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Cephalic vein cutdown for totally implantable central venous port in children: A retrospective analysis of prospectively collected data
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Abstracts / Journal of Pediatric Surgery 49 (2014) 1181–1185
were included. PCTs included in MA were only individually analyzed if they focused on additional endpoints. Endpoints of the study were advantages and disadvantages of laparoscopy compared with the open operation. A total of 20 manuscripts met the inclusion criteria (9 MA and 11 RCT). Studies providing evidence Level 1a were identified for five types of laparoscopic procedures (laparoscopic appendectomy, inguinal hernia repair, orchidopexy, pyloromyotomy, and varicocelectomy). Studies providing evidence Level 1b were identified for two types of laparoscopic procedures (fundoplication and pyeloplasty). The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy). Studies providing evidence Level 1 are only available for seven laparoscopic procedures in pediatric surgery. Effort has to be made to extend the existing Level 1 evidence and to gain high level evidence for further laparoscopic procedures.—Thomas A. Angerpointner http://dx.doi.org/10.1016/j.jpedsurg.2014.05.004
Patency of neck veins following ultrasound-guided percutaneous Hickman line insertion Wragg RC, Blundell S, Bader M. Pediatr Surg Int 2014; 30(3):301-304 (Mar) Venous occlusion following permanent central venous catheter (CVC) insertion by open cutdown or the landmark percutaneous technique has been reported between up to 25 %. However, there are no published data on the equivalent rate following ultrasoundguided percutaneous CVC insertion. The purpose of this study was to document the rate of venous occlusion associated with ultrasoundguided percutaneous CVC insertion in children. From 1 April 2010 to 1 December 2011, all children having elective or emergency removal of a Hickman line by the vascular access team had a Doppler ultrasound of their neck veins. Only Hickman lines inserted by the ultrasound-guided percutaneous route were included. Internal jugular, innominate and subclavian veins were scanned and recorded as patent, reduced or absent. One hundred consecutive children were identified and included. Median age was 6 years (range 21 days to 16 years). Indication for insertion was chemotherapy (60), parenteral nutrition (15), blood products (12), renal replacement (3) and other indications (10). Three children had absent flow at the time of line removal (median age 4 months, range 3–6 months), with 2 out of 3 requiring removal for infection. The venous occlusion rate following ultrasound-guided insertion of CVC was 3 %. The authors conclude that (1) complete venous occlusion is associated with younger age and CVC infection. (2) The venous occlusion rate of 3 % is significantly lower than the published series of either open cutdown or the landmark technique.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.005
Cephalic vein cutdown for totally implantable central venous port in children: A retrospective analysis of prospectively collected data Jung KH, Moon SB. Can J Surg 2014; 5721-57:21
The goal of this study was to evaluate the feasibility of a totally implantable central cephalic vein port (TICVP) cutdown in children for whom percutaneous techniques are not practical and to improve the success rate of this procedure. The authors gave 143 children (90
boys, 53 girls) a TICVP between 2002–2006 inclusive who were followed until March 2007; the median age was 52 months. The indications for the port implantation were chemotherapy, long-term intravenous antibiotics and total parenteral nutrition. All patients had an attempted cephalic vein (CV) cutdown for which the authors defined an arbitrary cutoff point at 8 months of age and a body weight of 15 kg. Port-a-Cath (Jan 2002–2005) and Celiste (Jan 2006Dec 2006) were used and the median port duration was 568 days. All of the procedures were performed under general anesthesia. The incision started from the delto-pectoral triangle and ran for 4–5 cm medially, parallel to the inferior margin of the clavicle. The CV was located in the delto-pectoral groove. The single incision has a cosmetic advantage over the 2-incision approach that is usually required for the external jugular vein (EJV) or the internal jugular vein (IJV). The length of the catheter was determined so that the tip was located at the junction of the superior vena cava and right atrium and this was confirmed intra-operatively by chest x-ray. If the CV was absent or its caliber was too small for the catheter, an EJV cutdown was attempted; if the latter failed, an IJV cutdown was the final option. Of the 143 cases, CV accounted for 73 (51%), EJV 39 (27%) and LIV 31 (22%). The overall success rate for the CV cutdown was 61.9%. Intra-operative complication rates are consistently lower with surgical methods compared with the fluoroscopyguided percutaneous subclavian puncture by interventional radiologists. There were 8.2% postoperative complications, mostly infections. The most frequent cause of failure was small caliber CV; the success rate would be improved by avoiding the small caliber CV on the basis of the authors’ reference body weight of 15 kg.— Sigmund H. Ein http://dx.doi.org/10.1016/j.jpedsurg.2014.05.006
Thorax Treatment of thoracic trauma in children: Literature review, red cross war memorial children's hospital data analysis, and guidelines for management van As AB, Manganyi R, Brooks A. Eur J Pediatr Surg 2013; 6(23): 434-443 (December)
Thoracic injuries continue to be a leading cause of childhood trauma, despite the government's efforts to curb the scourge of this problem. The authors review focuses on the incidence, etiology, and management of thoracic trauma in the pediatric population with reference to the recent experience at the authors institution in a developing country. For the literature review, the National Library of Medicine's PubMed data-base was searched for the following terms: "pediatric," "chest trauma," "hemothorax," "hemopneumothorax," "pneumothorax," "diaphragmatic," "esophageal," and "mediastinal injury." For the hospital data analysis, data of all 378 pediatric patients treated with thoracic injuries under the age of 13 years from 2008 to 2012 (a 5-year period), at the Red Cross War Memorial Children's Hospital, were retrospectively analyzed. The male to female ratio was 2.1:1 (255 males and 123 females). The mean age was 6.9 ± 2.3 years. Blunt chest trauma was responsible for chest injuries in 90.5 %, while penetrating trauma caused 9.5 % of the injuries. Road traffic crashes were the mean cause (48.9 %) with pedestrian injuries in 72.4 % and passenger injuries in 27.6 %, respectively. Sports injuries were the cause in 4 % and falls from a height in 22 %. Most injuries occurred at home: inside one's own home (5 %), outside one's own home (52 %); inside someone else's home (44 %); outside someone
Abstracts / Journal of Pediatric Surgery 49 (2014) 1181–1185
were included. PCTs included in MA were only individually analyzed if they focused on additional endpoints. Endpoints of the study were advantages and disadvantages of laparoscopy compared with the open operation. A total of 20 manuscripts met the inclusion criteria (9 MA and 11 RCT). Studies providing evidence Level 1a were identified for five types of laparoscopic procedures (laparoscopic appendectomy, inguinal hernia repair, orchidopexy, pyloromyotomy, and varicocelectomy). Studies providing evidence Level 1b were identified for two types of laparoscopic procedures (fundoplication and pyeloplasty). The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy). Studies providing evidence Level 1 are only available for seven laparoscopic procedures in pediatric surgery. Effort has to be made to extend the existing Level 1 evidence and to gain high level evidence for further laparoscopic procedures.—Thomas A. Angerpointner http://dx.doi.org/10.1016/j.jpedsurg.2014.05.004
Patency of neck veins following ultrasound-guided percutaneous Hickman line insertion Wragg RC, Blundell S, Bader M. Pediatr Surg Int 2014; 30(3):301-304 (Mar) Venous occlusion following permanent central venous catheter (CVC) insertion by open cutdown or the landmark percutaneous technique has been reported between up to 25 %. However, there are no published data on the equivalent rate following ultrasoundguided percutaneous CVC insertion. The purpose of this study was to document the rate of venous occlusion associated with ultrasoundguided percutaneous CVC insertion in children. From 1 April 2010 to 1 December 2011, all children having elective or emergency removal of a Hickman line by the vascular access team had a Doppler ultrasound of their neck veins. Only Hickman lines inserted by the ultrasound-guided percutaneous route were included. Internal jugular, innominate and subclavian veins were scanned and recorded as patent, reduced or absent. One hundred consecutive children were identified and included. Median age was 6 years (range 21 days to 16 years). Indication for insertion was chemotherapy (60), parenteral nutrition (15), blood products (12), renal replacement (3) and other indications (10). Three children had absent flow at the time of line removal (median age 4 months, range 3–6 months), with 2 out of 3 requiring removal for infection. The venous occlusion rate following ultrasound-guided insertion of CVC was 3 %. The authors conclude that (1) complete venous occlusion is associated with younger age and CVC infection. (2) The venous occlusion rate of 3 % is significantly lower than the published series of either open cutdown or the landmark technique.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.005
Cephalic vein cutdown for totally implantable central venous port in children: A retrospective analysis of prospectively collected data Jung KH, Moon SB. Can J Surg 2014; 5721-57:21
The goal of this study was to evaluate the feasibility of a totally implantable central cephalic vein port (TICVP) cutdown in children for whom percutaneous techniques are not practical and to improve the success rate of this procedure. The authors gave 143 children (90
boys, 53 girls) a TICVP between 2002–2006 inclusive who were followed until March 2007; the median age was 52 months. The indications for the port implantation were chemotherapy, long-term intravenous antibiotics and total parenteral nutrition. All patients had an attempted cephalic vein (CV) cutdown for which the authors defined an arbitrary cutoff point at 8 months of age and a body weight of 15 kg. Port-a-Cath (Jan 2002–2005) and Celiste (Jan 2006Dec 2006) were used and the median port duration was 568 days. All of the procedures were performed under general anesthesia. The incision started from the delto-pectoral triangle and ran for 4–5 cm medially, parallel to the inferior margin of the clavicle. The CV was located in the delto-pectoral groove. The single incision has a cosmetic advantage over the 2-incision approach that is usually required for the external jugular vein (EJV) or the internal jugular vein (IJV). The length of the catheter was determined so that the tip was located at the junction of the superior vena cava and right atrium and this was confirmed intra-operatively by chest x-ray. If the CV was absent or its caliber was too small for the catheter, an EJV cutdown was attempted; if the latter failed, an IJV cutdown was the final option. Of the 143 cases, CV accounted for 73 (51%), EJV 39 (27%) and LIV 31 (22%). The overall success rate for the CV cutdown was 61.9%. Intra-operative complication rates are consistently lower with surgical methods compared with the fluoroscopyguided percutaneous subclavian puncture by interventional radiologists. There were 8.2% postoperative complications, mostly infections. The most frequent cause of failure was small caliber CV; the success rate would be improved by avoiding the small caliber CV on the basis of the authors’ reference body weight of 15 kg.— Sigmund H. Ein http://dx.doi.org/10.1016/j.jpedsurg.2014.05.006
Thorax Treatment of thoracic trauma in children: Literature review, red cross war memorial children's hospital data analysis, and guidelines for management van As AB, Manganyi R, Brooks A. Eur J Pediatr Surg 2013; 6(23): 434-443 (December)
Thoracic injuries continue to be a leading cause of childhood trauma, despite the government's efforts to curb the scourge of this problem. The authors review focuses on the incidence, etiology, and management of thoracic trauma in the pediatric population with reference to the recent experience at the authors institution in a developing country. For the literature review, the National Library of Medicine's PubMed data-base was searched for the following terms: "pediatric," "chest trauma," "hemothorax," "hemopneumothorax," "pneumothorax," "diaphragmatic," "esophageal," and "mediastinal injury." For the hospital data analysis, data of all 378 pediatric patients treated with thoracic injuries under the age of 13 years from 2008 to 2012 (a 5-year period), at the Red Cross War Memorial Children's Hospital, were retrospectively analyzed. The male to female ratio was 2.1:1 (255 males and 123 females). The mean age was 6.9 ± 2.3 years. Blunt chest trauma was responsible for chest injuries in 90.5 %, while penetrating trauma caused 9.5 % of the injuries. Road traffic crashes were the mean cause (48.9 %) with pedestrian injuries in 72.4 % and passenger injuries in 27.6 %, respectively. Sports injuries were the cause in 4 % and falls from a height in 22 %. Most injuries occurred at home: inside one's own home (5 %), outside one's own home (52 %); inside someone else's home (44 %); outside someone