[MEDICAL PEDAGOGY - THE USE OF PEDAGOGICAL TOOLS TO PROMOTE HEALTH AND COPING IN PEDIATRIC HOSPITALIZATION].

INTRODUCTION: Teachers employed in educational centers inside hospitals, encounter thousands of hospitalized children every year. Although many pedagogical tools are at hand, in order to establish a designated unique pedagogical profession, their practice is in need of an organizing principle compatible with hospital goals. In this article we assert that hospital teachers can and should become an inherent and meaningful factor in promoting children's health and supporting healing processes. We will examine and elaborate on the potential basis for synergizing goals by exploring the meaning of structures of health and illness existing in the bio-medical model and those in integrative models. Through three examples from the hospital teacher's work, we will try to demonstrate how a combination of points of view can constitute both an organizing principle in pedagogical practice and a profit in holistic medical care for hospitalized children.

Oesophageal atresia: sonographic signs may prenatally predict surgical complexity.

OBJECTIVE: Oesophageal atresia (OA) is a major anomaly of varying severity. The complexity of surgical correction highly depends on the gap length of missing oesophagus and the presence of a distal fistula. The aim of this study was to identify antenatal sonographic findings associated with presence of a distal fistula and type of surgical repair METHODS: Prenatal medical records of neonates postnatally diagnosed with OA were reviewed. Sonographic signs of OA (small/absent stomach, polyhydramnios, oesophageal pouch) and the trimester at sign detection were recorded and compared between (1) OA with and without a distal fistula and (2) early one-step versus delayed two-step anastomosis. Multivariate analysis was performed. RESULTS: Overall, 80 cases of OA were included. Absence of a distal fistula was significantly associated with higher rates of small/absent stomach (100% vs 28.6%, P<0.0001), oesophageal pouch (100% vs 24.3%, P<0.0001) and severe polyhydramnios (66.7% vs 22.9%, P=0.006), compared with OA with a distal fistula.Cases requiring a delayed two-step repair had higher rates of small/absent stomach (84.2% vs 16.7%, P>0.0001), severe polyhydramnios (47.4% vs 16.7%, P=0.008) and oesophageal pouch (73.7% vs 18.5%, P<0.0001), compared with those corrected in an early one-step anastomosis.Multivariate logistic regression found small/absent stomach and pouch to be significantly and independently associated with a delayed two-step anastomosis. CONCLUSION: OA without a distal fistula is associated with higher rates of prenatal sonographic signs. Both small/absent stomach and a pouch are independently associated with a delayed two-step anastomosis. These findings may help improve antenatal parental counselling regarding the anticipated surgical repair.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience.

PURPOSE: Our purpose was to present our institutional experience with performing complete cytoreduction surgery and heated intraoperative chemotherapy (CRS-HIPEC) for children with disseminated intraabdominal malignancies, guided by a leading international center performing CRS-HIPEC in children. METHODS: Retrospective chart review of all cases of CRS-HIPEC in children in our institution, examining diagnosis, preoperative management, operative management, postoperative treatment, short term outcome including length of stay and complications, and long term outcome including survival and recurrence of disease. RESULTS: 9 children underwent CRS-HIPEC over 48months. The mean age of the patients was 8years. Tumors were: rhabdomyosarcoma (RMS), mesothelioma, Sertoli-Leydig, desmoplastic small round cell tumor, colon carcinoma and Wilms' tumor. Most patients received intraperitoneal cisplatin. Short term outcome was very good with median length of hospital stay of 13days and low rate of complications. Seven patients were alive at last follow up. Five patients developed a recurrent disease. Recurrence was intraabdominal in two of these patients. CONCLUSIONS: CRS-HIPEC for children with disseminated intraabdominal malignancies performed in a dedicated institution and with guidance by a leading international center can be performed safely. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: IV.

Minimal incision as a promising technique for resection of pilonidal sinus in children.

PURPOSE: To evaluate functional and long-term outcome of a minimal incision technique for resection of pilonidal sinus in children. PATIENTS AND METHODS: All children who underwent surgery for pilonidal sinus in our institution between October 2008 and March 2015 were included. We performed a retrospective chart review and a follow-up telephone survey. Demographic, clinical and outcome data were compared between patients who underwent either minimal incision or wide excision surgery. RESULTS: Study groups included 21 cases of minimal incision procedure and 21 cases of wide excision procedure with similar demographic and clinical characteristics. Postoperative functional outcome was significantly better in the minimal incision group with fewer days on analgesics (0 versus 2.5, P=0.005), fewer sick days (4 versus 14, P<0.001), and fewer days to full activity (10 versus 45, P<0.001). Reoperation rate was 28% for minimal incision and 9% for wide excision (P=0.238). Overall long-term favorable outcome (no reoperation/recurrent abscess/continued symptoms) rate was 62% after minimal incision and 45% after wide excision (P=0.354). CONCLUSION: The minimal incision is a promising technique for resection of pilonidal sinus in children as it is associated with better postoperative functional outcome and comparable long-term outcome compared with wide excision. LEVEL OF EVIDENCE: Therapeutic study- level III.

Giant omental hemorrhagic cyst presenting as acute hemorrhagic anemia in a 21-month-old infant.

An omental cyst is a very rare pathology, especially in small infants. Children generally present with abdominal distention with or without a palpable mass. The mass may be huge, simulating ascites. The most common presentation in children is that of a small-bowel obstruction. The differential diagnosis includes intestinal duplication cyst, ovarian, choledochal, pancreatic, splenic, or renal cysts, hydronephrosis, cystic teratoma, hydatid cyst, and ascites. We describe the clinical presentation, imaging features, surgical treatment, and postoperative course of a 21-month-old female infant with a congenital giant omental cyst. This entity is extremely rare but should be included in the differential diagnosis in similar cases.

[Trends in surgery--evolution or revolution?].

BACKGROUND: In recent years surgical procedures have developed enormously outpacing the rapid growth in medicine. OBJECTIVES: The aim of this article is to highlight the trends in surgical treatment over the past decade in comparison with reports in the scientific literature. METHODS: We reviewed the surgical trends in the Pediatric Surgical Department at the Sheba Medical Center between the years 1995-2006. The main parameters implemented in the assessment were: laparoscopic approach vs. traditional open surgery, elective vs. emergency operations and the extent of congenital abnormalities treated over the years. RESULTS: This study showed a decline in the number of open surgeries performed as opposed to a statistically significant increase in laparoscopic procedures and a decrease in elective surgery performed in tertiary medical centers, while the number of congenital abnormalities treated remained constant. CONCLUSION: The literature review revealed that similar changes in surgical management were found in other countries, confirming our study results. These trends, including clinical, professional and fiscal developments, require preparedness on a national level.