Hickman Central Venous Catheters in Children: Open Versus Percutaneous Technique.

BACKGROUND: The ideal technique for insertion of tunneled central venous catheters (CVCs) in children is still debatable. This study aimed to compare the outcomes of open versus percutaneous technique for the insertion of tunneled CVCs. METHODS: The study included 279 patients who had CVCs insertions from 2010 to 2020. Patients were divided into two groups according to the technique of insertion: group 1 (n = 90) included patients who had the open cutdown method and group 2 (n = 189) included patients who had the percutaneous technique. RESULTS: There was no difference in age and gender distribution between groups (P = 0.152 and 0.102, respectively). Chemotherapy was the most common indication of insertion (77 [85.56%] vs. 165 [87.30%]); in group 1 vs. 2, P = 0.688). The left external jugular was the most common site of insertion in group 1 (n = 66; 73.33%), and the left subclavian was the most common site in group 2 (n = 77; 40.74%). Complications of insertion were nonsignificantly higher in group 2 (P = 0.170). Nine patients in group 2 required conversion to cutdown technique (4.76%). Complications during removal were nonsignificantly higher in group 2 (P = 0.182), and the most common was bleeding (n = 4; 2.12%). The most common indication for catheter removal was the completion of the treatment (36 [40%] vs. 85 [44.97%] in groups 1 and 2, respectively). CONCLUSIONS: Percutaneous and open tunneled central venous catheter insertion are safe in pediatric patients who require long-term venous access. Both techniques have a low complication rate. The choice of each method should be tailored to the condition of each patient.

Recurrent pyloric stenosis.

Infantile hypertrophic pyloric stenosis is the most commonly encountered surgical disease among pediatric patients. Incomplete pyloromyotomy is not uncommon complication of pyloromyotomy. However, recurrent pyloric stenosis is extremely rare. Up until now, there are only five cases reported in the English literature. We report a child with recurrent pyloric stenosis who was managed by redo pyloromyotomy.

Efficacy and safety of endoscopic dilatation in the management of esophageal strictures in children.

OBJECTIVES: To determine the outcomes  of endoscopic dilatation of esophageal strictures in children. METHODS: Children younger than 18 years of age diagnosed with esophageal strictures over a period of 7 years (June 2010 to June 2017) were reviewed and analyzed retrospectively. The study took place at King Khalid University Hospital, Riyadh, Saudi Arabia. The patients' clinical characteristics, endoscopic findings, and details of the strictures, treatment, and outcomes were documented. RESULTS: Forty-three children with esophageal strictures were identified (median age, 8.1 years; range, 2-17 years; 23 [53.5%] boys). The median age at presentation was 2 years (range, 1-16 years), and the median follow-up period was 3 years (range, one month-17 years). Tracheoesophageal fistula (n=14, 32.6%), gastroesophageal reflux disease (n=10, 23.3%) and eosinophilic esophagitis (n=8, 18.6%) were the leading causes of esophageal strictures. Forty-three patients underwent 180 dilatation sessions; the median number of dilatation sessions per patient was 3 (range, 1-48), and the median interval between sessions was 8 weeks (range, 1-24 weeks). Among 180 dilatation sessions, 3 events (1.7%) of esophageal perforation were observed. The outcomes varied depending on the primary cause of the stricture; complete response was achieved the best in eosinophilic esophagitis-related strictures (87.5%), followed by anastomotic strictures post tracheoesophageal fistula repair (71.4%) and gastroesophageal reflux disease-related strictures (70%). CONCLUSION: Endoscopic dilatation is a safe and effective intervention in the management of esophageal strictures in children, with minimal complications when conducted by experts.

Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital.

RATIONALE, AIMS AND OBJECTIVES: Surgical site infections are the most common healthcare-associated infections. Appropriate surgical antimicrobial prophylaxis (SAP), which is an integral part of surgical site infection SSI prevention, is one of the major preventable risks to surgical patient safety. Several clinical practice guidelines (CPGs) for SAP have been published. The aim of this study was to adapt a CPG for SAP and to assess its implementability. METHODS: The methodology was based on two validated tools for CPGs, namely, the ADAPTE and the Guideline Implementability Appraisal (GLIA). RESULTS: The ADAPTE CPG adaptation process methodology was utilized to produce an adapted CPG for SAP based on the American Society of Health System Pharmacists 2013 CPG. The finalized CPG was then assessed to identify any possible intrinsic barriers for implementation. CONCLUSIONS: In conclusion, the ADAPTE tool is a practical and successful tool for production of CPGs. The GLIA tool is useful for assessing and preparing the finalized adapted CPG for the transition from the production stage to the implementation stage. GLIA could be added to the ADAPTE process either as a final step or to check the draft of the CPG before finalization.

Esophageal foreign bodies in children: Emphasis on complicated cases.

BACKGROUND: Esophageal foreign bodies (EFBs) are a relatively common clinical problem in pediatric patients. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. This study was conducted to review our experience in managing esophageal foreign bodies in pediatric patients, with an emphasis on the management and outcomes of complicated cases. METHODS: Between March 1995 and March 2013, the records of all children up to the age of 12 years who were admitted to King Khalid University Hospital, Riyadh, Saudi Arabia, with a final diagnosis of EFBs were reviewed. The medical records were analyzed with respect to demographic data, presenting symptoms, workup investigation, management, complications, and outcomes. RESULTS: Seventy patients were identified (38 boys and 32 girls). The ages ranged from 5 days to 12 years (mean: 4.4 years). Fifty-three (75.7%) patients presented within 24 hours. Thirteen (18.6%) patients had underlying predisposing factors. The most common EFB, found in 30 (42.8%) patients, was a coin. Witnessed ingestion of a FB was documented in 52 (74.2%) patients. The most common symptoms were drooling of saliva in 42 (60%) patients, followed by vomiting in 36 (51.4%) patients. Four (5.7%) patients presented with complications secondary to FB impaction, including hypopharyngeal wall perforation, acquired esophageobronchial fistula, localized esophageal perforation with inflammation, and perforation with stricture formation. The follow-up period ranged from 2 to 12 months, and all patients had complete recovery without any sequelae. CONCLUSION: EFBs are a relatively common problem in pediatric patients, and underlying predisposing factors to EFB impaction are not uncommon. Long-retained EFBs are associated with a higher incidence of complications. Rigid esophagoscopy was successful in extracting most of the EFBs and was shown to be a safe and effective procedure.