Background: Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We a...Background: Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We aimed to determine the accuracy of this technique. Methods: All children undergoing both upper gastrointestinal series (UGI) and US for possible malrotation over a 3- year period were reviewed. Patients were excluded if US did not include SMV/SMA orientation or if the duodenojejunal flexure was not visualized on UGI. Results: Of 211 eligible patients, UGI and US were both normal in 62% and both abnormal in 15% . Forty- four had abnormal US and normal UGI (false positive, 21% ), and 5 patients had normal US and abnormal UGI (false negative, 2% ). Of these 5, none were found to have a short mesenteric base, which put them at risk for volvulus. Among abnormal ultrasounds, inversion of SMV/SMA and a “ whirlpool” sign were more predictive for malrotation and volvulus than anterior/ posterior orientation. Conclusions: Ultrasonography is a good screening tool that effectively rules out malrotation at risk for volvulus. Children with an abnormal ultrasound should have an UGI or go to the operating room, depending on clinical findings.展开更多
To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy ra...To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993- 1996 and 1997- 2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Results: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4- fold and 3.0- fold regional variation in 1993- 1996 and 1997- 2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23- 2.61; P<.005). Conclusions: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.展开更多
Aspiration of Timothy grass in the airway is a well-recognized cause of bronc hiectasis, and management often requires pulmonary resection. The authors descri be 2 cases of Timothy grass aspiration with established pu...Aspiration of Timothy grass in the airway is a well-recognized cause of bronc hiectasis, and management often requires pulmonary resection. The authors descri be 2 cases of Timothy grass aspiration with established pulmonary infection that were successfully managed by bronchoscopic removal with subsequent improvement. Every effort should be made to accomplish this goal, and pulmonary resection sh ould be considered a last resort in these cases.展开更多
Aim of Study: The aim of this study was to determine if the presence of an appendicolith is associated with an increased risk for recurrent appendicitis after nonoperative treatment of pediatric ruptured appendix with...Aim of Study: The aim of this study was to determine if the presence of an appendicolith is associated with an increased risk for recurrent appendicitis after nonoperative treatment of pediatric ruptured appendix with inflammatory mass or abscess. Methods: Ninety-six pediatric patients (52 girls, 44 boys), aged 16 months to 17 years (average, 7 years), were managed between 1980 and 2003. All were treated nonoperatively with intravenous triple antibiotics for 5 to 21 days. All children had at least a 2- year follow-up. This study was approved by the hospital research ethics board. Main Results: Six children (6% ) who became worse and 41 (46% ) who had an interval appendectomy were eliminated from the study. The other 49 patients comprised the study group and received no further treatment. Twenty-eight (57% ) had no recurrence, and 21 (43% ) had a recurrence within 1 month to 2 years (average, 3 months). In the study group, 31 (63% ) children had no appendicolith on radiological imaging and 18 (37% ) had. Presence of an appendicolith was associated with a 72% rate of recurrent appendicitis compared with a recurrence rate of 26% in those with no appendicolith (χ 2 test, P < .004). Conclusion: We conclude that the patients with appendicolith should have an interval appendectomy.展开更多
文摘Background: Early diagnosis of malrotation can prevent fatal midgut volvulus. Abnormal orientation of the superior mesenteric artery (SMA) and vein (SMV) on ultrasonography (US) has been described in malrotation. We aimed to determine the accuracy of this technique. Methods: All children undergoing both upper gastrointestinal series (UGI) and US for possible malrotation over a 3- year period were reviewed. Patients were excluded if US did not include SMV/SMA orientation or if the duodenojejunal flexure was not visualized on UGI. Results: Of 211 eligible patients, UGI and US were both normal in 62% and both abnormal in 15% . Forty- four had abnormal US and normal UGI (false positive, 21% ), and 5 patients had normal US and abnormal UGI (false negative, 2% ). Of these 5, none were found to have a short mesenteric base, which put them at risk for volvulus. Among abnormal ultrasounds, inversion of SMV/SMA and a “ whirlpool” sign were more predictive for malrotation and volvulus than anterior/ posterior orientation. Conclusions: Ultrasonography is a good screening tool that effectively rules out malrotation at risk for volvulus. Children with an abnormal ultrasound should have an UGI or go to the operating room, depending on clinical findings.
文摘To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993- 1996 and 1997- 2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Results: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4- fold and 3.0- fold regional variation in 1993- 1996 and 1997- 2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23- 2.61; P<.005). Conclusions: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.
文摘Aspiration of Timothy grass in the airway is a well-recognized cause of bronc hiectasis, and management often requires pulmonary resection. The authors descri be 2 cases of Timothy grass aspiration with established pulmonary infection that were successfully managed by bronchoscopic removal with subsequent improvement. Every effort should be made to accomplish this goal, and pulmonary resection sh ould be considered a last resort in these cases.
文摘Aim of Study: The aim of this study was to determine if the presence of an appendicolith is associated with an increased risk for recurrent appendicitis after nonoperative treatment of pediatric ruptured appendix with inflammatory mass or abscess. Methods: Ninety-six pediatric patients (52 girls, 44 boys), aged 16 months to 17 years (average, 7 years), were managed between 1980 and 2003. All were treated nonoperatively with intravenous triple antibiotics for 5 to 21 days. All children had at least a 2- year follow-up. This study was approved by the hospital research ethics board. Main Results: Six children (6% ) who became worse and 41 (46% ) who had an interval appendectomy were eliminated from the study. The other 49 patients comprised the study group and received no further treatment. Twenty-eight (57% ) had no recurrence, and 21 (43% ) had a recurrence within 1 month to 2 years (average, 3 months). In the study group, 31 (63% ) children had no appendicolith on radiological imaging and 18 (37% ) had. Presence of an appendicolith was associated with a 72% rate of recurrent appendicitis compared with a recurrence rate of 26% in those with no appendicolith (χ 2 test, P < .004). Conclusion: We conclude that the patients with appendicolith should have an interval appendectomy.
