Use of Lumen-apposing Metal Stents for Endoscopic Drainage of Intra-abdominal Fluid Collections in Pediatric Patients.

INTRODUCTION: Intraabdominal fluid collections that previously required surgical intervention can now be drained with less invasive techniques. The use of lumen-apposing metal stents (LAMS) to treat pancreatic pseudocysts and perirectal abscesses has been shown to be a safe and effective technique in adults. We aim to evaluate the indications, outcomes, and complications of the use of LAMS in pediatric patients at our institution. METHODS: A retrospective chart review was performed to study patients up to 18 years of age at the Children's Hospital at Montefiore who underwent drainage of intraabdominal fluid collections with the use of LAMS. The main outcome measures were technical and clinical success and associated adverse events with LAMS placement. RESULTS: Seven patients (2 girls) ranging from 9 to 18 years were identified. Four patients had perirectal abscess postperforated appendicitis and 3 patients had pancreatic pseudocysts. All of the patients had complete resolution of the collections, with no recurrence, and our technical and clinical success rate was 100%. Only 1 patient had mild bleeding after placement that spontaneously resolved. DISCUSSION: Our study demonstrates the efficacy and safety of the use of LAMS for the drainage of intraabdominal fluid collections in pediatric patients, although the number of patients included is limited.

Interface micromotion of uncemented femoral components from postmortem retrieved total hip replacements.

Axial torsional loads representative of gait and stair climbing conditions were applied to transverse sections of 8 uncemented postmortem retrievals and a high-resolution imaging system with digital image correlation was used to measure local micromotion along the bone-implant interface. For 7 components that were radiographically stable, there was limited micromotion for gait loading (1.42 ± 1.33 µm) that increased significantly (P = .0032) for stair climb loading (7.32 ± 9.96 µm). A radiographically loose component had motions on the order of 2.3 mm with gait loading. There was a strong inverse relationship between the amount of bone-implant contact (contact fraction) (P = .001) and micromotion. The uncemented components had greater contact fraction (41.8% ± 14.4% vs 11.5% ± 10.2%, P = .0033) and less median micromotion (0.81 ± 0.79 µm vs 28.8 ± 51.1 µm) compared to a previously reported study of cemented retrievals.