bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOZ047.61: Elective tracheostomy in critically ill children: to do or not to do? Ten year experience from an academic center in Pakistan
Authors: Ishaque S , Karim F , Qazi S H , Abbas Q 
Published: June 2019

Abstract

Background
Tracheostomy is one of the oldest and most commonly performed procedures among critically ill patients. The advantages of an elective tracheostomy in pediatric intensive care unit are improved patient comfort, lesser need for sedative drugs, early weaning from mechanical ventilation support eventually leading to reduced cost of care.

Objective
This study describes the frequency, indications, complications, and outcome of elective pediatric tracheostomies in critically ill children from a single pediatric intensive care unit of a tertiary care center.

Design
This is a retrospective cohort study of patients undergoing tracheostomy.

Setting
This is a pediatric intensive care unit (PICU) of a tertiary-care hospital.

Patients
All patients underwent tracheostomy in our PICU over the ten-year period.

Main Results
A total of 48 children underwent a tracheostomy, corresponding to a 1.5% of the total PICU admissions during the study period. 34/48 (71%) patients were male. A 25% of our patients undergoing a tracheostomy had an underlying CNS condition, followed closely by a respiratory problem (11/48 patients).The main indication for tracheostomy in children was prolonged mechanical ventilation secondary to respiratory 35/48 (73%), that included upper airway obstruction, foreign body aspiration or pneumonia and neurological or neuromuscular illness (6.3%) including traumatic brain injury, meningitis/encephalitis, Gullain Barre’ syndrome, and neurodegenerative disorders. Two patients died from tracheostomy-related complications, making it an overall mortality rate of 4%.

Conclusion
Tracheostomy in children is a relatively frequent procedure at our hospital. The commonest indication was prolonged mechanical ventilation. Early tracheostomy is associated with better patient outcomes in terms of morbidity and length of stay.
DOZ047.62: Fixed the gap, solved the problem? Children operated on of esophageal atresia: what happen 3 years later
Authors: Bevilacqua F , Ragni B , Conforti A , Morini F , Dotta A , Bagolan P , Aite L 
Published: June 2019

Abstract

Background
With improvements in surgical care long-term morbidity of patients with esophageal atresia (EA) has been recently taken into account (Lees et al., 2018). Morbidities include gastrointestinal and respiratory complication, problems of nutrition and growth, feeding difficulties, oral aversion or food refusal (Menzies et al., 2016).

Aim
Purpose of this study is to explore eating problems and its implications at 3 years in infants born with esophageal atresia.

Methods
A retrospective study including all infants operated for EA at our Institution in the period ranging from January 2012 and January 2016 who attended our follow-up program. A specific interview was set up for the study. The interview was delivered by telephone by a trained psychologist.

Results
Parents of 51 children (male = 67%) were interviewed. Twenty-two percent of children showed a growth <10th percentile; 30% presented oral aversion for a period of their life; 45% still have episodes of chock during meals and 18% of these had more than one episode a week; 45% suffer of GERD and 41% experienced recurrent respiratory problems; 37% of parents experience anxiety during meals. Fifty-seven percent attended kindergarten (8% with a dedicated educator during meal time), and 92% attended preschool (26% with dedicated educator during meal time). Currently 67% of the families benefit of social facilities.

Conclusions
Three years after surgical repair of the structural defect, a high percentage of family still experience physical and psychological problems related to eating behavior of their children. Efforts of the health care team as well as research should focus on how to prevent eating problems and improve quality of life both of children and families.
DOZ047.66: Thoracoscopic posterior tracheopexy during primary esophageal atresia repair
Authors: Tytgat S H A J , van der Zee D C , Verweij J W , van Tuyll van Serooskerken E S , Lindeboom M Y A 
Published: June 2019

Abstract

Background
Esophageal atresia (EA) is usually accompanied by some form of tracheomalacia. During the early phases in life, excessive dynamic collapse of the trachea can cause a wide spectrum of symptoms ranging from mild complaints to apparent life-threatening events (ALTE’s). Therapeutic strategies for severe tracheomalacia include aortopexy to lift the anterior weakened cartilaginous rings or posterior tracheopexy of the floppy membranous tracheal intrusion. Earlier we have introduced a new approach in which the posterior tracheopexy is performed directly during primary thoracoscopic correction of EA.

Methods
In the period 2017–2018, all consecutive EA patients (27) underwent a rigid tracheobronchoscopic evaluation during induction of anesthesia prior to the thoracoscopic EA repair. Tracheomalacia was diagnosed in 11 patients. During the subsequent thoracoscopic procedure, the posterior tracheal membrane was fixed to the anterior longitudinal spinal ligament with nonabsorbable sutures. The esophageal ends were then mobilized toward the right hemithorax and anastomosed.

Results
On preoperative RTB, six patients had a severe (66–99%) mid tracheal collapse and five patients had a moderate (33–66%) collapse. Thoracoscopic posterior tracheopexy with on to three sutures was possible in all 11 patients, prior to the formation of the esophageal anastomosis. Median time per suture was 6 minutes (range: 4–12 minutes). All operative procedures were uneventful. A median follow-up of 10 months (range: 2–22 months) revealed that eight patients recovered without any respiratory symptoms, one patient had respiratory symptoms caused by a suture granuloma that was removed by bronchoscopy, one patient had a respiratory syncytial virus bronchiolitis and one patient had a rhinovirus infection. None of the patients experienced any ALTE’s.

Conclusion
Eleven patients have been treated by thoracoscopic posterior tracheopexy during primary EA repair. This technique could prevent potentially deleterious sequelae of moderate to severe tracheomalacia that may complicate the lives of EA patients. Also, a second, sometimes complex surgical procedure can be prevented as the posterior tracheopexy is performed during the primary thoracoscopic EA correction.
DOZ047.73: Endoscopic treatment of esophageal atresia
Authors: Vogiatzoglou T , Arrigo S , Gandullia P 
Published: June 2019

Abstract

Aim of the Study
The aim of this study was to provide an overview of endoscopic treatment in children after reconstruction of esophageal atresia.

Methods
This study, conducted at a single tertiary center, reviewed patients requiring endoscopic treatment during a 15-year period, from 2004 to 2018. Collected data include number, frequency, complications, and effectiveness of esophageal anastomotic dilations.

Results
A total of 55 children with esophageal atresia (EA) underwent upper gastrointestinal endoscopy. Of those, 37 required therapeutic endoscopy with dilation procedures for anastomotic strictures. Thirty-five patients underwent dilations using only through-the-scope (TTS) balloon (BD),1 patient using only a Savary bougie (SB), and 1 using both. A total of 126 dilations were performed using BD in 36 patients and 6 dilations using SB in 2 patients. Specifically, in children treated only with BD were performed 1 dilation in 6 children (17.1%), 2 in 6 children (17.1%), 3 in 7 children (20%), 4 in 6 children (17.1%), 5 in 6 children (17.1%), 7 in 2 children (5.7%), and 8 in 2 children (5.7%). Balloon catheter sizes ranged from 6 mm to 15 mm. In 2 patients (5.4%) stents were placed, 1 and 6 stents, respectively. Intralesional triamcinolone was injected in 8 patients (21.6%) as additional therapy. Major complications included perforation in 4 patients (10,8%), resolved with conservative treatment. All patients had clinical improvement in the follow-up.

Conclusion
Currently, endoscopic treatment for esophageal anastomotic stricture is the first procedure adopted in clinical practice after the surgical approach, since it is regarded safe and effective. Balloon dilations are preferred in our overview as a treatment option for esophageal anastomotic strictures. Symptom relief is reported in all cases, while the rate of complications is very low. Sometimes, refractory strictures influence the patient's quality of life and therapeutic alternatives such as stent placement should be considered.
DOZ047.87: Longitudinal evaluation of lung function in infants with esophageal atresia
Authors: Landolfo F , Conforti A , Columbo C , Calzolari F , Savignoni F , Scuglia M , Braguglia A , Dotta A , Bagolan P 
Published: June 2019

Abstract

Introduction
Patients affected by esophageal atresia (EA) often faced airway problems, due to multifactorial dynamics (tracheomalacia, gastroesophageal reflex disorder, etc.). The aim of this study was to longitudinally evaluate the lung function test (LFT) in those infants to explore how the LFT modifies at mid-term follow-up.

Methods
Retrospective evaluation of lung functions in infants treated for EA (2010–2017) was performed at three time points: 6 months, 12 months, and 24 months.
Tidal volume (Vt), respiratory rate (RR), and time to peak tidal expiratory flow as a percentage of total expiratory time (tPTEF/te) were analyzed. ANOVA test was used as appropriate.

Results
During the study period 172 patients were treated for EA. Of those 50 infants (28%) underwent LFT at 6 months, 30 at 12 months, and 11 at 24 months. Tracheomalacia was present in 20 infants (42%). Both Vt (6,79 ml/kg vs 7,82 ml/kg vs 8,37 ml/kg—p = 0,001) and RR (49,7 a/min vs 40,6 a/min vs 34,0 a/min—p = 0,020) significantly improved, while there was no significant difference for tPTEF/te (0,25 vs 0,26 vs 0,29—p = 0,62) despite the data showing an improvement trend.

Conclusion
The preliminary data suggest that, although EA patients may present impaired LTF in early infancy, lung function seems to improve over time, showing normal pulmonary function test at 24 months. The presence of selection bias and the retrospective nature of the study limit our result. Nonetheless, evaluation of lung function is warranted in EA infants to early detect respiratory symptoms, ideally reducing the impact on short- and long-term pulmonary outcomes.
DOZ047.94: The thoracoscopic approach for esophageal atresia and tracheoesophageal fistula—lessons learnt from 178 cases
Authors: Patkowski D , Gerus S , Rasiewicz M , Polok M , Świątek K , Dzielendziak A , Palczewski M , Borselle D , Toczewski K , Śmigiel R 
Published: June 2019

Abstract

Purpose
The aim of this study was to present an operative technique based on personal experience with 178 cases of thoracoscopic repair with different types of EA/TOF.

Material and Methods
From 2005 178 patients (111 boys, 47 girls) underwent thoracoscopic repair in different hospitals. The first author was involved in all cases except two final procedures of staged repair.

Results
There were 30 cases of type A, 10 of type B, 129 of type C, 2 of type D, and 7 of H-type isolated fistulas. There was no contraindication to thoracoscopy if the surgical intervention was considered. The smallest operated patient weighed 1000 g. If the patient was respiratory unstable, only the fistula was closed, and the anastomosis was completed later (3 cases). All cases of type C, type D, and H-type fistula were completed thoracoscopically without conversion. Four cases of type A had primary thoracoscopic anastomosis. For the remaining long-gap EA (type A and B exclusively) stage internal traction suture technique was used. There were 16 deaths with 3 related to postoperative surgical complications. The operative technique evolved with growing experience. At the beginning the lateral position was used, which finally changed to a complete prone position. Three trocars 2 × 2,5–3,5 mm and 1 × 5 mm in diameter were placed around the scapula. The 5 mm telescope 25–30 degrees was preferred. A pneumothorax was maintained with 4–6 mmHg. The azygos vein was never divided, and the anastomosis was almost in each case made above the vein. In the majority of cases the vein separated the anastomosis and the fistula closure site. At the beginning the TEF was closed with 5 mm titanic clips. As the clips in a few cases disappeared on X-ray taken later ligation of the fistula was started. The esophageal anastomosis was made over the nasogastric tube using routinely sliding (slipping) 4–0 or 5–0 absorbable knots. If there was a considerable tension two or three sliding knots were placed and closed gradually. If the anastomosis was successful, the chest drainage was not routinely used. For the primary cases there was no need to use the electrocautery—the procedure was bloodless with blunt tissue dissection. The first procedure took almost 360 minutes; the last cases were completed within 60 to 80 minutes.

Conclusions
The thoracoscopic repair of EA/TOF is an effective method and based on our experience it is the procedure of choice if performed by an experienced endoscopic pediatric surgeon.
DOZ047.95: Crossing the disciplines: what airway surgeons can learn from interventional cardiology
Authors: Brigger M T , El-Said H 
Published: June 2019

Abstract
The intimate association of airway and cardiac anatomy has long led to frequent and collegial collaboration between airway surgeons and cardiovascular surgeons. While surgical colleagues tend to provide clear lines of interaction, communication between all members of the team is critical to long-term outcomes. Interventional cardiologists are integral to the care of children with combined cardiac and airway problems and have increasingly redefined the indications for open surgical repair of cardiac defects. In a similar vein, collaboration between airway surgeons and interventional cardiologists yields a blending of strategies, approaches, and instrumentation that allows for innovative approaches to primary airway problems. The nonsurgical and minimally invasive practice of interventional cardiologists can provide an invaluable viewpoint that has direct application to difficult problems of the airway. Using a case-based approach, representative strategies applying various principles of interventional cardiology will be used to illustrate the cross-discipline value. Specific cases will focus on the role of diagnostic approaches and strategies, imaging modalities including fluoroscopy as well as advanced computed tomography and magnetic resonance imaging techniques, instrumentation including wires, balloons, and stents that have evolved to manage pediatric cardiac anomalies and have been demonstrated to be useful in managing the pediatric airway. The cases will demonstrate how innovation and cross-fertilization of ideas cultivate advancement in both disciplines and advocate for institutional collaboration.
Mitochondrial clearance and maturation of autophagosomes are compromised in LRRK2 G2019S familial Parkinson’s disease patient fibroblasts
Authors: Korecka Joanna A , Thomas Ria , Christensen Dan P , Hinrich Anthony J , Ferrari Eliza J , Levy Simon A , Hastings Michelle L , Hallett Penelope J , Isacson Ole 
Published: June 2019

AbstractThis study utilized human fibroblasts as a preclinical discovery and diagnostic platform for identification of cell biological signatures specific for the LRRK2 G2019S mutation producing Parkinson’s disease (PD). Using live cell imaging with a pH-sensitive Rosella biosensor probe reflecting lysosomal breakdown of mitochondria, mitophagy rates were found to be decreased in fibroblasts carrying the LRRK2 G2019S mutation compared to cells isolated from healthy subject (HS) controls. The mutant LRRK2 increased kinase activity was reduced by pharmacological inhibition and targeted antisense oligonucleotide treatment, which normalized mitophagy rates in the G2019S cells and also increased mitophagy levels in HS cells. Detailed mechanistic analysis showed a reduction of mature autophagosomes in LRRK2 G2019S fibroblasts, which was rescued by LRRK2 specific kinase inhibition. These findings demonstrate an important role for LRRK2 protein in regulation of mitochondrial clearance by the lysosomes, which is hampered in PD with the G2019S mutation. The current results are relevant for cell phenotypic diagnostic approaches and potentially for stratification of PD patients for targeted therapy.
Very Unusual Sellar/Suprasellar Region Masses: A Review
Authors: Abushamat Layla A , Kerr Janice M , Lopes M Beatriz S , Kleinschmidt-DeMasters Bette K 
Published: June 2019

AbstractThe cause of sellar region masses in large retrospective series is overwhelmingly pituitary adenomas (84.6%), followed by craniopharyngiomas (3.2%), cystic nonneoplastic lesions (2.8%), inflammatory lesions (1.1%), meningiomas (0.94%), metastases (0.6%), and chordomas (0.5%) (1). While other rare lesions were also identified (collectively 6.0%), single unusual entities in the above-cited series numbered <1–2 examples each out of the 4122 cases, underscoring their rarity. We searched our joint files for rare, often singular, sellar/suprasellar masses that we had encountered over the past several decades in our own specialty, tertiary care specialty pituitary center practices. Cases for this review were subjectively selected for their challenging clinical and/or histological features as well as teaching value based on the senior authors' (MBSL, BKD) collective experience with over 7000 examples. We excluded entities deemed to be already well-appreciated by neuropathologists such as mixed adenoma-gangliocytoma, posterior pituitary tumors, metastases, and hypophysitis. We identified examples that, in our judgment, were sufficiently unusual enough to warrant further reporting. Herein, we present 3 diffuse large cell B cell pituitary lymphomas confined to the sellar region with first presentation at that site, 2 sarcomas primary to sella in nonirradiated patients, and 1 case each of granulomatosis with polyangiitis and neurosarcoidosis with first presentations as a sellar/suprasellar mass. Other cases included 1 of chronic lymphocytic leukemia within a gonadotroph adenoma and 1 of ectopic nerve fascicles embedded within a somatotroph adenoma, neither of which impacted patient care. Our objective was to share these examples and review the relevant literature.
Total arch replacement with bilateral extra-anatomical axillary artery bypass and frozen elephant trunk technique for Kommerell’s diverticulum
Authors: Takeyoshi Daisuke , Kitahara Hiroto , Tatsukawa Takamitsu , Kobayashi Daita , Ise Hayato , Nakanishi Sentaro , Kanamori Taro , Ishikawa Natsuya , Kamiya Hiroyuki 
Published: June 2019

Abstract
A Kommerell’s diverticulum is a rare congenital aortic arch anomaly associated with a high rate of aortic rupture or dissection. Therefore, surgical or endovascular repair should be considered early. A 64-year-old man was incidentally found to have an aortic arch anomaly, Kommerell’s diverticulum, with a right aberrant subclavian artery and distal arch aneurysm. Hybrid total arch replacement with bilateral extra-anatomical axillary artery bypass and frozen elephant trunk technique was performed. This particular surgical approach would be a treatment option for any type of Kommerell’s diverticulum.
Biplane Fluoroscopic-Guided Balloon Rhizotomy for Trigeminal Neuralgia: A Technical Note
Authors: Vance Awais Z , El Ahmadieh Tarek Y , Christian Zachary , Aoun Salah G , Barnett Samuel L , White Jonathan A 
Published: June 2019

Abstract

BACKGROUND
The classic percutaneous technique used to cannulate the foramen ovale for the treatment of trigeminal neuralgia can place important anatomic structures, such as the distal cervical internal carotid artery, at risk.

OBJECTIVE
To use fixed anatomic landmarks to safely and reliably locate the foramen ovale on anteroposterior (AP) fluoroscopy.

METHODS
Locating the foramen ovale was initially tested using AP fluoroscopy on cadaveric skulls in the neurosurgical simulation lab. Fluoroscopic landmarks were identified and utilized to assist in successfully locating the foramen ovale during percutaneous balloon rhizotomy procedures in patients with trigeminal neuralgia. This technique has been successfully used in multiple patients. In this report, we describe our technique in detail.

RESULTS
The AP fluoroscopy is directed laterally in the coronal plane until a line drawn inferiorly from the lateral orbital rim bisects the inner concavity of the mandibular angle. Fluoroscopy is then directed inferiorly until the top of the petrous ridge bisects the mandibular ramus. The foramen ovale will come into view within the window between the mandibular ramus and hard palate. Two case illustrations are provided.

CONCLUSION
Balloon rhizotomy is a commonly used treatment option for trigeminal neuralgia. Direct visualization of the foramen ovale can reliably be achieved on AP fluoroscopy using specific anatomic landmarks. This technique can be utilized to increase the accuracy and safety of the procedure.
A 3D-Printed Simulator and Teaching Module for Placing S2-Alar-Iliac Screws
Authors: Bow Hansen , Zuckerman Scott L , Griffith Brenton , Lewis Steven , McGruder Chandler , Pruthi Sumit , Parker Scott L 
Published: June 2019

Abstract

BACKGROUND
The concept of the S2-alar-iliac (S2AI) screw was developed approximately one decade ago and has rapidly become an important component of spinal arthrodesis. Two challenges to placing S2AI screws are gaining an intuition for free-hand screw placement trajectory and acquisition of the appropriate radiograph to both guide screw placement and diagnose misplacement.

OBJECTIVE
To present the design and manufacture of an S2AI screw placement simulator and teaching module that addresses both challenges.

METHODS
This simulator involves using a 3D printer to create a life-sized pelvis. Participants first used this print to practice placing free-hand S2AI screws. Then participants used another print to practice taking radiographs showing the posterior superior iliac spine-anterior superior iliac spine corridor (teardrop) view.

RESULTS
The accuracy of screw placement increased from 17 to 80% on the left side and 7 to 100% on the right side. The number of radiographs taken by each participant to obtain the teardrop view decreased after practice with the simulator compared to baseline.

CONCLUSION
Practice with the S2AI simulator led to an improved intuition of an appropriate free-hand S2AI screw trajectory and a decrease in the number of radiographs needed for obtaining the correct diagnostic view.