Current trends in the surgical treatment of pediatric ovarian torsion: we can do better.

INTRODUCTION: Current literature strongly recommends ovarian preservation for pediatric patients with ovarian torsion. The purpose of this study was to evaluate national trends in the surgical management of pediatric ovarian torsion and to compare outcomes between pediatric surgeons (PED) and gynecologists (GYN). METHODS: We queried Pediatric Health Information System (PHIS) data from 2007 to 2011 for patients <18years old with a diagnosis of ovarian torsion who underwent a surgical procedure. Patients with malignant disease were excluded. Outcomes were compared between pediatric surgeons and gynecologists. RESULTS: A total of 1151 patients were identified with a mean age of 10.7±4.1years with a bimodal distribution. Pediatric surgeons performed the majority of procedures (81%) and were more likely to use a laparoscopic approach (PED 27% vs. GYN 17%, p<.05). Pediatric surgeons were more likely to perform an oophorectomy (PED 38% vs. GYN 27%, p<.01), and more likely to administer antibiotics for this clean procedure (PED 61% vs. GYN 29%, p<.001). The overall reoperation rate was 5.1% and did not differ significantly by subspecialty (PED 4.4% vs. GYN 7.8%, p>.05). CONCLUSIONS: These data demonstrate a significant opportunity for pediatric surgeons and gynecologists to improve ovarian salvage rates and to reduce unnecessary antibiotic utilization for children with ovarian torsion.

Cardiac conduction through engineered tissue.

In children, interruption of cardiac atrioventricular (AV) electrical conduction can result from congenital defects, surgical interventions, and maternal autoimmune diseases during pregnancy. Complete AV conduction block is typically treated by implanting an electronic pacemaker device, although long-term pacing therapy in pediatric patients has significant complications. As a first step toward developing a substitute treatment, we implanted engineered tissue constructs in rat hearts to create an alternative AV conduction pathway. We found that skeletal muscle-derived cells in the constructs exhibited sustained electrical coupling through persistent expression and function of gap junction proteins. Using fluorescence in situ hybridization and polymerase chain reaction analyses, myogenic cells in the constructs were shown to survive in the AV groove of implanted hearts for the duration of the animal's natural life. Perfusion of hearts with fluorescently labeled lec-tin demonstrated that implanted tissues became vascularized and immunostaining verified the presence of proteins important in electromechanical integration of myogenic cells with surrounding re-cipient rat cardiomyocytes. Finally, using optical mapping and electrophysiological analyses, we provide evidence of permanent AV conduction through the implant in one-third of recipient animals. Our experiments provide a proof-of-principle that engineered tissue constructs can function as an electrical conduit and, ultimately, may offer a substitute treatment to conventional pacing therapy.