A CT scan-based formula for predicting central venous catheter length in pediatric patients.

PURPOSE: Placement of a central venous catheter (CVC) is the most commonly performed pediatric procedure. This study aims to develop simple formulas to calculate intravascular length of CVCs prior to insertion to minimize reliance on fluoroscopic and radiographic imaging, which may not be uniformly available. METHODS: We performed a single-institution, retrospective review of 115 pediatric patients who received both CVC placement and computed tomography (CT) imaging of the chest within 3 months of the procedure. Using measurements from the CT imaging, formulas calculating the length of the intravascular component of the CVC based on height and insertion laterality were developed and compared to previously published formulas. These formulas were then trialed prospectively to validate reliability and application. RESULTS: Formulas were developed for right-sided and left subclavian insertion. The right-side formula accurately predicted CVC length in 52.6% of patients, compared to 47.4% by the Andropoulos formula. The left subclavian formula accurately estimated 62.5%, compared to 34.5% by the Stroud formula. CONCLUSIONS: The optimal intravascular length of central venous catheters may be determined by simple formulas based on patient height and insertion site. LEVEL OF EVIDENCE: III.

Management of intravascular thrombus in cases of bilateral Wilms tumor or horseshoe kidney.

PURPOSE: To describe the oncologic and surgical management of bilateral Wilms tumor or Wilms tumor arising in a horseshoe kidney with intravenous tumor thrombus to help pediatric surgeons negotiate this rare and difficult anatomic circumstance. METHODS: A single-institution, retrospective medical record review identified 4 cases of bilateral WT and one case of WT arising in a horseshoe kidney with intravenous tumor thrombus between 2009 and 2021. The presentation, imaging, chemotherapy regimen, intraoperative approach, and surgical and oncologic outcomes were reviewed for each of these patients. RESULTS: All patients received a total of 12 weeks of neoadjuvant chemotherapy. In two patients, a staged approach to the bilateral tumors was undertaken with the first side being operated on after six weeks of therapy and the other side undergoing surgery after an additional six weeks of therapy. Of five patients, four underwent nephron-sparing surgery of all tumors and one underwent unilateral radical nephroureterectomy with contralateral nephron-sparing surgery. Tumor thrombectomy was performed in four of five cases; one patient demonstrated a complete response of the intravenous tumor thrombus to neoadjuvant chemotherapy and did not require thrombectomy. Three patients received adjuvant flank radiotherapy. Three patients developed medically managed stage II or III chronic kidney disease and no patient required renal replacement therapy or kidney transplant to date. CONCLUSION: Nephron-sparing surgery is feasible and safe to perform in selected cases of bilateral Wilms tumor with intravascular thrombus by utilizing three-drug neoadjuvant chemotherapy, staged approaches to each kidney when appropriate, and detailed preoperative and/or intraoperative mapping of renal venous anatomy. Successful nephron-sparing surgery with tumor thrombectomy is dependent on a branched renal venous system or the presence of accessory renal veins. LEVEL OF EVIDENCE: Level 4.

Pancreatoduodenectomia en el Hospital Nacional Rosales, estudio de cinco años 2012 a 2017 / Pancreatoduodenectomy at the Rosales National Hospital, five-year study from 2012 to 2017

La Pancreatoduodenectomia cefálica (PD) es una de las cirugías abdominales con relativa alta morbilidad y mortalidad. Es el único procedimiento quirúrgico disponible para tratar el cáncer de la cabeza del páncreas y en la zona periampular. Por ser el Hospital Nacional Rosales el centro de referencia de tercer nivel, nos parece necesario conocer sus indicaciones, manejo y evolución. Se utilizó un diseño observacional, de seguimiento de una cohorte de pacientes sometidos a dicha cirugía en ese centro en el periodo de enero 2012 a octubre 2017, basado en fuentes documentales. Se identificaron 15 expedientes de pacientes. El diagnóstico más frecuente fue el adenocarcinoma de la ampolla de Vater. El 80% de los casos fueron ASA I. Se prefirió la disección y reconstrucción clásica. La tasa de morbilidad fue del 86.6% y de mortalidad de 46.6% siendo la mayoría de las causas de muerte, causas sistémicas. El HNR se comporta como un centro de bajo volumen para PD. La morbilidad y la mortalidad son altas