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ABSTRACT: The incidence of Clostridium difficile-associated disease (CDAD) in the adult population doubled in the past decade, with increasing morbidity and mortality; however, little research has been performed in the pediatric population. We characterized C difficile infection in the pediatric population, with emphasis on the surgical population.
At a university-based children's hospital, we reviewed 231 patient (birth to 18 years of age) records containing a diagnosis of CDAD between January 1, 2002, and December 31, 2008.
Clostridium difficile-associated disease incidence increased from 250 per 100,000 hospitalizations in 2002 to 580 per 100,000 hospitalizations in 2008. No fatalities or surgical interventions were attributable to CDAD. Eighty-seven percent of patients received antibiotics within 2 months of diagnosis. Fifty-two percent of patients underwent operative intervention within 2 months of diagnosis; of these, 89% percent received previous antibiotic therapy and 57% were immunosuppressed. The most common antecedent procedures were bone marrow biopsy and line placement for myelodysplastic diseases (40%), followed by renal transplant (11%).
Pediatric CDAD incidence doubled during the study period but was not associated with death or operative intervention. A substantial number of CDAD cases were associated with previous operative procedures, particularly in immunosuppressed patients and those who received prior antibiotics.
Journal of Pediatric Surgery 07/2012; 47(7):1385-9. · 1.45 Impact Factor
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ABSTRACT: Echocardiographic analysis of patent ductus arteriosus (PDA), proximal left main pulmonary artery (LPA) and descending thoracic aorta (Ao) dimensions in preterm infants who undergo surgical ligation of the PDA. A discussion for percutaneous ductal occlusion in preterm infants.
Echocardiographic analysis of the LPA diameter, PDA diameter, PDA length, and descending thoracic aorta diameter in 55 preterm infants who underwent surgical ligation of the PDA from 2004 to 2008. Patients were stratified by weight into four groups: those less than 750 g, 751-1,000 g, 1,001-1,250 g, and those greater than 1,250 g. Mean and standard deviation for each structure dimension was calculated in each weight group. Structural dimensions were compared between groups using ANOVA for multiple comparisions.
The mean patient weight was 1,018 g (560-2,400 g). The mean ductal length was 4.1 mm (2.5-5.3 mm). The mean ductal diameter was 2.2 mm (1.5-3.6 mm). The mean LPA diameter was 3 mm (1.5-4.5 mm). The mean aortic diameter was 4.3 mm (2.7-7.8 mm). The alpha value for between weight groups for PDA length was 0.21, PDA diameter 0.16, LPA diameter 0.39, and aortic diameter 0.1.
No statistical significance was seen when comparing structure dimension by weight. This suggests uniform structural dimensions across a broad weight distribution in this patient population. To date, there has been no attempt to standardize dimensions of these vascular structures. The information gathered in this study may be useful in developing an implantable device for ductal occlusion in preterm infants. (ECHOCARDIOGRAPHY 2010;27:575-579).
Echocardiography 03/2010; 27(5):575-9. · 1.24 Impact Factor
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ABSTRACT: Idiopathic chronic childhood constipation (ICCC) includes children who are severely constipated and who are resistant to behavioral or medical treatments. These children are distinguished from those with Hirschsprung's disease (HSCR) by the presence of enteric ganglia in rectal biopsy specimens. We investigated potential autonomic dysfunction by examining nerves in rectal mucosa.
Immunostaining, confocal microscopy, and nerve analysis were performed on formalin-fixed and on Zamboni-fixed rectal biopsy specimens from children who were severely constipated. A computer-assisted neuron tracing technique was used to determine mucosal nerve density in Zamboni-fixed biopsy sections.
Nerves in Zamboni-fixed biopsy specimens were better stained than in formalin-fixed biopsy specimens. Regardless of fixation method, a deficiency of mucosal nerves was observed in ICCC when compared to children who are not constipated. Analysis of autotraced mucosal nerves confirmed the deficiency in ICCC biopsy specimens. Mucosal nerves were also severely deficient in patients with HSCR, even in transitional segments that contained ganglia.
Most patients with ICCC had decreased innervation of the rectal mucosa. Because mucosal nerves are critical for the peristaltic reflex, water secretion, and absorption, their deficiency can be related to patient constipation. Mucosal nerve density provides a pathologic basis for diagnosis of dysfunction in children who do not have HSCR but are chronically constipated. The study validates the neuron tracing method for objective evaluation of mucosal innervation.
Journal of Pediatric Surgery 05/2009; 44(4):773-82. · 1.45 Impact Factor
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ABSTRACT: Complications from previously published techniques for laparoscopic gastrostomy tube placement include skin pressure necrosis and extraluminal migration. We developed a modified technique utilizing subcutaneous stay-sutures in order to minimize such complications. This study aimed to identify, quantify, and characterize complications of the modified procedure.
Charts were reviewed of all pediatric patients undergoing laparoscopic gastrostomy tube placement over 79 months. Complications requiring reoperation, readmission, or outpatient treatment were identified and classified as major or minor.
Laparoscopic gastrostomy tubes were placed via modified procedure in 82 patients. Two (2.44%) high-risk patients with significant comorbidities were readmitted for wound infections, two (2.44%) received outpatient antibiotics for cellulitis, and three (3.66%) developed stitch abscesses which resolved with local care. None of the patients had initial intraperitoneal placement, intraperitoneal location upon tube replacement, extraluminal migration, tube-related pressure necrosis, or procedure-related death.
Subcutaneous placement of absorbable stay-sutures for laparoscopic gastrostomy tubes offers significant benefits. We eliminated complications associated with presence of external sutures, as well as those associated with early suture removal. This modified technique avoids additional visits for suture removal, avoids pressure necrosis from external stay-sutures, and provides improved adherence of stomach to abdominal wall, thereby preventing extraluminal migration and intraperitoneal tube replacement.
Pediatric Surgery International 03/2009; 25(4):349-53. · 1.25 Impact Factor
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ABSTRACT: Yolk sac tumors (YSTs) represent 3% of malignancies in childhood and most commonly arise in the gonads. Hepatic YSTs are rare and previous reported cases were treated with resection and/or chemotherapy with mixed results. We present the first case of an unresectable hepatic YST in a 2-year-old boy treated successfully with liver transplantation.
Journal of Pediatric Surgery 08/2005; 40(7):1185-7. · 1.45 Impact Factor
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ABSTRACT: Inflammatory myofibroblastic tumor (IMT), popularly known as inflammatory pseudotumor, is a slow growing quasi-neoplastic lesion with a distinct histologic appearance and benign clinical course. A case of a neck IMT with infiltration into the trachea causing asthmalike symptoms in a 12-year-old girl is described. Both tracheal and neck IMT have been described, but no other case has displayed this infiltration. A review of the pertinent literature and the etiology, diagnosis, treatment, and outcomes of this tumor are discussed. It is important to consider IMT in a differential diagnosis because it can be easily misdiagnosed as a malignancy. A surgeon must not perform radical surgery, radiation, or chemotherapy until a final pathologic diagnosis is made because of the nature of this lesion.
Journal of Pediatric Surgery 11/2004; 39(10):e1-4. · 1.45 Impact Factor
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ABSTRACT: Obesity has become a health-care crisis in the United States. Adolescent obesity is now one of the most common childhood disorders, with 4.7 million American adolescents having a body mass index (BMI) greater than the 95th percentile. Most patients do not respond to diet modification or exercise programs and attention is now turning toward surgery as a source of weight loss in adolescents. Few studies have looked at the overall morbidity and mortality of weight loss surgery in this patient population.
This is a retrospective study of medical charts of 15 bariatric surgical procedures performed on 14 adolescents without known genetic syndromes associated with severe childhood obesity from 1971 to 2001 at the University of Minnesota. Procedures performed on these patients included vertical banded gastroplasty (n = 7), Roux-en-Y gastric bypass (n = 5), and jejunoileal bypass (n = 3). Jejunoileal bypass procedures were performed from 1971 to 1977, after which time this procedure was abandoned. Patient age ranged from 13 to 17 years (mean, 15.7 years). Mean follow-up time was 6 years, with 9 patients available for long-term follow-up.
All procedures were performed using an open technique by 1 surgeon. There were no perioperative deaths; complications included 1 case of wound infection, 2 episodes of dumping syndrome that resolved without revision, 1 episode of hypoglycemia, and 1 case of short-term electrolyte imbalance in a patient who underwent jejunoileal bypass. The average BMI dropped from 58.5 +/- 13.7 to 32.1 +/- 9.7 kg/m(2) (P < .01)--a 45% reduction.
Surgery for morbid obesity is safe and results in significant weight loss in adolescents who fail medical therapy.
Surgery for Obesity and Related Diseases 1(4):394-8. · 3.93 Impact Factor
