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ABSTRACT: We report a 26-week gestational age newborn who developed an entero-enteric fistula associated with a small bowel stricture following a mild episode of necrotizing enterocolitis. The fistula led to a delay in the diagnosis and surgical treatment of the stricture, and should therefore be considered in the setting of partial or intermittent obstruction in the newborn who has had necrotizing enterocolitis.
European Journal of Pediatric Surgery 05/2005; 15(2):137-9. · 0.81 Impact Factor
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ABSTRACT: OBJECTIVE: The sonographic double wall sign has been well described in the literature and is often the cornerstone in suggesting the diagnosis of an enteric duplication cyst. We report two cases with this sign that were erroneously diagnosed as enteric cysts and a third case without this sonographic feature that proved to be a duplication cyst. Histologic analysis of the specimens helps explain the cause of the sonographic pitfalls. CONCLUSION: The potential sonographic visualization of the split hypoechoic muscularis propria layer or identification of all five layers will increase the specificity in making the sonographic diagnosis of duplication cyst.
American Journal of Roentgenology 03/2005; 184(2):521-5. · 2.78 Impact Factor
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ABSTRACT: The training of general surgeons in pediatric surgery is an important educational role of pediatric surgeons (PS). The authored surveyed this training process and the related expectations and perceptions of competence.
The authors surveyed all practicing members of the Canadian Association of Paediatric Surgeons (CAPS) in Canada, all general surgery program directors (PD), and all final year general surgery residents (GS). Questions included exposure to pediatric surgery, expected and perceived competence in managing common pediatric general surgical problems, and trainee practice intentions.
Response rate to date was 51% from PS, 69% from PD, and 19% from GS. Sixty-seven percent of PS considered the exposure to pediatric surgery satisfactory, yet only 1 of 7 residents planning on pursuing general surgery felt adequately prepared. Trainees were expected to be competent in the conditions polled by 65% of PS and 74% of PD, yet only 38% of the trainees actually felt competent in them. The largest discrepancies were found for infant hernia, newborn colostomy, and cryptorchidism. Presence of a fellowship program and size of training program had no impact on perceived competence.
Training of general surgeons in pediatric surgery varies across Canadian programs. Perceived resident competence often lags behind program and faculty expectations. These data can be used for directing educational priorities in general surgery programs.
Journal of Pediatric Surgery 06/2001; 36(5):706-10. · 1.45 Impact Factor
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ABSTRACT: To estimate the costs of Canadian pediatric trauma and identify cost predictors.
A chart review.
A regional trauma centre. STUDY MATERIAL: The charts of all 221 children who suffered traumatic injuries with an Injury Severity Score (ISS) of 4 or more seen over 6 years at a regional trauma centre.
Patient data, injury data, all hospital-based costs, excluding nursing, food and medication costs.
Mean (and standard deviation) patient age was 12.8 (5) years. Sixty percent were boys. Motor vehicle accidents (MVAs) accounted for 71% of the injuries, followed by falls (11%). The mean (and SD) total cost of care was Can$7,582 (Can$12,370), and the cost of media was Can$2,666. Total cost correlated directly with age (r = 0.29, p < 0.001) and Injury Severity Score (ISS) (r = 0.34, p < 0.001) and inversely with the Pediatric Trauma Score (PTS) (r = -0.20, p = 0.003). The presence of extremity injuries correlated significantly with total cost (r = 0.22, p = 0.001) and PTS (r = -0.25, p < 0.001) but not with the ISS. Logistic regression analysis identified runk injury, ISS and PTS as the main determinants of survival.
The cost of pediatric trauma in Canada can be predicted from admission data and trauma scores. The cost of extremity injuries is significant and can be predicted by the PTS but not the ISS.
Canadian journal of surgery. Journal canadien de chirurgie 04/2001; 44(2):117-21. · 1.05 Impact Factor
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ABSTRACT: Unilateral ovarian agenesis (UOA) and fallopian descent problems are very rare congenital defects. We present an unusual case of UOA associated with fallopian-tube maldescent discovered incidentally during a laparotomy in a female infant for a persistent heterogeneous right ovarian cyst refractory to needle aspiration. A necrotic, hemorrhagic paratubal cyst was found associated with a normal right adnexa. The left ovary was absent and a rudimentary left fallopian tube was found tightly stretched over the sigmoid colon to the left retroperitoneum. This previously unreported constellation of anomalies may carry significant potential risks for bowel obstruction and later fertility.
Pediatric Surgery International 04/2001; 17(2-3):228-9. · 1.25 Impact Factor
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ABSTRACT: The aim of this study was to assess long-term disability after pediatric trauma and identify predicting factors.
A phone survey was conducted of all pediatric trauma patients with an Injury Severity Score (ISS) > or = 4 seen over 6 years at a regional trauma center. The questionnaire was a modification of the Rand Health Insurance Study scales.
Of 218 eligible trauma registry patients, 19 were deceased, 64 unreachable, 19 declined, and 116 interviewed. There were no demographic differences between respondents and nonrespondents. Sixty-three percent of the respondents were boys, mean age at injury was 13, ISS 16.7, and mean interval since injury was 4.4 (range, 1 to 7) years. Sixty-three children (54%) had no limitations on follow-up; the remainder had either limitations in physical or role activities (28%), mobility (16%), or self-care ability (2%). Significant correlations were found between the presence of disability and trauma scores and number of body regions injured. Stepwise logistic regression identified number of regions injured, mechanism of injury, and ISS as the main determinants for presence of long-term disability.
Half of injured children do have long-term sequelae. Their occurrence can be predicted from trauma scores, mechanism of injury, and number of regions injured.
Journal of Pediatric Surgery 06/2000; 35(5):684-7. · 1.45 Impact Factor
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ABSTRACT: A case is presented in which an unusual, phallic-shaped perineal lipoma raised the question of ambiguous genitalia following the delivery of an otherwise healthy female infant. The management of the case is described, and the critical features of the physical examination that contradicted that diagnosis are highlighted.
Journal of Pediatric and Adolescent Gynecology 06/2000; 13(2):71-4. · 1.54 Impact Factor
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ABSTRACT: The authors present an anterior rectal cyst in a 14-month-old girl. This rare variant of rectal duplications presented with recurrent urinary infections. The diagnosis was challenging in view of the multiple differential diagnoses to be considered. Magnetic resonance imaging appeared to be the most accurate preoperative investigation. The cyst was removed uneventfully by partial excision and mucosal ablation. An awareness of this variant can lead to early diagnosis and curative resection.
Journal of Pediatric Surgery 05/2000; 35(4):613-4. · 1.45 Impact Factor
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ABSTRACT: This report describes a rare type IIIb variant of long gap pure esophageal atresia treated with delayed primary repair. Preoperative imaging showed a distal pouch with a unusually long tapering end, and a 5-vertebral body gap. Delayed exploration with mobilization of the distal pouch allowed for successful primary repair without the need of myotomy. The characteristic radiological appearance of this rare variant enables its preoperative recognition and warrants attempting primary repair with a good expectation of success.
Journal of Pediatric Surgery 01/2000; 34(12):1881-3. · 1.45 Impact Factor
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ABSTRACT: Sledding accidents are frequent and vary in severity. Penetrating sledding injuries are uncommon but may be devastating. Snow-racers--sleds with both steering and braking devices--may be associated with an increased rate of injury. The authors present 2 cases of lower-torso penetrating trauma associated with the use of snow-racers. Both cases involved penetration--of the perineum in one case and the inguinal area in the other--by wooden sticks. Both patients recovered fully after prompt surgical intervention. The authors suggest that the absence of a protective panel at the front of the snow-racer may result in the sledder's lower torso being more exposed to objects encountered while sledding. The injuries reported raise concerns about the safety of modern sleds and the possibility that design changes are needed.
Canadian Medical Association Journal 03/1999; 160(3):353-4. · 8.22 Impact Factor
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ABSTRACT: Masses in the inguinal canal other than hernias are rare occurrences, and their preoperative diagnosis requires a high index of suspicion. A soft, partly reducible groin mass in a 3-month-old boy proved to be a cystic lymphangioma within the inguinal canal. A 15-month-old female who presented with an irreducible inguinal mass was found to have a neuroblastoma metastasis in the groin. An irreducible groin mass in a 6-year-old female proved to be an inguinal canal epidermal inclusion cyst. A 14-year-old female presented with a painful groin swelling that represented an incarcerated hemorrhagic ovarian cyst. An awareness of the wide spectrum of entities other than the standard bowel, testicle, and ovary in the inguinal canal can help to identify uncommon pathologies preoperatively.
Pediatric Surgery International 02/1999; 15(7):515-6. · 1.25 Impact Factor
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ABSTRACT: The diagnosis of pheochromocytoma (Pheo) can be challenging due to the variety of potential presentations of this infrequent tumor. A 16-year-old boy presented with hypertension and sudden abdominal pain after minor blunt abdominal trauma. Both computer tomography (CT) and magnetic resonance (MR) scanning identified a right suprarenal mass, and raised the possibility of a Pheo. This diagnosis was confirmed through urine catecholamine testing and (131)I metaiodobenzylguanidine (MIBG) scanning. An extra-adrenal Pheo was successfully resected. The presentation of Pheos is quite variable, and patients may often be essentially asymptomatic. Pheo should be considered in hypertensive pediatric patients with a history of blunt abdominal trauma.
Pediatric Surgery International 02/1999; 15(7):508-9. · 1.25 Impact Factor
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ABSTRACT: Gastrointestinal abnormalities are frequent in patients with Down syndrome (DS), gastroesophageal reflux (GER) being prominent among them. A 10-year-old boy with DS presented with progressive daily vomiting and an upper gastrointestinal study documenting reflux. A laparoscopic Nissen fundoplication was performed uneventfully. Postoperative inability to take solids was noted and a contrast study showed a tight gastroesophageal junction and poor peristalsis. Persistent symptoms were not alleviated by esophageal dilatation, despite a relaxing lower esophageal sphincter. Esophageal manometry documented complete esophageal aperistalsis. A percutaneous endoscopic gastrostomy was placed and the patient required long-term tube feeds. Esophageal aperistalsis is a rare condition in DS, likely superimposed on GER. Fundoplication may adversely affect the already abnormal esophageal motility in these children. Esophageal manometry preoperatively will identify motility disorders and assist in selecting the best management for these patients.
Pediatric Surgery International 02/1999; 15(7):510-1. · 1.25 Impact Factor
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American Journal of Roentgenology 02/1999; 172(1):235-7. · 2.78 Impact Factor
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ABSTRACT: Peri-catheter calcification is an unusual and previously unreported complication of central venous (CV) catheterization in infants. A 1. 9 Fr Silastic CV catheter was placed in a term infant for administration of total parenteral nutrition and antibiotics following intra-abdominal sepsis. The catheter was removed, without complication, at a later date after another septic episode. Imaging studies performed in the investigation of a possible intra-abdominal abscess revealed a cylindrical density within a clot in the inferior vena cava (IVC). The density was presumed to be a retained catheter fragment. Further investigation indicated total occlusion of the IVC. Surgical exploration of the IVC revealed only a calcified thrombus. This case represents a rare and previously unreported complication of CV catheterization in infants. Diagnosing this condition on radiographic evidence alone can be difficult. It is hoped that awareness of the potential for this complication will avoid unnecessary invasive procedures in the future. We also suggest a high level of clinical suspicion and routine Doppler ultrasound investigations to detect IVC thrombosis when indwelling CV catheters are used in infants.
Pediatric Surgery International 11/1998; 13(8):610-2. · 1.25 Impact Factor
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ABSTRACT: Congenital epidermoid splenic cysts are very rare. They are known to become symptomatic as a consequence of enlargement, hemorrhage, rupture, or infection. Recent options in the treatment of splenic cysts have included percutaneous drainage, partial splenectomy, or open splenic cystectomy. The authors present the first report of a pediatric patient with a large epidermoid cyst of the spleen treated by laparoscopic partial cyst excision and omental packing. Follow-up at 1 year confirms no recurrence. Laparoscopy provides a minimal access method of obtaining pathological confirmation of diagnosis, reduction of cyst complications, and a short hospital stay, while preserving splenic function.
Journal of Pediatric Surgery 10/1998; 33(9):1439-40. · 1.45 Impact Factor
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ABSTRACT: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question.
We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were assessed by written examination, objective structured clinical examination (OSCE), ward evaluations, self-assessment objectives questionnaire, and satisfaction survey.
Data for 54 students showed no differences in scores between groups on any parameter. No specific concerns related to the absence of general surgery were identified.
Effective undergraduate surgical education can be offered in many specialty settings. Removal of the requirement for general surgery in clerkship may lead to a more effective use of all educational opportunities. A careful analysis of local programs and facilities is necessary before suggesting this change to other institutions.
The American Journal of Surgery 07/1998; 175(6):515-7. · 2.78 Impact Factor
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ABSTRACT: The surgical management of cystic hygromas can be challenging, and accurate diagnosis and anatomic localization is essential. The literature on the use of magnetic resonance imaging (MRI) in pediatric cystic hygromas is sparse and mostly limited to radiological descriptions.
The authors present five cases of cystic hygromas in children ranging in age from 1 to 13 years. The preoperative MRI scans and patient charts were reviewed with attention to the clinical, radiological, surgical, and histological findings.
MRI produced highly detailed multiplanar renderings of the cystic hygromas that were both diagnostic and predictive of the subsequent intraoperative findings. This modality helped specifically in some cases to identify lesion extensions that required specific surgical attention. There were no recurrences or complications at a mean follow-up of 18 months.
The use of MRI in cystic hygromas can facilitate accurate diagnosis and assist in the preoperative planning, thereby contributing to the successful treatment of these lesions.
Journal of Pediatric Surgery 07/1998; 33(6):839-41. · 1.45 Impact Factor
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ABSTRACT: Small-bowel obstruction caused by knotting of a peritoneal shunt catheter is an extremely rare and severe complication of a ventriculoperitoneal (VP) shunt. In the 1-week-old female infant reported here who had a VP shunt, inability to remove the peritoneal catheter was followed by small-bowel obstruction and necrosis due to intestinal strangulation in a tight loop of the catheter. An uncomplicated primary resection of the necrotic segment was followed by placement of a temporary ventriculoatrial shunt. The authors suggest that when withdrawal of the peritoneal part of a VP shunt meets with resistance, an intraoperative radiograph should be obtained to assess the position of the remaining catheter. If knotting is observed, an attempt to straighten the catheter with a guide wire is worthwhile. Should this fail, immediate laparoscopy or laparotomy is indicated.
Canadian journal of surgery. Journal canadien de chirurgie 07/1998; 41(3):239-40. · 1.05 Impact Factor
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ABSTRACT: Educational objectives can be used both in the standardization of curricula and in their evaluation. Surveys of subspecialty objectives can clarify educational priorities and identify areas of proficiency and deficiency.
Fifty-one third-year and 56 fourth-year medical students were surveyed on their perceived mastery level of 60 pediatric surgery cognitive objectives. The same objectives were also used to survey 34 pediatric surgeons and 126 practicing family physicians. Physicians' expected and students' self-reported proficiency was scored for each objective from 0 (not required/unaware of condition) to 3 (confident with diagnosis and management of condition). Information regarding pediatric surgery instruction was also obtained from the undergraduate deans of 12 Canadian medical schools. Data were analyzed using descriptive methods and one-way analysis of variance (ANOVA) and were compared with existing objectives listings in the subspecialty.
Students' familiarity scores increased significantly from third-year to fourth-year (P < .05), and approximated in fourth year the expected proficiency levels. Family physicians' and pediatric surgeons' expectations were remarkably similar. Eleven items were identified by both physician groups as nonessential (mean score < 1.5), whereas 29 were perceived as essential (score > 2.0). The fourth-year students' perceived knowledge of all but 3 of these 29 objectives was adequate. Comparison of the data with previous objectives listings showed similar expected competencies. Deans' data showed varied but mostly limited exposure to pediatric surgery in the undergraduate curriculum.
The current study has allowed a revision of undergraduate objectives in pediatric surgery based on broad stakeholder input. It has also clarified both the expected and the perceived student mastery of these objectives, and identified areas of specific stress required. The results can be used toward establishing a unified, reliable, undergraduate curriculum for pediatric general surgery.
Journal of Pediatric Surgery 06/1998; 33(6):852-5. · 1.45 Impact Factor
