Benign hepatic tumors are commonly observed in adults,but rarely reported in children.The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking.Benign hepatic tum...Benign hepatic tumors are commonly observed in adults,but rarely reported in children.The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking.Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors.In pediatric patients,most benign focal liver lesions are inborn and may grow like the rest of the body.Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis.Selection of the appropriate imaging test is challenging,since it depends on a number of age-related factors.This paper will discuss the most frequently encountered benign liver tumors in children(infantile hepatic hemangioendothelioma,mesenchymal hamartoma,focal nodular hyperplasia,nodular regenerative hyperplasia,and hepatocellular adenoma),as well as a comparison to the current knowledge regarding such tumors in adult patients.The current emphasis is on imaging features,which are helpful not only for the initial diagnosis,but also for pre- and posttreatment evaluation and follow-up.In addition,future perspectives of contrast-enhanced ultrasound(CEUS) in pediatric patients are highlighted,with descriptions of enhancement patterns for each lesion being discussed.The role of advanced imaging tests such as CEUS and magnetic resonance imaging,which allow for non-invasive assessment of liver tumors,is of utmost importance in pediatric patients,especially when repeated imaging tests are needed and radiation exposure should be avoided.展开更多
AIM To summarize the reported Middle East respiratory syndrome-coronavirus(MERS-Co V) cases, the associated clinical presentations and the outcomes. METHODS We searched the Saudi Ministry of Health website, the World ...AIM To summarize the reported Middle East respiratory syndrome-coronavirus(MERS-Co V) cases, the associated clinical presentations and the outcomes. METHODS We searched the Saudi Ministry of Health website, the World Health Organization website, and the Flutracker website. We also searched MEDLINE and Pub Med for the keywords: Middle East respiratory syndromecoronavirus, MERS-Co V in combination with pediatric, children, childhood, infancy and pregnancy from the initial discovery of the virus in 2012 to 2016. The retrieved articles were also read to further find other articles. Relevant data were placed into an excel sheet and analyzed accordingly. Descriptive analytic statistics were used in the final analysis as deemed necessary.RESULTS From June 2012 to April 19, 2016, there were a total of 31 pediatric MERS-Co V cases. Of these cases 13(42%) were asymptomatic and the male to female ratio was 1.7:1. The mean age of patients was 9.8 ± 5.4 years. Twenty-five(80.6%) of the cases were reported from the Kingdom of Saudi Arabia. The most common source of infection was household contact(10 of 15 with reported source) and 5 patients acquired infection within a health care facility. Using real time reverse transcriptase polymerase chain reaction of pediatric patients revealed that 9 out of 552(1.6%) was positive in the Kingdom of Saudi Arabia. CONCLUSION Utilizing serology for MERS-CoV infection in Jordan andSaudi Arabia did not reveal any positive patients. Thus, the number of the pediatric MERS-CoV is low; the exact reason for the low prevalence of the disease in children is not known.展开更多
Video capsule endoscopy (CE) for evaluation the esophagus (ECE), small bowel (SBCE) and the colon (CCE) is particularly useful in pediatrics, because this imaging modality does not require ionizing radiation, deep sed...Video capsule endoscopy (CE) for evaluation the esophagus (ECE), small bowel (SBCE) and the colon (CCE) is particularly useful in pediatrics, because this imaging modality does not require ionizing radiation, deep sedation or general anesthesia. The risk of capsule retention appears to be dependent on indication rather than age and parallels the adult experience by indication, making SBCE a relatively safe procedure with a significant diagnostic yield. The newest indication, assessment of mucosal change, greatly enhances and expands its potential benefit. The diagnostic role of CE extends beyond the SB. The use of ECE also may enhance our knowledge of esophageal disease and assist patient care. Colon CCE is a novel minimally invasive and painless endoscopic technique allowing exploration of the colon without need for sedation, rectal intubation and gas insufflation. The limited data on ECE and CCE in pediatrics does not yet allow the same conclusions regarding efficacy; however, both appear to provide safe methods to assess and monitor mucosal change in their respective areas with little discomfort. Moreover, although experience has been limited, the patency capsule may help lessen the potential of capsule retention; and newly researched protocols for bowel cleaning may further enhance CE’s diagnostic yield. However, further research is needed to optimize the use of the various CE procedures in pediatric populations.展开更多
目的探究喉罩麻醉与气管插管麻醉在小儿腹腔镜手术术后恢复质量。方法选取2015年6月—2016年9月在本院儿科行腹腔镜手术的患儿60例,随机分为观察组和对照组两组,每组各30例。观察组行喉罩麻醉,对照组行气管插管麻醉,比较两组患儿的各项...目的探究喉罩麻醉与气管插管麻醉在小儿腹腔镜手术术后恢复质量。方法选取2015年6月—2016年9月在本院儿科行腹腔镜手术的患儿60例,随机分为观察组和对照组两组,每组各30例。观察组行喉罩麻醉,对照组行气管插管麻醉,比较两组患儿的各项生命体征指标及麻醉效果指标,观察两组患儿手术过程中心率、呼吸、血压、最高血压及血氧饱和度等指标。结果观察组患儿各术中不良反应率显著低于对照组(P<0.05)。对照组麻醉后5 min(t_2)心率为(85.6±11.7)次/分、麻醉后15 min(t_3)心率为(74.2±5.3)次/分,均高于观察组麻醉后5 min(t_2)心率为(86.3±9.4)次/分、麻醉后15 min(t_3)心率为(81.2±6.6)次/分,差异有统计学意义(P<0.05)。苏醒时间观察组为(10.3±5.7) min,显著短于对照组的(16.9±7.7) min,差异有统计学意义(P<0.05)。对照组最高血压t_2为(85.3±7.4) mm Hg、t_3为(86.4±4.6)mm Hg、显著高于观察组在t_2时的(84.7±3.4) mm Hg、t_3时的(86.4±4.6) mm Hg,差异有统计学意义(P<0.05)。观察组喉痉挛、术后躁动、呼吸抑制和术后恶心呕吐的发生率显著低于对照组(P<0.05)。结论经喉罩麻醉苏醒期短,麻醉平稳,心率及呼吸较对照组低,血氧饱和度高,手术恢复质量高,建议临床推广应用。展开更多
AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary childre...AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary children's hospital.We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected choledocholithiasis.Patients were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected CBDS.RESULTS:CBDS were identified in 84% at the time of ERCP.Abdominal ultrasound identified CBDS in 36% of patients.Conjugated bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to 8.8.Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,respectively.CONCLUSION:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.展开更多
AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged...AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.展开更多
While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so cert...While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so certain modifications can be made in order to make robotic surgery successful in children.While the cost of robotic surgery remains high compared to open procedures,patients experience greater satisfaction and quality of life with robotic surgery.Robotic pyeloplasty is a standard of care in older children,and has even been performed in infants and re-do surgery.Other robotic procedures performed in children include heminephroureterectomy,ureteroureterostomy,ureteral reimplantation,urachal cyst excision,bladder diverticulectomy,and bladder reconstructive procedures such as augmentation,appendicovesicostomy,antegrade continence enema,bladder neck reconstruction and sling,as well as other procedures.Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection.Future improvements in technology with production of pediatric-sized robotic instruments,along with increases in robotictrained pediatric urologists and surgeon experience along each’s learning curve,will help to further advance the field of robotic surgery in pediatric urology.展开更多
AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition. METHODS: One-hund...AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition. METHODS: One-hundred-eighty children (90 males, median age at diagnosis 7.3 years; range, 0-18 years) with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers. RESULTS: One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed, but the cholelithiasis recurred in 3 of them. Sixty-five percent of symptomatic children treated became asymptomatic. Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported. Thirty- four children received no treatment and were followed with clinical and echographic controls; in no case thedevelopment of complications was reported. CONCLUSION: The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.展开更多
Wireless capsule endoscope (WCE) for the investigation of the small bowel is an approved technique both in adults and children (more than 10 years old). The present review provides data on the indications, diagnostic ...Wireless capsule endoscope (WCE) for the investigation of the small bowel is an approved technique both in adults and children (more than 10 years old). The present review provides data on the indications, diagnostic yield, adverse events and limitations of the WCE technique in children and tries to predict the future of WCE usage in this population of patients.展开更多
文摘Benign hepatic tumors are commonly observed in adults,but rarely reported in children.The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking.Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors.In pediatric patients,most benign focal liver lesions are inborn and may grow like the rest of the body.Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis.Selection of the appropriate imaging test is challenging,since it depends on a number of age-related factors.This paper will discuss the most frequently encountered benign liver tumors in children(infantile hepatic hemangioendothelioma,mesenchymal hamartoma,focal nodular hyperplasia,nodular regenerative hyperplasia,and hepatocellular adenoma),as well as a comparison to the current knowledge regarding such tumors in adult patients.The current emphasis is on imaging features,which are helpful not only for the initial diagnosis,but also for pre- and posttreatment evaluation and follow-up.In addition,future perspectives of contrast-enhanced ultrasound(CEUS) in pediatric patients are highlighted,with descriptions of enhancement patterns for each lesion being discussed.The role of advanced imaging tests such as CEUS and magnetic resonance imaging,which allow for non-invasive assessment of liver tumors,is of utmost importance in pediatric patients,especially when repeated imaging tests are needed and radiation exposure should be avoided.
文摘AIM To summarize the reported Middle East respiratory syndrome-coronavirus(MERS-Co V) cases, the associated clinical presentations and the outcomes. METHODS We searched the Saudi Ministry of Health website, the World Health Organization website, and the Flutracker website. We also searched MEDLINE and Pub Med for the keywords: Middle East respiratory syndromecoronavirus, MERS-Co V in combination with pediatric, children, childhood, infancy and pregnancy from the initial discovery of the virus in 2012 to 2016. The retrieved articles were also read to further find other articles. Relevant data were placed into an excel sheet and analyzed accordingly. Descriptive analytic statistics were used in the final analysis as deemed necessary.RESULTS From June 2012 to April 19, 2016, there were a total of 31 pediatric MERS-Co V cases. Of these cases 13(42%) were asymptomatic and the male to female ratio was 1.7:1. The mean age of patients was 9.8 ± 5.4 years. Twenty-five(80.6%) of the cases were reported from the Kingdom of Saudi Arabia. The most common source of infection was household contact(10 of 15 with reported source) and 5 patients acquired infection within a health care facility. Using real time reverse transcriptase polymerase chain reaction of pediatric patients revealed that 9 out of 552(1.6%) was positive in the Kingdom of Saudi Arabia. CONCLUSION Utilizing serology for MERS-CoV infection in Jordan andSaudi Arabia did not reveal any positive patients. Thus, the number of the pediatric MERS-CoV is low; the exact reason for the low prevalence of the disease in children is not known.
文摘Video capsule endoscopy (CE) for evaluation the esophagus (ECE), small bowel (SBCE) and the colon (CCE) is particularly useful in pediatrics, because this imaging modality does not require ionizing radiation, deep sedation or general anesthesia. The risk of capsule retention appears to be dependent on indication rather than age and parallels the adult experience by indication, making SBCE a relatively safe procedure with a significant diagnostic yield. The newest indication, assessment of mucosal change, greatly enhances and expands its potential benefit. The diagnostic role of CE extends beyond the SB. The use of ECE also may enhance our knowledge of esophageal disease and assist patient care. Colon CCE is a novel minimally invasive and painless endoscopic technique allowing exploration of the colon without need for sedation, rectal intubation and gas insufflation. The limited data on ECE and CCE in pediatrics does not yet allow the same conclusions regarding efficacy; however, both appear to provide safe methods to assess and monitor mucosal change in their respective areas with little discomfort. Moreover, although experience has been limited, the patency capsule may help lessen the potential of capsule retention; and newly researched protocols for bowel cleaning may further enhance CE’s diagnostic yield. However, further research is needed to optimize the use of the various CE procedures in pediatric populations.
文摘目的探究喉罩麻醉与气管插管麻醉在小儿腹腔镜手术术后恢复质量。方法选取2015年6月—2016年9月在本院儿科行腹腔镜手术的患儿60例,随机分为观察组和对照组两组,每组各30例。观察组行喉罩麻醉,对照组行气管插管麻醉,比较两组患儿的各项生命体征指标及麻醉效果指标,观察两组患儿手术过程中心率、呼吸、血压、最高血压及血氧饱和度等指标。结果观察组患儿各术中不良反应率显著低于对照组(P<0.05)。对照组麻醉后5 min(t_2)心率为(85.6±11.7)次/分、麻醉后15 min(t_3)心率为(74.2±5.3)次/分,均高于观察组麻醉后5 min(t_2)心率为(86.3±9.4)次/分、麻醉后15 min(t_3)心率为(81.2±6.6)次/分,差异有统计学意义(P<0.05)。苏醒时间观察组为(10.3±5.7) min,显著短于对照组的(16.9±7.7) min,差异有统计学意义(P<0.05)。对照组最高血压t_2为(85.3±7.4) mm Hg、t_3为(86.4±4.6)mm Hg、显著高于观察组在t_2时的(84.7±3.4) mm Hg、t_3时的(86.4±4.6) mm Hg,差异有统计学意义(P<0.05)。观察组喉痉挛、术后躁动、呼吸抑制和术后恶心呕吐的发生率显著低于对照组(P<0.05)。结论经喉罩麻醉苏醒期短,麻醉平稳,心率及呼吸较对照组低,血氧饱和度高,手术恢复质量高,建议临床推广应用。
文摘AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary children's hospital.We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected choledocholithiasis.Patients were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected CBDS.RESULTS:CBDS were identified in 84% at the time of ERCP.Abdominal ultrasound identified CBDS in 36% of patients.Conjugated bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to 8.8.Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,respectively.CONCLUSION:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.
文摘AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.
文摘While robotic surgery has shown clear utility and advantages in the adult population,its role in pediatrics remains controversial.Pediatric-sized robotic instruments and equipment are not readily available yet,so certain modifications can be made in order to make robotic surgery successful in children.While the cost of robotic surgery remains high compared to open procedures,patients experience greater satisfaction and quality of life with robotic surgery.Robotic pyeloplasty is a standard of care in older children,and has even been performed in infants and re-do surgery.Other robotic procedures performed in children include heminephroureterectomy,ureteroureterostomy,ureteral reimplantation,urachal cyst excision,bladder diverticulectomy,and bladder reconstructive procedures such as augmentation,appendicovesicostomy,antegrade continence enema,bladder neck reconstruction and sling,as well as other procedures.Robotic surgery has also been used in oncologic cases such as partial nephrectomy and retroperitoneal lymph node dissection.Future improvements in technology with production of pediatric-sized robotic instruments,along with increases in robotictrained pediatric urologists and surgeon experience along each’s learning curve,will help to further advance the field of robotic surgery in pediatric urology.
文摘AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition. METHODS: One-hundred-eighty children (90 males, median age at diagnosis 7.3 years; range, 0-18 years) with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers. RESULTS: One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed, but the cholelithiasis recurred in 3 of them. Sixty-five percent of symptomatic children treated became asymptomatic. Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported. Thirty- four children received no treatment and were followed with clinical and echographic controls; in no case thedevelopment of complications was reported. CONCLUSION: The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.
文摘Wireless capsule endoscope (WCE) for the investigation of the small bowel is an approved technique both in adults and children (more than 10 years old). The present review provides data on the indications, diagnostic yield, adverse events and limitations of the WCE technique in children and tries to predict the future of WCE usage in this population of patients.
