Rate Of Complications In Children Research Articles

Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry.

Contemporary multicentre data on clinical and diagnostic spectrum and outcome in myocarditis are limited. Study aims were to describe baseline features, 1-year follow-up, and baseline predictors of outcome in clinically suspected or biopsy-proven myocarditis (2013 European Society of Cardiology criteria) in adult and paediatric patients from the EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. Five hundred eighty-one (68.0% male) patients, 493 adults, median age 38 (27-52) years, and 88 children, aged 8 (3-13) years, were divided into 3 groups: Group 1 (n = 233), clinically suspected myocarditis with abnormal cardiac magnetic resonance; Group 2 (n = 222), biopsy-proven myocarditis; and Group 3 (n = 126) clinically suspected myocarditis with normal or inconclusive or no cardiac magnetic resonance. Baseline features were analysed overall, in adults vs. children, and among groups. One-year outcome events included death/heart transplantation, ventricular assist device (VAD) or implantable cardioverter defibrillator (ICD) implantation, and hospitalization for cardiac causes. Endomyocardial biopsy, mainly right ventricular, had a similarly low complication rate in children and adults (4.7% vs. 4.9%, P = NS), with no procedure-related death. A classical myocarditis pattern on cardiac magnetic resonance was found in 31.3% of children and in 57.9% of adults with biopsy-proven myocarditis (P < .001). At 1-year follow-up, 11/410 patients (2.7%) died, 7 (1.7%) received a heart transplant, 3 underwent VAD (0.7%), and 16 (3.9%) underwent ICD implantation. Independent predictors at diagnosis of death or heart transplantation or hospitalization or VAD implantation or ICD implantation at 1-year follow-up were lower left ventricular ejection fraction and the need for immunosuppressants for new myocarditis diagnosis refractory to non-aetiology-driven therapy. Endomyocardial biopsy was safe, and cardiac magnetic resonance using Lake Louise criteria was less sensitive, particularly in children. Virus-negative lymphocytic myocarditis was predominant both in children and adults, and use of immunosuppressive treatments was low. Lower left ventricular ejection fraction and the need for immunosuppressants at diagnosis were independent predictors of unfavourable outcome events at 1 year.

Fifteen Years of Spinal Fusion Outcomes in Children With Cerebral Palsy: Are We Getting Better?

Retrospective multicenter study. We reviewed 15-year trends in operative factors, radiographic and quality of life outcomes, and complication rates in children with cerebral palsy (CP)-related scoliosis who underwent spinal fusion. Over the past two decades, significant efforts have been made to decrease complications and improve outcomes of this population. We retrospectively reviewed a multicenter registry of pediatric CP patients who underwent spinal fusion from 2008 to 2020. We evaluated baseline and operative, hospitalization, and complication data as well as radiographic and quality of life outcomes at a minimum 2-year follow-up. Mean estimated blood loss and transfusion volume declined from 2.7±2.0L in 2008 to 0.71±0.34L in 2020 and 1.0±0.5L in 2008 to 0.5±0.2L in 2020, respectively, with a concomitant increase in antifibrinolytic use from 58% to 97% (all, P <0.01). Unit rod and pelvic fusion use declined from 33% in 2008 to 0% in 2020 and 96% in 2008 to 79% in 2020, respectively (both, P <0.05). Mean postoperative intubation time declined from 2.5±2.6 to 0.42±0.63 days ( P< 0.01). No changes were observed in preoperative and postoperative coronal angle and pelvic obliquity, operative time, frequency of anterior/anterior-posterior approach, and durations of hospital and intensive care unit stays. Improvements in the Caregiver Priorities and Child Health Index of Life with Disabilities postoperatively did not change significantly over the study period. Complication rates, including reoperation, superficial and deep surgical site infection, and gastrointestinal and medical complications remained stable over the study period. Over the past 15 years of CP scoliosis surgery, surgical blood loss, transfusion volumes, duration of postoperative intubation, and pelvic fusion rates have decreased. However, the degree of radiographic correction, the rates of surgical and medical complications (including infection), and health-related quality of life measures have broadly remained constant.

The effect of ventilation tube insertion in pediatric cochlear implantation candidates with otitis media with effusion on postoperative complications

ObjectiveOtitis media with effusion (OME) is a common finding in pediatric cochlear implant(CI) candidates and may be managed by inserting ventilation tubes. This study aimed to compare postoperative complication rates in children who underwent CI without and with OME, including patients who were treated without and with ventilation tube insertion. MethodsA population-based retrospective cohort study was conducted, including all CI patients, under ten years of age, at our institution, between 2007 and 2020. The study's population was divided into three groups based on their middle ear status at CI: 1) OME previously treated with VT, 2) untreated OME, and 3) normal-aerated ears. Postoperative complications of the groups were reviewed and served as our primary outcome measure. ResultsOf the 257 implanted ears included, 53, 42, and 162 ears belonged to the VT-treated OME, untreated OME, and aerated groups, respectively. Acute mastoiditis (AM) rate was significantly higher in the OME group compared to the aerated groups (9.5 % vs. 2.5 %, p = 0.0134) and in the VT-treated compared to the untreated OME groups (15.1 % vs. 2.3 %, p = 0.0356). Similarly, the rate of developing chronic suppurative otitis media without cholesteatoma (CSOMWC) was significantly higher in the OME compared to the aerated groups (12.6 % vs. 2.5 %, p = 0.0011) and in the VT-treated compared to the untreated OME groups (18.8 % vs. 4.7 %, p = 0.0366). Other complications rated were very low and similar between the groups. No other statistical difference was found between the groups. ConclusionVT insertion in pediatric CI candidates with OME increased postoperative AM and CSOMWC. We believe that, at least in our population, VT introduction prior to CI, for OME, surgery should be avoided.

Tek ürolog tarafından kısmen modifiye giyotin tekniği ile yapılan sünnet sonuçları

OBJECTIVE: Circumcision which has a history nearly same with the history of humanity has been being applied in many different techniques over the centuries. Over the times, by the increasing developments in science especially medicine, the circumcision applied in operating room and in appropriate sterilization conditions is one of the oldest known surgical procedures. In this retrospective study, we aimed to discuss the results of the modified guillotine method. MATERIAL and METHODS: Between December 2015 and July 2021, 1295 cases who were circumcised using modified guillotine technique were reviewed retrospectively. Their mean age, duration of surgery and surgical intervention results were evaluated. RESULTS: The mean age of the patients was 4.48±2.7. The mean procedure time was calculated as 15.9±3.3 minutes. In 7 (0%.54) patients complications due to anesthesia, in 25 (1%.93) patients complications due to surgical intervention were observed. Mortal or morbid complications were not observed. CONCLUSION: The modified guillotine method with low complication rates in children who underwent circumcision is a successful surgical procedure which can be used in a second step peripheral district governmental hospital. Keywords: circumcision, guillotine method, child

The effect of hyperthyroidism at thyroidectomy on complication rates in children with Graves' disease.

Graves' disease (GD) is the most common cause of childhood hyperthyroidism. Surgery is often chosen as a treatment modality given the high relapse rates and side effects of antithyroid drugs and has shown to be safe and efficacious. The goal of our study was to evaluate whether hyperthyroidism at time of thyroidectomy is associated with higher intra and postoperative complication rates. A retrospective cohort study of children who underwent thyroidectomy for GD by high-volume pediatric otolaryngologists between 2014 and 2021. 64 patients met inclusion criteria. Patients with hyperthyroidism (defined as free T4≥1.63ng/dL) were more likely to be treated with beta-blocker preoperatively compared to the euthyroid group (20/24 patients (83%) vs 23/40 patients (58%) respectively, p=0.035). Twenty (83%) patients with hyperthyroidism and 39 euthyroid patients (98%) were treated with methimazole prior to surgery. Intraoperative tachycardia was noted in 5% of euthyroid patients and 20.8% of patients with hyperthyroidism. The mean peak heart rate intra-operatively and the number of patients with heart rate ≥120bmp were significantly higher for patients with hyperthyroidism (96.5±16.2 vs 87.6±22.1bpm, p=0.02). Two patients required administration of esmolol during surgery for heart rate control, both with hyperthyroidism. Intra-operative peak systolic blood pressure, operative time, estimated blood loss, persistent hypocalcemia, length of admission and recurrent laryngeal nerve paralysis rates were similar among groups. Hyperthyroidism at surgery is associated with increased heart rate intraoperatively, with no increased risk for other complications. While optimizing thyroid hormone levels before surgery should be pursued in all children, our data suggest that hyperthyroidism should not delay the surgery.

Glaucoma surgery complications in children compared to adults using insurance claims data

Glaucoma surgery complication rates in children and adults have been reported in single- and multi-center studies but have not been characterized in large, nationally representative cohorts. We examine claims data from a US commercial insurance database.

The Importance of Flexible Bronchoscopy in Difficult-to-treat Asthma from a Pediatric Pulmonology Perspective.

ObjectiveAsthma is the most common chronic lung disease in childhood. Difficult-to-treat asthma is defined as the continuation of symptoms or attacks of patients despite step 4 or 5 of Global Initiative for Asthma therapy. In the differential diagnosis of these patients, flexible fiberoptic bronchoscopy is recommended to exclude other lung diseases. In this study, we aimed to examine the clinical and radiologic features and flexible fiberoptic bronchoscopy findings of patients referred to our pediatric pulmonology department due to difficult-to-treat asthma and determine the effects of flexible fiberoptic bronchoscopy on the differential diagnosis and treatment.Materials and MethodsThe demographic characteristics and flexible fiberoptic bronchoscopy results of 62 patients who were diagnosed as having difficult-to-treat asthma in our pediatric pulmonology department between January 2015 and June 2020 were evaluated retrospectively. The symptoms, history, medications, physical examination findings, pulmonary function tests, and radiologic findings of patients who underwent flexible fiberoptic bronchoscopy were evaluated.ResultsThe median age of the patients was 69 (interquartile range: 42-108 months). The most common reasons for the referral of these patients were chronic cough, recurrent pulmonary infections, and persistent wheezing. All patients had chest radiography and 37 (59.7%) had chest computed tomography at their first admission; 14 (37.8%) patients had abnormal findings on chest computed tomography. There was no significant difference in terms of age, physical examination findings, pulmonary function test results, and radiologic examinations between patients with and without pathologic bronchoscopy findings. None of the patients had complications during and after flexible fiberoptic bronchoscopy. The most common diagnoses of patients based on flexible fiberoptic bronchoscopy were persistent bacterial bronchitis in 19 (30.6%) patients, tracheomalacia and/or bronchomalacia in 12 (19.4%), and anatomic anomalies in 3 (4.8%) patients (separation of lingula into 3, separation of right upper lobe bronchus into 4, and tracheal dyskinesia). Mycobacterium tuberculosis growth was observed in the tuberculosis culture of 1 patient. According to the flexible fiberoptic bronchoscopy and bronchoalveolar lavage results, antituberculosis treatment was initiated in 1 patient and polypoid mass excision was performed in 1 patient. A proton pump inhibitor was started in 9 (15.5%) patients, physiotherapy in 5 (8.0%), antibiotics in 14 (22.5%), and ipratropium bromide in 7 (11.2%) patients. All patients were followed up with the diagnosis of asthma except for 2 patients.ConclusionTo date, there is no prospective study evaluating the importance of flexible fiberoptic bronchoscopy in difficult-to-treat asthma in childhood. In our small cohort, persistent bacterial bronchitis, airway tracheomalacia and/or bronchomalacia, gastroesophageal reflux, and other anatomic anomalies were successfully diagnosed using flexible fiberoptic bronchoscopy and treated without any complications, suggesting that flexible fiberoptic bronchoscopy is an important diagnostic tool with a low complication rate in children with difficult-to-treat asthma.KeywordsDifficult-to-treat asthma, flexible fiberoptic bronchoscopy, persistent bacterial bronchitis, gastroesophageal reflux

Paediatric Anterior Cruciate Ligament (ACL) Injuries: Current Concepts Review.

Over the past two decades, there has been a documented increase in paediatric ACL injuries because of a rise in younger age sports participation at the competitive level, awareness about sports-related injuries, and advanced imaging modalities. A PubMed electronic database search was done, which revealed 1366 hits over the last five years (2016 - 2020). Finally, 37 articles that contributed to new findings were included. This review was conducted based on predefined research questions. Early surgical reconstruction is recommended in children due to the increasing demand for early return to sports and to prevent the instability that can lead to progressive cartilage and meniscal damage. With the evolution of several "physeal sparing" ACL reconstruction (ACLR) techniques, a favorable clinical outcome with less growth disturbance is achievable. Although different autograft options are available, hamstring autografts are most commonly preferred. A specific pattern of a bone bruise not extending into the metaphysis, and lateral meniscus tears are the most common associated injuries. Following paediatric ACLR, complications like graft rupture and contralateral ACL injuries are two to three folds higher than with adult ACLR. Unprepared early return to sports is one of the reasons for increased complication rates in children; thus, clearance criteria for return to sports need to be standardized, and early return to sports (< 9 months post ACLR) should be avoided. Neuromuscular training protocols are recommended to minimize complications like graft ruptures.

Assessment of Lacrijet monocanalicular intubation for congenital nasolacrimal duct obstruction.

To assess the success rate and complications of Lacrijet monocanalicular stent (FCI S.A.S, Paris, France) intubation in children treated for congenital nasolacrimal duct obstruction (CNLDO). Retrospective review study which included children with CNLDO that were intubated with Lacrijet monocanalucilar silicone tube.The Lacrijet tube remained in place for 11-15 weeks post operatively and was removed in the clinic with topical anesthesia. Operative time was recorded for each case. All children were evaluated using the following parameters preoperatively and postoperatively: tear meniscus height, Fluorescein dye disappearance test (FDDT), and MUNK score. The study included 20 eyes with mean age of 26.25 ± 11.25 months. 17 eyes (85%) had undergone probing previously. Mean operation time of Lacrijet intubation was 8.5 min (95% CI 7.04-9.95). Mean follow-up period was 204.65 ± 105.27 days. Lacrijet intubation resulted in statistically significant improvements in tear meniscus height (P < .001), FDDT (P < 0.001), and MUNK score (P < 0.001) in all children. Two different sizes of Lacrijet intubations were used. Complete success was obtained in all cases. No complications were observed. Lacrijet lacrimal intubation has a high rate of success, shortens surgical time and has a low rate of complications in children with CNLDO.

Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.

Ureteral wall thickness at the stone site: A critical predictor of success and complications in children undergoing semi-rigid ureteroscopy

We retrospectively assessed the role of ureteral wall thickness (UWT) at the ureteral stone site in predicting the stone-free status and the complication rates in children undergoing semi-rigid ureterorenoscopy (URS). The children who underwent URS and had undergone non-contrast abdominal computerized tomography before the URS were included in the study. The following protocol was used to determine the outcome. Immediately before removing the stent, all children were evaluated by ultrasound (US) and plain film (KUB) for residual stones in the upper urinary tract and after removing the double J stent, the presence of stone fragments in the ureter was checked with URS. The children were considered stone-free if no residual fragments were identified in radiologic imaging and the evaluation of the ureter by URS. The case was accepted as a failure if any fragments were seen on immediate US, KUB, and/or during URS just after the stent removal. The patients who could not complete the standard primary URS procedure due to stone-related reasons (patients for whom we could not pass the safety guidewire behind the stone and/or the procedure was terminated due to pyuria during the procedure) were also accepted as a failure. The possible factors related to the patient, stone, ureter, and the operation that could affect the outcome and the complications following the URS were evaluated. The children's median age was six years (1-17 years). Among the 89 children included in the study, 69 (78%) were stone-free, and 20 (22%) presented residual stone after the first URS session. The ROC analysis revealed that a UWT value of 4.5mm (sensitivity 60%, specificity 92%) was the optimal cut-off value predictive of the URS outcome. The regression analysis revealed UWT >4.5mm (p=0.006) and multiple stone presentation (p=0.005) as independent risk factors for residual stone. Complications were detected in 15 (17%) children. Thick ureteral wall (p=0.012) and longer operative time (p=0.016) were defined as the independent risk factors for complications. Increased UWT is associated with the adverse outcomes of URS due to tissue hypertrophy, edema, and mucosal bleeding may cause difficulty in removing the stone. The thick ureteral wall might increase the risk of complications due to the necessity of manipulating the instruments or the involuntary forceful use of instruments while removing the stone. UWT was the only independent variable affecting both increased failure and complication rates in children undergoing URS.

Vitamin A in Children Hospitalized for Measles in a High-income Country.

Worldwide medical authorities recommend vitamin A supplementation for severe measles requiring hospitalization; however, evidence supporting its use in high-income countries is lacking. A nationwide vitamin A shortage reported in concomitance with a recent measles outbreak in Italy provided an opportunity to test the effectiveness of vitamin A in a high-income setting, approximating an unbiased allocation. We conducted a prospective controlled cohort study involving children admitted for measles to a tertiary-care hospital in Southern Italy. The primary outcome was the duration of fever. Secondary outcomes included the length of hospitalization, rate of complications, need for antibiotic treatment and body temperature. A total of 108 inpatient children (36% female, median age 16.3 months) were enrolled; 36 received 2 doses of oil-based vitamin A according to age, and 72 matched controls received standard care. There were no significant differences between the study groups in the duration of fever (7.03 ± 2.67 vs. 6.82 ± 3.27, P = 0.72), length of hospitalization (median, 5.0 vs. 5.0 days, P = 0.50), maximum body temperature (median, 39°C in both groups, P = 0.23), rate of organ (69.4% vs. 63.9%, P = 0.72) and hematologic complications (41.7% vs. 59.7%, P = 0.12), or need for antibiotic treatment (66.7% vs. 61.1%, P = 0.72). Overall, vitamin A supplementation did not reduce the risk of any complications (relative risk, 1.33; 95% confidence intervals: 0.59-2.96). Vitamin A does not change the clinical course of measles infection or the rate of complications in children hospitalized in a high-income country. EU PAS 31805.

Mechanical complications of cerebrospinal fluid shunt. Differences between adult and pediatric populations: myths or reality?

Shunt malfunctions seem more frequent in children (44 to 81%) than in adults (18 to 29%). Because of discrepancies between studies, it is not possible to affirm this disparity. The objective was to verify whether the incidence of cerebrospinal fluid (CSF) shunt malfunctions is higher in children than adults. We present a retrospective series of child and adult patients who underwent CSF shunt placement between 2000 and 2013 with a Sophysa SM8® valve. 599 adults and 98 children (sex ratio 1.28) underwent CSF shunt placement. Age at first surgery ranged between 1 day of life and 90 years (mean of 55.8 years, SD 25.8, median 64.8 years). The mean follow-up was 4 years (SD 4.264, 0-16; median 3 years). The cumulative complication rate was 25.5% (178/697). Mechanical complications were disconnection (25.1%), migration (11.8%), intracranial catheter obstruction (8.9%) and malposition (8.4%). The mean delay for the first revision was 1.90 years (0-13.9), (SD 2.73, median 0.5). The probability of shunt failure was 65% at 10 years in the child group and 36% at 10 years in the adult group. Moreover, in the child group, 33% of revisions occurred during the first year after shunt placement versus 17% in the adult group. Thus, the probability of shunt failure was higher in children than in adults (log-rank test, p < 0.001). This is the first retrospective study, comparing children and adults undergoing CSF shunt using the same valve, able to confirm the higher rate of complications in children.

Complications of Ventriculoperitoneal Shunts in Children with Pediatric Hydrocephalus a Local Study at Benha University Hospitals

Ventriculoperitoneal shunting is the main way used for extra-thecal cerebrospinal fluid (CSF) diversion. Despite being the main corner stone of treating different types of hydrocephalus, VP shunts has unfortunately a lot of complications making surgeries to treat these complications much more than initial shunt insertions.Methods:It is a clinical retrospective observational study that was conducted on 221 patients wth congenital hydrocephalus of both genders with age ranging from 0 to 18 yrs old who came with symptoms and signs of shunt complications and were primarily shunted at Benha university hospital between 2016 and 2019. A complete clinical assessment was done, history taking, a final diagnosis was made, and a treatment of individual patients was planned accordingly. Patients were followed up till the end of the study post-operatively. Data was analyzed using the SPSS (version 16.0). VP shunt was inserted for 221 patients. 113 (51.1%) patients had various forms of complications. Obstructive complications accounts for the most common complications as they happened in 48 (42.5%) of complicated patients followed by infective complications as they appeared in 27 (24%) patients.Conclusions: Despite .great revolution in the field of neurosurgery in the past 100 years and sincere efforts from neurosurgeons worldwide , shunt complications still common among shunted patients.Background Hydrocephalus is regarded as an imbalance in the formation and absorption of CSF to a sufficient magnitude producing accumulation of CSF fluid with in ventricular system of the brain leading to an elevation of intracranial pressure. Compensatory adjustments especially in very young subjects may occur that may reduce prevailing CSF pressure to normal range on count of functioning brain tissue [1]. Hydrocephalus is the second most common congenital brain malforma-tion [2].Congenital hydrocephalus is type of hydrocephalus that is present or its underlying cause at birth. majority of cases are attributed to aqueductal stenosis , chiarri malformation , dandy walker malformation ,arachnoid cyst. approximately 55% of all cases of congenital hydrocephalus are due to Primary aqueductal stenosis whereas aqueductal stenosis secondary to neoplasm, infection, or hemorrhage accounts for another 5% [4]. Till now , the standard treatment of hydrocephalus is ventriculoperitoneal shunt. The technique of using the peritoneal cavity for CSF absorption in ventriculoperitoneal shunting (VPS) was developed by Kausch in 1908 [3]. Al- though VPS insertion is the most common neurosurgical Procedure done worldwide, complication rates in Children are high ranging from 10% to 100% [11]. The advent of endoscopic third ventriculostomy has gained popularity due to the high complication and failure rates of ventriculoperitoneal shunt [12]. VP shunts are prone to a lot of complications such as mechanical blockage, shunt infection, shunt migration, and various abdominal complications[13].

Flexible intramedullary nailing for radial neck fractures in children

The aim of this study was to analyze the outcomes of treatment and the rate of complications in children treated with flexible intramedullary nailing (FIN) for radial neck fractures. The study included 26 children (11 males and 15 females) with a median age of 9.5 years, treated with FIN for the radial neck fractures between May 2011 and May 2018. Immobilization after the surgery was not used. The median follow-up was 41 months. According to the Judet classification, 15 fractures were classified as type III and 11 as Type IV. For each patient, clinical, radiological, and disability of the arm, shoulder, and hand (DASH) scores were calculated. All patients achieved complete radiographic healing at a median of 5 weeks. The nails were removed at a median of 4 months. The rate of complications was 11.5%, including 1 radial head necrosis, 1 angulation of 15°, and 1 displacement of the radial head. Twenty patients (76.9%) achieved a perfect clinical healing, while 23 patients (88.5%) achieved a perfect radiological healing. The median DASH score was 1.25. No cases of delayed healing were recorded. After removing of the nails, all patients returned to full function of the extremity and all complications were resolved. The use of FIN for treating fractures of the radial neck in children shows very good functional and cosmetic results. It allows mobilization with rapid pain reduction. It is a minimally invasive, simple, and reproducible technique with a low rate of complication. Owing to excellent results, surgical stabilization of radial head and neck fractures using FIN is recommended in children and adolescents. Level IV, Therapeutic study.

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience.

Focal atrial tachycardia accounts for up to 10-15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia. Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study. The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5-18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%). The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.

MP65-20 THE HYPOSPADIAS COMPLICATION RATE IN CHILDREN WITH SEVERE EXTRA-GENITAL ANOMALIES: ARE WE STAGING FOR A REASON?

You have accessJournal of UrologyPediatrics: Hypospadias and Penile Surgery (MP65)1 Apr 2020MP65-20 THE HYPOSPADIAS COMPLICATION RATE IN CHILDREN WITH SEVERE EXTRA-GENITAL ANOMALIES: ARE WE STAGING FOR A REASON? Sarah Holzman*, Carol Davis-Dao, Zayn Suhale, Amanda Macaraeg, Joshua Chamberlin, Kai-wen Chuang, Heidi Stephany, Elias Wehbi, and Antoine Khoury Sarah Holzman*Sarah Holzman* More articles by this author , Carol Davis-DaoCarol Davis-Dao More articles by this author , Zayn SuhaleZayn Suhale More articles by this author , Amanda MacaraegAmanda Macaraeg More articles by this author , Joshua ChamberlinJoshua Chamberlin More articles by this author , Kai-wen ChuangKai-wen Chuang More articles by this author , Heidi StephanyHeidi Stephany More articles by this author , Elias WehbiElias Wehbi More articles by this author , and Antoine KhouryAntoine Khoury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000940.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with hypospadias may have extra-genital anomalies. The effect of these anomalies on surgical planning and complication rates are not well defined. We sought to review our experience with hypospadias and identify if patients with extra-genital anomalies had higher complication rates. METHODS: We reviewed a prospectively-managed hypospadias database for patients who underwent hypospadias repair at our institution from 2008-2019. We identified patients with complex genetic syndromes or severe neurologic, cardiac or gastrointestinal anomalies. Patients with prior hypospadias repair performed outside our institution were excluded. We evaluated hypospadias severity, type of repair and complications. Complications were stratified by severity ranging from simple complications to severe. Primary outcome was complication rate. Analyses were conducted using Chi-square and logistic regression. RESULTS: Our database included 733 patients including 26 patients with severe anomalies. Meatal location was recorded as distal, mid-shaft and proximal in 13, 6 and 11 patients with severe anomalies, respectively. Twelve children had severe cardiac anomalies including tetralogy of Fallot, transposition of the great arteries, atrial and ventral septal defects. Three children had VATER, 5 children had neurologic syndromes and 6 had chromosomal anomalies. Complication rate amongst children with extra-genital anomalies was 19% (5/26) compared to 15% (105/707) in children without anomalies but this was not significant (p=0.54). There was no difference in severe complications between the two groups. The rate of planned staged procedures was higher in children with extra-genital anomalies with 23% (6/26) staged procedures compared to 6% in children without these anomalies (39/666, p=0.0005). In regression analysis, staged procedures remained significant when adjusting for hypospadias location (OR= 3.5, 95% CI: 1.1-12, p=0.04). We did not find an association between severe extra-genital anomalies and complication rate adjusting for single or staged procedure and hypospadias location (OR= 0.88, 95% CI: 0.29-2.6, p=0.81). CONCLUSIONS: Children with severe extra-genital anomalies had a higher staged repair rate compared to their peers; however, their complication rate did not differ. Staged repair may have a protective effect against complications as these children are thought to have impaired wound healing. Given the rare nature of hypospadias with severe anomalies, further study is required to verify these findings. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e981-e981 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Holzman* More articles by this author Carol Davis-Dao More articles by this author Zayn Suhale More articles by this author Amanda Macaraeg More articles by this author Joshua Chamberlin More articles by this author Kai-wen Chuang More articles by this author Heidi Stephany More articles by this author Elias Wehbi More articles by this author Antoine Khoury More articles by this author Expand All Advertisement PDF downloadLoading ...

Vitamin A in Children Hospitalized for Measles in a High-Income Country

Background: Worldwide medical authorities recommend vitamin A supplementation for severe measles requiring hospitalization; however, evidence supporting its use in high-income countries is lacking. A nationwide vitamin A shortage reported in concomitance with a recent measles outbreak in Italy provided an opportunity to test the effectiveness of vitamin A in a high-income setting, simulating a random allocation to treatment. Methods: We conducted a prospective controlled cohort study involving children admitted to a tertiary-care hospital in Southern Italy. The primary outcome was the duration of fever· Secondary outcomes included the length of hospitalization, rate of complications, need for antibiotic treatment, and body temperature. The study has been registered to the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance ( EU PAS 31805). Findings: A total of 108 inpatient children (36% females, median age 16·3 months) were enrolled; 36 received two doses of oil-based vitamin A according to age, and 72 matched controls received standard care. There were no significant differences between the study groups in the duration of fever (7·03±2·67 vs· 6·82±3·27, p=0·74), length of hospitalization (median, 5·5 vs· 5·0 days, p=0·36), maximum body temperature (median, 39°C in both groups, p=0·90), rate of organ (69·4% vs· 63·9%, p=0·56) and hematological complications (41·7% vs· 59·7%, p=0·07), or the need for antibiotic treatment (66·7% vs· 61·1%, p=0·57). Overall, vitamin A supplementation did not reduce the risk of any complications (relative risk, 1·33; 95% confidence intervals 0·59 to 2·96). Sub-group analysis in children with chronic conditions, weight-for-age <2 SD, known measles contact, or receiving care within 48h of fever did not demonstrate effectiveness of vitamin A over standard care. Interpretation: Vitamin A does not change the clinical course of measles virus infection or the rate of complications in children hospitalized in a high-income country. Trial Registration: The study has been registered to the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP®). Funding Statement: Department of Translational Medical Sciences, University of Naples Federico II. Declaration of Interests: The authors stated that there were no conflicts of interest to declare. Ethics Approval Statement: The study protocol was approved by the “Ethical Committee Federico II” of the University of Naples, Italy. Patients’ caregivers signed specific informed consent, and all patients’ data were analyzed and reported anonymously by using a single patient code.

The Efficacy of Guy's Stone Score for Predicting the Stone-Free and Complication Rates in Children Treated by Percutaneous Nephrolithotomy.

Introduction: To determine the efficacy of Guy's stone score (GSS) for predicting stone-free and complication rates after percutaneous nephrolithotomy (PCNL) in children. Patients and Methods: A total of 197 renal units (RUs) in 173 children (≤17 years) who referred to our clinic were included in our study. RUs with stones were classified as four groups according to GSS. The results were designated as stone free or as having residual stones. Complications were evaluated according to GSS, the Satava, and modified Clavien grading system. All parameters were evaluated by using univariate and multivariate analysis. Results: The median age of patients was 6 years (1-17 years). Stone-free status was 77% and complication rate was 17%. Stone-free rate was established 89% for group 1, 78% for group 2, 75% for group 3, and 57% for group 4. There was a positive association between GSS and stone-free status (p = 0.02). No relationship was found between GSS and the complication rate (p = 0.42). In multivariate analysis, GSS was the only independent factor for predicting stone-free status. Conclusion: Current study revealed that GSS has a predictive ability for stone-free status; however, GSS is insufficient for predicting complications after pediatric PCNL. Even though, GSS does not fully reflect the characteristics of the pediatric population, we believe that it might provide useful insights for clinicians when recommending and discussing treatment options for children with urolithiasis.

Optimal Timing for Surgical Excision of Nevus Sebaceus on the Scalp: A Single-Center Experience.

Treatment of nevus sebaceus (NS) on the scalp is usually surgical excision, but the optimal timing is debatable. The scalp presents significant challenges to the reconstructive surgeon because the lack of elasticity of the scalp makes the repair of defects difficult. The aim of this study was to investigate the optimal timing for surgical excision of NS on the scalp through postoperative outcomes. The authors retrospectively reviewed the postoperative cosmetic results of patients with a follow-up period of 12 to 15 months. The variables analyzed were patient demographics, preoperative tumor size, location, operative time, cosmetic results, and complications. This study enrolled 62 patients, including 30 adults and 32 children. The main complications were hair loss, hypertrophic scar, and widening of the scar. The overall complication rate was 17.7%, and the complication rate in children (9/32, 28.1%) was higher than that in adults (2/30, 6.7%) (p < .05). Tumor location, shape, and size showed no association with complications. Complications after surgical excision of NS on the scalp are more likely to occur in children than in adults. On the basis of these findings, surgical excision of NS on the scalp can be delayed until after childhood.