Is postoperative transanastomotic feeding beneficial in neonates with congenital duodenal obstruction?

PURPOSE: We aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO). METHODS: This is a retrospective study reviewing medical records of neonates operated for CDO during 2003-2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital's data protection officer was obtained. RESULTS: One hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096). CONCLUSION: Neonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.

Congenital Duodenal Obstruction: National Trends in Management and Outcomes during the Last Quarter of a Century in Norway.

INTRODUCTION: During the last quarter of a century, new surgical techniques in neonates have been introduced, and neonatal intensive care has developed. Few studies have explored the implementation of new techniques and if outcomes in neonates undergoing gastrointestinal surgery have improved in the last decades. Therefore, this study aimed to investigate possible changes in postoperative outcomes and surgical techniques in all neonates operated for congenital duodenal obstruction (CDO) 1995 to 2020 in Norway. MATERIAL AND METHODS: This is a national multicenter retrospective study of all neonates undergoing surgery for CDO in Norway from 1995 to 2020. Results from three periods (1995-2003, 2004-2012, and 2013-2020) were compared. The study was approved by the local data protection officers (2020/13386) and (2020/15125). RESULTS: We included 186 patients: 41 in period 1 (1995-2003), 83 in period 2 (2004-2012), and 62 in period 3 (2013-2020). Seventy (38%) neonates had Down syndrome and 104 (62%) had additional malformations/disorders. Birth weight, gender, frequency of Down syndrome, and other malformations/disorders did not differ between the three periods. We observed an increased rate of prenatal diagnosis throughout the study period (p < 0.001). The only change in surgical technique was the increased use of transanastomotic feeding tubes (p < 0.001). Length of stay, postoperative complication rate, days with parenteral nutrition, and 30-day mortality rate were stable over time. CONCLUSION: Perioperative treatment and postoperative outcomes in neonates with CDO have been surprisingly unchanged during the last quarter of a century. Only an increased rate of prenatal diagnosis and more frequent use of transanastomotic feeding tubes were observed.

The anatomy of the medial part of the knee.

BACKGROUND: While the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to perform a quantitative evaluation of their anatomic attachment sites as well as their relationships to pertinent osseous landmarks. METHODS: Dissections were performed and measurements were made for eight nonpaired fresh-frozen cadaveric knees with use of an electromagnetic three-dimensional tracking sensor system. RESULTS: In addition to the medial epicondyle and the adductor tubercle, a third osseous prominence, the gastrocnemius tubercle, which corresponded to the attachment site of the medial gastrocnemius tendon, was identified. The average length of the superficial medial (tibial) collateral ligament was 94.8 mm. The superficial medial collateral ligament femoral attachment was 3.2 mm proximal and 4.8 mm posterior to the medial epicondyle. The superficial medial collateral ligament had two separate attachments on the tibia. The distal attachment of the superficial medial collateral ligament on the tibia was 61.2 mm distal to the knee joint. The deep medial collateral ligament consisted of meniscofemoral and meniscotibial portions. The posterior oblique ligament femoral attachment was 7.7 mm distal and 6.4 mm posterior to the adductor tubercle and 1.4 mm distal and 2.9 mm anterior to the gastrocnemius tubercle. The medial patellofemoral ligament attachment on the femur was 1.9 mm anterior and 3.8 mm distal to the adductor tubercle. CONCLUSIONS: The medial knee ligament structures have a consistent attachment pattern.

Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study.

BACKGROUND: This study was conducted to determine if risk factors for groin injuries among male soccer players could be identified. HYPOTHESIS: Previous groin injuries, reduced function scores, age, findings on clinical examination, and low isometric groin strength are associated with increased risk of new groin injuries. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 508 players representing 31 amateur teams were tested during the 2004 preseason for potential risk factors for groin injury through a questionnaire on previous injury and function score (Groin Outcome Score [GrOS]) and a clinical examination of the groin. Generalized estimating equations were used in univariate analyses to identify candidate risk factors, and factors with a P value <.10 were then examined in a multivariate model. RESULTS: During the soccer season, 61 groin injuries affecting 55 legs (51 players) were registered. The total incidence of groin injuries was 0.6 injuries per 1000 playing hours (95% confidence interval [CI], 0.4-0.7), 0.3 injuries per 1000 training hours (95% CI, 0.2-0.4), and 1.8 injuries per 1000 match hours (95% CI, 1.2-2.5). In a multivariate analysis, previous acute groin injury (adjusted odds ratio [OR], 2.60; 95% CI, 1.10-6.11) and weak adductor muscles as determined clinically (adjusted OR, 4.28; 95% CI, 1.31-14.0) were significantly associated with increased risk of groin injuries. A multivariate analysis based only on acute time-loss injuries revealed the 40-m sprint test result (adjusted OR, 2.03 for 1 standard deviation change [injured group faster]; 95% CI, 1.06-3.88; P = .03) and functional testing of the rectal abdominal muscles (adjusted OR, 15.5 [painful in 19% of the players in the injured group compared to 16% in the uninjured group]; 95% CI, 1.11-217; P = .04) as significant risk factors. CONCLUSION: A history of acute groin injury and weak adductor muscles are significant risk factors for new groin injuries.

Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study.

BACKGROUND: Strain injuries of the posterior thigh are common in soccer. It seems that previous injury and age are important risk factors, but the literature is limited. This study was conducted to see if we could identify intrinsic risk factors for hamstring injuries among male soccer players. HYPOTHESIS: We hypothesized that previous hamstring injuries, reduced function scores, abnormalities on a clinical examination, high maximum sprint speed, poor hamstring strength, or low hamstring/quadriceps ratio can predict increased risk of new hamstring injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 508 players representing 31 amateur teams were tested during the 2004 preseason for potential risk factors for hamstring injury through a questionnaire on previous injury and function score (Hamstring Outcome Score [HaOS]), a clinical examination of the hamstring, and specific hamstring relevant tests. Generalized estimating equations were used in univariate analyses to identify candidate risk factors, and factors with a P value of <.10 were then examined in a multivariate model. RESULTS: During the soccer season, 76 hamstring injuries, affecting 65 legs (61 players), were registered. Univariate analyses revealed previous acute hamstring injury (yes/no) (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.54-4.45), HaOS function score with all subscores except "Soreness" (OR for a 10-point difference in total score, 1.29; 95% CI, 1.08-1.54), age (OR, 1.25; 95% CI, 0.96-1.63), and player position (P = .09) as candidate predictors of high injury risk. In a multivariate analysis, the most important risk factor for injuries to the hamstring was previous acute hamstring injury (yes/no) (adjusted OR, 2.19; 95% CI, 1.19-4.03; P = .01). CONCLUSION: In a multivariate analysis, previous acute hamstring injury was found to be a significant risk factor for new hamstring injuries. Previously injured players have more than twice as high a risk of sustaining a new hamstring injury.