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Ganka Douglas,
Marni E Axelrad,
Mary L Brandt,
Elizabeth Crabtree,
Jennifer E Dietrich,
Shannon French,
Sheila Gunn,
Lefkothea Karaviti, Monica E Lopez,
Charles G Macias,
Laurence B McCullough,
Deepa Suresh,
Elise Austin,
V Reid Sutton
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ABSTRACT: Children born with disorders of sexual differentiation (DSD) pose numerous challenges for the parents, family, and treating physicians. The pediatrician is usually the first medical contact for newborns with DSD or for toddlers and children who present with DSD at a later time.Several years ago, we formed a Gender Medicine Team (GMT) at Baylor College of Medicine and Texas Children's Hospital (TCH) to explore and evaluate the most appropriate management strategies, which had long been a matter of concern and contention. Subsequently, the GMT, composed of experts in the fields of endocrinology, ethics, genetics, gynecology, psychology, pediatric surgery, and urology, formed a Task Force to evaluate the information available from our own experiences and from reviews of the literature. Utilizing the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system to assess the evidence and recommendations, the Task Force developed a consensus statement for clinical management of DSD and for making appropriate sex assignments.
Pediatric Annals 04/2012; 41(4):e1-7. · 0.48 Impact Factor
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ABSTRACT: Our center previously reported its experience with pediatric gallbladder disease and cholecystectomies from 1980 to 1996. We aimed to determine the current clinical characteristics and risk factors for symptomatic pediatric gallbladder disease and cholecystectomies and compare these findings with our historical series.
Retrospective, cross-sectional study of children, 0 to 18 years of age, who underwent a cholecystectomy from January 2005 to October 2008.
We evaluated 404 patients: 73% girls; 39% Hispanic and 35% white. The mean age was 13.10 ± 0.91 years. The primary indications for surgery in patients 3 years or older were symptomatic cholelithiasis (53%), obstructive disease (28%), and biliary dyskinesia (16%). The median BMI percentile was 89%; 39% were classified as obese. Of the patients with nonhemolytic gallstone disease, 35% were obese and 18% were severely obese; BMI percentile was 99% or higher. Gallstone disease was associated with hemolytic disease in 23% (73/324) of patients and with obesity in 39% (126/324). Logistic regression demonstrated older age (P = .019) and Hispanic ethnicity (P < .0001) as independent risk factors for nonhemolytic gallstone disease. Compared with our historical series, children undergoing cholecystectomy are more likely to be Hispanic (P = .003) and severely obese (P < .0279).
Obesity and Hispanic ethnicity are strongly correlated with symptomatic pediatric gallbladder disease. In comparison with our historical series, hemolytic disease is no longer the predominant risk factor for symptomatic gallstone disease in children.
PEDIATRICS 12/2011; 129(1):e82-8. · 4.47 Impact Factor
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Ganka Douglas,
Marni E Axelrad,
Mary L Brandt,
Elizabeth Crabtree,
Jennifer E Dietrich,
Shannon French,
Sheila Gunn,
Lefkothea Karaviti, Monica E Lopez,
Charles G Macias,
Laurence B McCullough,
Deepa Suresh,
V Reid Sutton
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ABSTRACT: The Gender Medicine Team (GMT), comprised of members with expertise in endocrinology, ethics, genetics, gynecology, pediatric surgery, psychology, and urology, at Texas Children's Hospital and Baylor College of Medicine formed a task force to formulate a consensus statement on practice guidelines for managing disorders of sexual differentiation (DSD) and for making sex assignments. The GMT task force reviewed published evidence and incorporated findings from clinical experience. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence presented in the literature for establishing evidence-based guidelines. The task force presents a consensus statement regarding specific diagnostic and therapeutic issues in the management of individuals who present with DSD. The consensus statement includes recommendations for (1) laboratory workup, (2) acute management, (3) sex assignment in an ethical framework that includes education and involvement of the parents, and (4) surgical management.
International Journal of Pediatric Endocrinology 01/2010; 2010:919707.
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ABSTRACT: Interval appendectomy may be advisable after successful nonoperative treatment of perforated appendicitis. To reduce the perceived morbidity of interval appendectomy, we sought to determine if the operation could be done on an outpatient basis. This study is focused on patient comfort and safety after laparoscopic interval appendectomy (LIA).
This is a retrospective review of the clinical course and length of stay of 24 children who had LIA during a 4-year period.
Of the 24 patients, 12 were discharged on the evening of surgery without incident. Nine additional patients were observed for the first postoperative night-2 for short episodes of temperature elevation, 3 for pain treated within the first 4 hours of recovery and requiring no further treatment, and 4 because the idea of outpatient appendectomy had yet to become popular. None of these patients was febrile overnight, none required narcotic or parenteral analgesics after leaving the recovery room, and all accepted feedings without nausea or vomiting. It is likely that all 9 of these patients could have been discharged on the day of operation. Three other patients stayed in the hospital for treatment of pain, low-grade fever, or slow resumption of feeding.
Of 24 patients, 21(88%) were or could have been discharged on the day of operation. When interval appendectomy is indicated, LIA can be performed safely as an outpatient surgical procedure in most children.
Journal of Pediatric Surgery 12/2008; 43(11):1970-2. · 1.45 Impact Factor
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ABSTRACT: Gastric diverticulum is a rare entity; the patient usually presents with vague abdominal pain, nausea, vomiting, and weight loss. Diverticulectomy is required for patients with intractable symptoms or complications. We report the laparoscopic excision of a gastric diverticulum in a 15-year-old girl who had been symptomatic for 5 years. A five-port technique and a linear cutting and stapling device were used.
Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2007; 17(2):246-8. · 1.40 Impact Factor
