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São Paulo, Brazil

Rodriguez K.A.,Pediatric Surgery
Journal of trauma nursing : the official journal of the Society of Trauma Nurses | Year: 2010

Trauma is the leading cause of pediatric morbidity and mortality in the United States. There are known gaps in access to pediatric trauma care and rehabilitation services. We postulate that aftercare is fragmented or nonexistent. We propose that postdischarge "medical home" style care, championed by a pediatric nurse practitioner, leads to improved short-term outcomes and caretaker and provider satisfaction. Source


Varela P.,Pediatric Surgery | Romanini M.V.,University of Genoa | Asquasciati C.,G Gaslini Institute | Torre M.,G Gaslini Institute
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2010

The removal of the substernal bar after the Nuss operation is not always an easy and fast maneuver. Only a few different technical solutions have been described. In the original Nuss technique, the patient was lying on dorsal decubitus and rotated on the side during the procedure. The Noguchi technique avoids the rotation of the patient, but requires two incisions and straightening of the bar before pulling it out the thorax. Recently, another technique was proposed, avoiding the need of straightening the bar, but it is feasible only if two operative beds in a large operative room are available. We propose another approach for the removal of the bar: The patient is lying on the lateral decubitus, only one incision is performed, and the bar is pulled out along the thoracic wall. Twenty-one bars were removed by using the present approach without any complications. The advantages of our approach on the previous techniques are the single incision, no need of rotating the patient, straightening the bar, or having two operative beds. Our approach is not feasible when metallic stabilizers have been used on both sides, but in our experience, this was not necessary in order to stabilize the bar. © Mary Ann Liebert, Inc. Source


Wadie G.M.,Sacred Heart Medical Center | Moriarty K.P.,Pediatric Surgery
Pediatric Nephrology | Year: 2012

Vesicoureteral reflux (VUR) is a heterogeneous disease and its management remains one of the most controversial topics in pediatrics. Management options include surveillance, antibiotics, and surgery. The approval of dextranomer/hyaluronic acid (DHA) as a bulking agent by the Food and Drug Administration was followed by wide acceptance of endoscopic techniques as a major tool in the management of reflux. Pyelonephritis rather than VUR is the most common cause of kidney damage in children. It should be emphasized that the primary goal of diagnosing and treating VUR should be preventing this complication. There are no sufficient data in the literature to address the impact of the different treatment modalities on the incidence of febrile urinary tract infections (feb-UTIs) denoting pyelonephritis, with very few studies evaluating endoscopic treatment in light of this clear and well-defined outcome. The fact that we can correct the anatomy at the vesicoureteral junction with a simple and relatively safe outpatient procedure does not justify offering it to all patients. In this review, we attempt to critically evaluate the available literature pertaining to the impact of different treatment modalities on reducing the incidence of febrile UTIs and kidney damage, with a special emphasis on endoscopic treatment. © IPNA 2011. Source


Naseri M.,Dr Sheikh Children Hospital | Naseri M.,Mashad University of Medical science | Hiradfar M.,Pediatric Surgery
Indian Pediatrics | Year: 2012

Reduced nocturnal bladder capacity has been suggested in the pathogenesis of nocturnal enuresis. This study was conducted to define frequency of bladder dysfunction in enuretic children and determine parameters which might predict bladder dysfunction. 60 children were enrolled. Full urodynamic study (UDS) was done in case of abnormal uroflowmetry, abnormal bladder ultrasound, daytime incontinence and age 10 years. Of 60 patients ultrasound 48 underwent complete UDS. In 11, results of UDS were unreliable. The results were normal in 10 (20.8%) and 27 (56.2%) had abnormal UDS .The study revealed that abnormal UDS is common in enuretic children and overactive bladder is the most common findings. No clinical feature were found, which could identify children requiring UDS. Source


Rothenberg S.S.,Pediatric Surgery | Rothenberg S.S.,Columbia University
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2013

Background: Laparoscopic fundoplication for gastroesophageal reflux disease has become a common procedure performed in infants and children over the last 20 years. This report describes a 20-year experience with nearly 2000 consecutive laparoscopic Nissen fundoplications. Subjects and Methods: With Institutional Review Board approval, the data of all patients undergoing fundoplication from 1992 to 2011 were reviewed. Data were kept prospectively from the time of first encounter with each patient. Ages ranged from 5 days to 18 years, and weight ranged from 1.2 to 120 kg. The 2008 fundoplications were performed by or under the direct supervision of a single surgeon. Patients were divided into groups based on age: <6 months, 6-12 months, 1-6 years, and >6 years. Data on indications, surgical demographics, postoperative course including any complications, and long-term follow-up were kept prospectively on each patient. Results: Average operative time dropped dramatically from 109 minutes for the first 30 cases compared with 35 minutes for the last 30. Of the 283 procedures that were redo fundoplications, 85 patients had had previous open surgery, and 198 cases had had previous laparoscopic surgery. Intraoperative and postoperative complication rates were 0.13% and 4.0%, respectively, in the primary group but were 2.2% and 4.2%, respectively, in the redo group. Average time to discharge post-fundoplication for the primary group was 1.1 days. The overall wrap failure rate for primary fundoplications was 4.6% and was highest in the <6-month age group. The failure rate in the redo group was 6.8%. The most common causes of wrap failure were hiatal hernia (46%) and slipped Nissen (34%). Conclusions: This study shows in a large operative experience over 20 years that laparoscopic fundoplication is safe and effective in the pediatric population. Technical considerations are paramount to improved outcomes, and key points include adequate creation of intraabdominal esophagus, limited hiatal dissection, creation of a tension-free and appropriate orientation, and positioning of the wrap. Clinical results are favorable to the traditional open fundoplication but with a significant decrease in morbidity and hospitalization. Laparoscopic Nissen fundoplication should be considered the gold standard for antireflux procedures. © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

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