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1.
Spine J ; 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32200118

RESUMO

BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) exposes the anterior aspect of the spine through a retroperitoneal approach. Access to the anterior spine requires mobilization of intra-abdominal viscera/vasculature, which can become complicated as scarring and/or adhesions develop from prior abdominal surgical interventions, increasing risk of intraoperative complications. The literature suggests that "significant prior abdominal surgery" is a relative contraindication of ALIF surgery; however, there is no consensus within the literature as to what defines "major/significant" abdominal surgeries. Additionally, the association between the number of prior abdominal surgeries and perioperative complications in ALIF surgery has not been explored within the literature. PURPOSE: This study seeks to explore the association between perioperative complications of ALIF surgery and the type (major and/or minor) and number of prior abdominal surgeries. DESIGN: A retrospective cohort study was performed to examine perioperative complications in ALIF patients with or without prior history of abdominal surgery. PATIENT SAMPLE: All consecutive patients undergoing ALIF with or without a history of prior abdominal surgery from 2008 to 2018 at a single tertiary center were evaluated. Patients under the age of 18, patients with spinal malignancy, or patients who had ALIF above L3 were excluded. OUTCOME MEASURES: Perioperative complications included intraoperative complications during ALIF surgery and postoperative complications within 90 days of ALIF surgery. Intraoperative complications include vascular injury, ureter injury, retroperitoneal hematoma, etc. Postoperative complications include urinary tract infection, revision of abdominal scar, ileus, deep vein thrombosis, pulmonary embolism, etc. Other outcome measures include readmission within 90 days, length of ALIF surgery, and length of hospital stay. METHODS: Electronic medical records of 660 patients who underwent ALIF between 2008 and 2018 were retrospectively reviewed. Patient demographics, Charleston Comorbidity Index (CCI), level of fusion, past abdominal surgical history, use of access surgeon during exposure, intraoperative, and postoperative complications were collected. Predictors of intraoperative and postoperative complications were analyzed using simple and multivariable logistic regression. Statistical analysis was performed using JMP 14.0 (SAS, Cary, North Carolina) software. RESULTS: After controlling for age, length of ALIF, gender, multilevel ALIF, and the use of an access surgeon, there was no significant association between the type of prior abdominal surgery (major and/or minor) and intraoperative complications on multivariable logistic regression analysis (Minor: OR=1.68; 95% CI: .58-4.86 & Major: OR=1.99; 95% CI: .80-4.91). On multivariable logistic regression, the odds of developing an intraoperative complication increases by 52% for each additional prior abdominal surgery after adjusting for age, length of ALIF, gender, multilevel ALIF, and the use of an access surgeon (OR=1.52, 95% CI: 1.10 - 2.11). Iliac vein laceration was the most common intraoperative complication (n=27, 4%). Neither the type (major and/or minor) nor the number of prior abdominal surgeries were significant predictors of postoperative complications (Minor: OR=1.29; 95% CI: .72-2.31, Major: OR=1.24; 95% CI: .77-2.00, & Number: OR=1.03; 95% CI: .84-1.26). CONCLUSION: With each additional prior abdominal surgery, accumulation of scarring and adhesions can likely obscure anatomical landmarks and increase the risk of developing an intraoperative complication. Therefore, the number of prior abdominal surgeries should be taken into consideration during planning and operative exposure of the anterior spine via a retroperitoneal approach.

3.
J Pediatr Surg ; 50(6): 996-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25805006

RESUMO

BACKGROUND/PURPOSE: Although graft loss remains the biggest challenge for all pediatric kidney transplant (KT) recipients, unique challenges exist within different age groups. We aim to evaluate the different characteristics and graft survival outcomes of young children and adolescents undergoing KT. METHODS: Children who underwent isolated KT between 2000 and 2013 at our institution were included in this retrospective analysis. Patient characteristics and outcomes were compared using student's t-test, chi-square test, Kaplan-Meier curve and Cox proportional hazards model. RESULTS: Of 73 children who underwent KT, 31 were <12 (young children), and 42 were ≥ 12 years old (adolescents). Overall patient survival was 100%. The younger group had superior 5-year (100% vs. 75.5%) and 10-year (94.4% vs. 43.8%) graft survival (p=0.008). Factors predictive of poor graft survival on multivariate analysis were older age at transplantation (HR 1.2, CI 1-1.4, p=0.047), female gender (HR 9.0, CI 1.9-43, p=0.006), and acute rejection episodes (HR 13, CI 2-90, p=0.008). The most common causes of graft loss were acute and chronic rejection episodes and immunosuppression nonadherence. CONCLUSION: Adolescents undergoing KT have inferior graft survival compared to younger children. In adjusted modeling, children with older age, female gender, and acute rejection episodes have inferior graft survival.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Transplante de Rim/mortalidade , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais
4.
Am J Surg ; 208(4): 591-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25110291

RESUMO

BACKGROUND: Factors influencing recurrence of ileocecal Crohn's disease (CD) after surgical resection may differ between adolescents and adults. METHODS: CD patients who underwent ileocecectomy were retrospectively divided into pediatric onset (age at diagnosis ≤ 16 years, n = 34) and adult onset (>16, n = 108) patients to evaluate differences in risks of endoscopic and clinical recurrence. RESULTS: In 142 patients, rates of any recurrence, endoscopic recurrence, and clinical recurrence at 5 years were 78%, 88%, and 65%, respectively. Risks of recurrence were similar between groups. Younger patients were more likely to be on immunologics preoperatively and more likely to be started on immunoprophylaxis postoperatively. Immediate postoperative prophylaxis was predictive of delayed clinical recurrence only in the older group. CONCLUSIONS: Despite increased preoperative and postoperative immunoprophylaxis in younger patients, recurrence rates of CD after ileocecectomy do not differ between these groups. Immediate postoperative prophylaxis was predictive of delayed clinical recurrence only in patients with adult onset CD.


Assuntos
Colectomia/métodos , Colite/cirurgia , Colo/cirurgia , Doença de Crohn/cirurgia , Endoscopia Gastrointestinal/métodos , Ileíte/cirurgia , Íleo/cirurgia , Adolescente , Adulto , Idade de Início , Idoso , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Colite/epidemiologia , Doença de Crohn/epidemiologia , Feminino , Seguimentos , Humanos , Ileíte/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
5.
Neonatology ; 105(4): 263-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24556975

RESUMO

Duodenal atresia (DA) is a well-described congenital anomaly that usually responds well to surgical correction. Associated defects are common, and these confounding variables often influence outcome. The authors present a case of a newborn female with an unusual constellation of problems including DA with annular pancreas, trisomy 21, and coarctation of the aorta. She developed protracted complications postoperatively and was treated with an innovative surgical strategy.


Assuntos
Anormalidades Múltiplas , Fístula Anastomótica/cirurgia , Obstrução Duodenal/cirurgia , Duodenostomia/efeitos adversos , Piloro/cirurgia , Grampeamento Cirúrgico , Fístula Anastomótica/etiologia , Coartação Aórtica/complicações , Coartação Aórtica/terapia , Síndrome de Down/complicações , Obstrução Duodenal/complicações , Obstrução Duodenal/diagnóstico , Duodenostomia/métodos , Feminino , Gastrostomia , Humanos , Recém-Nascido , Atresia Intestinal , Jejunostomia , Pâncreas/anormalidades , Pancreatopatias/complicações , Reoperação , Resultado do Tratamento , Cicatrização
6.
J Pediatr Surg ; 48(4): 876-9, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23583150

RESUMO

We present a case of a 15 year old girl who developed transient left ventricular apical ballooning syndrome, Tako-tsubo cardiomyopathy, after a significant motor vehicle accident. On post-trauma day three she developed heart failure with mid-to-apical left ventricular wall dysfunction with an EF of 10%-15%. The patient eventually regained full cardiac function by post-trauma day seven. Here we present the first case report of trauma induced left ventricular apical ballooning syndrome in pediatrics.


Assuntos
Acidentes de Trânsito , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Adolescente , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Traumatismo Múltiplo , Cardiomiopatia de Takotsubo/tratamento farmacológico
7.
J Pediatr Orthop ; 29(8): 856-9, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19934698

RESUMO

Pediatric Chance fractures are uncommon injuries. They are the result of a flexion-distraction force applied to the spine, and most commonly occur from motor vehicle accidents in which passengers are wearing lap seat belts as opposed to 3-point restraints with a chest strap. Neurologic injuries are rarely associated with Chance fractures in children, but accompanying intraabdominal injuries are often found and carry a potential for significant morbidity. We present 3 siblings in a minivan who were involved in a high-speed motor vehicle accident and as a result of wearing their 3-point restraints improperly, suffered Chance fractures. None had neurologic dysfunction, but 2 had serious intra-abdominal injuries requiring surgical repair. All 3 Chance fractures were treated with cast immobilization. This case report shows the importance of wearing 3-point restraints properly while traveling in a motor vehicle.


Assuntos
Acidentes de Trânsito , Cintos de Segurança , Fraturas da Coluna Vertebral/etiologia , Traumatismos Abdominais/cirurgia , Adolescente , Moldes Cirúrgicos , Criança , Desenho de Equipamento , Feminino , Humanos , Masculino , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/cirurgia , Fraturas da Coluna Vertebral/prevenção & controle , Fraturas da Coluna Vertebral/cirurgia
8.
Curr Opin Pediatr ; 21(3): 344-9, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19417664

RESUMO

PURPOSE OF REVIEW: Teratomas are rare neoplasms composed of tissue elements derived from the germinal layers of the embryo. Although they may originate anywhere along the midline, teratomas are most commonly found in sacrococcygeal, gonadal, mediastinal, retroperitoneal, cervicofacial and intracranial locations. Clinical behavior varies significantly by site and size. The presence of immature or premalignant elements may influence therapy and long-term outcome. This report reviews the current literature with regard to the diagnosis, management and outcome of teratomas in infants and children. RECENT FINDINGS: Recently, large case series have further elucidated the biologic behavior and clinical course of these rare tumors. Emerging evidence indicates that age of diagnosis is an increasingly important prognostic feature independent of tumor location. Advances in imaging are facilitating earlier diagnosis and identification of patients at higher risk of adverse outcome. In select cases, fetal and early neonatal interventions are improving outcome and survival. SUMMARY: Presenting symptoms may vary widely based on location; however, independent of primary location, definitive therapy for teratomas is complete surgical resection. Early diagnosis, timely intervention and meticulous follow-up are critical in the long-term favorable outcome.


Assuntos
Neoplasias Encefálicas , Neoplasias do Mediastino , Neoplasias de Tecido Gonadal , Neoplasias Retroperitoneais , Neoplasias da Coluna Vertebral , Teratoma , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/epidemiologia , Neoplasias do Mediastino/cirurgia , Morbidade , Neoplasias de Tecido Gonadal/diagnóstico , Neoplasias de Tecido Gonadal/epidemiologia , Neoplasias de Tecido Gonadal/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/epidemiologia , Neoplasias Retroperitoneais/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/cirurgia , Teratoma/diagnóstico , Teratoma/epidemiologia , Teratoma/cirurgia
9.
J Pediatr Surg ; 41(1): 113-9; discussion 113-9, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16410119

RESUMO

BACKGROUND/PURPOSE: The emergence of improved outcomes for small bowel (SB) transplantation has raised questions regarding the utility of autologous intestinal lengthening for patients with short bowel syndrome (SBS). Chronic immunosuppression, multiple hospitalizations, and posttransplant lymphoproliferative disease are significant adverse factors. The purpose of this study is to evaluate the 20-year single institution experience with the Bianchi procedure and analyze its role in the management of pediatric SBS. METHODS: Medical records for 19 consecutive patients who underwent the Bianchi procedure from 1984 to 2004 were reviewed. Patients were categorized into 3 groups: less than 5 years, 5 to 9.9 years, and 10 years or more after surgery. Various outcome variables were evaluated. Data are presented in tabular format as the number of patients (%) or average (range). RESULTS: Nineteen patients were included in the study. Of 16 patients weaned from total parenteral nutrition (TPN), 7 (44%) responded to Bianchi procedure alone and 9 patients (56%) required SB transplant at an average of 4.09 years (range, 0.7-13.64 years) post-Bianchi. Four patients (21%) died, 1 received SB transplant and died of unrelated causes, and 3 were still on TPN and had not received SB transplantation. CONCLUSION: The Bianchi procedure facilitated weaning from TPN and eliminated the need for supplemental nutrition in select patients. Although the role of surgery is primarily adjunctive in the treatment of SBS, it offers therapeutic benefit in decreasing parenteral nutrition requirements and promoting intestinal adaptation. In particular, the Bianchi procedure has significant potential to improve the prognosis of pediatric patients with SBS.


Assuntos
Intestino Delgado/transplante , Síndrome do Intestino Curto/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Intestino Delgado/anatomia & histologia , Masculino , Nutrição Parenteral Total , Estudos Retrospectivos , Resultado do Tratamento
10.
J Pediatr Surg ; 41(1): 260-5, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16410144

RESUMO

BACKGROUND/PURPOSE: Chemokine receptor (CCR7 [cysteine chemokine receptor 7]) and ligand (CCL19) interactions trigger dendritic cell (DC) recruitment from sites of antigen uptake to secondary lymphoid organs for T-cell priming and tumor lysis. Inhibition of this interaction may allow some aggressive tumors to evade immune detection. Although we have shown dysfunctional DC migration in murine neuroblastoma (NB) in vivo, the molecular mechanisms of impairment are unknown. We hypothesize that NB-induced aberrant CCR7-CCL19 signaling impairs DC migration. METHODS: Bone marrow-derived DCs were isolated from A/J mice (n = 24), matured, and cocultured with murine NB (TBJ) or media (control) for 7 days. CCR7 and CCL19 protein and RNA expressions by control and NB-exposed DC were measured by flow cytometry, Western blot analysis, and polymerase chain reaction. Migration assays using Transwell plates (Corning Incorporated, Corning, NY, via Fisher Scientific, Pittsburgh, Pa) were performed with matured DC and CCL19. Furthermore, to determine if these changes in DC migration could be overcome, superphysiological concentrations of CCL19 (100 ng/mL) were used. Results are reported as the average percentage +/- SD. RESULTS: No significant differences in CCR7 or CCL19 protein expression between tumor and control were seen at 7 days. However, NB significantly decreased CCL19-induced migration by more than 50%: control (26.48% +/- 1.52%) vs DC cocultured with TBJ (12.7% +/- 0.3%) (P < .05). Superphysiological doses up to 100 ng/mL CCL19 showed no significant upregulation in migration in DC cocultured with tumor cells. CONCLUSIONS: Although in vitro coculture with NB does not induce significant changes in either CCR7 or CCL19 expression, profound functional impairments in CCR7/CCL19-mediated migration occurs. These findings suggest that intracellular signal transduction pathways for these chemokines may be impaired by tumor. Targeting this chemokine-receptor pathway may provide a novel therapeutic strategy.


Assuntos
Movimento Celular , Quimiocinas CC/metabolismo , Células Dendríticas/fisiologia , Neuroblastoma/imunologia , Receptores de Quimiocinas/metabolismo , Animais , Western Blotting , Quimiocina CCL19 , Quimiocinas/fisiologia , Perfilação da Expressão Gênica , Camundongos , Neuroblastoma/genética , Neuroblastoma/patologia , Reação em Cadeia da Polimerase , Receptores CCR7 , Transdução de Sinais , Células Tumorais Cultivadas
11.
J Pediatr Surg ; 40(6): 983-7, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15991182

RESUMO

BACKGROUND/PURPOSE: Dendritic cell (DC) migration from tumors to T-cell priming sites is critical in developing antitumor cytotoxicity. Cysteine cysteine receptor 7 (CCR7), a promigratory chemokine receptor, regulates DC recruitment to secondary lymphoid organs. Tumors may inhibit CCR7 expression to evade immunodetection. Previous work implicates impaired DC migration as a critical defect in immunity to neuroblastoma (NB). However, the mechanism has yet to be defined. We hypothesize that NB abrogates DC CCR7 expression and signaling, leading to decreased antitumor immunity. METHODS: A/J mice (N = 36) were injected with saline (control) or murine NB (TBJ) and bone marrow-derived DC were isolated at 7, 14, and 28 days. CCR7 expression was analyzed by polymerase chain reaction, Western blot, and flow cytometry. Cytometry data were analyzed using the paired Student's t test. RESULTS: Dendritic cells isolated from mice with NB had a 60% increase in CCR7 protein expression by flow cytometry compared with control mice at day 7. However, there was a 43% downregulation of CCR7 expression by DC from tumor-bearing mice compared with controls 2 weeks postinoculation (P < .005). These observations were confirmed by polymerase chain reaction and Western blot analysis. CONCLUSION: Neuroblastoma initially upregulates CCR7 expression by DC. However, with tumor progression, this chemokine is downregulated, likely leading to impaired DC migration. Immunotherapeutic strategies to bypass or augment CCR7-dependent DC trafficking may improve survival for patients with aggressive disease.


Assuntos
Células Dendríticas/metabolismo , Neuroblastoma/imunologia , Receptores de Quimiocinas/metabolismo , Animais , Linhagem Celular Tumoral , Movimento Celular/fisiologia , Células Dendríticas/fisiologia , Regulação da Expressão Gênica , Camundongos , Camundongos Endogâmicos A , RNA Mensageiro/metabolismo , Receptores CCR7
12.
J Pediatr Surg ; 40(1): 244-9; discussion 249-50, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15868592

RESUMO

BACKGROUND/PURPOSE: CD40 expression by dendritic cells (DCs) critically regulates their maturation/antitumor activity. CD40-CD40 ligand (CD40L) signaling stimulates DC-mediated IL-12 production/cytotoxicity. Recent studies suggest that neuroblastoma (NB)-derived gangliosides impair DC maturation, IL-12 secretion, and NK/T-cell activity. Neuroblastoma ganglioside-mediated abrogation of CD40 expression by DC and tumor-induced tolerance has not been studied. The purpose of this study is to determine if NB inhibits DC IL-12 production via CD40. The contributory role of the NB-derived ganglioside GM3 in this process is also examined. METHODS: Dendritic cells were generated from bone marrow of mice injected with saline (control) or murine NB. Control DCs were matured with or without GM3. Dendritic cells were cocultured with NB cells treated with or without a ganglioside synthesis inhibitor. Dendritic cell groups were analyzed for maturation/costimulatory markers. Control and tumor-derived DC were stimulated with CD40L or Staphylococcus aureus and studied for IL-12 expression. RESULTS: CD40 expression on DC generated from NB bearing mice decreased by 64% (P < .001). GM3 down-regulated DC maturation and CD40 expression. Only CD40-dependent IL-12 production was abrogated (60%, P < .01) in DC derived from NB-bearing mice. Dendritic cell capacity to synthesize IL-12 remained intact. CONCLUSIONS: Neuroblastoma-induced inhibition of DC function may result from ganglioside-mediated CD40 signaling deficiency. Strategies to bypass/augment CD40-CD40L signaling may improve current NB immunotherapies.


Assuntos
Antígenos CD40/biossíntese , Células Dendríticas/imunologia , Gangliosídeo G(M3)/imunologia , Interleucina-12/biossíntese , Neoplasias do Sistema Nervoso/imunologia , Neuroblastoma/imunologia , Animais , Ligante de CD40/imunologia , Linhagem Celular Tumoral , Células Dendríticas/metabolismo , Modelos Animais de Doenças , Regulação para Baixo , Gangliosídeo G(M3)/metabolismo , Camundongos , Camundongos Endogâmicos , Transdução de Sinais
13.
J Pediatr Surg ; 39(3): 335-9; discussion 335-9, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15017548

RESUMO

PURPOSE: In addition to the structural, ultrastructural, and functional changes that occur after extensive enterectomy or in utero bowel loss that results in short bowel syndrome (SBS), a complex array of humoral responses take place that may also affect adaptation of the remaining small intestine as well as nutritional status or growth. These include alterations in the levels of circulating hormones and trophic substances such as growth hormone (GH) and insulinlike growth factors (IGF-1 and IGFBP-3). The purpose of this investigation is to report on the management/treatment of 3 children with SBS (>4 years in duration) and growth failure. METHODS: Serum measures of growth factors and the response to GH stimulation after an arginine insulin tolerance test (AITT) were determined. Weight and height z-scores as well as linear growth velocity were calculated annually pre- and postinitiation of medication therapy. RESULTS: Patient 1 (boy, 8.5 years old, midgut volvulus, 18-cm bowel) was found to be GH deficient, whereas patients 2 (girl, 12.5 years old, gastroschisis, 70-cm bowel) and 3 (boy, 9 years old, jejunal atresia, 21 cm bowel) were found to have limited GH responsiveness. Subsequently, treatment with GH (1) and growth releasing factor (GRF; 2 & 3) was prescribed. Z-scores for both weight and height improved over time. Positive linear growth velocity was observed from initiation of therapy (<0.5 cm/yr for all) to more than 3 years of treatment (mean 1, 4.7 cm/yr; 2, 8.7 cm/yr; 3, 5.0 cm/yr [age adjusted normals >4.5, >8.5, and >4.9 cm/yr, respectively]). All patients received a regular diet with oral supplements, whereas 2 received parenteral nutrition support for about 1 year. CONCLUSIONS: In children with medically refractory SBS, it is not only important to offer trophic factors but also essential that sufficient nutrient substrate be provided to achieve adequate growth.


Assuntos
Transtornos do Crescimento/terapia , Substâncias de Crescimento/uso terapêutico , Síndrome do Intestino Curto/complicações , Estatura , Peso Corporal , Criança , Suplementos Nutricionais , Feminino , Transtornos do Crescimento/etiologia , Hormônio Liberador de Hormônio do Crescimento/uso terapêutico , Substâncias de Crescimento/sangue , Hormônio do Crescimento Humano/sangue , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/uso terapêutico , Fator de Crescimento Insulin-Like I/uso terapêutico , Masculino , Terapia Nutricional , Nutrição Parenteral Total
14.
Semin Pediatr Surg ; 13(1): 61-71, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14765372

RESUMO

Neuroblastoma, the most common extracranial solid tumor of childhood, remains a challenge for clinicians and investigators in pediatric surgical oncology. The absence of effective conventional therapies for most patients with neuroblastoma justifies the application of novel, biology-based, experimental approaches to the treatment of this deadly disease. The observation that some aggressive neuroblastomas, particularly in infants, may spontaneously regress suggested that immune-mediated mechanisms may be important in the biology of this disease. Advances in the understanding of the cognate interactions between T cells, antigen-presenting cells and tumors have demonstrated the sentinel role of dendritic cells (DC), the most potent antigen presenting cells, in initiating the cellular immune response to cancer. Until recently the function of DC in pediatric solid tumors, especially neuroblastoma, had not been extensively studied. This review discusses the role of DC in initiating and coordinating the immune response against cancer, the ability of neuroblastoma to induce DC dysregulation at multiple levels by inhibiting DC maturation and function, and the current vaccine strategies being designed to employ the unique ability of DC to promote neuroblastoma regression.


Assuntos
Células Dendríticas/imunologia , Neuroblastoma/imunologia , Neuroblastoma/terapia , Animais , Vacinas Anticâncer , Células Dendríticas/efeitos dos fármacos , Gangliosídeos/farmacologia , Humanos , Imunoterapia/métodos , Interleucina-12/antagonistas & inibidores , Interleucina-12/biossíntese , Células Matadoras Naturais/imunologia , Ativação Linfocitária , Neuroblastoma/patologia , Linfócitos T/imunologia
16.
Pediatr Emerg Care ; 19(6): 412-4, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14676491

RESUMO

Torsion of a wandering spleen is a rare cause of abdominal pain in children. The most common presentation is acute abdominal pain, although signs and symptoms vary widely. Due to the risk of splenic infarction, rapid and accurate diagnosis is essential. Wandering spleen and splenic torsion can be diagnosed by Doppler ultrasound and CT scan. Treatment options include splenopexy or splenectomy. This case describes a 9-year-old girl with torsion of a wandering spleen, complicated by splenic infarction and managed by splenectomy.


Assuntos
Dor Abdominal/etiologia , Baço/anormalidades , Criança , Emergências , Feminino , Febre/etiologia , Humanos , Isquemia/etiologia , Leucocitose , Ligamentos/anormalidades , Necrose , Pâncreas/irrigação sanguínea , Pâncreas/patologia , Pancreatectomia/métodos , Baço/diagnóstico por imagem , Esplenectomia , Infarto do Baço/etiologia , Infarto do Baço/patologia , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgia , Ultrassonografia , Vômito/etiologia
17.
Contemp Top Lab Anim Sci ; 42(6): 36-8, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14615959

RESUMO

Hirschsprung's disease is characterized by aganglionosis of the distal colon and hypertonicity of the anal sphincter. Endothelin receptor type B mutant (piebald) mice phenotypically resemble infants with Hirschsprung's disease in that these mice are susceptible to developing toxic megacolon because of the absence of ganglion cells in their distal colon. Therefore, we hypothesized that newborn piebald mice would have a higher resting anal sphincter pressure than would newborn wild-type mice. To test this hypothesis, we developed a reliable and reproducible technique for measuring the resting anal sphincter pressure in mice. Heterozygote breeding pairs of endothelin receptor type B mutant mice were purchased and bred in our animal facility. Pregnant, time-dated C57BL/6J mice provided control newborn mice. One-day-old newborn mice were evaluated for resting anal sphincter pressure. Under the operating microscope, a 24-gauge open-tip epidural catheter was placed into the anus until a deflection (approximately 3 to 5 mm) was noticed on a polygraph pressure monitor. Three consecutive measurements were obtained for each mouse. Mean values for each group were determined and compared using Student's t test. The resting anal sphincter pressure (mean +/- standard deviation) in newborn C57BL/6J mice was 13.3 +/- 2.6 mmHg, whereas that in piebald mice 22.7 +/- 2.5 mmHg (P < 0.0001). Therefore, because of their increased resting anal sphincter pressure, piebald mice may provide a useful animal model for the study of Hirschsprung's disease.


Assuntos
Canal Anal/fisiopatologia , Hipertonia Muscular/veterinária , Miografia/métodos , Piebaldismo/veterinária , Animais , Camundongos , Camundongos Mutantes , Hipertonia Muscular/complicações , Hipertonia Muscular/fisiopatologia , Miografia/instrumentação , Piebaldismo/complicações , Receptores de Endotelina/genética
18.
J Pediatr Surg ; 38(7): 1043-7, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12861535

RESUMO

BACKGROUND/PURPOSE: Although intestinal transplantation (ITx) has succeeded in liberating children with intestinal failure from total parenteral nutrition (TPN), positive growth has yet to be achieved in the majority of patients. This investigation aims to evaluate levels of serum growth factors as they relate to growth parameters and nutritional outcomes. METHODS: Serum measures of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) that had been obtained before and after transplantation were reviewed (with Institutional Review Board approval) in a subset of pediatric ITx recipients. Z-scores for weight and height were calculated at transplant and biannually thereafter for 2 years. RESULTS: Five children received a small bowel/liver transplant between August 1996 and March 2000 (median age, 1.3 years). Before transplantation, levels of IGF-1 and IGFBP-3 were low in 60% and 67% of patients, respectively. Posttransplant levels of these growth factors were within normal limits or elevated in all but 2 patients (IGFBP-3 only). A positive trend in z-scores was observed in just one of 5 patients for weight and in 2 of 5 for height/length during the follow-up period. Of the 3 patients who experienced negative linear growth velocity over time, 2 had low pretransplant levels of both IGF-1 and IGFBP-3. All patients were weaned from TPN within 3 months after transplant. CONCLUSIONS: Pretransplant levels of growth mediators may be predictive factors in children who will require an intensive regimen of nutritional rehabilitation posttransplant to promote the growth process. Absorption studies may aid in determining the appropriate nutrient substrates for the post-ITx population.


Assuntos
Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Atresia Intestinal/cirurgia , Intestinos/transplante , Transplante de Fígado/fisiologia , Síndrome do Intestino Curto/cirurgia , Antropometria , Feminino , Crescimento , Humanos , Lactente , Intestinos/fisiologia , Masculino , Nutrição Parenteral Total
19.
J Pediatr Surg ; 38(6): 857-62, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12778381

RESUMO

BACKGROUND/PURPOSE: The authors previously described the complete regression of established neuroblastoma (NB) by the adoptive transfer of syngeneic interleukin-12 transduced dendritic cells (DC) from naive mice. However, some malignancies, like NB, abrogate DC immunostimulation. The authors hypothesize that IL-12 transduction of DC from NB-bearing mice will have the same antitumor properties. METHODS: A/J mice (n = 32) with established NB received peritumoral injection of 1 x 10(6) DC (DC, IL-12 DC, day 7 IL-12 DC or day 14 IL-12 DC) on day 7. Tumor growth, phenotype, and ability to induce NK and T cell activity were measured. RESULTS: Vaccination with naive admIL-12 DC resulted in 100% tumor regression and prolonged survival. Transduced DC induced only partial responses in 75% (day 7) and 25% (day 14) of animals. No differences in phenotype or effector cell activation were noted between admIL-12DC in tumor-bearing or naive mice. CONCLUSIONS: IL-12 DC from tumor-bearing animals have a decreased ability to induce antitumor activity against established murine NB. This decreased capacity appears to be related to the duration of exposure to tumor because day 14 transduced DC had less of an effect than day 7 DC, despite similar phenotypes and ability to activate immune effector cells.


Assuntos
Células Dendríticas/imunologia , Imunoterapia Adotiva/métodos , Neuroblastoma/imunologia , Neuroblastoma/terapia , Animais , Células Dendríticas/metabolismo , Células Dendríticas/virologia , Imunofenotipagem , Interleucina-12/biossíntese , Interleucina-12/genética , Células Matadoras Naturais/imunologia , Ativação Linfocitária , Masculino , Camundongos , Camundongos Endogâmicos A , Linfócitos T Citotóxicos/imunologia , Células Tumorais Cultivadas
20.
J Pediatr Surg ; 38(6): 946-9, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12778399

RESUMO

BACKGROUND: Children with Down's syndrome (DS) have a reportedly poorer outcome after treatment of Hirschsprung's disease (HD) compared with control children. Because of overall improvements in their management, the authors hypothesized that the diagnosis of DS would not influence outcome after the management of HD. METHODS: Consecutive children with HD (1995 through 2002) were collected prospectively then divided retrospectively into those with DS and controls (C). Patients who underwent surgery at another institution and those with total colonic aganglionosis were excluded. RESULTS: Of 66 patients, 9 had DS. Mean age at diagnosis, gender, racial distribution, gestational age, and proximity to our center were similar between groups. Presenting symptoms, location of the transition zone, and type of initial operation were similar. Patients with DS had significantly more comorbidities than controls, which generated significantly greater treatment costs and a higher mortality rate. However, with an average of 22 months of follow-up, the overall outcome including postoperative complications, enterocolitis, and constipation was similar. CONCLUSIONS: These data suggest that in contrast to earlier reports, DS has minimal influence on surgical outcome of patients with HD. Although the overall cost of treating patients with DS is greater, this mainly reflects the impact of managing comorbidities.


Assuntos
Síndrome de Down/fisiopatologia , Doença de Hirschsprung/cirurgia , Anastomose Cirúrgica/economia , Anastomose Cirúrgica/métodos , Comorbidade/tendências , Diagnóstico Diferencial , Síndrome de Down/complicações , Enterocolite/diagnóstico , Enterocolite/economia , Enterocolite/cirurgia , Feminino , Doença de Hirschsprung/complicações , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/economia , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/economia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
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