Journal of pediatric surgery
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This study tests the hypothesis that steroid administration improves the outcome of biliary atresia (BA) by evaluating the efficacy of postoperative steroid use on surgical outcomes in infants with BA. ⋯ The Kasai PE continues to be the procedure of choice in infants with BA younger than 3 months. A significantly improved clearance of postoperative jaundice and lower serum bilirubin levels were observed in patients receiving steroids. However, steroids had no effect on the incidence of cholangitis, need for liver transplantation, and overall survival. A prospective study with standardized dose and length of steroid administration and longer period of follow-up is necessary to more accurately assess the effectiveness of steroids after PE.
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Orthotopic liver transplantation (OLT) is the only treatment option for unresectable hepatoblastoma (HB) and hepatocellular carcinoma (HCC) in children. Aggregated outcomes of OLT for these hepatic malignancies have not been evaluated in the United Network for Organ Sharing national database. ⋯ Orthotopic liver transplantation remains a viable option for pediatric patients with unresectable primary hepatic malignancies and results in good long-term survival. Pretransplant medical condition is an important predictor of outcome. Thus, in conjunction with better chemotherapy regimens, earlier evaluation for OLT in patients with unresectable HB and HCC may result in yet further improved long-term survival.
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Klippel-Trenaunay syndrome is a rare congenital disorder characterized by combined vascular malformations, varicosities, and limb enlargement. A child case of Klippel-Trenaunay syndrome with a large cervicomediastinal cystic lymphatic malformation and a vascular mass on the chest wall has been presented to demonstrate combined use of conservative and surgical approaches in this syndrome. Cystic lymphatic malformation was treated by sclerotherapies including ultrasound-guided transthoracic bleomycin injection into mediastinal cyst, which was tried for the first time in the literature, and vascular chest wall tumor necessitated surgical excision.
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Clinical Trial
Continuous noninvasive monitoring of cardiac performance and tissue perfusion in pediatric trauma patients.
The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. ⋯ Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.
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Clinical Trial
The antegrade continence enema successfully treats idiopathic slow-transit constipation.
Antegrade continence enemas (ACEs) are successful for constipation and/or fecal incontinence caused by anorectal malformations or spina bifida but have been thought to be less successful in the treatment for patients with colonic dysmotility. We studied the long-term efficacy of ACE in a large group of patients with idiopathic slow-transit constipation (STC). ⋯ Antegrade continence enemas were successful in 34 (81%) of 42 children with STC, contradicting views that ACEs are less effective in patients with colonic dysmotility.