bluuebunny/crossref_metadata_2025 huggingface dataset:
DOZ047.111: Acute kidney injury in esophageal atresia
Authors: Massolo A C , Conforti A , Landolfo F , Columbo C , Monaco F , Giliberti P , Valfré L , Romiti A , Caoci S , Dotta A , Braguglia A , Bagolan P
Published: June 2019

Background

Oesophageal atresia (OA) is characterized by a significant morbidity during the neonatal period. Affected infants are exposed to multiple potentially nephrotoxic factors, predisposing them to acute kidney injury (AKI), which is associated with poorer outcomes. Children who survive neonatal AKI are at risk of long-lasting renal complications (including chronic kidney disease and hypertension).

Aims

The purpose of this study is to investigate AKI prevalence in infants with OA and identify potential contributing factors.

Methods

Retrospective analysis was conducted on clinical records of patients with OA between 2017 and 2018 in a single referral centre. AKI severity was defined according to established international pRIFLE criteria (Risk of renal dysfunction, kidney Injury, Failure or Loss of kidney function and End-stage renal disease) based on change in serum creatinine and urine output during hospitalization collected 5 days after birth. Risk factors, (including potentially nephrotoxic medications, significant infection, urine output, blood pressure), and outcome data (length of hospitalization, duration of intubation) were recorded. Statistical analysis was performed using Graphpad.

Results

Thirty-nine OA cases were identified; 6 were excluded for lack of data and 33 were included in the study group. Eighteen (55%), who developed AKI (pRIFLE category Risk or Injury), were compared with 15 patients (45%) with no AKI. AKI was significantly higher in infants with long-gap OA (P = 0.02), significantly associated with vancomycin administration (P = 0.03), with the use of three or more antibiotics during hospitalization (P = 0.0005), and with postoperative muscle paralysis (P = 0.001). Infants with OA and AKI experienced longer mechanical ventilation (P = 0.004) and hospital stay (P = 0.003). No significant association was found with hypotension, or steroid exposure. Incomplete recording of urine output prevented stratification of AKI based on this parameter.

Conclusions

OA, particularly more severe cases, are at risk of AKI. Renal function should be routinely assessed, during hospitalization and follow-up. Focusing on prevention and avoiding prolonged courses of nephrotoxic medications may improve outcome.
DOZ047.114: Fundoplications in patients born with esophageal atresia: preoperative workup and evaluation of postoperative symptoms
Authors: van Lennep M , Krishnan U , Saoji R , van Wijk M P
Published: June 2019

Background

The consensus esophageal atresia (EA) guideline recommends performing contrast esophagogram, esophagogastroduodenoscopy with biopsies and pH(+ /-impedance) measurement prior to fundoplication to assess upper gastrointestinal anatomy, severity of gastroesophageal reflux disease (GERD), and exclude eosinophilic esophagitis (EoE).(Krishnan et al. JPGN 2016) Our aim was to evaluate which of these investigations were performed prior to fundoplication and which in case of postoperative symptoms.

Methods

In this multicenter international retrospective cohort study, all EA patients who underwent fundoplication between 2006 and 2017 were included.

Results

Forty EA patients (52% male, median age 2.3 years [0.08–17 years], 82.5% type C) were included in three centers worldwide; 32(80%) underwent complete and 8 (20%) partial fundoplication. Preoperative investigations included contrast esophagogram (n = 35, 88%), esophagogastroduodenoscopy (n = 33, 83%), and pH(+/-impedance) measurement (n = 11, 28%). Only six patients (15%) underwent all three recommended preoperative investigations. Esophagogastroduodenoscopy prefundoplication revealed abnormalities in 33%, including esophageal strictures in 18%, EoE in 6%, hiatal hernia in 6%, and intestinal metaplasia in 3%. Patients with EoE underwent partial fundoplication; no associations between diagnostic testing outcomes and type of fundoplication were found. Nearly all patients had symptoms postfundoplication (n = 34, 85%). Symptoms included dysphagia (53%), gagging (33%), oral food aversion (23%), bloating (8%), and/or dumping (3%). Recurrent GERD symptoms were present in 34 patients (85%). Twenty-one patients (53%) had pH(+/-impedance) tests performed, which were abnormal in 14 patients (67%). Thirty-five patients (88%) also had EGD performed, which showed abnormalities in 5 patients (13%), of which 3 patients (8%) had strictures on EGD. One of these patients with postoperative strictures had EoE (3%). Abnormalities of 2 other patients on EGD were not further specified.

Conclusion

Preoperative diagnostic workup for fundoplication in EA patients varies greatly. Although the majority of patients had some preoperative evaluation, only 15% underwent all gastrointestinal diagnostic tests that are currently advocated by the consensus EA guidelines.

Postoperatively, most patients (85%) had symptoms for which testing was indicated. A large percentage still had evidence of GERD. More research is needed to tailor (surgical) management of GERD in EA patients, develop a postoperative testing paradigm, and evaluate the efficacy and safety of fundoplication in this specific patient group.
DOZ047.12: A comparative analysis of concerns of caregivers with repaired esophageal Atresia-Tracheoesophageal fistula
Authors: Arslan S S , Türer Ö B , Demir N , Karaduman A , Tanyel F C , Soyer T
Published: June 2019

Aim

Children with esophageal atresia and tracheoesophageal fistula (EA-TEF) may experience feeding and swallowing difficulties, which result in stressful interactions between children and caregivers, and potentially impact the concerns of caregivers. The aim of this study was to assess concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties and compare the concerns according to type of atresia, repair time and time to start oral feeding.

Methods

Caregivers accompanying 24 children with EA-TEF were included. Age, sex, type of atresia, repair time, and time to start oral feeding of children were noted. Parents completed the Feeding/Swallowing Impact Survey (FS-IS) to assess the concerns of caregivers related to feeding–swallowing difficulties. It has three subscales, including daily activities, worry, and feeding difficulties. Average scores range between 1 and 5, of which increasing scores reflect more caregiver concern.

Results

The mean age was 3.41 ± 2.71 years, of which 66.7% were male. 56.3% of cases were isolated EA, and 43.8% were EA–distal TEF. 60.9% of cases received early repair (<1 month of age), and 39.1% had delayed repair (between 1 and 12 months). The median time to start oral feeding was 4 weeks (min = 2, max = 128). The mean scores of daily activities, worry, feeding difficulties, and the total score were 2.40 ± 1.01, 2.79 ± 1.06, 2.14 ± 0.95, and 2.49 ± 0.88, respectively. Caregivers of children with isolated EA reported more problems with ‘daily activities’, ‘feeding difficulties’, and ‘total score’ than EA–distal TEF (P < 0.05). Caregivers of children who received delayed repair reported more problems with the ‘daily activities’ subscale and ‘total score’ than children with early repair (P < 0.05). Moderate to strong correlations were found between the ‘daily activities’ and ‘feeding difficulties’ subscales of FS-IS and time to start oral feeding (P < 0.05, r = 0.56–0.69).

Conclusions

This study suggests that concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties are associated with the surgical outcome of EA. Caregivers of children with isolated-EA and/or delayed repair and/or delay in oral intake may have higher concerns related to feeding–swallowing difficulties.
DOZ047.123: Choose typology: oral communication multiple congenital bronchogenic cysts and thyroglossal duct remnant, case report
Authors: Attya H , Gupta S L
Published: June 2019

Background

Thyroglossal duct remnants, most frequently presenting as cysts, are the most common congenital anomalies of the neck. Bronchogenic cysts are rare congenital anomalies of the primitive foregut and are a subtype of foregut supplication cysts. Those cysts are the most common cystic lesions of the mediastinum. They can present in other areas such as the neck. Such cystic lesions are usually seen in pediatric population and symptomology depends on the location, size and degree of compression to the surrounding structures. The synchronous presence of both lesions in one patient is rare. To the best of our knowledge, such presentation has not been reported in the literature. We present a case of multiple lesions in the neck and mediastinum including precricoid, paraglotttic and paratracheal regions.

Case Presentation

A full-term male newborn presented in day 1 post normal vaginal delivery with progressive stridor and decreased feeding. Urgent airway endoscopy revealed a left supraglottic cyst and proximal non pulsatile tracheal wall compression by another cystic lesion. Aspiration of the supraglottic cyst was done and one month later, he developed stridor again for which he had endoscopic marsupialization of right supraglottic cyst and internal aspiration of paratracheal cyst. MRI showed right paratracheal cystic lesion with evidence of a tubular tract and an infected cyst inferiorly. Decision was made to explore the neck for definite removal of the cysts. Three lesions were identified: a precricoid mass, and paraglottic and paratracheal cysts. Cervical lesions were carefully dissected and excised. For the paratracheal cyst which extended to the mediastinum, incision and drainage was done and part of cyst wall was excised, and a drain inserted into the cyst. Histopathology confirmed the precrcoid lesion to be a thyroglossal duct remnant, the paraglottic cyst in keeping with bronchogenic cyst and the paratracheal cyst wall showed granulation tissue.

Discussion

The fact that the embryological basis for development of thyroglossal duct cyst and bronchogenic cyst is different makes diagnosis of both lesions is challenging and such presentation is unique. Definite diagnosis depends on accurate history, imaging particularly MRI and histopathology. Surgery is the treatment of choice for symptomatic cases.
DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?
Authors: Rasiewicz M , Świątek K , Gerus S , Patkowski D
Published: June 2019

Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge.

The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis.

We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies.

Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group.

Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.
DOZ047.15: Esophageal anastomosis diameter at initial endoscopy after surgery predicts treatment outcomes in patients with esophageal atresia or stricture
Authors: Clark S J , Ngo P D , Staffa S J , Smithers C J , Hamilton T E , Jennings R , Manfredi M A
Published: June 2019

Background

Children with esophageal atresia (EA) are at risk for anastomotic stricture that may ultimately need surgical resection. No studies have examined the relationship between anastomotic diameter at the time of initial postop endoscopy and treatment outcomes.

Methods

A retrospective chart review was performed of patients with EA who underwent a Foker procedure for repair of long-gap esophageal atresia (LGEA), primary repair of EA, or stricture resection for refractory stricture who were seen between January 2016 and May 2018. A refractory stricture was defined as one requiring ≥5 dilations ≤5 months after surgery. The anastomosis diameter was estimated by the endoscopist. We divided diameter sizes into the following groups: 1–2.9 mm, 3–4.9 mm, 5–6.9 mm, 7–8.9 mm, 9–10.9 mm, and 11–14 mm. The Wilcoxon rank sum test and Fisher's exact test were used.

Results

Forty-five patients who had a Foker procedure, 37 who had primary repair, and 58 who had stricture resection were identified. The first EGD occurred a median of 22 days (IQR 21–28) after surgery. Among all EA patients with initial diameter of <3 mm, 82% developed refractory stricture and 41% required stricture resection. Of all patients with initial diameter <5 mm, 74% developed refractory stricture and 33% required stricture resection. Of patients who underwent a Foker procedure with initial diameter <3 mm, 56% required stricture resection; of these patients with initial diameter <5 mm, 53% required stricture resection. Among all EA patients, refractory strictures were significantly more likely in patients with smaller initial diameters (P < 0.001), from 18 patients (82%) with stricture 1–2 mm to 0 patients (0%) with stricture 11–14 mm. Patients with smaller anastomoses were more likely to need stricture resection (P = 0.020); 9 patients (41%) with size 1–2 mm underwent stricture resection, while none (0%) with size 11–14 mm needed stricture resection. These differences remained statistically significant for patients who underwent a Foker procedure (P ≤ 0.001 for stricture resection and refractory stricture).

Conclusion

Endoscopy performed shortly after EA repair or stricture resection can help predict which patients are more likely to develop a refractory stricture or require a stricture resection.
DOZ047.26: Longitudinal motor development from infancy to adolescence in children with esophageal atresia
Authors: Møinichen U I , Mikkelsen A , Faugli A , Holm I , Jsselstijn H I , Emblem R
Published: June 2019

Introduction

Motor performance may be affected in children with esophageal atresia (EA), but the development of motor performance from infancy to adolescence has not been properly studied. We have followed EA patients from one to 15 years of age and assessed development of motor performance.

Methods

Of 44 EA patients, born 1999–2002, 3 died, 6 with missing data, 4 excluded, and 10 refused to participate. Of 21 children were included. Perinatal data collected from medical records, and physical therapy was registered. The children were evaluated with The Bayley Scale of Infant Development-Second Edition at one year of age, and re-evaluated in adolescence with The Motor Assessment Battery for Children Second Edition. Both tests are well validated for fine and gross motor performance. The motor performances was categorized as normal, at risk or delayed at both evaluations.

Results

Of 21 EA children (GA 38.7, range: 34–40.7), 4 (19%) were premature, 18 (86%) had Gross type C, major cardiac anomaly in 1, VACTERL in 4 (19%).

At 15.1 months, 19/21 (90%) had motor performance within normal range, 1 child had delayed motor performance, and 1 child at risk for motor delay.

At 15 years 15/21 (71%) had motor performance within normal range, 3/21 (14%) children showed delayed motor performance and 3/21 (14%) at risk for motor delay. 5/21 (24%) EA patients had deteriorated and 1/21 (5%) remained delayed in motor performance, when grown up from 1 to 15 years of age. The gross motor function most often affected in adolescence was the balance skills.

Impaired motor performance was correlated to prematurity (r = .499, P = .021), but not to other perinatal morbidity factors.

The EA patients had not been offered systematic follow-up physical therapy program during childhood.

Conclusion

Motor performance was within normal range in 90% of the EA infants, but in adolescence, only 71% of the patients showed normal motor performance. However, at one year of age it is hard to distinguish the children who have mild motor delay. Close monitoring in childhood might help to diagnose them earlier and offer appropriate intervention.
DOZ047.28: Clinical utility of cardiopulmonary exercise testing in children with esophageal atresia
Authors: Belessis Y , McBride J , Plush L , Purcell M , Field P
Published: June 2019

Background

Respiratory morbidity in children with esophageal atresia/tracheoesophageal fistula (OA/TOF), due to impaired mucociliary clearance, recurrent infections, and aspiration, may impair pulmonary function during childhood and this may persist into adult life. Early recognition of reduced lung function could optimize respiratory management and improve long-term outcomes. However, static lung function assessments, using spirometry and body plethysmography, may not sensitively identify impaired lung function. Cardiopulmonary exercise testing (CPET), which involves a dynamic assessment of respiratory function and determines aerobic capacity, degree of fitness, and ventilatory (breathing) reserve during maximal exertion, may detect poor lung function earlier.

Aim

This study determines the clinical utility of cardiopulmonary exercise testing in children with OA/TOF.

Methods

Retrospective chart review of children attending a multidisciplinary OA/TOF clinic who underwent spirometry, plethysmography, and a maximal CPET (Bruce Treadmill Protocol). Plethysmography and CPET were performed on the same day in 16 children; 4 children within 2 days and 6 within 2 months. Studies exceeding 2 months were not analyzed (n = 2).

Results

Thirty-nine children, aged ≥ 7 years, underwent CPET when clinically well. Thirty-two children, 7–18 years, achieved a maximal CPET (82.1%). There was no significant exercise-induced drop in PPFEV1 in any child. One child experienced a reduction in oxygen saturation to 92%. Exercise capacity (VO2MAX, peak oxygen consumption) was normal in 30 children (93.8%). However reduced ventilatory or breathing reserve (BR), defined as <20% predicted, was identified in 18 children (56.3%). Four of these children had no ventilatory reserve (BR = 0). In contrast, spirometry was normal in 20 children (62.5%). Nine (28%) had a mild obstructive or restrictive pattern. One child had moderate restriction and 2 had a mixed pattern. Plethysmography (n = 26) revealed mild restrictive lung disease in 9 (34.6%). An additional 3 children had air-trapping.

Conclusion

Children with OA/TOF have significant lung function impairment. Spirometry and plethysmography revealed normal or mildly abnormal airway function/lung volumes in the majority of children. CPET identified significant ventilation limitation in over half of all children. CPET assessment is a feasible and sensitive assessment of cardiorespiratory function in children with OA/TOF. Further evaluation of risk factors and longitudinal CPET assessments may inform future management guidelines.
DOZ047.38: 10-years of experience with thoracoscopic approach for congenital H-type tracheoesophageal fistulas
Authors: Dzielendziak A , Toczewski K , Śmigiel R , Patkowski D
Published: June 2019

Introduction

Isolated H-type tracheoesophageal fistula has been distinguished in the group of congenital anomalies of the trachea and esophagus. It is a rare defect that causes diagnostic difficulties even for experienced clinicians.

Material and Methods

A retrospective analysis of the medical history of patients, who were operated in the Department of Pediatric Surgery and Urology in Wroclaw between 2009 and 2018 due to H-type tracheoesophageal fistula, was performed.

Results

The study group consists of 7 patients (4 boys and 3 girls). The diagnosis was made postnatally between 1 day of life and 4 months of age. The spectrum of symptoms was broad and varied from saturation disturbances to difficulties in food intake and recurrent pneumonia. In all patients, a contrast study was performed (the result of which was not always unambiguous).

After diagnosis of the H-type fistula in bronchoscopy, the thoracoscopy was performed. All procedures were performed using 5 mm scope and 3 mm instruments. The pressure used during procedures was between 3 and 6 mmHg. All patients underwent right-sided thoracoscopy. To help with fistula identification in 3 patients, an urethral catheter was left in the fistula during the bronchoscopy. The size and appearance of fistulas were variable. Clips or sutures were used to close the fistulas. After surgery, the nasogastric tube was left in the esophagus for 7 days. After a control contrast study, the tube was removed and the full oral feeding was started. In 6 patients, the primary procedure turned out to be the final and no complications were observed in the postoperative course. In one patient in the postoperative course, the chylothorax was observed, the treatment of which required a rethoracoscopy with successful local tissue electrocoagulation.

Conclusions

The congenital isolated tracheoesphageal fistula is a rare disorder. It causes unspecific clinical symptoms, therefore the diagnosis is often difficult. The thoracoscopic access in the hands of skilled surgeon is a safe method and should be the treatment of choice.
DOZ047.49: Tracheoscopic findings and their impact on respiratory symptoms in children with esophageal atresia
Authors: Janina F , Josef H , Grigore C , Martin D
Published: June 2019

Introduction

Esophageal atresia is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis and occasionally to life threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms.

Methods

In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations and corresponding clinical symptoms were retrospectively analyzed.

Results

The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B, C, D) compared to patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. Presence of respiratory symptoms like cough, stridor or bronchitis was not associated with a higher grade of tracheal collapse compared to patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in non-symptomatic patients).

Conclusion

Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of > 80%, a ventral pulsation and obstructive apnea or cyanosis in combination, are at risk for life threatening situations.
DOZ047.59: Development of operational tactics for esophageal atresia in the Republic of Tatarstan (Russia)
Authors: Podshivalin A , Sageeva G , Lvov A
Published: June 2019

The Children's Republican Hospital of Kazan was opened in 1977 with the participation of prof. Rokytskyi, with rapid thoracic surgery development. In atresia of the esophagus, right-sided median thoracotomy, ligation of the tracheoesophageal fistula, Hayat esophagoplasty were performed. The duration of the operation was 2–3-4 h. With the installation of a pleural drainage for 2–3 weeks and a nasogastric tube for 1 month. When radical surgery was impossible, the upper and lower esophagostomas were applied, followed by coloesophagoplasty in 2–3 years. In 2003, the reconstruction and renovation of the surgical and resuscitation departments for neonates began. A new neonatal surgery team had been formed, studying in Ospedale Giannina Gaslini, Genova, Italy and St. Petersburg, Russia. As a result we introduced a single-row suture into the neonatal surgery for esophagoplasty. The duration of drainage was 7–10 days, the duration of the nasogastric tube was 2 weeks. The duration of hospital stay was reduced to 1–1.5 months. Another, ‘stormy’ development of neonatal surgery has undergone in 2013. The accumulated experience in the open surgery of the esophagus allowed us to begin to perform thoracoscopic esophagoplasty. Starting from 2013, more than 20 patients are operated annually with esophageal atresia of various forms. Mortality of about 3% in 5 years. We perform thoracoscopy, ligation and resection of tracheoesophageal fistula, end-to-end esophagoplasty with various diastasis. Esophageal anastomosis nodular extracarporal single row. The minimum weight of a patient with thoracoscopic esophagoplasty is 1200 g. The term draining of the pleural cavity is 3–5 days. A complicated group of patients consists of newborns with Long Gap. The final choice of surgical tactics is not yet decided. The primary and obligatory operation that is performed in LG is gastrostomy to feed the patient, with previous thoracoscopy and resection of the tracheoesophageal fistula with type 3 esophageal atresia. At the age of 2 weeks, gastroscopy and gastrography are performed in order to determine the diastasis between the esophagus. In conclusion, it is necessary to say the following. We consider thoracoscopic access for esophageal pathology as optimal, providing the patient with weighs more than 1200 g and without no concomitant pathology.
DOZ047.64: Sham feeding promotes oral feeding success in long-gap esophageal atresia, even with traction sutures in situ
Authors: Hawley A D , Armstrong R K , Brooks J-A E , Pellicano A , Nightingale M G , Crameri J , Teague W J
Published: June 2019

Introduction

Sham feeding (SF) and staged repair using traction suture techniques (TST) were both introduced to the management of long-gap esophageal atresia (LGOA) at The Royal Children's Hospital, Melbourne (RCH) in January 2012. Previous studies report SF to reduce time to full oral feeding (FOF) postdefinitive repair. In our practice, SF is individually tailored, supervised, and involves offering 2–4 feeds daily. This single-center experience describes SF in newborns with LGOA, including those with staged TST prior to definitive repair, and the impact of SF on time to FOF.

Methods

Patients admitted 2000–2018 with LGOA were identified from the Nate Myers Oesophageal Atresia Database, RCH. Those with incomplete data or complications preventing oral feeds were excluded. Patients were grouped into two epochs: Group 1 (2000–2011, no SF, no TST) and Group 2 (2012–2018, all offered SF, some TST). Demographics and time to FOF were compared between groups. Parametric data (mean, SD) were analyzed with two sample t-test, and nonparametric data (median, IQR) with Mann–Whitney test; P < 0.05 significant. Ethics approval was obtained (HREC#QA/51247/RCHM-2019).

Results

Of 37 LGOA patients, six met exclusion criteria leaving 31 for analysis; Group 1, n = 13; Group 2, n = 18. Groups did not differ in gestation (P = 0.63), birth weight (P = 0.91) or time to definitive repair (P = 0.85). In Group 2, 12/18 had successful SF, including 9 who underwent TST. Three additional patients with TST were unsuccessful with SF. Compared with Group 1, FOF was significantly reduced in those 12 patients with successful SF (median FOF 730 days, IQR 125–1100 vs. median FOF 75 days IQR 56–227; P = 0.03). Small sample size precluded meaningful subgroup analyses of successful versus unsuccessful SF patients. Importantly, no patient aspirated during SF, though one developed oral aversion post-TST and one ceased SF at parental request.

Conclusions

In LGOA, successful SF improves time to FOF postdefinitive repair, and was not associated with aspiration in our experience. Further, we report success with SF in patients undergoing staged repair with TST, including following traction suture placement. To our knowledge, this is the first report of SF in LGOA patients during the period between traction suture placement and definitive repair.
DOZ047.74: Long-term outcome of preserving the native esophagus in long-gap esophageal atresia by thoracoscopic traction technique
Authors: Tytgat S H A J , van Tuyll van Serooskerken E S , van der Zee D C , Verweij J W , Lindeboom M Y A
Published: June 2019

Background

Long-gap esophageal atresia (LGEA) is defined as atresia without distal tracheoesophageal fistula. Preserving the native esophagus is considered superior over intestinal interposition. Thoracoscopic traction technique facilitates lengthening of the esophageal ends, and allows anastomosis within the first weeks of life. The aim of this study was to evaluate the long-term outcome of LGEA patients treated by thoracoscopic traction technique.

Methods

From 2007 to 2018, 13 consecutive patients with LGEA were treated by thoracoscopic traction technique. During the first operation a bronchoscopy was performed to evaluate the presence of a proximal fistula. Then thoracoscopic traction sutures were placed at both esophageal ends. Initially a gastrostomy was performed. However, nowadays only a gastropexy is performed to prevent the stomach from migrating into the thorax. Approximation of the esophageal ends was evaluated by postoperative X-rays. Thoracoscopic adhesiolysis was performed when necessary. Both ends were anastomosed during the final surgical procedure, usually within a week.

Results

In 11 patients the anastomosis could be completed by thoracoscopic traction technique. In two patients the elongation procedure failed. In the first patient the sutures tore out. The second patient had an accidental perforation of the proximal pouch by the Replogle tube. Median time on ventilation until after the final anastomosis was 14 days (range 4–34 days). Five patients required chest tube drainage for anastomotic leakage. The median hospitalization time during the first admission was 47 days (range 31–170 days). All patients needed a median of 4 (range 1–16) dilatations for anastomotic stenosis. Ten patients needed a fundoplication within a median time of 8 weeks (range 2–16 weeks) after the esophageal anastomosis. One patient developed an esophago-bronchial fistula. Median weight at age of 2 years was −1.88 SD (range −3.54 – −0.16) and at age of 4 years −1.53 SD (range −2.94–0.66). All patients tolerated full oral feeding.

Conclusion

LGEA can be treated successfully after elongation by thoracoscopic traction technique. The procedure leads to an earlier anastomosis and shorter initial hospital stay as compared to delayed primary anastomosis. Full oral feeding is possible in all patients. Dilatation for anastomotic strictures and antireflux surgery is necessary in (almost) all patients.
DOZ047.75: Ectopic pancreas in children with esophageal atresia: not an incidental association
Authors: García L , Giné C , Laín A , Barila P , López M
Published: June 2019

Aim of the Study

Ectopic pancreas (EP) is pancreatic tissue lacking vascular or anatomic connection with the main body of the pancreas. Incidence in the general population ranges between 0.15% and 5.2%, and it is most commonly located in the stomach. It is usually asymptomatic, but it can lead to intestinal occlusion, bleeding, or malignant degeneration. After a patient with esophageal atresia (EA) debuted with a symptomatic EP, we aimed to determine EP incidence in our series of EA patients.

Method

Prospective single center review (2016–2018) was performed of children with upper gastrointestinal diseases who underwent diagnostic or therapeutic esophagogastroduodenoscopy (EGD). Patients were divided according to main diagnosis and gastric EP was actively searched for in every case.

Results

EGD was performed in 192 patients and the main diagnoses were EA in 53 (27.60%), eosinophilic esophagitis in 37 (19.27%), celiac disease in 23 (11.97%), and other upper gastrointestinal disorders in 79 (41.14%). EP was found in 7 cases (4 ♂/3 ♀), all of them in the EA group (7/53, 13.2%). Out of the 7, 4 had type III EA and in every case the EP was found at a prepyloric location. One patient debuted with hematemesis, so surgical excision was performed. Since the remaining 6 are asymptomatic, conservative treatment has been proposed. PE was not found in any of the other groups (P < 0.05).

Conclusion

In this series, the incidence of EP in children with EA was higher (13.2%) than the one found in other groups (0%) or in the general population (0.15%–5.2%). These findings suggest that there is an association between EP and EA. Ectopic pancreas should be ruled out in every patient with esophageal atresia due to its potential morbidity, and when found, long-term follow-up is advisable.
DOZ047.86: Open tracheostomy vs percutaneous tracheostomy in pediatrics
Authors: Urquizo M , Lobos P , Coraglia C , Mercado P , Gallegos D F
Published: June 2019

Introduction

Tracheostomy is one of the most frequent surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. The most widely used technique is open; however, the percutaneous technique guided by endoscopy is becoming increasingly common. Due to the current controversy, this study presents our experience in both techniques.

Methodology

Retrospective and descriptive analysis was carried out of 100 patients selected between 2010 and 2017. They were divided into two groups: open tracheostomy (TA) and percutaneous tracheostomy (PT), with 50 patients each according to the technique used. The age, diagnosis, indication of tracheostomy, days of intubation, endoscopic findings, cannula size, surgical time, intraoperative complications, and definitive decannulation were analyzed. A bibliographic review was also carried out.

Results and Discussion

The main indication for tracheostomy in both groups was prolonged orotracheal intubation (TA group 78% and TP group 82%). Children who underwent percutaneous tracheostomy were older in age (median age of 9 years for TA group and 2.5 years for PT group). There were no significant differences regarding the days of previous intubation: 19 days for the TA group and 13 days for the TP group. Weaning was achieved before mechanical ventilation for the TP group (7 days in the TP group and 19 days in the TA group). The surgical time was almost 50% less for the TP group (TA group 80 minutes and TP group 45 minutes). There were no intraoperative complications in any group. Distant complications were more frequent in the TA group (34%). Definitive decannulation was achieved in 17 patients in the TA group (34%) and in 19 patients in the TP group (38%). The long-term follow-up was performed for 8 months by the TA group (r: 1–36 m) and 9 months by the TP group (r: 1–48 m).

Conclusions

Percutaneous tracheostomy is feasible in children. Simultaneous endoscopic vision is recommended for the control of complications during the procedure. At the same time it allows us to diagnose preexisting injuries. The size of the tracheostomy kit should be adjusted to the age of the patient and the size of the tracheostomy cannula to perform a safe tracheostomy.
DOZ047.88: Esophageal atresia: a scientometric analysis of the global research architecture and collaborative networks
Authors: Friedmacher F , O’Connor B R
Published: June 2019

Background

Esophageal atresia (EA) and tracheoesophageal fistula (TEF) represent a spectrum of relatively rare and complex malformations, which remain a major therapeutic challenge for most involved specialists. Whereas the number of EA/TEF-related publications is constantly growing, no thorough assessment of the global research architecture has been performed yet. Hence, this study aimed to critically evaluate the scientific EA/TEF activities in relation to geographical developments and existing research networks using a combination of scientometric methodologies and visualization tools.

Methods

A comprehensive search strategy for the Web of Science™ database was designed to retrieve bibliographic data on scientific EA/TEF publications for the time span between January 1900 and December 2018. The total reseach output of countries, institutions, individual authors, and collaborative networks was analzyed. Semiqualitative research measures, including citation rate and h-index, were assessed. Choropleth mapping and network diagrams were employed to visualize results.

Results

A total of 4586 publications on EA/TEF were identified, originating from 86 countries (79.0% written in English). The largest number was published by the USA (n = 799; 17.4%), the UK (n = 260; 5.7%), and Canada (n = 190; 4.1%). The USA produced the highest number of co-operative articles (n = 73) and the most productive collaborative networks were established between USA/Canada (n = 22), USA/Netherlands (n = 19), and USA/Germany (n = 13). Scientific papers from the UK received the highest average citation rate, with 17.6 citations per item, whereas the USA, with 47, had the highest country-specific h-index. Eighty-two articles were published under the auspices of multicenter research consortiums and national study groups. The most productive institutions and authors were based in the UK, the USA, France, Canada, Australia, the Netherlands, Finland, and Spain.

Conclusions

This is the first in-depth analysis of the worldwide EA/TEF research activity, offering unique insights into the global scientific landscape in this field. Over the past decades, EA/TEF research has increasingly become multidisciplinary but the main research endeavors continue to be concentrated in a few high-income countries. International EA/TEF collaborations and translational research should be strengthened to foster true scientific progress with this rare condition.
A New Sequence Type of Neisseria meningitidis Serogroup C Associated With a 2016 Meningitis Outbreak in Mali
Authors: Sanogo Yibayiri Osee , Guindo Ibréhima , Diarra Seydou , Retchless Adam C , Abdou Mahamadou , Coulibaly Souleymane , Maiga Mahamadou Farka , Coumaré Mama , Diarra Bakary , Chen Alexander , Chang How-Yi , Vuong Jeni T , Acosta Anna M , Sow Samba , Novak Ryan T , Wang Xin
Published: June 2019

In 2016, Mali reported a bacterial meningitis outbreak consisting of 39 suspected cases between epidemiologic weeks 9 and 17 with 15% case fatality ratio in the health district of Ouéléssebougou, 80 kilometers from the capital Bamako. Cerebrospinal fluid specimens from 29 cases were tested by culture and real-time polymerase chain reaction; 22 (76%) were positive for bacterial meningitis pathogens, 16 (73%) of which were Neisseria meningitidis (Nm). Of the Nm-positive specimens, 14 (88%) were N meningitidis serogroup C (NmC), 1 was NmW, and 1 was nongroupable. Eight NmC isolates recovered by culture from the outbreak were characterized using whole genome sequencing. Genomics analysis revealed that all 8 isolates belonged to a new sequence type (ST) 12446 of clonal complex 10217 that formed a distinct clade genetically similar to ST-10217, a NmC strain that recently caused large epidemics of meningitis in Niger and Nigeria. The emergence of a new ST of NmC associated with an outbreak in the African meningitis belt further highlights the need for continued molecular surveillance in the region.
Assessment of Effectiveness of Seasonal Influenza Vaccination During Pregnancy in Preventing Influenza Infection in Infants in England, 2013–2014 and 2014–2015
Authors: Walker Jemma L , Zhao Hongxin , Dabrera Gavin , Andrews Nick , Thomas Sarah L , Tsang Camille , Ellis Joanna , Donati Matthew , Pebody Richard G
Published: June 2019

Maternal influenza vaccination is increasingly recognized to protect infants from influenza infection in their first 6 months. We used the screening method to estimate vaccine effectiveness (VE) against laboratory-confirmed influenza in infants in England, using newly available uptake data from the Clinical Practice Research Datalink pregnancy register, matched on week of birth and region and adjusted for ethnicity. We found VE of 66% (95% confidence interval [CI], 18%–84%) in the 2013–2014 season and 50% (95% CI, 11%–72%) in 2014–2015, with similar VE against influenza-related hospitalization. VE against the dominant circulating influenza strain was higher, at 78% (95% CI, 16%–94%) against H1N1 in 2013–2014, and 60% (95% CI, 16%–81%) against H3N2 in 2014–2015.
Two Kinds of High-Level Probability
Authors: Hemmo Meir , Shenker Orly
Published: June 2019

According to influential views the probabilities in classical statistical mechanics and other special sciences are objective chances, although the underlying mechanical theory is deterministic, since the deterministic low level is inadmissible or unavailable from the high level. Here two intuitions pull in opposite directions: One intuition is that if the world is deterministic, probability can only express subjective ignorance. The other intuition is that probability of high-level phenomena, especially thermodynamic ones, is dictated by the state of affairs in the world. We argue in support of this second intuition and we show that in fact there are two different ways in which high-level probability describes matters of fact, even if the underlying microscopic reality is deterministic. Our analysis is novel, but supports approaches by, e.g., Loewer, Albert, Frigg and Hoefer, List and Pivato. In particular, the reductive view we propose here can be seen as a naturalization of the above approaches. We consider consequences of our result for nonreductive physicalist approaches, such as functionalism, that admit multiple realization of the kinds that appear in the special sciences by physical kinds. We show that nonreductive physicalism implies the existence of nonphysical matters of fact.
The Role of Fecal Microbiota Transplantation in Reducing Intestinal Colonization With Antibiotic-Resistant Organisms: The Current Landscape and Future Directions
Authors: Woodworth Michael H , Hayden Mary K , Young Vincent B , Kwon Jennie H
Published: June 2019

The intestinal tract is a recognized reservoir of antibiotic-resistant organisms (ARO), and a potential target for strategies to reduce ARO colonization. Microbiome therapies such as fecal microbiota transplantation (FMT) have been established as an effective treatment for recurrent Clostridioides difficile infection and may be an effective approach for reducing intestinal ARO colonization. In this article, we review the current published literature on the role of FMT for eradication of intestinal ARO colonization, review the potential benefit and limitations of the use of FMT in this setting, and outline a research agenda for the future study of FMT for intestinal ARO colonization.
Percutaneous Endoscopic Contralateral Lumbar Foraminal Decompression via an Interlaminar Approach: 2-Dimensional Operative Video
Authors: Kashlan Osama Nezar , Kim Hyeun Sung , Khalsa Siri Sahib S , Ravindra Singh , Yong Zhang , Oh Seong Woon , Noh Jeong Hoon , Jang Il-Tae , Oh Seong-Hoon
Published: June 2019

Nerve root compression by foraminal pathology is challenging for a surgeon to decompress without violating the facet joint, which may necessitate a fusion procedure. One nonfusion approach to foraminal pathology is a combination intracanal approach for a laminotomy/foraminotomy followed by a paraspinal Wiltse approach for far lateral decompression. Unfortunately, even with the combination approach, it continues to be difficult to achieve adequate decompression without violating much of the facet joint overlying the nerve root.

Spine endoscopy offers the ability to decompress the foraminal portion of the nerve without significant violation of the facet joint. We present a surgical video describing the technique for performing a percutaneous endoscopic contralateral L5-S1 foraminal decompression via an interlaminar approach, for a patient presenting with a left L5 radiculopathy due to L5-S1 foraminal stenosis. We explain the differences in the endoscopic channel docking point between ipsilateral and contralateral interlaminar approaches. The steps of an endoscopic foraminotomy are then described: dissect soft tissue and ligamentum flavum off the medial left S1 lamina and superior articulating process (SAP), undercut the superior articulating process of S1 and the inferior articulating process (IAP) of L5 with a drill, resect lateral ligamentum flavum off SAP and IAP exposing epidural fat, and finally dissect the left L5 nerve root and remove compressive lesions throughout its course in the lateral recess, foramen, and laterally. The presentation ends with an intraoperative photograph showing a decompressed L5 nerve root and postoperative imaging confirming this decompression.

Appropriate patient consent was obtained.
Detection of Geosmithia morbida on Numerous Insect Species in Four Eastern States
Authors: Moore Melanie , Juzwik Jennifer , Miller Fredric , Roberts Leah , Ginzel Matthew D.
Published: June 2019

Thousand cankers disease is caused by the coalescence of numerous Geosmithia morbida cankers on branches and stems of Juglans species, leading to branch dieback and eventual tree death. The fungus sporulates in galleries of the walnut twig beetle (Pityophthorus juglandis), allowing for acquisition of pathogen propagules and its subsequent transmission to other branches or trees following adult emergence. Recently, G. morbida has been isolated from Xylosandrus crassiusculus and Xyleborinus saxesenii collected in Ohio and Stenomimus pallidus collected in Indiana. These beetles are known to colonize diseased Juglans nigra in these states. In this study, an operational trap survey for ambrosia beetles, bark beetles, and other weevils was conducted in four eastern states, and captured beetles were assayed to detect G. morbida using both culture and PCR-based methods. A new primer pair (GmF3/GmR13), based on the β-tubulin region, was designed for G. morbida DNA detection. The pathogen was detected on 18 insect species using molecular methods, and live cultures were isolated from two species. This is the first report of the pathogen in Illinois and Minnesota.
The expanded BXD family of mice: A cohort for experimental systems genetics and precision medicine
Authors: Ashbrook David G. , Arends Danny , Prins Pjotr , Mulligan Megan K. , Roy Suheeta , Williams Evan G. , Lutz Cathleen M. , Valenzuela Alicia , Bohl Casey J. , Ingels Jesse F. , McCarty Melinda S. , Centeno Arthur G. , Hager Reinmar , Auwerx Johan , Sen Saunak , Lu Lu , Williams Robert W.
Published: June 2019

The challenge of precision medicine is to model complex interactions among DNA variants, sets of phenotypes, and complex environmental factors and confounders. We have expanded the BXD family, creating a powerful and extensible test bed for experimental precision medicine and an ideal cohort to study gene-by-environmental interactions.

These BXD segregate for over 6 million variants, with a mean minor allele frequency close to 0.5. We have increased the family two-fold to 150 inbred strains, all derived from C57BL/6J and DBA/2J. We have also generated updated and comprehensive genotypes and an unrivaled deep phenome.

Approximately 10,000 recombinations have been located, allowing precision of quantitative trait loci mapping of ±2.0 Mb over much of the genome and ±0.5 Mb for Mendelian loci. The BXD phenome includes more than 100 ‘omics data sets and >7000 quantitative and clinical phenotypes, all of which is publicly available.

The BXD family is an enduring, collaborative, and replicable resource to test causal and mechanistic links between genomes and phenomes at many stages and under a wide variety of treatments and interventions.