| 1. |
- Brands Viktorsdóttir, Margrét, et al.
(författare)
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Complications according to underlying disease in children undergoing video-assisted gastrostomy
- 2017
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Ingår i: Medical Research Archives. - 2375-1916. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to identify short-term complications after video-assisted gastrostomy in children and to examine the association between complications and underlying disease.Methods: This was a retrospective study at a single institution. Data for all children who underwent video-assisted gastrostomy during 12 years was collected. Complications occurring within three months postoperatively were analyzed.Results: Among 421 children undergoing video-assisted gastrostomy, 402 were included in the study. The median age at surgery was two years (range one month-14 years). The most common underlying disorder was neurological disease (49%). There were two major postoperative complications and 78% had minor complications. Minor complications included granulation tissue (43%), leakage (16%), wound infection (14%), vomiting, dislodgement and pain. There was no significant difference in frequency of the various complications when compared between the underlying diseases (p=0.10-0.82). Wound infection was registered in overall 14% and occurred least frequently in children with neurologic disease and syndromes (10% and 9% respectively).Conclusion: Serious complications after video-assisted gastrostomy are rare, while minor complications occur in 78% of the children. There is no association between the frequency of complications and underlying disease according to this study.
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| 2. |
- Burman, Linnéa, et al.
(författare)
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Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants
- 2019
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Ingår i: The Surgery Journal. - : Georg Thieme Verlag KG. - 2378-5128 .- 2378-5136. ; 5:3, s. 96-102
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Tidskriftsartikel (refereegranskat)abstract
- Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1-24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4-30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes , but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.
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| 3. |
- Dahlin, Lars B, et al.
(författare)
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Carpal tunnel syndrome and treatment of recurrent symptoms.
- 2010
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 1651-2073. ; 44, s. 41375-41375
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Carpal tunnel syndrome is the most common compression lesion of peripheral nerves with a prevalence of 4%. It is often treated by release of the flexor retinaculum, which may completely relieve the symptoms. Although such treatment is considered successful, there are probably many patients with persistent or recurrent symptoms. Recurrence implies that the patient's symptoms were initially relieved but recurred some time after the operation; this is a controversial field in which clear definitions, aetiology, diagnosis, and treatment seem uncertain. We describe recurrence of carpal tunnel syndrome and summarise possibilities for diagnosis and treatment of the condition.
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| 4. |
- Ekselius, Julia, et al.
(författare)
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Treatment and Outcome for Children with Esophageal Atresia from a Gender Perspective
- 2017
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Ingår i: Surgery research and practice. - : Hindawi Limited. - 2356-7759 .- 2356-6124. ; 2017
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Tidskriftsartikel (refereegranskat)abstract
- Background: Besides the incidence of esophageal atresia (EA) being higher in males, no other gender-specific differences in EA have been reported. The aim of this study was to search for gender-specific differences in EA.Methods: A retrospective study was conducted at a tertiary center for pediatric surgery. The medical charts of infants born with EA were reviewed. 20 girls were identified, and 20 boys were selected as matched controls with respect to concomitant malformations. Their treatment and outcome were evaluated.Results: Polyhydramnios was more common in pregnancies with boys, 40%, versus girls, 10%, with EA (p < 0.01). In total, 36 (90%) children had patent ductus arteriosus, without any gender difference (18 and 18, resp., p=1). The distribution of days at the different levels of care was not equally distributed between boys and girls. Boys with EA had significantly more postoperative days (median 5 days) in the ward than girls (median 5 and 2 days, resp., p=0.04). No other gender-specific differences in surgical treatment, complications, or symptoms at follow-up were identified.Conclusion: Polyhydramnios appears to be more frequent in pregnancies with boys than girls with EA. In this study, boys have longer stays than girls at the pediatric surgery ward.
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| 5. |
- Elliver, Matilda, et al.
(författare)
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Associations between Th1-related cytokines and complicated pediatric appendicitis
- 2024
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Ingår i: Scientific Reports. - 2045-2322. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- The pathogenesis of appendicitis is not understood fully, and the diagnosis can be challenging. Previous research has suggested an association between a T helper (Th) 1-dependent immune response and complicated appendicitis. This prospective cohort study aimed to evaluate the association between serum concentrations of the Th1-associated cytokines interleukin (IL)-1α, IL-1β, IL-2, IL-6, IL-10, IL-17A and tumor necrosis factor beta (TNF-β) and the risk of complicated appendicitis in children. Appendicitis severity was determined through histopathological examination. A total of 137 children < 15 years with appendicitis were included with a median age of 10 years (IQR 8-12); 86 (63%) were boys, and 58 (42%) had complicated appendicitis. Children with complicated appendicitis had significantly higher concentrations of serum IL-6 and IL-10, and lower of TNF-β. After adjustment for age, symptom duration, and presence of appendicolith in a multivariable logistic regression, a higher concentration of IL-6 remained associated with an increased risk of complicated appendicitis (aOR 1.001 [95% CI 1.000-1.002], p = 0.02). Serum concentrations of IL-1α, IL-1β, IL-2, IL-10, IL-17A and TNF-β were not significantly associated with the risk of complicated appendicitis. In conclusion, our results suggests that the systemic inflammatory response in complicated appendicitis is complex and not solely Th1-dependent.
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| 6. |
- Elofsson, Axel, et al.
(författare)
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Laparoscopic or Open Appendectomy for Pediatric Appendicitis?
- 2016
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Ingår i: MOJ Surgery. - : MedCrave Group, LLC. - 2379-6162. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aimed to compare open appendectomy (OA) and laparoscopic appendectomy (LA) in children by analyzing the differences in outcomes between the two techniques. Materials and Methods: This was a single-institution retrospective study. Data were collected from the medical records of all children <15 years of age who underwent an appendectomy from 2006 through 2014. Preoperative parameters, appendicitis severity, surgery time, complications, pain treatment, and postoperative outcome including days of hospital stay were collected. LA was performed with a two- or three-port technique, and a McBurney incision was adopted for OA. Conversions were regarded as OA. Results: A total of 406 appendectomies were performed during the study period, 146 (36%) OA (61 conversions) and 260 (64%) LA. No differences were found between the two groups regarding surgery time, operative and postoperative complications, and postoperative pain treatment. In cases of Phlegmonous appendicitis, LA was associated with a significantly shorter median hospital stay than was OA (1 and 1.8 days, respectively; p < 0.01). Healthy and Phlegmonous appendices were more commonly treated with LA (p < 0.01 for both); gangrenous, perforated, and abscessed appendices were more commonly treated with open surgery (p = 0.02, p < 0.01, and p < 0.01, respectively). Conclusion: The study identified no disadvantages of LA compared with OA. Therefore, LA should be the preferred technique because it is associated
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| 7. |
- Eriksson, David, et al.
(författare)
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Predictive factors for time to full enteral feeding after pyloromyotomy for infantile hypertrophic pyloric stenosis
- 2020
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Ingår i: World Journal of Pediatric Surgery. - : BMJ. - 2516-5410. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of the study was to evaluate how different parameters in the preoperative, perioperative, and postoperative period affect time to full enteral feeding (TFEF) in children undergoing pyloromyotomy. Methods A retrospective study of all children operated for infantile hypertrophic pyloric stenosis between 2001 and 2017 was conducted. Parameters in demographics and in the preoperative and postoperative period were evaluated against TFEF (hours) using linear regression models. Results In the whole cohort of 175 children, mean TFEF was 47 hours with Standard Deviation (SD) of ±35. In the multivariate model, TFEF decreased with age [beta (B): -0.62; 95% confidence interval (95% CI) -1.05 to -0.19; p=0.005) and increased with the presence of severe underlying disease (congenital heart defect or syndrome) (B: 26.5; 95% CI 3.3 to 49.7; p=0.026). Hence, for every day of age, the time to fully fed decreased by 0.6 hour, and the presence of an underlying disease increased the time to fully fed with over one day. TFEF did not seem to be affected by prematurity, weight loss, symptom duration, preoperative acid/base balance or electrolyte values, surgical method, or method of postoperative feeding. Conclusions TFEF decreased with higher age and increased in children with a severe underlying disease. These results may be useful in providing adequate parental information regarding what affects TFEF and the length of hospital stay.
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| 8. |
- Gudjonsdottir, Johanna, et al.
(författare)
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An Evaluation of Serum IgE and Th2-Associated Interleukins in Children With Uncomplicated and Complicated Appendicitis
- 2022
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Ingår i: Frontiers in Pediatrics. - : Frontiers Media SA. - 2296-2360. ; 10, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Background: The pathogenesis of appendicitis is not understood completely and establishing a correct diagnosis can be clinically challenging. Previous investigations have shown an association between a T helper cell (Th)2-mediated inflammatory response, for example immunoglobulin E (IgE)-mediated allergy, and a decreased risk of complicated appendicitis. The present study aimed to evaluate differences in serum concentrations of IgE and Th2-associated interleukins (IL) in children with uncomplicated and complicated appendicitis.Method: A prospective study including children <15 years with appendicitis. Blood samples were collected preoperatively at the time of clinical assessment at the Pediatric Emergency Department and analyzed for concentrations of serum total IgE and IL-4, IL-9, and IL-13. Associations with complicated appendicitis were evaluated through logistic regression adjusting for age, appendicolith, and symptom duration.Results: 138 children with confirmed appendicitis were included. The median age was 10 (IQR 8–12) years, 87 (63%) were boys and 58 (42%) had complicated appendicitis. Children with complicated appendicitis had significantly higher concentrations of IL-9 and IL-13 compared to children with uncomplicated appendicitis. In the univariate logistic regression, high concentrations of IL-13 were associated with an increased risk of complicated appendicitis [OR 1.02 (95% CI 1.01–1.04) p = 0.005], which remained in the multivariate analysis [aOR 1.02 (95% CI 1.01–1.04), p = 0.01]. Serum concentrations of IgE, IL-4, and IL-9 did not significantly affect the risk of complicated appendicitis.Conclusion: High levels of IL-13 seem to be associated with an increased risk of complicated appendicitis. This is incongruent with the hypothesis of an Th1/Th17-driven inflammation in this type of appendicitis.
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| 9. |
- Gudjonsdottir, Johanna, et al.
(författare)
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Associations of hair cortisol concentrations with paediatric appendicitis
- 2021
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Ingår i: Scientific Reports. - : Nature Portfolio. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- The pathogenesis of paediatric appendicitis is still an enigma. In recent years, it has become more evident that our inherent immunological responses affect the trajectory of the disease course. Long-term stress has an impact on our immune system; however, it is practically and ethically challenging to prospectively track blood measurements of cortisol-levels in asymptomatic children should an acute appendicitis episode develop. The aim of this case-control study was therefore to evaluate the effect of increased stress measured as historical imprints in hair (hair cortisol concentrations [HCC]), on the risk of developing appendicitis and complicated appendicitis. 51 children (aged<15 years) with appendicitis (34 with complicated appendicitis), were compared to 86 healthy controls. HCC reflecting the activity of the HPA-axis 0-3 and 4-6 months prior to sampling was evaluated and compared between groups as well as between the two measurements of each study subject. In the univariate analysis with both cases and controls, an increase in HCC between the measurement timepoints was associated with a substantial increase in risk of appendicitis (OR 7.52 [95% CI 2.49-22.67], p=0.001). This increased risk remained in the multivariate analysis after adjustment for age, sex and season (aOR OR 10.76 [95%CI 2.50-46.28], p =0.001). When comparing the cases of uncomplicated and complicated appendicitis through a multivariate analysis, adjusted for age and sex, the children with an increased HCC prior to appendicitis had a substantial and statistically significant increase in risk of complicated appendicitis (aOR 7.86 [95% CI 1.20-51.63], p=0.03). Biological stress, measured as an increase in HCC, seems to be associated with an increased risk of paediatric appendicitis and a more complicated disease course.
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| 10. |
- Hallabro, Nilla, et al.
(författare)
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Mapping of referral patterns for undescended testes – Risk factors for referral of children with normal testes
- 2023
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Ingår i: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131. ; 19:3, s. 1-320
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Tidskriftsartikel (refereegranskat)abstract
- Background: Accurate referral of boys with suspected undescended testes (UDT) is of importance to preserve fertility and reduce risk of future testicular cancer. While late referral is well studied, there is less knowledge about incorrect referrals, hence, referral of boys with normal testes. Objective: To evaluate the proportion of UDT referrals that did not lead to surgery or follow-up, and to assess risk factors for referral of boys with normal testes. Study design: All UDT referrals to a tertiary center of pediatric surgery during 2019–2020 were retrospectively assessed. Only children with suspected UDT in the referral (not suspected retractile testicles) were included. Primary outcome was normal testes at examination by a pediatric urologist. Independent variables were age, season, region of residence, referring care unit, referrer's educational level, referrer's findings, and ultrasound result. Risk factors for not needing surgery/follow-up were assessed with logistic regression and presented as adjusted odds ratios with a 95% confidence interval (aOR, [95% CI]). Results: A total of 378 out of 740 included boys (51.1%) had normal testes. Patients >4 years (aOR 0,53, 95% CI [0,30-0,94]), referrals from pediatric clinics (aOR 0.27, 95% CI [0.14–0.51]) or surgery clinics (aOR 0.06, 95% CI [0.01–0.38]) had lower risk of normal testes. Boys referred during spring (aOR 1.80, 95% CI [1.06–3.05]), by a non-specialist physician (aOR 1.58, 95% CI [1.01–2.48]) or referrer's description of bilateral UDT (aOR 2.34, 95% CI [1.58–3.45]), or retractile testes (aOR 6.99, 95% CI [3.61–13.55]) had higher risk of not needing surgery/follow-up. None of the referred boys that had normal testes had been re-admitted at the end of this study (October 2022). Discussion: Over 50% of boys referred for UDT had normal testes. This is higher or equal to previous reports. Efforts to reduce this rate should in our setting probably be directed towards well-child centers and training in examination of testicles. The main limitation of this study is the retrospective design and the rather short follow-up time, which however should have very modest effect on the main findings. Conclusion: Over 50% of boys referred for UDT have normal testes. A national survey regarding the management and examination of boys testicles has been launched and directed at well-child centers to further evaluate the findings of the current study.[Formula
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