RESUMEN
INTRODUCTION: Pelvi-Ureteric Junction Obstruction (PUJO) is a common cause of hydronephrosis (HDN) in children. While ultrasonography (USG) is useful for initial assessment and grading of hydronephrosis, it cannot differentiate obstructive from non-obstructive cases. Renal Dynamic Scintigraphy (RDS) confirms the diagnosis but involves ionizing radiation exposure. Ureteric jets using colour Doppler USG have been proposed for diagnosing obstructive HDN. OBJECTIVE: Our study aimed to evaluate Ureteric Jet Frequency (UJF) and Relative Jet Frequency (RJF) in unilateral PUJO before and after furosemide (Lasix) administration, assessing their diagnostic and post-operative utility. MATERIALS AND METHODS: Children (<14 years) with unilateral HDN underwent USG and RDS for PUJO diagnosis. Pyeloplasty was performed based on standard criteria. UJF and RJF were assessed before and after furosemide administration (0.5 mg/kg) by colour Doppler USG. The non-obstructed side was taken as the control. Follow-up included repeat RDS and ureteric jet assessment. RESULTS: Fifty-two cases were included. UJF (pre- and post-Lasix) was significantly lower in the obstructed side compared to the non-obstructed side at baseline and post-pyeloplasty (p < 0.0001). However, the baseline UJF difference between cases and controls was not significant (p > 0.05). UJF and RJF (pre- and post-Lasix) increased postoperatively. The UJF difference decreased postoperatively (p < 0.05). (attached Table) CONCLUSION: UJF and RJF are useful for diagnosing and monitoring unilateral PUJO. The effect of furosemide on UJF needs to be assessed using additional studies with larger sample sizes to understand if it can affect UJF in a way similar to that noted in diuretic scintigraphy.
RESUMEN
Background: Ventilating a pediatric patient during thoracoscopy is challenging. Few studies have highlighted the impact of capnothorax in children by measuring regional cerebral oxygen saturation (rcSO2) with near infrared spectroscopy. In this systematic review, we aimed to summarize the data from relevant studies and assess whether thoracoscopy in children is associated with intraoperative pathological cerebral desaturation. Methods: The authors systematically searched four databases for relevant studies on the measurement of rcSO2 during pediatric thoracoscopic procedures. The primary outcome was the proportion of patients with pathological desaturation, that is, >20% decline in the intraoperative rcSO2. Risk of bias among the included studies was estimated using the Newcastle-Ottawa scale. Results: The systematic search resulted in 776 articles, of which 7 studies were included in the analysis. In total, 88 patients (99 procedures) with an age ranging from 0 days to 8.1 years were included. Of these, 43 (49%) patients were neonates. The included cohort had esophageal atresia and tracheoesophageal fistula (n = 26), long-gap esophageal atresia (n = 5), congenital diaphragmatic hernia (n = 14), and congenital pulmonary airway malformations and other conditions needing lung resection (n = 43). Of the total 99 procedures, pathological desaturation was noticed in 13 (13.1%, 95% confidence interval 7.2-21.4) of them. Upon quality assessment, most of the studies were weaker in the selection and comparability domains. Conclusion: In this review, pathological cerebral desaturation was noticed in 13.1% of the pediatric thoracoscopic procedures. However, due to limited methodological quality of the included studies, further randomized multicentric studies comparing rcSO2 in open versus thoracoscopic surgeries are needed to derive definitive conclusions.
Asunto(s)
Atresia Esofágica , Hernias Diafragmáticas Congénitas , Fístula Traqueoesofágica , Niño , Humanos , Recién Nacido , Atresia Esofágica/cirugía , Hernias Diafragmáticas Congénitas/cirugía , Pulmón/cirugía , Estudios Retrospectivos , Toracoscopía/métodos , Fístula Traqueoesofágica/cirugía , Resultado del Tratamiento , Lactante , Preescolar , Periodo Intraoperatorio , Oxígeno/análisisRESUMEN
The occurrence of postoperative necrotising enterocolitis (NEC) is rare. In comparison with the commonly known inciting factors for the development of NEC, surgical stress as a cause of NEC is relatively uncommon. We report a case of incarcerated inguinal hernia in a preterm infant who clinically deteriorated in the postoperative period because of NEC following herniotomy. The patient's clinical, biochemical and radiological features were suggestive of NEC, and the patient responded to the appropriate treatment based on the diagnosis. To conclude, incarcerated inguinal hernia should always be considered a causative factor for postoperative NEC.
Asunto(s)
Enterocolitis Necrotizante , Hernia Inguinal , Enfermedades del Recién Nacido , Lactante , Recién Nacido , Humanos , Recien Nacido Prematuro , Hernia Inguinal/cirugía , Enterocolitis Necrotizante/etiología , Enterocolitis Necrotizante/cirugíaRESUMEN
Oesophageal diverticulum occurring secondary to motility disorders or gastro-oesophageal reflux disease (GERD) is common in adults but true congenital oesophageal diverticula are rare in infants and children. We present a case of a toddler boy who presented with dysphagia and vomiting after feeds after weaning was attempted starting at 6 months of age. Barium esophagogram revealed a diverticulum in the upper one-third of the oesophagus within the thoracic cavity. The child underwent multiple interventions elsewhere without definitive surgery that highlights the rarity of this condition. Thoracotomy and repair were performed by us with a satisfactory outcome. The review of the literature on the clinical presentation and management of this rare condition has been discussed, highlighting similar reported cases.
Asunto(s)
Trastornos de Deglución , Divertículo Esofágico , Divertículo , Reflujo Gastroesofágico , Trastornos de Deglución/etiología , Divertículo Esofágico/diagnóstico , Divertículo Esofágico/diagnóstico por imagen , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/cirugía , Humanos , Lactante , MasculinoRESUMEN
Medical image captioning provides the visual information of medical images in the form of natural language. It requires an efficient approach to understand and evaluate the similarity between visual and textual elements and to generate a sequence of output words. A novel show, attend, and tell model (ATM) is implemented, which considers a visual attention approach using an encoder-decoder model. But the show, attend, and tell model is sensitive to its initial parameters. Therefore, a Strength Pareto Evolutionary Algorithm-II (SPEA-II) is utilized to optimize the initial parameters of the ATM. Finally, experiments are considered using the benchmark data sets and competitive medical image captioning techniques. Performance analysis shows that the SPEA-II-based ATM performs significantly better as compared to the existing models.
Asunto(s)
Aprendizaje Profundo , Algoritmos , Benchmarking , Evolución Biológica , LenguajeRESUMEN
Lipoblastoma is a rare benign mesenchymal tumour derived from embryonic white fat tissue. Lipoblastoma generally occurs in children less than 3 years of age, and fewer than 200 cases have been reported in the English literature. There are hardly a dozen reports describing intrathoracic and thoracic involvement. We report a case of a 7-year-old boy who presented with a slowly growing right thoracic wall mass for a duration of 1 year. Radiological investigations (ultrasonography and contrast-enhanced CT of the chest showed the presence of a fat-containing, low density extrapulmonary soft tissue mass) could not confirm the diagnosis, and repeat biopsies also were not conclusive. The mass was excised and histopathology confirmed it as lipoblastoma. A review of literature pertaining to the clinical presentation, radiological features and histopathology of this rare condition has been discussed.
Asunto(s)
Lipoblastoma , Lipoma , Mesenquimoma , Radiología , Pared Torácica , Niño , Humanos , Lactante , Lipoblastoma/diagnóstico por imagen , Lipoblastoma/cirugía , Masculino , Pared Torácica/diagnóstico por imagen , Pared Torácica/cirugía , UltrasonografíaRESUMEN
Traumatic aortic dissection following sudden deceleration injury requires urgent treatment as it may result in formation of aneurysm that may expand or rupture leading to catastrophe. Confirmation of diagnosis of aortic dissection often requires contrast-enhanced computed tomography (CECT) or magnetic resonance imaging, which is time-consuming. Often, there is a significant time lag between the CECT chest and surgical intervention. Progression of aortic dissections may be missed on CECT chest, which would be done in the initial hours after injury. Transesophageal echocardiography (TEE) is equally efficient for the diagnosis of aortic dissection. It may also provide additional information that can be very useful for the management. We report the case of a descending thoracic aortic dissection where TEE plays a crucial role during the surgical management of the patient.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica , Lesiones Cardíacas/diagnóstico por imagen , Accidentes de Tránsito , Anciano , Disección Aórtica/cirugía , Aneurisma Falso/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Medios de Contraste , Lesiones Cardíacas/cirugía , Humanos , Masculino , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
IMPORTANCE: Chronic rhinosinusitis (CRS) is the persistent inflammation of the sinus and nasal passages lasting over 3 months. The etiology of CRS is not well understood. OBJECTIVE: To obtain insights into the disease process, we contrasted the microbiome and immune response from patients with CRS and healthy controls. DESIGN, SETTING, AND PARTICIPANTS: A case vs control design was used. Samples were collected in the operating room in an institutional hospital or clinic. Thirty patients with CRS and 12 healthy controls undergoing surgery were recruited. MAIN OUTCOMES AND MEASURES: The microbiome was analyzed by deep sequencing of the bacterial 16S and fungal 18S ribosomal RNA genes. Immune response was measured by quantification of 30 different cytokines by multiplexed enzyme-linked immunosorbent assay, and immune cells in the lavage were identified by flow cytometry. The immune response of peripheral blood leukocytes to the lavage microbiota was assessed by interleukin (IL)-5 enzyme-linked immunospot assay. RESULTS: While quantitative increase in most bacterial and fungal species was observed in patients with CRS relative to controls, the microbiomes of patients with CRS were qualitatively similar to the controls. Because these results indicated that bacteria and fungi are not triggering CRS, we undertook a more detailed characterization of the immune response. Patients with CRS had increased levels of the following cytokines: IL-4, IL-5, IL-8, and IL-13, along with increased levels of eosinophils and basophils in the lavage. Importantly, peripheral blood leukocytes isolated from patients with CRS responded to control lavage samples (ie, to commensals) to produce IL-5. In contrast, the same lavage sample evoked no IL-5 production in leukocytes from healthy controls. CONCLUSIONS AND RELEVANCE: These findings support the theory that in some cases CRS results from an immune hyperresponsiveness to commensal organisms.