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BACKGROUND: Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the presentation, workup, management and outcome of rare cecal anomalies in children and to analyze the skills needed for their successful treatment. METHODS: A retrospective chart review was conducted of all cases of cecal anomalies managed by the pediatric surgical service at a tertiary hospital from June 2017 to January 2020. Data regarding demographics, clinical presentation, radiological studies, surgical treatment, pathology, complications, and outcome were collected. RESULTS: Five cases of cecal anomalies were encountered over a period of 32 months, including a cecal volvulus, cecal duplication, cecal intussusception, and two cecal masses (one ulcerated lipoma and one polyp). All patients, except the patient with cecal duplication, presented acutely and were managed surgically. Long-term follow-up of 17-24 months was unremarkable in all cases. CONCLUSIONS: A wide knowledge base, careful judgment, and creativity enable pediatric surgeons to successfully treat rare conditions such as rare cecal anomalies. These skills should be part of the education of pediatric surgery trainees.
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Doenças do Ceco , Volvo Intestinal , Intussuscepção , Humanos , Criança , Estudos Retrospectivos , Doenças do Ceco/diagnóstico , Doenças do Ceco/cirurgia , Doenças do Ceco/etiologia , Ceco/cirurgia , Ceco/anormalidades , Ceco/patologia , Volvo Intestinal/complicações , Volvo Intestinal/epidemiologia , Volvo Intestinal/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/cirurgiaRESUMO
INTRODUCTION: Preterm infants with necrotizing enterocolitis (NEC) are at increased risk of cerebral injury and neurodevelopmental dysfunction. N-acetyl-cysteine (NAC) is a known anti-inflammatory and antioxidant agent. Currently, there is no prophylactic treatment in clinical use to prevent NEC and its neurodevelopmental sequelae. We sought to determine whether brain inflammation/apoptosis accompanies NEC systemic inflammation, and whether it can be attenuated by maternal NAC treatment during pregnancy and/or in the neonatal period in a rat model. MATERIAL AND METHODS: An established NEC newborn model (hypoxia 5% O2 for 10 min and formula feeding thrice daily, beginning on day 1 for 4 days) was used in Sprague-Dawley rat pups (n = 32). An additional group of pups (n = 33) received NAC (300 mg/kg intraperitoneal thrice daily) in addition to NEC conditions (NEC-NAC). Control pups (n = 33) were nursed and remained with the dam in room air. Two additional groups included pups of dams treated once daily with NAC (300 mg/kg intravenous) in the last 3 days of pregnancy. After birth, pups were randomized into NAC-NEC (n = 33) with NEC conditions and NAC-NEC-NAC (n = 36) with additional postnatal NAC treatment. Pups were sacrificed on the fifth day of life. Pup serum interleukin (IL)-6 protein levels, and brain nuclear factor kappa B (NF-κB) p65, neuronal nitric oxide synthase (nNOS), Caspase 3, tumor necrosis factor alpha (TNF-α), IL-6 and IL-1ß protein levels were determined by ELISA, western blot and TUNEL staining, and the groups were compared using analysis of variance (ANOVA). RESULTS: NEC pups had significantly increased serum IL-6 levels compared with the control group as well as increased neuronal apoptosis and brain protein levels of NF-κB, nNOS, Caspase 3, TNF-α, IL-6 and IL-1ß compared with control. In all NAC treatment groups, levels of serum IL-6, neuronal apoptosis and brain NF-κB, nNOS, Caspase 3, TNF-α, IL-6 and IL-1ß protein levels were significantly reduced compared with the NEC group. The most pronounced decrease was demonstrated within the NAC-NEC-NAC group. CONCLUSIONS: NAC treatment can attenuate newborn inflammatory response syndrome and decrease offspring brain neuroapoptosis and inflammation in a rat model of NEC by inhibition of NF-κB, nNOS and Caspase 3 pathways.
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Acetilcisteína/farmacologia , Acetilcisteína/uso terapêutico , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Lesões Encefálicas/tratamento farmacológico , Enterocolite Necrosante/tratamento farmacológico , Inflamação/tratamento farmacológico , Animais , Animais Recém-Nascidos , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Apoptose/efeitos dos fármacos , Lesões Encefálicas/etiologia , Caspase 3/metabolismo , Modelos Animais de Doenças , Enterocolite Necrosante/complicações , Enterocolite Necrosante/prevenção & controle , Feminino , Marcação In Situ das Extremidades Cortadas , Inflamação/complicações , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Gravidez , Ratos , Ratos Sprague-Dawley , Fator de Transcrição RelA/metabolismo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
PURPOSE: Our aims were to describe the feasibility of diagnosis of DAA in early pregnancy and to assess its prenatal prevalence, associated anomalies and outcome. MATERIALS AND METHODS: A retrospective cohort review of all DAA cases diagnosed by early prenatal transvaginal scans at 12-17 weeks of gestation between the years 2007-2018 was performed. Associated anomalies, genetic abnormalities and long-term postnatal outcome were evaluated. RESULTS: 12 cases of DAA were diagnosed by early prenatal transvaginal scans at a median of 15 (range: 12-17) weeks of gestation out of a total of 28â654 early scans preformed with a prevalence of at least 1:2378. Associated anomalies/genetic abnormalities were found in 5/12 (42â%) cases. The diagnosis was confirmed postnatally in all newborns. In two cases termination of pregnancy was performed. Four patients (40â%) were symptomatic. Six patients (60â%) underwent surgery due to symptoms or due to severe obstruction on imaging with resolution of symptoms in all except one patient. CONCLUSION: DAA can be readily diagnosed transvaginally even in the first trimester. Its prevalence is 1:2387. A search for associated anomalies and genetic abnormalities should be performed. If DAA is isolated, the prognosis with or without surgery is usually good.
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Anel Vascular , Feminino , Humanos , Recém-Nascido , Gravidez , Diagnóstico Pré-Natal , Prevalência , Estudos Retrospectivos , Ultrassonografia Pré-NatalRESUMO
Perinatal hypoxia is a major cause of infant brain damage, lifelong neurological disability, and infant mortality. N-Acetyl-Cysteine (NAC) is a powerful antioxidant that acts directly as a scavenger of free radicals. We hypothesized that maternal-antenatal and offspring-postnatal NAC can protect offspring brains from hypoxic brain damage.Sixty six newborn rats were randomized into four study groups. Group 1: Control (CON) received no hypoxic intervention. Group 2: Hypoxia (HYP)-received hypoxia protocol. Group 3: Hypoxia-NAC (HYP-NAC). received hypoxia protocol and treated with NAC following each hypoxia episode. Group 4: NAC Hypoxia (NAC-HYP) treated with NAC during pregnancy, pups subject to hypoxia protocol. Each group was evaluated for: neurological function (Righting reflex), serum proinflammatory IL-6 protein levels (ELISA), brain protein levels: NF-κB p65, neuronal nitric oxide synthase (nNOS), TNF-α, and IL-6 (Western blot) and neuronal apoptosis (histology evaluation with TUNEL stain). Hypoxia significantly increased pups brain protein levels compared to controls. NAC administration to dams or offspring demonstrated lower brain NF-κB p65, nNOS, TNF-α and IL-6 protein levels compared to hypoxia alone. Hypoxia significantly increased brain apoptosis as evidenced by higher grade of brain TUNEL reaction. NAC administration to dams or offspring significantly reduce this effect. Hypoxia induced acute sensorimotor dysfunction. NAC treatment to dams significantly attenuated hypoxia-induced acute sensorimotor dysfunction. Prophylactic NAC treatment of dams during pregnancy confers long-term protection to offspring with hypoxia associated brain injury, measured by several pathways of injury and correlated markers with pathology and behavior. This implies we may consider prophylactic NAC treatment for patients at risk for hypoxia during labor.
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Acetilcisteína/metabolismo , Asfixia Neonatal/complicações , Encéfalo/metabolismo , Hipóxia Encefálica/prevenção & controle , Inflamação , Estresse Oxidativo , Animais , Animais Recém-Nascidos , Antioxidantes/metabolismo , Regulação da Expressão Gênica , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/metabolismo , Marcação In Situ das Extremidades Cortadas , Interleucina-6/genética , Óxido Nítrico Sintase Tipo I/genética , Ratos , Ratos Sprague-Dawley , Fator de Transcrição RelA/genética , Fator de Necrose Tumoral alfa/genéticaRESUMO
INTRODUCTION: Pheochromocytoma is a rare, catecholamine secreting tumor arising from chromaffin cells of the adrenal medulla and it is responsible for 0.5-2% of pediatric hypertension cases. We hereby present a case of a 13-year-old girl with obesity, excessive hypertension, prediabetes and secondary nocturnal enuresis, who was eventually diagnosed with pheochromocytoma. Most symptoms significantly improved after treating the tumor. We suggest that this diagnosis should be considered in pediatric patients presenting with similar symptoms.
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Neoplasias das Glândulas Suprarrenais , Hipertensão , Enurese Noturna , Feocromocitoma , Adolescente , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Criança , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Enurese Noturna/diagnóstico , Enurese Noturna/etiologia , Feocromocitoma/complicações , Feocromocitoma/diagnósticoRESUMO
BACKGROUND: Unilateral renal agenesis is a rare finding. There are no large-scale studies reporting this finding in early pregnancy. OBJECTIVES: To evaluate the incidence of unilateral renal agenesis (URA) and of associated anomalies diagnosed by early prenatal trans-vaginal sonography. METHODS: We performed a retrospective chart review of all 59,382 trans-vaginal scans performed at 14-16 weeks gestation by a single operator at different clinics during the period 1994-2013. RESULTS: The incidence of URA was 1:1212 (49/59382 cases). Associated anomalies were diagnosed in 22 cases (45%). Renal anomalies were diagnosed in 22.4%. Extra-renal anomalies (with exclusion of a single umbilical artery or nuchal edema as isolated findings) were diagnosed in 24.5%. Ambiguous genitalia were diagnosed in 8.2%. CONCLUSIONS: URA is a rare finding in early trans-vaginal sonography. Associated anomalies are very common and should be sought.
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Rim Único/diagnóstico por imagem , Rim Único/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/embriologia , Masculino , GravidezRESUMO
BACKGROUND: Gastric bezoars in children are infrequent. Most are trichobezoars. Surgical intervention is sometimes necessary. OBJECTIVES: To describe the clinical findings and radiological workup, as well as treatment and outcome of patients with complicated gastric bezoars who underwent surgery in our institution. METHODS: We conducted a retrospective review of all cases of surgery for gastric bezoars performed in our institution between 2000 and 2010. Data collected included gender and age of the patients, composition and extent of the bezoar, presenting signs and symptoms, imaging studies used, performance of endoscopy, and surgical approach. Outcome was measured by the presence of postoperative complications. RESULTS: We identified seven patients with gastric bezoars who underwent surgery. All were females aged 4-19 years. Six had trichobezoars and one had a mass composed of latex gloves. Presenting symptoms included abdominal pain, vomiting, weight loss, and halitosis. All patients had a palpable epigastric mass. A large variety of imaging modalities was used. Endoscopic removal was attempted in three patients and the laparoscopic approach in one patient, but both routes failed. All patients eventually underwent laparotomy with gastrotomy and recovered without complications. CONCLUSIONS: The presence of gastric bezoars should be suspected in any child with unexplained abdominal pain, vomiting, weight loss, or halitosis, or with a palpable abdominal mass, especially in girls. A variety of imaging modalities can aid in diagnosis. Endoscopic removal might be attempted, although failure of this approach is frequent, necessitating surgical intervention, preferably laparotomy and gastrotomy, which has an excellent outcome.
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Dor Abdominal/etiologia , Bezoares/cirurgia , Laparotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Bezoares/complicações , Bezoares/diagnóstico , Criança , Pré-Escolar , Endoscopia/métodos , Feminino , Humanos , Estudos Retrospectivos , Vômito/etiologia , Adulto JovemRESUMO
BACKGROUND: Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity. METHODS: The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data. RESULTS: During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days). CONCLUSIONS: The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.
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BACKGROUND: The impact of IPAA on long-term outcomes in adults is favorable. Studies on functional outcome and quality of life in children are sparse. OBJECTIVE: The aim of this study was to evaluate the functional and quality-of-life outcomes after IPAA in children and to investigate the possible correlations between the two. DESIGN: Standardized validated questionnaires of bowel/psychosocial functioning and quality of life were used to assess outcome. SETTING: This study was conducted at a tertiary medical center. PATIENTS: All children who had surgery at <18 years of age and were followed up at our institute were included. Global Assessment of Function Scale questionnaires were used to evaluate functional outcome. Quality of life in patients >18 years at the time of follow-up was scored by using the Short Form 36 questionnaire completed by the patients. Quality of life in the younger patients at the time of follow-up was scored using the Child Health Questionarie-28 filled by the parents. RESULTS: Data were obtained in 26 patients (25 with a preoperative diagnosis of ulcerative colitis) at a median follow-up of 6 years. The median age at surgery was 15 years. Quality of life was comparable to the general population for children >18 at the time of follow-up in 7 of 8 items, but was lower than in the general population in 7 of 12 items for those who were younger at the time of follow-up. The mean functional score was found to be negatively correlated to all 8 Short Form 36 parameters (r > 0.5; p < 0.005), but only to one of the Child Health Questionarie-28 parameters. LIMITATIONS: This study was limited by its small sample size. CONCLUSIONS: The functional outcomes among pediatric patients undergoing IPAA are good. Parents' perception of their child's quality of life is poorer in comparison with the perception by patients themselves when older and with no correlation to the functional results.
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Bolsas Cólicas , Qualidade de Vida , Polipose Adenomatosa do Colo/cirurgia , Adolescente , Criança , Colite Ulcerativa/cirurgia , Doença de Crohn/cirurgia , Indicadores Básicos de Saúde , Humanos , Recuperação de Função Fisiológica , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVE: To characterize gastrointestinal bubbles detected since early pregnancy and to describe corresponding diagnoses. METHOD: A retrospective cohort review of all cases in which gastrointestinal bubbles were detected starting in early prenatal transvaginal scans at 14-17 weeks of gestation between the years 2007 and 2021. Sonographic features and data regarding associated anomalies, genetic abnormalities, and pregnancy outcome were evaluated. RESULTS: Bubbles were detected in 23 of 27 073 early scans and a total of 31 394 scans. Diagnosis was available in 22 cases. Transient bubbles were detected in 10 cases and represented normal peristalsis. Fixed double bubble was detected in nine cases. Double-walled double bubbles represented duodenal duplications (three cases) and esophageal duplications (two cases). Simple cysts represented duodenal atresia (three cases) and a pancreatic cyst (one case). A triple bubble represented duodenal obstruction from Ladd bands in one case. Quadribubble was detected in two cases and represented jejunal atresia. CONCLUSION: Prenatal detection of gastrointestinal bubbles can accurately diagnose physiological versus pathological upper gastrointestinal conditions. Transient bubbles are physiological. Fixed double bubbles might represent either duodenal atresia or esophageal/duodenal duplications when a double wall is demonstrated. Three or four bubbles might represent more distal intrinsic or extrinsic obstruction.
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Obstrução Duodenal , Ultrassonografia Pré-Natal , Feminino , Gravidez , Humanos , Estudos Retrospectivos , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/genética , Resultado da Gravidez , Diagnóstico Pré-NatalRESUMO
Background: Inappropriate exposure or activity of sex hormones in-utero has been postulated as a leading cause for the development of hypospadias and cryptorchidism. Anthropometric sexually dimorphic traits such as the 2nd to 4th digit ratio (2D:4D), anogenital distance (AGD) and the stretched penile length (SPL), have been associated with androgen and estrogen activity in-utero. Purpose: Evaluate anthropometric parameters in patients with hypospadias or cryptorchidism compared with healthy controls. Materials and methods: This is a case control study of male patients operated on between 2019 and 2020. Three groups were included: Hypospadias, cryptorchidism and a demographically similar control group. Anthropometric parameters 2D:4D, AGD and SPL were measured intra-operatively and compared between the groups. Results: Included in the study were 179 pediatric patients between the ages of 9-15 months (58 patients with hypospadias, 69 with cryptorchidism and 47 controls). There was no difference in AGD, 2D:4D and SPL between patients with cryptorchidism, hypospadias and controls. Conclusions: Anthropometric characteristics associated with androgen activity in utero were not different in patients with hypospadias and cryptorchidism compared with controls.
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(1) Background: To examine the incidence of the prenatal diagnosis of the renal double-collecting system (rDCS) and describe its clinical outcome and associated genetic abnormalities. (2) Methods: This retrospective study included women who attended the obstetric clinic for early fetal anatomic sonography with findings of a renal DCS. Diagnosis was conducted by an expert sonographer using defined criteria. (3) Results: In total, 29,268 women underwent early ultrasound anatomical screening at 14-16 weeks, and 383 cases of rDCS were diagnosed (prevalence: 1:76). Associated abnormalities were diagnosed in eleven pregnancies; four had chromosomal aberrations. No chromosomal abnormalities were reported in isolated cases. Ectopic uretrocele and dysplastic kidney were diagnosed in 6 (1.5%) and 5 (1.3%) fetuses, respectively. One girl was diagnosed with vesicoureteral reflux and recurrent UTIs, and two boys were diagnosed with undescended testis. The recurrence rate of rDCS was 8% in subsequent pregnancies. (4) Conclusions: In light of its benign nature, we speculate that isolated rDCS may be considered a benign anatomic variant, but a repeat examination in the third trimester is recommended to assess hydronephrosis.
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Necrotizing enterocolitis (NEC) brain injury is mediated through Toll-like receptor 4 (TLR4) on the intestinal epithelium and brain microglia. Our aim was to determine whether postnatal and/or prenatal NAC can modify NEC associated intestinal and brain TLR4 expression and brain glutathione levels in a rat model of NEC. Newborn Sprague-Dawley rats were randomized into three groups: Control (n = 33); NEC (n = 32)-hypoxia and formula feeding; and NEC-NAC (n = 34)-received NAC (300 mg/kg IP) in addition to NEC conditions. Two additional groups included pups of dams treated once daily with NAC (300 mg/kg IV) for the last 3 days of pregnancy: NAC-NEC (n = 33) or NAC-NEC-NAC (n = 36) with additional postnatal NAC. Pups were sacrificed on the fifth day, and ileum and brains harvested for TLR-4 and glutathione protein levels. Brain and ileum TLR-4 protein levels were significantly increased in NEC offspring as compared to control (brain 2.5 ± 0.6 vs. 0.88 ± 0.12 U and ileum 0.24 ± 0.04 vs. 0.09 ± 0.01, p < 0.05). When NAC was administered only to dams (NAC-NEC) a significant decrease in TLR-4 levels was demonstrated in both offspring brain (1.53 ± 0.41 vs. 2.5 ± 0.6 U, p < 0.05) and ileum (0.12 ± 0.03 vs. 0.24 ± 0.04 U, p < 0.05) as compared to NEC. The same pattern was demonstrated when NAC was administered only or postnatally. The decrease in brain and ileum glutathione levels observed in NEC offspring was reversed with all NAC treatment groups. NAC reverses the increase in ileum and brain TLR-4 levels and the decrease in brain and ileum glutathione levels associated with NEC in a rat model, and thus may protect from NEC associated brain injury.
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Lesões Encefálicas , Enterocolite Necrosante , Animais , Ratos , Acetilcisteína/farmacologia , Animais Recém-Nascidos , Encéfalo/metabolismo , Lesões Encefálicas/metabolismo , Modelos Animais de Doenças , Enterocolite Necrosante/tratamento farmacológico , Enterocolite Necrosante/metabolismo , Glutationa/metabolismo , Íleo/metabolismo , Intestinos , Ratos Sprague-Dawley , Roedores/metabolismo , Receptor 4 Toll-Like/metabolismoRESUMO
OBJECTIVE: The aim of this study to describe the presentation of double inlet left ventricle (DILV) very early in prenatal life, to assess its prevalence and to portray the associated anomalies. METHODS: This was a retrospective study which included all the women who attended our clinic for early fetal screening sonography, between 2006 and 2020. Most of the screening was done at 14-16 weeks of gestation (except one high risk pregnancy, which was performed at nine gestational weeks), and included an anatomic fetal scan and Doppler imaging. The diagnosis of DILV was done based on sonographic features of abnormal four-chamber view. Complete fetal echocardiography was carried out to rule out additional heart malformations. RESULTS: Out of 26,805 early prenatal transvaginal ultrasound screening examinations, 14 cases of DILV were diagnosed. The gestational age range of our DILV diagnosis was 9-16 gestational weeks. All pregnancies were terminated as per parental request. In five fetuses, a chromosomal analysis was performed, one had trisomy 21, and the rest fetuses had a normal karyotype. In two fetuses, an autopsy was performed and the diagnosis of DILV was confirmed in both. CONCLUSIONS: Very early prenatal detection of DILV is possible and may have an implication in parent decision regarding their pregnancy future.
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Baías , Ultrassonografia Pré-Natal , Gravidez , Feminino , Humanos , Lactente , Ultrassonografia Pré-Natal/métodos , Estudos Retrospectivos , Ventrículos do Coração/diagnóstico por imagem , Diagnóstico Pré-Natal , Idade GestacionalRESUMO
Colorectal cancer (CRC) is a rare condition in the pediatric population, but it is usually associated with worse prognosis compared to the adult population. Surgical resection is the gold standard and most effective treatment for CRC. Cytoreductive surgery (CRS) and Heated Intra-Peritoneal Chemotherapy (HIPEC) is a feasible option in resectable primary tumour with carcinomatosis and non-evidence of extra-abdominal disease. Although it is very uncommon in children when performed, CRS-HIPEC is based on the description by Sugarbaker et al. and the two most common administrated drugs are Cisplatin and Mitomycin-C. We present a review of the cases found in the literature of peritoneal carcinomatosis from CRC treated with CRS and HIPEC in children. A systematic search was performed in the major databases up to February 2020. We included all the reviews and studies reporting clinical data on pediatric patients with peritoneal colorectal carcinomatosis. Nine cases were extracted from the literature. Patient age was between 11 and 16 years old. All patients underwent neoadjuvant chemotherapy. All patients were treated with HIPEC and the majority of them received a complete cytoreduction (CC-0). At follow-up, three patients were found free from disease with an average time of follow up of 74 weeks (40-100). In 33% of cases, recurrence was described. No postoperative death within 30 days from surgery was observed. CRS and HIPEC can be a feasible option for CRC peritoneal carcinomatosis in children. Because CRC is unusual among the pediatric population, multi-institutional studies should be done to achieve larger cohorts and a more reliable analysis.
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Antineoplásicos/uso terapêutico , Neoplasias Colorretais/secundário , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Peritoneais/terapia , Quimioterapia do Câncer por Perfusão Regional , Criança , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Humanos , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/secundário , PrognósticoRESUMO
PURPOSE: Our aim was to characterize excised breast masses in children and adolescent and to identify factors associated with a more aggressive pathology. METHODS: Retrospective review of all female patients <19 who underwent excision of breast masses at our institution between 1999 and 2018. Demographic, clinical, imaging, pathological and management data were collected. We assessed possible association of any of the variables with a more aggressive pathology (phyllodes tumor and malignancy). Correlation between core needle biopsy results and final pathology results was also calculated. RESULTS: 70 patients were included. Median age was 17â¯years (range: 11-19). Resected mass size was 4â¯cm (range: 2-16). Final pathology results were: fibroadenoma (49), juvenile fibroadenoma (7), hamartoma (5), benign phyllodes (7), malignant phyllodes (1) and sarcoma (1). Pathology was benign in 61 (87%) patients and more aggressive (phyllodes and sarcoma) in 9 (13%). None of the tested variables was associated with a more aggressive pathology. Presurgical core biopsy results matched final pathology in only 63.6%. CONCLUSIONS: Excised breast masses in children and adolescents are sometimes of a more aggressive pathology, which cannot be predicted by presurgical factors, including a core needle biopsy. Prognosis study LEVEL OF EVIDENCE: III.
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Neoplasias da Mama/patologia , Fibroadenoma/patologia , Hamartoma/patologia , Tumor Filoide/patologia , Sarcoma/patologia , Adolescente , Biópsia com Agulha de Grande Calibre , Mama/patologia , Neoplasias da Mama/cirurgia , Criança , Feminino , Fibroadenoma/cirurgia , Hamartoma/cirurgia , Humanos , Tumor Filoide/cirurgia , Estudos Retrospectivos , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/patologia , Adulto JovemRESUMO
Background: Maternal administration of magnesium sulfate (Mg) is used in humans to protect the fetal brain during preterm delivery. We sought to determine the neuroprotective mechanism of Mg in a rat model of late gestation maternal inflammation.Methods: Pregnant rats at 20 d of gestation (20 total, four groups, N = 5 in each group) received i.p. LPS or saline. Dams were randomized for s.c. saline or Mg supplementation 2 h prior and following the LPS/saline injections. Dams were sacrificed 4 h following the last treatment. Fetal brains were collected from the four treatment groups. Fetal brain caspase 3 active form, NF-kB p65, neuronal nitric oxide synthase (phospho-nNos), and proinflammatory cytokines levels were determined by western blot.Results: Maternal LPS at e20 significantly (p < .01) increased fetal brain caspase 3 active form (af) (0.27 ± 0.02 versus 0.15 ± 0.06u), NFkB (0.23 ± 0.01 versus 0.13 ± 0.01u), and phospho-nNOS (0.22 ± 0.01 versus 0.12 ± 0.01u) and fetal brain proinflammatory cytokines (IL-6 0.21 ± 0.01 versus 0.11 ± 0.01 u; TNFα 0.29 ± 0.01 versus 0.15 ± 0.01u), compared with control fetuses. Mg treatment significantly (p < .05) reduced fetal brain caspase 3 af (0.16 ± 0.01u), NFkB p65 (0.11 ± 0.01u), phospho-nNOS (0.1 ± 0.01u), as well as brain proinflammatory cytokines (IL-6 0.07 ± 0.01u; TNFα 0.15 ± 0.01u) to levels similar to controls.Conclusion: Maternal inflammation-induced fetal brain injury at late gestation may be mediated by the activation of inflammatory response, oxidative stress, and apoptosis. Maternal Mg may attenuate the injury by inhibition of these putative pathways.
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Sulfato de Magnésio , Roedores , Animais , Encéfalo , Feminino , Feto , Inflamação/tratamento farmacológico , Lipopolissacarídeos , Sulfato de Magnésio/farmacologia , Gravidez , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND: Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease of neonates, especially premature neonates. To date, there is no prophylactic treatment against NEC, except breast milk and slow increase in enteral feeding, and there is no antenatal prophylaxis. AIMS: To assess possible protective effects of antenatal N-Acetyl Cysteine (NAC) against the intestinal pathophysiological changes associated with NEC in a rat model of NEC and against its associated mortality. METHODS: Newborn Sprague-Dawley rats were divided into 5 groups: control (n = 33); NEC (n = 32)-subjected to hypoxia and formula feeding for 4 days to induce NEC; NEC-NAC (n = 34)-with induced NEC and concomitant postnatal NAC administration; NAC-NEC (n = 33)-born to dams treated with NAC for the last 3 days of pregnancy starting at gestational age of 18 days, and then subjected to induced NEC after birth; NAC-NEC-NAC (n = 36)-subjected to induced NEC with both prenatal and postnatal NAC treatment. At day of life 5, weight and survival of pups in the different groups were examined, and pups were euthanized. Ileal TNF-α, IL-6, IL-1ß, IL-10, NFkB p65, iNOS and cleaved caspase 3 protein levels (western blot) and mRNA expression (RT-PCR) were compared between groups. RESULTS: Pup mortality was significantly reduced in the NAC-NEC-NAC group compared to NEC (11% vs. 34%, P<0.05). Ileal protein levels and mRNA expression of all injury markers tested except IL-10 were significantly increased in NEC compared to control. These markers were significantly reduced in all NAC treatment groups (NEC-NAC, NAC-NEC, and NAC-NEC-NAC) compared to NEC. The most pronounced decrease was observed in the NAC-NEC NAC group. CONCLUSIONS: Antenatal NAC decreases injury markers and mortality associated with NEC in a rat model. Antenatal administration of NAC may present a novel approach for NEC prophylaxis in pregnancies with risk for preterm birth.
Assuntos
Acetilcisteína/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Enterocolite Necrosante/prevenção & controle , Sequestradores de Radicais Livres/uso terapêutico , Acetilcisteína/administração & dosagem , Animais , Anti-Inflamatórios/administração & dosagem , Caspase 3/metabolismo , Enterocolite Necrosante/tratamento farmacológico , Enterocolite Necrosante/metabolismo , Feminino , Sequestradores de Radicais Livres/administração & dosagem , Interleucinas/metabolismo , Masculino , NF-kappa B/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms. Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries. Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1 ± 3.4 vs. 10.6 ± 3.6, 13% vs. 3%, 1 [0-3] vs. 1 [0-1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1 ± 3.4 vs. 7.4 ± 5.3, 1 [1-3] vs. 1 [1-2], 1 [0-3] vs. 0 [0-1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1 ± 3.4 vs. 8.5 ± 3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1-5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49-12.5, (P < .01). Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.