubMed - in process] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=351328 Fri, 12 Jan 2007 13:46:02 +0100 351328 http://www.medworm.com/index.php?rid=351327&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17210481%26dopt%3DAbstract This article examines the most debated aspects of the diagnosis and management of the diseased pediatric appendix. PMID: 17210481 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=351327 Fri, 12 Jan 2007 13:46:02 +0100 351327 http://www.medworm.com/index.php?rid=351326&cid=s_33252_33_f&fid=33252&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D17210482%26dopt%3DAbstract Authors: Snyder CL Prenatally, the umbilicus is of paramount importance, providing the gateway between the mother and the fetus. As the fetus becomes increasingly autonomous at the end of the second month of fetal life, the connections (vitelline, urachal) diminish in significance and involute. Disturbances in this process can result in a wide variety of abnormalities, ranging from relatively minor defects identified at birth (umbilical granulation tissue) to life-threatening complications quiescent until late adulthood (urachal carcinoma). This section will review the 'state of the art' in evaluation and management of these umbilical and related abnormalities. PMID: 17210482 [PubMed - as supplied by publisher] (Source: Seminars in Pediatric Surgery) Seminars in Pediatric Surgery journals http://www.medworm.com/rss/comments.php?id=351326 Fri, 12 Jan 2007 13:46:02 +0100 351326