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1.
Am Surg ; 88(3): 532-533, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33284025

RESUMO

We believe this to be the first case report of jejunosigmoid bypass harboring small bowel adenocarcinoma. The mechanism of malignant degeneration could be similar to that of carcinogenesis of ureterosigmoidostomy that is of historical interest. This case represents an example of why it is imperative for surgeons to be diligent in their preparation and workup of a patient before a complex operation, especially in patients with peculiar or unknown surgical histories.


Assuntos
Adenocarcinoma/etiologia , Colo Sigmoide/cirurgia , Neoplasias Duodenais/etiologia , Jejuno/cirurgia , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/cirurgia , Neoplasias Duodenais/cirurgia , Feminino , Humanos
2.
Am J Surg ; 216(3): 524-527, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29203037

RESUMO

INTRODUCTION: Anastomotic leak and conduit necrosis are devastating complications following Ivor Lewis esophagectomy. Near infrared imaging (NIR) using IndoCyanine Green allows for real time tissue perfusion assessment which may reduce anastomotic leak during minimally invasive Ivor Lewis esophagectomy (MIE). METHODS: Forty consecutive MIE were performed by a single surgeon at a tertiary referral center. The first 20 were assessed for gastric conduit perfusion by clinical criteria (Group 1). The second 20 were also assessed using NIR laparoscopic system (Group 2). RESULTS: Comparing Group 1 to Group 2, no significant differences were found in overall complication rate, readmission or reoperation rate. NIR resulted in resection of the non perfused proximal portion of the conduit in 30% (6/20). Two patients in group 2 group developed anastomotic leak (2/20) compared to 0 in Group 1 (p = 0.49). Graft necrosis led to one mortality in Group 1, while there were 0 mortalities in Group 2. (p = 1.0). CONCLUSION: Although NIR plays a role in assessment of tissue perfusion, in our study its use did not result in reduction of anastomotic leak rate.


Assuntos
Fístula Anastomótica/prevenção & controle , Esofagectomia/métodos , Verde de Indocianina/farmacologia , Laparoscopia/métodos , Imagem Óptica/métodos , Procedimentos de Cirurgia Plástica/métodos , Estômago/irrigação sanguínea , Idoso , Anastomose Cirúrgica/métodos , Fístula Anastomótica/diagnóstico , Angiografia/métodos , Corantes/farmacologia , Feminino , Seguimentos , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estômago/cirurgia
3.
J Laparoendosc Adv Surg Tech A ; 27(12): 1279-1283, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28777676

RESUMO

BACKGROUND: Standard treatment for locally advanced esophageal cancer includes neoadjuvant therapy followed by surgical resection. However, many patients experience a period of decreased oral intake during neoadjuvant treatment and are at risk for malnutrition. We hypothesize that use of jejunostomy tube (j-tube) feedings during neoadjuvant therapy in selected patients may be associated with better perioperative outcomes. METHODS: A prospectively collected database at a single institution was retrospectively analyzed. The study period was from 2005 to 2015. Patients who underwent j-tube placement before neoadjuvant therapy before definitive resection for esophageal cancer were included in the analysis. Perioperative outcomes were compared between patients who adhered to recommended tube feeds during neoadjuvant therapy (users) and patients who did not adhere (nonusers). RESULTS: During the study period, 94/301 patients received a j-tube before or during neoadjuvant therapy for esophageal cancer. Seventy-three patients utilized tube feeds regularly during the neoadjuvant phase, while 21 patients did not. The groups did not differ significantly with respect to clinical factors such as dysphagia on presentation, postneoadjuvant therapy performance status, or Charlson Comorbidity Index. Perioperative pneumonia rates were lower in j-tube users compared to nonusers (6.8% [5 of 73] versus 23.8% [5 of 21]), respectively, P = .036); this difference remained significant with adjustment for type of surgery (odds ratio = 0.16, P = .018). CONCLUSIONS: j-Tube users had a significantly lower incidence of pneumonia within 30 days of curative resection when compared to nonusers. j-Tube feedings during neoadjuvant therapy for selected patients with locally advanced esophageal cancer should be encouraged.


Assuntos
Nutrição Enteral/métodos , Neoplasias Esofágicas/terapia , Intubação Gastrointestinal/métodos , Jejunostomia/métodos , Terapia Neoadjuvante/métodos , Adulto , Idoso , Nutrição Enteral/efeitos adversos , Feminino , Humanos , Intubação Gastrointestinal/efeitos adversos , Jejunostomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
4.
Pediatr Surg Int ; 32(7): 701-4, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27278391

RESUMO

PURPOSE: In 2011, we established a dedicated center for patients with chest wall deformities. Here, we evaluate the center's effect on patient volume and management. METHODS: A retrospective review of 699 patients with chest wall anomalies was performed. Patients were compared, based on the date of initial consultation, before the pectus center opened (July 2009-June 2011, Group 1) versus after (July 2011-June 2013, Group 2). Analysis was performed utilizing Chi-square and Mann-Whitney U tests. RESULTS: 320 patients were in Group 1 and 379 in Group 2, an 18.4 % increase in patient volume. Excavatum patients increased from 172 (Group 1) to 189 (Group 2). Carinatum patients increased from 125 (Group 1) to 165 (Group 2). Patients undergoing operative repair of carinatum/mixed defects dropped significantly from 15 % (Group 1) to 1 % (Group 2) (p < 0.01), whereas those undergoing nonoperative bracing for carinatum/mixed defects rose significantly from 19 % (Group 1) to 63 % (Group 2) (p < 0.01). Patients traveled 3-1249 miles for a single visit. CONCLUSION: Initiating a dedicated pectus center increased patient volume and provided an effective transition to nonoperative bracing for carinatum patients. The concentrated focus of medical staff dedicated to chest wall deformities has allowed us to treat patients on a local and regional level.


Assuntos
Tórax em Funil/cirurgia , Modelos Organizacionais , Centros Cirúrgicos/organização & administração , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos
5.
Pediatr Surg Int ; 32(7): 665-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27220493

RESUMO

PURPOSE: Literature reports worse outcomes for operations performed during off-hours. As this has not been studied in pediatric extracorporeal life support (ECLS), we compared complications based on the timing of cannulation.. METHODS: This is a retrospective review of 176 pediatric ECLS patients between 2004 and 2015. Patients cannulated during daytime hours (7:00 A.M. to 7:00 P.M., M-F) were compared to off-hours (nighttime or weekend) using t-test and Chi-square. RESULTS: The most common indications for ECLS were congenital diaphragmatic hernia (33 %) and persistent pulmonary hypertension (23 %). When comparing regular hours (40 %) to off-hours cannulation (60 %), there were no significant differences in central nervous system complications, hemorrhage (extra-cranial), cannula repositioning, conversion from venovenous to venoarterial, mortality on ECLS, or survival-to-discharge. The overall complication rate was slightly lower in the off-hours group (45.7 % versus 61.9 %, P = 0.034). CONCLUSION: Outcomes were not significantly worse for patients undergoing ELCS cannulation during off-hours compared to normal weekday working hours.


Assuntos
Cateterismo/normas , Anormalidades Congênitas/terapia , Oxigenação por Membrana Extracorpórea/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo
6.
J Pediatr Surg ; 51(9): 1490-1, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26949145

RESUMO

PURPOSE: Historically, a chest radiograph was obtained after central line placement in the operating room. Recent retrospective studies have questioned the need for this radiograph. The prevailing current practice at our center is to order chest radiograph only for symptomatic patients. This study examines the outcomes of selective chest radiography after fluoroscopic guided central line placement. METHODS: After obtaining institutional review board approval, a single institution retrospective chart review of patients undergoing central venous catheter placement by the pediatric surgery or interventional radiology service between January 2010 and July 2014 was performed. Outcome measures included CXR within 24h of catheter placement, reason for chest radiograph, complication, and complication requiring intervention. RESULTS: In the study population 622 catheters were placed under fluoroscopy. A chest radiograph was performed in 118 (19%) patients within 24h of the line placement with 25 (4%) of these patients being symptomatic in the recovery room. One patient required chest tube for shortness of breath and pleural effusion. Four symptomatic patients (0.6%) were found to have a pneumothorax, none of which required chest tube placement. There were no re-operations because of mal-position of the catheter. In the 504 patients with no postoperative chest x-ray, there were no adverse outcomes. At our institution the current average charge of a chest radiograph is $283, thus we produced savings of $142,632 for the study period without adverse events. CONCLUSION: After placement of central venous catheter under fluoroscopic guidance, a chest radiograph is unlikely to be helpful in an asymptomatic patient.


Assuntos
Cateterismo Venoso Central/métodos , Derrame Pleural/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia Intervencionista , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/economia , Análise Custo-Benefício , Fluoroscopia , Humanos , Missouri , Derrame Pleural/economia , Derrame Pleural/etiologia , Pneumotórax/economia , Pneumotórax/etiologia , Complicações Pós-Operatórias/economia , Radiografia Torácica/economia , Estudos Retrospectivos
7.
J Pediatr Surg ; 51(8): 1279-82, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26876090

RESUMO

BACKGROUND: Hypertrophic pyloric stenosis (HPS) is the most common diagnosis requiring surgery in infants. Electrolytes are used as a marker of resuscitation for these patients prior to general anesthesia induction. Often multiple fluid boluses and electrolyte panels are needed, delaying operative intervention. We have attempted to predict the amount of IV fluid boluses needed for electrolyte correction based on initial values. METHODS: A single center retrospective review of all patients diagnosed with HPS from 2008 through 2014 was performed. Abnormal electrolytes were defined as chloride <100mmol/L, bicarbonate ≥30mmol/L or potassium >5.2 or <3.1mmol/L. Patients with abnormal electrolytes were resuscitated with 20ml/kg saline boluses and continuous fluids at 1.5 times maintenance rate. RESULTS: During the study period 542 patients were identified with HPS. Of the 505 who were analyzed 202 patients had electrolyte abnormalities requiring IV fluid resuscitation above maintenance, and 303 patients had normal electrolytes at time of diagnosis. Weight on presentation was significantly lower in the patients with abnormal electrolytes (3.8 vs 4.1kg, p<0.01). Length of stay was significantly longer in the patients with electrolyte abnormalities, 2.6 vs 1.9days (p<0.01). Fluid given was higher over the entire hospital stay for patients with abnormal electrolytes (106 vs 91ml/kg/d, p<0.01). The number of electrolyte panels drawn was significantly higher in patients with initial electrolyte abnormalities, 2.8 vs 1.3 (p<0.01). Chloride was the most sensitive and specific indicator of the need for multiple saline boluses. Using an ROC curve, parameters of initial Cl(-)80mmol/L and the need for 3 or more boluses AUC was 0.71. Modifying the parameters to initial Cl(-) ≤97mmol/L and 2 boluses AUC was 0.65. A patient with an initial Cl(-)85 will need three 20ml/kg boluses 73% (95% CI 52-88%) of the time. A patient with an initial Cl(-) ≤97 will need two 20ml/kg boluses at a rate of 73% (95% CI 64-80%). CONCLUSION: Children with electrolyte abnormalities at time of diagnosis of HPS have a longer length of stay; require more fluid resuscitation and more lab draws. This study reveals high sensitivity and specificity of presenting chloride in determining the need for multiple boluses. We recommend the administration of two 20ml/kg saline boluses separated by an hour prior to rechecking labs in patients with initial Cl(-) value ≤97mmol/L. If the presenting Cl(-) <85 three boluses of 20ml/kg of saline separated by an hour are recommended. If implemented these modifications have potential to save time by not delaying care for extraneous lab results and money in the form of fewer lab draws.


Assuntos
Hidratação , Estenose Pilórica Hipertrófica/terapia , Bicarbonatos/sangue , Cloretos/sangue , Eletrólitos/sangue , Feminino , Humanos , Lactente , Masculino , Potássio/sangue , Estenose Pilórica Hipertrófica/cirurgia , Curva ROC , Ressuscitação , Estudos Retrospectivos , Sensibilidade e Especificidade , Cloreto de Sódio/uso terapêutico
8.
J Pediatr Surg ; 51(4): 541-4, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26732283

RESUMO

BACKGROUND: Inflammatory myofibroblastic tumor (IMFT) is an uncommon neoplasm in children. METHODS: Retrospective review from 1993 to 2014 of patients ≤18years of age with a histopathologic diagnosis of IMFT treated at two tertiary centers. RESULTS: Thirty-two patients were diagnosed with IMFT. Mean (±SD) age was 9.3±5.7years at diagnosis. Tumor location was variable: abdomen/pelvis (28%), head/neck region (22%), intrathoracic (22%), genitourinary (9%), bowel (6%) liver (6%), and musculoskeletal (6%). Median follow-up was 2.6±4.6years, with 3 recurrences and 2 deaths, which occurred only after recurrence. Positive microscopic margin after resection was associated with recurrence, compared to those that had a negative margin (40% vs. 0%, p=0.04). Recurrence was associated with increased mortality (67% vs 0%, p=0.01). Time from first symptoms to resection was shorter in those with recurrence (25.8±22 vs. 179±275days, p=0.01) and in nonsurvivors (44.0±8.0 vs. 194.3±53.4days, p=0.02). Adjuvant chemotherapy, not including steroid monotherapy, either given before or after resection, was administered more often to nonsurvivors (100% vs 4%, p=0.009), and use of corticosteroids was also higher in the nonsurvivors (100% vs. 15%, p=0.04). CONCLUSIONS: IMFT is a rare pediatric neoplasm with variable locations. Complete excision is critical for cure. Proposed guidelines for diagnosis, treatment and surveillance of theses tumors in children are reported.


Assuntos
Granuloma de Células Plasmáticas , Adolescente , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Criança , Pré-Escolar , Feminino , Seguimentos , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/tratamento farmacológico , Granuloma de Células Plasmáticas/mortalidade , Granuloma de Células Plasmáticas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
J Laparoendosc Adv Surg Tech A ; 26(1): 62-5, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26779726

RESUMO

INTRODUCTION: Traditionally open resection with hepaticojejunostomy (HJ) reconstruction has been the surgical treatment for cases of choledochal cyst. Our center has recently transitioned from open to laparoscopic and HJ to hepaticoduodenostomy (HD) as our preferred method of excision and biliary reconstruction. Our initial experience is presented here. MATERIALS AND METHODS: A single-center retrospective chart review was performed from 2005 to 2014. All patients undergoing surgical treatment for choledochal disease were considered. RESULTS: During the study period 18 patients had surgical treatment for choledochal cyst disease. The average age of all patients was 4.7 years (range, 2 months-15.5 years). Eleven of these patients had laparoscopic excision and reconstruction. Of these 11 patients, 7 had an HD anastomosis. Comparing the laparoscopic with the open group and the HD with the HJ group, there was no significant difference in operative time, estimated blood loss, time to regular diet, length of stay, or complication rate. Mean follow-up of 3.1 years revealed no documented cases of bile reflux or cholangitis. A recent adaptation in technique may improve ease of HD anastomosis. In this method, two strands of temporary monofilament suture cut to 8-10 cm each are tied extracorporeally. This knot is then placed on the outside of the medial corner. The anastomosis is then completed in a running fashion with the two strands and then secured intracorporeally at the lateral corner. CONCLUSIONS: Laparoscopic choledochal cyst resection with both HJ and HD reconstruction appears safe and has equivalent outcomes to open procedures in our series.


Assuntos
Cisto do Colédoco/cirurgia , Duodeno/cirurgia , Jejuno/cirurgia , Laparoscopia , Fígado/cirurgia , Adolescente , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Colangite/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Laparoendosc Adv Surg Tech A ; 25(12): 1040-3, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26258954

RESUMO

INTRODUCTION: An upper gastrointestinal (UGI) series is a standard preoperative test for patients being evaluated for gastrostomy tube placement. We have recently begun to question the value of the radiation-exposing series in patients who tolerate gastric feeds. MATERIALS AND METHODS: A retrospective review was conducted in patients who underwent laparoscopic gastrostomy tube placement between 2000 and 2012. Demographics, indication for gastrostomy tube, comorbidities, preoperative imaging, and nutrition were analyzed. Patients with foregut pathology and those who underwent prior gastrointestinal surgery were excluded. RESULTS: Among 695 patients who underwent laparoscopic gastrostomy tube placement, the most common indications were failure to thrive (53%), neurologic disorder (25%), and dysphagia (12%). A UGI series was obtained for 420 patients (60%). Of these, 96 were found to have abnormalities (reflux, aspiration, anatomic). However, only 2 of these patients (0.3%) had a change in management, with 1 patient undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy for suspected malrotation. In the subset analysis of 256 patients tolerating goal gastric feeds, 161 (63%) had a preoperative UGI series with only 2 patients (1.2%) having a resultant change in operative management: 1 undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy. Of the 275 patients who did not have a preoperative UGI series, 1 patient (0.4%) was found to have malrotation postoperatively after two coins became lodged in the duodenum. This patient subsequently underwent an elective Ladd procedure. CONCLUSIONS: We found minimal impact of an UGI series during evaluation for gastrostomy alone. These studies may be able to be reserved for those with clear clinical indications.


Assuntos
Tomada de Decisão Clínica , Gastrostomia/métodos , Laparoscopia/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos Desnecessários , Trato Gastrointestinal Superior/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cuidados Pré-Operatórios/estatística & dados numéricos , Radiografia , Estudos Retrospectivos , Adulto Jovem
11.
J Pediatr Surg ; 50(11): 1937-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26100690

RESUMO

BACKGROUND: Minimally invasive bar repair for pectus patients produces substantial pain which dictates the post-operative hospital course. We have data from 2 randomized trials comparing epidural catheter placement to patient controlled analgesia. The purpose of this study was to compare the outcomes of patients who were enrolled in the trials to those that did not participate in the trials. METHODS: A retrospective chart review was performed on patients not enrolled in the trials to compare to the prospective datasets from October 2006 to June 2014. Perioperative outcomes were examined. RESULTS: There were 135 patients in a study protocol (IS) and 195 patients that were not enrolled in a study (OS). Comparing the entire IS and OS groups, length of stay was less in the IS group, as was time to regular diet. Average pain scores, operative time and complication rates were not significantly different between the groups. Of the IS patients a significantly lower number of patients had epidural failure, requiring substitution of a PCA for pain control. CONCLUSIONS: There are benefits derived from participating in our randomized trials comparing epidural to patient controlled analgesia after bar placement for pectus excavatum regardless of which arm is utilized.


Assuntos
Analgesia Controlada pelo Paciente , Anestesia Epidural , Tórax em Funil/cirurgia , Dor Pós-Operatória/prevenção & controle , Adolescente , Anestésicos/administração & dosagem , Feminino , Fentanila/administração & dosagem , Humanos , Hidromorfona/administração & dosagem , Tempo de Internação , Masculino , Midazolam/administração & dosagem , Duração da Cirurgia , Manejo da Dor , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
12.
J Surg Res ; 196(2): 320-4, 2015 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-25824668

RESUMO

BACKGROUND: Chemical fibrinolysis has been shown to be as effective as surgical debridement for the treatment of pediatric empyema. However, no studies effectively evaluate antibiotic treatment. We evaluated antibiotic utilization among different treatments of pediatric empyema. METHODS: This is a retrospective review of 169 empyema patients who underwent chemical and/or mechanical fibrinolysis at a dedicated children's hospital from 2005-2013. Data points included duration of therapy, cultures, presence of necrosis or abscess, and adverse drug reactions. Immunocompromised patients and those with additional foci of infection were excluded. RESULTS: Twenty-seven patients underwent video-assisted thoracoscopic surgery (VATS), 123 had chemical fibrinolysis via tube thoracostomy with tissue plasminogen activator (tPA), and 19 had tPA followed by VATS. The mean (± standard deviation) duration of total antibiotic therapy was 25.7 ± 6.5 d; following a 24 h afebrile period of 19.4 ± 6.3 d. Patients who had tPA had a significantly shorter duration of parenteral antibiotic therapy when compared with primary VATS (9.2 ± 3.6 d versus 11.6 ± 5.5 d, P = 0.04) and VATS following tPA (9.2 ± 3.6 d versus 14.3 ± 8.1 d, P < 0.01). Patients with necrosis or abscess (n = 26) had an increased total duration of antibiotics (29.3 ± 5.7 d versus 25.1 ± 6.4 d, P < 0.01). Seventy patients (41%) had an adverse reaction related to antibiotic use. CONCLUSIONS: Patients with empyema currently receive a protracted variable course of antibiotic therapy influenced by primary treatment and the presence of necrosis or abscess. With a high incidence of adverse reactions, a standardized protocol with truncated treatment duration should be considered.


Assuntos
Antibacterianos/uso terapêutico , Empiema Pleural/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
13.
J Surg Res ; 195(2): 418-21, 2015 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-25770737

RESUMO

BACKGROUND: Although the safety of same day discharge (SDD) after laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis (SC) and biliary dyskinesia (BD) in adults has been well documented in the literature, the same data in the pediatric population are lacking. We have recently instituted a protocol for SDD after LC for SC and BD, and this study is an analysis of our initial experience. METHODS: A retrospective chart review of all patients who underwent LC for BD and SC in our institution from January 2011-July 2014 was performed. RESULTS: A total of 227 LC were performed for SC and BD during the study period. Approximately 25% (n = 57) of patients were in the SDD group. The remaining 75% (n = 170) of patients were admitted at least overnight stay (ONS) for the following reasons: medical 16.5% (n = 28), surgery ending too late 4.1% (n = 7), or clinical care habits 79.4% (n = 135). Comparing the SDD group with ONS group, no differences were found in the complication rate, readmissions, or follow up before scheduled appointment. Length of stay was significantly less for the SDD group than for the ONS. A trend for more SDDs was observed as time elapsed from initiation of the protocol. Also, earlier completion of surgery trended toward SDD. CONCLUSIONS: SDD appears safe for pediatric patients undergoing LC for BD or SC. The main obstacles to discharge were time of surgery completion and clinical care habits, both of which improved as comfort level with SDD grew among the staff.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Discinesia Biliar/cirurgia , Colecistectomia Laparoscópica , Colelitíase/cirurgia , Adolescente , Criança , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Humanos , Masculino , Estudos Retrospectivos
14.
J Pediatr Intensive Care ; 4(1): 10-15, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31110844

RESUMO

Blunt abdominal trauma is an important cause of pediatric morbidity and mortality. The spleen and liver are the most common abdominal organs injured. Trauma to either organ can result in life-threatening bleeding. Controversy exists regarding which patients should be imaged and the correct imaging modality depending on the level of clinical suspicion for injury. Nonoperative management of blunt abdominal trauma is the standard of care for hemodynamically stable patients. However, the optimal protocol to maximize patient safety while minimizing resource utilization is a matter of debate. Adjunctive therapies for pediatric spleen and liver trauma are also an area of ongoing research. A review of the current literature on the diagnosis, management, and follow-up of pediatric spleen and liver blunt trauma is presented.

15.
J Pediatr Intensive Care ; 4(1): 16-20, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31110845

RESUMO

The pediatric patient is especially prone to blunt renal trauma due to the size and location of pediatric kidneys. No clear guidelines have been established for the management of these injuries in children to achieve the highest rate of renal salvage with low morbidity. Wide-ranging literature exists on this subject, but consists of vastly different management strategies. This review is written to summarize the different approaches to blunt renal trauma and highlight opportunities for further research.

16.
Case Rep Surg ; 2012: 316147, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22966475

RESUMO

Focal intestinal perforation (FIP) has long been described in the pediatric literature. Peritoneal drainage (PD) is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP. The infant recovered well from this episode and was discharged home without known sequelae. Subsequently, the same patient presented 16 months later with peritonitis. A perforation was discovered at laparotomy without evidence of surrounding necrosis. Given this finding, we believe this second episode of perforation was at the same site as the initial episode of FIP. The finding of FIP has been described without findings of surrounding necrosis. However, we believe this to be the first report of delayed perforation greater than 1 year from initial presentation after FIP treated definitively with peritoneal drain.

17.
Bioorg Chem ; 33(1): 16-21, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15668179

RESUMO

A 120 member library of peptidocalix[4]arenes was synthesized and screened for catalysis of the hydrolysis of p-nitrophenyl acetate. His-Ser-His-calix[4]arene was found to catalyze this reaction with v(0)=3.24 x 10(-8)M/s, an increase of 1520% above background and 30% above the tripeptide (His-Ser-His) alone.


Assuntos
Hidrocarbonetos Aromáticos com Pontes/química , Calixarenos/síntese química , Hidrólise , Oligopeptídeos/química , Fenóis/síntese química , Hidrocarbonetos Aromáticos com Pontes/farmacologia , Calixarenos/farmacologia , Catálise , Modelos Químicos , Nitrofenóis/química , Oligopeptídeos/farmacologia , Fenóis/farmacologia , Fatores de Tempo
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