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BACKGROUND: Congenital esophageal stenosis (CES) is a rare malformation of the digestive tract. Endoscopic dilation and thoracotomy have been the main treatments for CES. However, there is no well-defined management protocol. Magnetic compression stricturoplasty (MCS) has been used in refractory esophageal stricture in children after esophageal atresia. CASE SUMMARY: We describe the first case of MCS for CES in one female child patient. The child (aged 3 years and 1 mo) was admitted due to frequent vomiting and choking after eating complementary food since 7 mo old. Esophagography and gastroendoscopy showed that there was stenosis in the lower esophagus, suggesting a diagnosis of CES. The patient did not receive any treatment for esophageal stricture including surgery or endoscopic dilation procedures before MCS. MCS procedure was smoothly conducted without complications. At 24 mo after MCS, durable esophageal patency without dysphagia was achieved. CONCLUSION: MCS may serve as an alternative and efficient method for patients with CES.
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From June to August 2018, a 1-hr resolution concentration dataset of ozone and its gaseous precursors (volatile organic compounds(VOCs) and NOx), and meteorological parameters were synchronously monitored by online instruments of the Nankai University Air Quality Research Supersite. The relationships and variation characteristics between ozone and its precursors were analyzed. According to the photochemical age, the initial concentrations of VOCs were calculated, and the photochemical loss of the concentration of VOCs during the daytime (06:00-24:00) was corrected. The initial and directly monitored concentrations of VOCs were incorporated into the PMF model for source apportionment. The results indicated that the mean concentration of O3 in Tianjin in summer was (41.3±25.7)×10-9, while that of VOCs was (13.9±12.3)×10-9. The average concentration of alkane (7.0±6.8)×10-9 was clearly higher than that of other VOC species. The species with high concentrations of alkanes were propane and ethane, accounting for 47% of the total alkane concentration. The average ozone formation potential (OFP) in summer was 52.1×10-9, and the OFP value of alkene was the highest and its contribution reached 57%. During the daytime, alkene loss accounted for 75% of the total VOC loss. The major sources of VOCs that were calculated based on the initial concentration data were the chemical industry and solvent usage (25%), automobile exhaust (22%), combustion source (19%), LPG/NG (19%), and gasoline volatilization (15%), respectively. Compared with the apportionment results based on directly monitored concentrations, the contribution of the chemical industry and solvent usage decreased by 4%, while automobile exhaust decreased by 5%. By combining the results of PMF apportionment and the OFP model to analyze the relative contributions of emission sources to ozone formation, and we found that the highest contribution source of ozone was the chemical industry and solvent usage (26%) in summer. Compared with the analysis results based on the directly monitored concentrations, the OFP values of the chemical industry and solvent usage decreased by 7%, while that of NG/LPG apparently decreased by 13%.
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RATIONALE: Rectal atresia caused by necrotizing enterocolitis (NEC) is a serious and rare complication in children. Magnetic compression anastomosis (MCA) has been effectively applied in children with congenital oesophageal atresia and biliary atresia. Herein, we reported a case of successfully application of MCA in an infant with rectal atresia following NEC. PATIENT CONCERNS: A 30 weeks premature birth female fetal infant was transferred to our neonatal intensive care unit due to premature delivery, low birth weight, and neonatal respiratory distress. On postpartum day 11, the infant developed abdominal distension and mucosanguineous feces. This infant was then clinically diagnosed as NEC. She underwent anesthesia and intestinal fistula operation on postpartum day 11 because of NEC. DIAGNOSIS: After 3 months, radiographic examination revealed rectal atresia and stricture. INTERVENTIONS: This infant was successfully treated with MCA following a cecum-rectal anastomosis and ileocecal valve was reserved. OUTCOMES: On postoperative day 9, she passed the 2 magnets per rectum. In addition, there were no difficult defecation or fecal incontinence or other short-term complications. After the 7-month follow-up, the patient had an excellent clinical outcome. LESSONS: MCA is a feasible and effective method for treating rectal atresia in infants.
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Enterocolite Necrosante/diagnóstico , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Atresia Intestinal/diagnóstico , Reto/anormalidades , Anastomose Cirúrgica , Diagnóstico Diferencial , Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/complicações , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/cirurgia , ImãsRESUMO
RATIONALE: Neonatal long-gap esophageal atresia (LGEA) with tracheoesophageal fistula (TEF) is an uncommon but serious congenital malformation of the esophagus in newborns, and it remains challenging for pediatric surgeons. Magnetic compress has been shown to be effective for the treatment of LGEA in children and adults. However, the implementation of this unique technique for neonatal LGEA has not been evaluated. PATIENT CONCERNS: A female infant was born at 37 weeks of gestation. Prenatal ultrasound imaging revealed signs of esophageal atresia, including the absence of the gastric bubble and polyhydramnios. DIAGNOSES: A diagnosis of LGEA with TEF was confirmed at birth by contrast X-ray. INTERVENTIONS: She was treated with magnetic compression anastomosis (MCA) following an esophago-esophagostomy. Two magnetic rings were customized, and the MCA was conducted during the same stage surgery of ligating the TEF. Under the magnetic force, the 2 magnet rings pulled along the gastric tube to achieve anastomosis. The postoperative permanent suction of these 2 pouches was instituted, and spontaneous growth was awaited. Magnet removal was performed at 36 days, and enteral nutrition was continued via a gastric tube for 4 weeks at post-operation. OUTCOMES: The upper gastrointestinal contrast confirmed the anastomotic patency perfectly after 3 months. The patient was followed up for 18 months, and exhibited durable esophageal patency without dysphagia. LESSONS: These results suggest that MCA is feasible and effective for treating LGEA in infants.
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Anastomose Cirúrgica/métodos , Atresia Esofágica/cirurgia , Fístula Traqueoesofágica/cirurgia , Atresia Esofágica/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Magnetismo , Fístula Traqueoesofágica/diagnóstico por imagemRESUMO
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief and authors, as portions of the clinical data used were inaccurate. Specifically, more than 500 cases of the total 1882 cases of hernia patients presented in the paper were actually hydrocele of tunica vaginalis, not hernia. The authors sincerely apologize for these errors.