27 research outputs found
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Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012.
BackgroundAlthough the incidence of gastroschisis is increasing, risk factors are not clearly identified.MethodsUsing the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis.ResultsThe prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges (9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%.ConclusionsThis is the largest population-based study summarizing current epidemiology of gastroschisis in California.Type of studyRetrospective comparative cohort study.Level of evidenceIII
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Resection of a thoracoabdominal ganglioneuroma via a retroperitoneal minimally invasive approach.
A 10-year-old girl presented to her pediatrician with a history of cough and fever. A chest radiograph revealed a paraspinal mass. On cross-sectional imaging, the mass traversed the diaphragm, extending from T9 to L1 spinal levels with involvement of the T10-12 neural foramen. Vanillylmandelic and homovanillic acid levels were normal. On review of historical radiographs, the mass had increased in size. Thus, surgical resection was recommended for diagnosis and treatment. The patient was placed in left lateral decubitus position. The retroperitoneal space was accessed inferior to the twelfth rib. One 12 mm and two 5 mm ports were used. Development of the retroperitoneal space was achieved with both blunt dissection and a vessel-sealing device. The diaphragm was incised to resect the thoracic component of the mass. The tumor was adherent at the neural foramen and was resected flush with the spine. The diaphragm repaired primarily. She was discharged home on post-operative day four without complication. Pathology demonstrated a ganglioneuroma. The patient was well at her follow-up, and imaging one year postoperatively was without recurrence. No additional treatment was required. A laparoscopic retroperitoneal approach allows for a safe, minimally invasive resection of a thoracoabdominal mass without violation of the abdominal cavity
Traumatic posterolateral abdominal wall hernia in a pediatric patient
Traumatic abdominal wall hernia (TAWH) is a relatively uncommon injury, with incidence estimates ranging from 1% to 9% of blunt abdominal trauma patients (1). Traumatic posterolateral abdominal wall hernia is an even less common subset of TAWH, in which intra- or extra-peritoneal contents herniate through a defect in the lumbar region within the superior or inferior lumbar triangles (2).The clinical presentation of traumatic posterolateral abdominal wall hernias range greatly, from abdominal wall ecchymosis to frank peritonitis. There is a paucity of reported cases in the pediatric surgical literature of traumatic abdominal wall hernias, and most of these cases are so-called ‘handle-bar injuries,’ resulting from bicycle crashes (3). We present a case report of a child who presented with a traumatic posterolateral abdominal wall hernia following a motor vehicle collision (MVC) and was found to have multiple intraabdominal injuries as well as a diffuse lumbar hernia with incarcerated bowel
Resection of a thoracoabdominal ganglioneuroma via a retroperitoneal minimally invasive approach
A 10-year-old girl presented to her pediatrician with a history of cough and fever. A chest radiograph revealed a paraspinal mass. On cross-sectional imaging, the mass traversed the diaphragm, extending from T9 to L1 spinal levels with involvement of the T10-12 neural foramen. Vanillylmandelic and homovanillic acid levels were normal. On review of historical radiographs, the mass had increased in size. Thus, surgical resection was recommended for diagnosis and treatment.The patient was placed in left lateral decubitus position. The retroperitoneal space was accessed inferior to the twelfth rib. One 12 mm and two 5 mm ports were used. Development of the retroperitoneal space was achieved with both blunt dissection and a vessel-sealing device. The diaphragm was incised to resect the thoracic component of the mass. The tumor was adherent at the neural foramen and was resected flush with the spine. The diaphragm repaired primarily. She was discharged home on post-operative day four without complication. Pathology demonstrated a ganglioneuroma. The patient was well at her follow-up, and imaging one year post-operatively was without recurrence. No additional treatment was required.A laparoscopic retroperitoneal approach allows for a safe, minimally invasive resection of a thoracoabdominal mass without violation of the abdominal cavity. Keywords: Pediatric laparoscopic, Retroperitoneoscopic, Ganglioneuroma, Ganglioneuroblastoma, Neuroblastoma, Thoracoabdominal resectio
Midgut volvulus and complex meconium peritonitis in a fetus with undiagnosed cystic fibrosis
In utero small bowel volvulus with meconium peritonitis is a rare complication of cystic fibrosis.We report the case of fetal small bowel volvulus with necrosis, perforation and meconium peritonitis in a fetus with undiagnosed cystic fibrosis. The mother presented with four days of decreased fetal movement and ultrasound findings of fetal small bowel dilation with wall thinning and ascites. The fetus' status declined three days thereafter, prompting an emergent delivery. The infant was born with peritonitis and underwent an exploratory laparotomy with a small bowel resection and interval anastomosis. Following restoration of continuity, the patient was able to tolerate oral and enteral nutrition with appropriate growth. This report provides an example of the signs, symptoms and sonographic findings associated with this rare fetal complication and explores the intricacies of prenatal genetic testing. Keywords: Cystic fibrosis, Fetal cystic fibrosis complication, Fetal small bowel volvulus, Fetal small bowel perforation, Complicated meconium peritoniti
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Cervical Spine Injury in Burned Trauma Patients: Incidence, Predictors, and Outcomes.
Cervical spine injuries (CIs) carry significant morbidity and mortality; hence, cervical spine immobilization is used liberally in trauma patients, including burns. The incidence, predictors, and outcomes of CI in burn patients are unknown. A retrospective cohort from the National Trauma Data Bank between 2007 and 2012 included all burned patients with and without CI. Predictors of CI were identified by logistic regression. Outcomes with and without CI were compared with Wilcoxon rank sum test. A total of 94,964 patients were identified with burn injuries. The incidence of CI was 0.79% (n = 745). Mechanism of injury, age, and injury severity score (ISS) were significant predictors of CI. Odds of CI were 109.4 (95% CI: 61.2-195.3, P < .0001) for motor vehicle injury, 87.8 (95% CI: 47.0-164.0, P < .0001) for falls, 1.2 (95% CI: 0.6-2.3, P = .66) for fire/flame, and 2.4 (95% CI: 1.0-5.5, P < .0001) for explosion compared with reference of hot object/substance. For every year increase in age, there were 1.02 higher odds of CI (95% CI: 1.01-1.02, P < .0001). For each point increase in ISS, there were 1.05 higher odds of CI (95% CI: 1.04-1.05, P < .0001). Patients with CI had higher mortality (10.3% vs 2.9%, P < .0001), longer total length of stay (12.0 vs 2.0 days, P < .0001), intensive care unit length of stay (4.0 vs 0.0 days, P < .001), and ventilator days (1.0 vs 0.0 days, P < .0001). The incidence of CI in burn patients is low, especially when due to fire, flame, or scalds; however, CI is associated with higher mortality and worse outcomes
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Spinal Angulation: A Limitation of the Fetal Lamb Model of Myelomeningocele
IntroductionThe surgically induced fetal lamb model is the most commonly used large animal model of myelomeningocele (MMC) but is subject to variation due to surgical technique during defect creation.Material and methodsThirty-one fetal lambs underwent creation of the MMC defect, followed by defect repair with either an extracellular matrix (ECM) patch (n = 10) or ECM seeded with placental mesenchymal stromal cells (n = 21). Postnatal hindlimb function was assessed using the Sheep Locomotor Rating (SLR) scale. Postmortem magnetic resonance imaging of the lumbar spine was used to measure the level and degree of spinal angulation, as well as cross-sectional area of remaining vertebral bone.ResultsMedian level of angulation was between the 2nd and 3rd lumbar vertebrae, with a median angle of 24.3 degrees (interquartile range 16.2-35.3). There was a negative correlation between angulation degree and SLR (r = -0.44, p = 0.013). Degree of angulation also negatively correlated with the normalized cross-sectional area of remaining vertebral bone (r = -0.75, p < 0.0001).DiscussionSurgical creation of fetal MMC leads to varying severity of spinal angulation in the ovine model, which affects postnatal functional outcomes. Postnatal assessment of spinal angulation aids in standardization of the surgical model of fetal MMC repair