Thoracoscopy in complicated parapneumonic effusion in children

OBJETIVO: O objetivo do presente trabalho foi avaliar nossa experiência com a toracoscopia no derrame parapneumônico complicado. MATERIAIS E MÉTODOS: Foi realizada revisão retrospectiva de prontuários de 23 crianças (12 meninas), idade média de 3 anos e 2 meses, operadas no Hospital de Clínicas de Porto Alegre, no período de julho de 1995 a julho de 1998. As indicações da toracoscopia foram derrame pleural residual e febre nos pacientes submetidos inicialmente à drenagem torácica fechada (n = 20) e presença de derrame pleural complicado com septações (n = 3) nas demais. A toracoscopia foi realizada com medistinoscópio (n = 8) ou videotoracoscópio (n = 15). Cinco crianças necessitaram refazer a toracoscopia devido à presença de febre e de líquido pleural loculado após a remoção do dreno torácico. Três crianças necessitaram a realização de drenagem aberta: pleurostomia (n = 2) ou secção e abertura do dreno torácico (n = 1). RESULTADOS: Todas as crianças tiveram completa recuperação clínica. Comparação entre as crianças que realizaram toracoscopia com mediastinoscópio ou com videotoracoscópio não mostrou nenhuma diferença. CONCLUSÕES: Concluímos que a toracoscopia deve ser usada em crianças com derrame pleural residual e febre, durante ou após drenagem torácica fechada, e deve ser considerada como primeira opção nas crianças com derrame no estágio fibrinopurulento. Além disso, concluímos que não há diferença entre a realização de toracoscopia com mediastinoscópio ou videotoracoscópio.OBJECTIVE: The aim of the present study was to evaluate our experience with thoracoscopy in complicated parapneumonic pleural effusion. MATERIALS AND METHODS: We carried out a retrospective review of 23 children (12 girls), median age 3.2 years, operated at Hospital de Clínicas de Porto Alegre, from July 1995 to July 1998. Indications for thoracoscopy were residual pleural effusion and fever in the patients initially submitted to closed thoracic drainage (n = 20), and presence of complicated pleural effusion with septations in the others (n = 3). Thoracoscopy was performed with a mediastinoscope (n = 8) or a videothoracoscope (n = 15). Five children needed to redo thoracoscopy due to the presence of fever and loculated pleural liquid after the removal of the thoracic drain. Three children required open drainage (pleurotomy in two and section and aperture of the thoracic drain in one). RESULTS: All children had a full clinical recovery. Comparison among children who performed thoracoscopy with a mediastinoscope and with videothoracoscope did not show any statistically significant difference. CONCLUSIONS: We concluded that thoracoscopy should be used in children with residual pleural effusion and fever, during or after chest drainage, and should be considered as the first-line therapy in children with fibrinopurulent effusion; there is no difference between the performance of thoracoscopy with a mediastinoscope or videothoracoscope

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Thyroid alar cartilage (TAC) laryngotracheal reconstruction for severe pediatric subglottic stenosis

PURPOSE: Laryngotracheoplasty has become an accepted treatrnent alternative for subglottic stenosis. However, the best autogenous material for laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been successfully used in single stage Iaryngotracheal reconstruction in children with subglottic stenosis. METHODS: This is a retrospective study of 6 children (mean age 16.6 months) undergoing TAC graft laryngotracheoplasty between September, 1995, and June, 1999. Two children had immediate tracheal intubation for congenital subglottic stenosis. Four others had previous tracheostomy: 3 for severe postintubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotracheal intubation was maintained postoperatively. RESULTS: Four children were successfully extubated 9 to 21 days (mean 15.5 days) postoperatively. Two required tracheostomy, which was maintained due to severe laryngomalacia and laryngotracheobronchomalacia. One child was treated with COz laser due to symptomatic recurrence of the subglottic stenosis 3 weeks after the surgery; another required fundoplication for gastroesophageal reflux 12 months after laryngotracheoplasty. There were no donor site complications in any of the six cases. Repeat laryngoscopy and bronchoscopy revealed a patent subglottic airway. Ali of them are without symptoms after a mean follow-up of 26 months. CONCLUSIONS: I) This preliminary experience indicates that the TAC graft technique is a viable option for laryngotracheal reconstruction; 2) the TAC graft has significant advantages, including a single operative incision and absence of donor-site morbidity