Clinical and experimental dental researchNga Thi Nguyen, Hanh Thi-My Tran, Nga Minh Truong
OBJECTIVES: This case report describes orthodontics-assisted autogenous tooth transplantation for a maxillary incisor injury in a pediatric patient with crowding and Class II malocclusion. MATERIAL AND METHODS: A 10-year-old boy presented with a compromised maxillary left central incisor with a periapical lesion after failed endodontic treatment, together with bimaxillary crowding and Class II malocclusion. The mandibular right second premolar was transplanted to replace the maxillary incisor and was integrated with comprehensive orthodontic treatment. RESULTS: After transplantation, endodontic treatment was completed when pulp vitality could not be maintained. During long-term follow-up, the transplanted tooth remained clinically stable, with healthy periodontal tissues and no progressive root resorption or bone loss. Orthodontic treatment achieved stable occlusion, improved function, and satisfactory smile esthetics. CONCLUSIONS: Orthodontics-assisted autogenous tooth transplantation may be a biologically favorable option for replacing a traumatized maxillary incisor in growing patients with crowding and malocclusion. Careful donor selection, coordinated orthodontic timing, and long-term follow-up are essential for stable functional and esthetic outcomes.
Hepatology communicationsSharad I Wadhwani, Bethany Reyna, Andrea Huerta, John C Bucuvalas, Laura M Gottlieb, Catherine Lee, Courtney R Lyles, Sue J Rhee, Amy M Shui, Jennifer C Lai
BACKGROUND: Children undergoing liver transplantation experience socioeconomic disparities in long-term outcomes, partly due to unaddressed material economic hardships such as food insecurity and housing instability. Health Advocates-trained lay health workers who assist families in navigating social and medical systems-may mitigate these disparities. We pilot-tested a Health Advocate intervention (NCT05700799) to assess feasibility, acceptability, and preliminary effects on caregiver experience and clinical outcomes in pediatric liver transplant recipients. METHODS: In this single-center study, 18 caregivers/child dyads participated in a 90-day Health Advocate program; they were provided weekly support from trained navigators. Navigators helped to identify and connect participants with community-based resources and communicated reported social risks to the transplant team. RESULTS: The patients' median age at transplant was 1.1 (0.7, 4.6) and the median age at study enrollment was 8.6 (4.3, 13.1) years; 83% remained in the intervention until their needs were met or the end of the 12-week intervention. Caregivers reported improvement in comfort discussing social risks with the transplant team and improved overall care experience (both median 1-point change). Clinical parameters, including the Medication Level Variability Index, trended toward improvements. Qualitative analysis demonstrated high enthusiasm for the intervention, with themes of enhanced communication, reduced stress, and practical assistance addressing diverse social needs. CONCLUSIONS: A Health Advocate intervention for pediatric liver transplant families was feasible, acceptable, and associated with improved caregiver experiences. These preliminary findings support testing this intervention in a multi-center effectiveness and implementation trial to evaluate its impact on improving longer-term transplant outcomes.
International journal of pediatric otorhinolaryngologyEric Cunningham, Alireza Zonnour, Krish Suresh, Michael G Brandel, Michael L Levy, Marc S Schwartz, Rick A Friedman
OBJECTIVE: Middle fossa craniotomy (MFC) with exposure of the internal auditory canal and/or petrous apex (anterior petrosectomy) is an uncommon operation in the pediatric population. We report our institution's experience and surgical outcomes with pediatric MFC. METHODS: Retrospective case series including all MFC with exposure of the internal auditory canal and/or petrous apex, performed between May 2018 and September 2024, in patients aged 18 years and younger. Primary outcome measures were pre-operative and postoperative facial nerve function and hearing status. RESULTS: Sixteen patients met inclusion criteria. Median age was 12 years (range 1-18), 10 (63%) were male and six (37%) were female. On preoperative MRI, median tumor size was 12.5 mm (range 3-63). Gross total resection was achieved in 11 (69%) cases, near total in 1 (6%), and subtotal in 4 (25%). Facial nerve outcomes were favorable: of 11 patients with preoperative House-Brackmann (HB) I, 10 (91%) maintained HBI postoperatively. All 9 patients with vestibular schwannoma (VS) had class A hearing preoperatively. At first postoperative follow-up (median 8 days), five (56%) maintained class A hearing and four (44%) were class D. CONCLUSIONS: MFC can be safely performed in children for appropriately selected skull base lesions. VS in NF2 is the most common indication, and MFC offers a valuable hearing-preserving option in these cases. Early intervention for small, growing tumors with associated hearing loss, coupled with modern intraoperative monitoring and multidisciplinary expertise, allow for facial nerve and hearing outcomes similar to the adult population.
International journal of pediatric otorhinolaryngologyNabil Faranesh, Tamem Zoabi
BACKGROUND: Tonsillar hypertrophy is a common cause of sleep-disordered breathing (SDB) in children and may contribute to swallowing dysfunction through upper airway obstruction. However, its impact on swallowing-related quality of life has not been well characterized. OBJECTIVE: To evaluate swallowing-related quality of life in children with tonsillar hypertrophy and SDB, assess the effect of surgical treatment, and validate an Arabic version of the Pediatric SWAL-QOL questionnaire. METHODS: In this prospective cohort study, 50 children with SDB and Brodsky grade ≥2 tonsillar hypertrophy were compared with 53 healthy controls. Swallowing-related quality of life was assessed using the Pediatric SWAL-QOL questionnaire. Surgical patients completed the questionnaire before and three months after surgery; controls completed it once. Forty-six children completed postoperative follow-up. The Arabic questionnaire underwent forward-backward translation and psychometric validation. RESULTS: Children with tonsillar hypertrophy and SDB demonstrated significantly worse preoperative SWAL-QOL scores than controls (31.74 ± 25.05 vs. 2.47 ± 4.00; p < 0.001). Following surgical treatment, scores improved significantly to 0.98 ± 1.69 (p < 0.001) and were no longer different from controls (p = 0.211). Significant improvement was observed across all SWAL-QOL domains. Dysphagia severity was not associated with Brodsky tonsil grade or recurrent tonsillitis. The Arabic SWAL-QOL demonstrated excellent test-retest reliability (ICC = 0.996) and high internal consistency (Cronbach's α > 0.80). CONCLUSIONS: Children with tonsillar hypertrophy and SDB experience significant swallowing dysfunction that improves substantially following surgical treatment. Dysphagia severity appears to be more closely related to functional upper airway obstruction than tonsil size alone. The Arabic Pediatric SWAL-QOL is a reliable tool for assessing swallowing dysfunction in Arabic-speaking pediatric populations.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansAntonio F Saad, Elenir B C Avritscher, Claudia Pedroza, Xiao Han, George R Saade
BACKGROUND: Dilapan-S, a synthetic osmotic dilator used for pre-induction cervical ripening, has proven to be as effective as the Foley balloon in terms of vaginal versus cesarean delivery and has been associated with increased patient satisfaction. Nevertheless, its ability to lower cesarean rates and its cost-effectiveness remain poorly studied. OBJECTIVE(S): To estimate the likelihood that synthetic osmotic dilators reduce cesarean deliveries and to evaluate their health system costs (2026 US$) and incremental cost-effectiveness compared to the Foley balloon during cervical ripening. STUDY DESIGN: Secondary Bayesian analyses were conducted using data from the single-center DILAFOL randomized controlled trial, which enrolled 419 parturients at ≥37 weeks' gestation with singleton pregnancies undergoing labor induction with an unfavorable cervix. Participants were randomized to receive synthetic osmotic dilators (n = 208) or a Foley balloon (n = 209) for cervical ripening. A Bayesian logistic regression model was used to estimate the probability of a reduced cesarean delivery rate with synthetic osmotic dilators. Health system costs were evaluated using Bayesian generalized linear models. The incremental cost-effectiveness ratio (ICER) was derived from these models using neutral priors, assuming no treatment effect. RESULTS: In intent-to-treat analysis, synthetic osmotic dilators had an 89% probability of reducing cesarean delivery compared to the Foley balloon (mean absolute risk difference, -5.0% (95% credible interval [CrI], [-12.8 to 2.7). Mean total obstetric cost per patient was $10,198 for synthetic osmotic dilators and $10,176 for Foley (RR, 1.00; 95% CrI, 0.94 - 1.06). Although synthetic osmotic dilators cost $399 per patient, this was largely offset by an 85% probability of reduced hospital costs ($8,771 vs. $9,081; RR, 0.97; 95% CrI, 0.90-1.03) and 99% probability of reduced physician costs ($1,028 vs. $1,094; RR, 0.94; 95% CrI, 0.89-0.99). The ICER of synthetic osmotic dilators versus Foley was $439 per cesarean delivery prevented (95% CrI, -$51,813 to $57, 697]), with 42% of posterior draws falling in the dominant quadrant (cost-saving and more effective). The probability of cost-effectiveness rose from 47% at $0 willingness-to-pay threshold to 85% at $15,000 per cesarean delivery prevented. Subgroup analyses suggested that economic benefits were most favorable among patients aged <35 years and nulliparous parturients, in whom the posterior probability of dominance was 52% and 39%, respectively. CONCLUSION(S): Despite its higher material cost, synthetic osmotic dilators likely reduced cesarean delivery rates with minimal impact on total health system costs and a favorable cost-effectiveness profile. These findings, which do not account for neonatal costs or future pregnancy outcomes, suggest that osmotic dilators represent good value in obstetric care, particularly among younger and nulliparous patients. Further validation across obstetric settings is warranted.
International journal of pediatric otorhinolaryngologyJózef Mierzwiński, Katarzyna Radomska, Paulina Mierzwińska-Dolny, Katarzyna Dylewska, Andrew J Fishman, Justyna Tyra
BACKGROUND: Subtotal petrosectomy (STP) is a radical otologic procedure aimed at complete eradication of diseased temporal bone air cells and creation of a closed, sterile cavity. While well established in adult otology, its role in pediatric patients remains insufficiently described. OBJECTIVES: To analyze current indications, outcomes and complication rates of subtotal petrosectomy in a pediatric population, with particular emphasis in age - related patterns of indications. MATERIALS AND METHODS: A retrospective review was conducted of 20 children (<18 years) who underwent STP between 2010 and 2024 at two tertiary referral centers. Patients were analyzed according to age groups (≤6 years vs. >6 years) and etiology, categorized as congenital (including congenital malformations, CHARGE syndrome and congenital CSF leaks) or acquired (cholesteatoma, chronic otitis media, traumatic and oncological lesions). Major and minor complications were recorded and analyzed using non - parametric statistical methods. RESULTS: The cohort included 15 boys and 5 girls with a mean follow-up of 4.3 ± 1.2 years. Congenital indications predominated in children ≤6 years, whereas acquired pathologies were significantly more common in older children (>6 years) (Fisher's exact test, p = 0.018). Patients treated for congenital indications were significantly younger than those with acquired pathologies (p = 0.0095). Major complications occurred in 2 of 20 patients (10%, 95% confidence interval 1,2-31,7%), including cholesteatoma recurrence requiring revision surgery and conversion to an open technique. Minor complications were observed in one patient (5%) and consisted of an abdominal hematoma). No cases of implant loss, permanent facial nerve palsy or wound dehiscence were observed. CONCLUSIONS: STP is a safe and effective procedure in selected pediatric patients, with low rates of major complications. Indications differ significantly by age, with congenital pathology predominating in younger children and acquired in older patients. In children, STP should be regarded not as salvage procedure but as a reconstructive strategy providing a stable anatomical foundation for long term hearing rehabilitation and disease control.
International journal of pediatric otorhinolaryngologyZakaria Tamani, Erika Mercier, Mathieu Bergeron
OBJECTIVE: To describe the incidence, clinical presentation, and management of postoperative complications following injection laryngoplasty for minor laryngeal clefts and to assess their impact on postoperative dysphagia evolution. METHODS: A unicentric retrospective case-control study of pediatric patients who underwent injection laryngoplasty for minor laryngeal clefts (hyaluronic acid-based injectable or sodium carboxymethylcellulose) between January 2018 and October 2025 in a tertiary pediatric center was conducted. Demographics, comorbidities, intraoperative variables, postoperative dysphagia outcomes, and Penetration-Aspiration Scale scores were analyzed. Ordinal logistic regression was used to evaluate the overall dysphagia trajectory. RESULTS: Among 48 patients, 10 (20.8%) developed postoperative complications. Case and control groups were comparable in age, sex, weight percentiles, gestational age and most comorbidities. Operative duration, injected volume, and intraoperative antibiotic use were similar (all p > 0.2). Swallowing outcomes (resolution, improvement, persistence, or worsening) did not differ between groups. Ordinal logistic regression showed no association between complications and the dysphagia trajectory (Odds ratio, OR 5.1, p = 0.2). PAS severity categories were also similar (p = 0.8). Patients with hyaluronic acid appeared to have more complications (26.5%) compared to methylcellulose (7.1%), despite not reaching statistical significance. CONCLUSION: Despite a higher-than-expected complication rate, postoperative inflammatory or infectious complications were not linked to worse swallowing function or higher PAS scores. These findings inform risk-benefit discussions and support informed shared decision-making with families regarding minor cleft treatment options.
International journal of pediatric otorhinolaryngologySara O'Sullivan-Bakshi, Henry Diamond-Pott, Diego F Kaune, Francesca Lanni, Jacob Riordan, Jaime P Doody
INTRODUCTION: Foreign body aspiration (FBA) is a serious and potentially life-threatening pediatric emergency. When promptly diagnosed and managed, outcomes are usually favorable, but delayed recognition can result in pneumonia, acute respiratory distress and even death. Prior studies show that language barriers and limited English proficiency (LEP) are associated with delayed diagnosis, increased risk of high-severity aspirations (e.g., nuts), and disparities in perioperative and emergency care. However, few investigations have directly examined the relationship between language barriers and clinical outcomes in pediatric FBA. This study sought to evaluate these associations in a large national cohort. METHODS: We conducted a retrospective cohort study using the TriNetX research network. Pediatric patients (<18 years) with an index diagnosis of FBA were included. Exclusion criteria were age ≥18, prior history of FBA, asthma, or neuromuscular disorders. Two cohorts were created: children with FBA and a documented ICD code for acculturation difficulty (language barrier group) and children with FBA without such documentation (control group). Summary statistics were generated, and cohorts were propensity matched via multivariate linear regression based on age, age at index event, gender, race, and ethnicity. Outcomes compared included pneumonia, bronchoscopy, prolonged hospital stay, chest radiograph utilization, acute respiratory distress, dyspnea, and critical care services. RESULTS: After propensity score matching for age, age at index event, sex, race, and ethnicity, 880 pediatric patients with foreign body aspiration (FBA) and documented language barriers were compared with 880 matched controls. Patients with language barriers experienced significantly higher rates of pneumonia (39.0% vs 21.8%; OR 2.29, 95% CI 1.86-2.82; p < 0.0001) and prolonged hospital stay (6.93% vs 2.16%; OR 3.38, 95% CI 2.00-5.70; p < 0.0001). Respiratory complications were also more common, including acute respiratory distress (8.64% vs 1.93%; OR 4.80, 95% CI 2.81-8.19; p < 0.0001) and dyspnea (13.1% vs 3.86%; OR 3.74, 95% CI 2.52-5.55; p < 0.0001). Chest radiograph utilization (26.5% vs 14.0%; OR 2.22, 95% CI 1.74-2.82; p < 0.0001) and critical care use (6.93% vs 2.05%; OR 3.57, 95% CI 2.09-6.09; p < 0.0001) were higher among language barrier patients, while bronchoscopy rates were similar between groups (4.21% vs 3.30%; OR 1.29, 95% CI 0.79-2.11; p = 0.32). DISCUSSION: This national analysis demonstrates that pediatric patients with language barriers face significantly higher morbidity and resource utilization following FBA. These findings reinforce evidence that LEP contributes to delayed recognition, higher complication rates, and disparities in perioperative and emergency care. In the context of FBA, where timely diagnosis is critical, language barriers may affect survival and recovery. Standardized use of professional interpreters and culturally tailored caregiver education represent actionable strategies to reduce these inequities and potentially improve outcomes in this vulnerable population. To our knowledge, this is the first large-scale national study to directly examine language barriers and pediatric FBA outcomes.
International journal of pediatric otorhinolaryngologyMelissa Ameloti Gomes Avelino, Marina Nahas Dafico Bernardes, Luiza Avelino Ferri, Marina Emília de Matos Moraes, Celso Gonçalves de Castro Filho, Thalles Edua…
OBJECTIVE: To describe a percutaneous contralateral vocal fold lateralization as an endoscopic technical modification procedure originally described by Lichtenberger for the management of pediatric bilateral vocal fold paralysis (BVFP), employing readily available materials, and to evaluate clinical outcomes in a public tertiary referral center. METHODS: This longitudinal observational case series included nine pediatric patients diagnosed with BVFP who had previously undergone tracheostomy and were managed at a tertiary university hospital in Central-West Brazil. Endoscopic vocal fold lateralization was performed using a 16-gauge peripheral intravenous catheter (Abocath®) as a substitute for the conventional Lichtenberger endo-extralaryngeal needle carrier. All procedures were conducted under general anesthesia with suspension laryngoscopy and endoscopic guidance. Postoperative primary outcome included respiratory status following decannulation over a minimum follow-up of six months, and secondary outcomes: phonatory quality, swallowing function, evidence of aspiration and other complications. RESULTS: The mean age at surgery was 4 years. The predominant etiology was idiopathic (7 cases), one neurologic and other cardiac causes. All patients achieved successful decannulation (100%). Transient postoperative dysphonia was observed in all cases. No major complications, including aspiration pneumonia or lower airway infections, were documented. Two patients required revision surgery, one with contralateral and other ipsilateral lateralization. Adequate glottic airway patency was achieved in all cases, with preservation of swallowing function and satisfactory phonatory outcomes. CONCLUSION: The proposed adaptation of the Lichtenberger vocal fold lateralization technique using a 16-gauge intravenous catheter is a safe, effective, and reproducible alternative for pediatric patients with BVFP. This low-cost modification facilitates successful decannulation while preserving laryngeal function, representing a valuable strategy in resource-limited settings and supporting vocal fold lateralization as a first-line surgical option in tracheostomized children with BVFP.
Annals of medicineZhi Yi Niu, Qian Yun Wu, Yu Zuo Bai
OBJECTIVE: To investigate the predictive value of gastrointestinal decompression volume and its temporal trend for surgical intervention in children with postoperative adhesive small bowel obstruction (ASBO). METHODS: This retrospective study included 131 children with postoperative ASBO who initially received conservative treatment from January 2015 to December 2024. Based on treatment outcomes, patients were categorized into a successful conservative treatment group (CT, n = 80) and a surgical treatment group (ST, n = 51). Clinical data were collected, with emphasis on daily gastrointestinal decompression volume and its changes during conservative treatment. To account for weight differences, the unit weight gastrointestinal decompression volume (mL/kg) was adopted as the main variable. Generalized estimating equations (GEEs) were used to analyze dynamic trends. Predictive performance was evaluated using univariate binary logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS: From Day 1, GEE analysis showed a significant interaction between time and group (p = 0.049). The CT group showed a rapid decrease in unit weight gastrointestinal decompression volume (p < 0.001), whereas the ST group exhibited a slower decline. The ST group had significantly higher volumes than the CT group from Days 1-3. Decompression volumes on Days 1 and 2 were identified as significant predictors of surgery. Area under the curve values for predicting surgical need were 0.705 and 0.718 on Days 1 and 2, and the corresponding optimal cutoff values were 11.5 and 13.9 mL/kg, respectively. CONCLUSION: Unit weight gastrointestinal decompression volume and its trajectory may serve as useful predictors of the need for surgical treatment in pediatric postoperative ASBO.
International journal of pediatric otorhinolaryngologyCaroline Casey, Noelia MaGowan, Joshua Rocker, Neha Patel
INTRODUCTION: Tonsillectomy is one of the most common procedures performed in children. A well-known complication of tonsillectomy is post-tonsillectomy hemorrhage (PTH). PTH is a very serious complication due to the potential for airway compromise and severe bleeding. Most hospital protocols call for observation in scenarios where there is no active bleeding and return to operating room in situations where bleeding is not controlled. In recent years, the use of tranexamic acid (TXA), an antifibrinolytic agent, has been incorporated into the management of post-tonsillectomy bleeds, through nebulization and/or intravenously (IV). The goal of this study is to systematically review publicly available hospital protocols for the management of pediatric PTH, with particular focus on the incorporation of nebulized and/or IV TXA, and to introduce a universally applicable protocol for PTH management. METHODS: A systematic review of publicly available hospital protocols for pediatric PTH was conducted in accordance with PRISMA guidelines. The Children's Hospital Association (CHA) database was used to identify protocols that were publicly available, written in English, and specific to pediatric PTH management. The protocols were analyzed for key management domains including specialist consultation and use and dosing of nebulized and IV TXA. RESULTS: Through this systematic review, we identified 12 publicly available hospital PTH protocols, all developed at quaternary or near-quaternary centers. Of these protocols, 83% of protocols outline when to use nebulized TXA, whereas 67% of protocols outline when to use IV TXA and in total 67% include the use of both IV and nebulized TXA. Nebulized TXA was most consistently recommended for active bleeding, with IV TXA reserved for active or higher-volume bleeding. Our guideline recommends nebulized TXA for all PTH patients, with IV TXA for all active bleeding and on a case by case basis for controlled bleeding. CONCLUSION: This study reveals 12 publicly available pediatric PTH hospital protocols, 67% of which included the use of nebulized and IV TXA. Our guideline combines key practical management guidelines for PTH, including when to consult services like Interventional Radiology and PICU, and is designed for applicability beyond tertiary referral centers, providing a practical framework for frontline providers across a range of clinical settings.
INTRODUCTION: Lateral epicondylar fractures in young patients have received limited attention in the literature. This study aims to describe their mechanism of injury, concomitant injuries, management, and long-term outcomes in pediatrics. METHODS: This IRB-approved retrospective case series included patients younger than 18 years diagnosed with lateral epicondyle fractures between (2015-2021). Data collected included patient demographics, fracture characteristics at presentation, management details, and clinical outcomes. Patient-reported outcome measures (PROMs) were assessed using the QuickDASH score and associated functional variables. RESULTS: Twenty-two patients (10 male, 12 female) with a mean age of 10.5 years and BMI of 19.2 were included. Sports-related injuries were the most common mechanism (9 patients, 40.9%), followed by other high-energy falls such as from bicycles, stairs, or hoverboards (13 patients, 59.1%). Sixteen patients (72.7%) had nondisplaced fractures, while six (27.3%) had displaced fractures. Concomitant injuries were present in 12 patients (54.5%), including elbow fracture-dislocations (6, 27.3%), coronoid process fractures (4, 18.2%), and ligamentous injuries (2, 9.1%). Among those with fracture-dislocations, three (50%) also had additional elbow fractures, most commonly involving the medial epicondyle. Three patients (13.6%) required operative intervention-two for symptomatic nonunion and one for lateral collateral ligament reconstruction. All other patients were treated with rigid immobilization in a long arm cast or splint for an average of 4.1 weeks. Post-immobilization stiffness occurred in 36.4% of patients but improved with physical therapy. Sixteen patients (72.7%) had a mean follow-up of 3.2 years. Their average QuickDASH score was 6.0 and the average time to return to activity was 17.4 weeks after injury. CONCLUSIONS: Lateral epicondyle fractures represent a rare but frequently missed fractures, typically resulting from sports activities or high-energy falls that impart axial load and valgus stress to a supinated forearm. Nondisplaced fractures are treated well with long arm immobilization, while displaced fractures and high-energy injuries warrant careful assessment for associated fractures or ligamentous damage, as these may require operative management.
Gynecological endocrinology : the official journal of the International Society of Gynecological EndocrinologyElene Asanidze, Alla Vash-Margita, Besik Asanidze, Mariam Kharaishvili, Maia Chiokadze, Ana Jibladze, Jenaro Kristesashvili
Peripheral precocious puberty (PPP) is a rare condition in early childhood, particularly among girls under 3 years of age. One cause of PPP is functional ovarian cysts that secrete estrogen at levels sufficient to trigger the development of premature secondary sexual characteristics. Unilateral ovarian agenesis is an uncommon congenital anomaly. The coexistence of both conditions in a single patient is extremely rare and poses unique diagnostic and management challenges. We report the case of a 2-year and 10-month-old girl presenting with concurrent breast development, pubarche, and recurrent vaginal bleeding. Pelvic imaging revealed a cyst in the left ovary and agenesis of the right ovary. Laparoscopy confirmed absence of the right ovary and ipsilateral fallopian tube. Based on clinical, hormonal, and radiologic findings, a diagnosis of PPP due to a functional ovarian cyst was made. Given the rapid progression of symptoms, increase in cyst size, and concern for torsion, a short observation period of three months was followed by ovarian-preserving laparoscopic cystectomy. Histopathology confirmed a benign follicular cyst. Postoperatively, the patient experienced partial regression of pubertal signs and complete resolution of vaginal bleeding. This case highlights the importance of individualized decision-making in managing PPP,especially in the presence of congenital anomalies.
Sleep medicineKris Ysabel Miranda Sanchez, Shania Sheth, Adele Baker, Indra Narang, Lena Xiao
BACKGROUND: Positional obstructive sleep apnea (POSA) is a condition characterized by airway obstruction that is exacerbated during supine sleep. Treatments include adenotonsillectomy and positive airway pressure (PAP) therapy. Positional therapy is an emerging treatment option and refers to a wearable device that physically prevents supine sleep. OBJECTIVE: To explore the experiences and preferences of children and caregivers with POSA treatments, including adenotonsillectomy, PAP therapy, and positional therapy. METHODS: Semi-structured interviews were conducted with the caregivers of children aged 4-18 years old who participated in a trial that evaluated the efficacy of positional therapy in children. Children were invited to participate when possible. Interviews were coded by two reviewers using thematic analysis and themes were generated by the research team. RESULTS: Four children and 16 caregivers participated. Four themes were identified: (1) comfort and convenience, (2) symptom improvement, (3) emotional, psychological, and social aspects of treatment, and (4) shared decision-making. Positional therapy was considered the least burdensome of the three therapies. It was viewed as simple and minimally invasive but was limited by modest symptom improvement. PAP therapy provided symptom relief, but discomfort and poor tolerance were barriers to nightly use. Adenotonsillectomy was the only treatment with curative potential, but was sometimes viewed less favorably due to concerns about surgical risks. CONCLUSION: Families have varied preferences regarding POSA treatments. Identifying priorities prior to treatment may improve treatment satisfaction. To optimize adherence to positional and PAP therapy in children, barriers such as sensory issues and setup and maintenance should be addressed.
The Journal of emergency medicineEduardo Saadi Neto, Kavita John-Pierce, Ivan Khapov, Graciela Maldonado, Larissa T Shiue, Tobias Kummer
BACKGROUND: Peripheral intravenous (PIV) cannulation is the most common in-hospital procedure. In patients with difficult access, standard upper-extremity veins may be unsuitable, and alternative access sites need to be sought. The great saphenous vein (GSV) at the level of the distal medial thigh has been proposed as a potential alternative site for rescue access. Yet, the feasibility and reliability of targeting this site remain underexplored. OBJECTIVE: To assess the feasibility of ultrasound visualization and measurement of the GSV in the distal medial thigh as a reliable target for rescue PIV access. METHODS: This prospective, cross-sectional study enrolled 166 pediatric and adult emergency department participants at a tertiary academic medical center. The GSV was evaluated bilaterally using high-frequency linear ultrasound. Depth and diameter measurements were recorded at proximal, medial, and distal sites. Detection rates and vessel characteristics were compared across age, sex, comorbidity status, and history of difficult IV access. RESULTS: The GSV was visualized in ≥95% of participants across all thigh regions. Median depth was greatest proximally (11.7 mm) and shortest distally (9.9 mm), while median diameter was largest proximally (3.0 mm) and smallest distally (2.8 mm). Visualization was consistent across age groups, sex, and history of difficult IV access. CONCLUSION: The distal medial thigh GSV can be reliably visualized using ultrasound across pediatric and adult populations, including those with prior difficult intravenous access. Its consistent visualization and favorable anatomical characteristics support its potential as a rescue site for ultrasound-guided peripheral venous access in the emergency department.
SurgeryChen Lew, Samuel J A Robinson, Sarah Goh, Md Nazmul Karim, Dragan Ilic
BACKGROUND: Five billion individuals worldwide lack access to safe and affordable surgical care, a deficit disproportionately skewed toward low- and middle-income countries. Global surgery may be defined as "an area of study, research, practice, and advocacy" aiming to improve health outcomes for surgical patients. Universities play an important role in global surgical work in high-income countries. We aimed to determine the relevant knowledge, attitudes, and perspectives of medical students in Australia and Aotearoa New Zealand (ANZ). METHODOLOGY: We surveyed senior medical students in ANZ medical schools (n = 24) from August to October 2022. Participants were recruited through university channels, social media, and snowball sampling. Participants completed questionnaires examining attitudes, exposures, and content knowledge relating to global surgery. RESULTS: A total of 851 eligible responses were analyzed. This included 189 of 851 (22.2%) participants with prior global surgery exposure, most commonly through student organizations (10.9%), and 686 of 851 (80.6%) participants believed global surgery to be relevant to medical students. Few participants (72 of 851; 8.5%) reported timetabled teaching of global surgery content, despite 494 of 741 (66.7%) supporting mandatory inclusion in medical school curricula. Preferred methods of global surgery exposure did not align with the methods received, and global surgery was infrequently reported in university curricula. Global surgery knowledge was limited and lower than that of students overseas. Despite this, participants indicated significant interest in global surgery teaching. CONCLUSION: ANZ medical students lack global surgery education and knowledge. Most global surgery education is delivered through nonacademic methods, including student societies and social media. Educators should consider these findings when planning medical school curricula.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and NeurotologyBenjamin Wajsberg, Sarah E Hughes, Emily Z Stucken, Gabrielle Watson, Samantha Anne
OBJECTIVE: To evaluate whether cochlear implantation reduces listening-related fatigue in children with unilateral hearing loss. STUDY DESIGN: Prospective within-subjects crossover study. SETTING: Three academic medical centers specializing in pediatric cochlear implantation. METHODS: Fatigue was assessed using the Vanderbilt Fatigue Scale and PedsQL™ 3.0 Multidimensional Fatigue Scale. Parent- and child-reported versions were completed after consecutive days of baseline cochlear implant use and following a three-day discontinuation during a holiday break. Paired t-tests compared conditions (P <0.05). Univariable regressions examined associations with age, sex, and deafness duration. Intraclass correlation coefficients assessed parent-child agreement. RESULTS: Of 69 eligible patients, 37 responded; 18 declined due to reluctance to discontinue CI use. Nineteen children (mean age 8.6 y, 26.3% male, mean deafness duration 3.4 y) completed the study. Parent-reported fatigue significantly worsened after implant non-use in mental (P=0.01) and physical domains (P=0.04) on the Vanderbilt scale, and in cognitive fatigue (P=0.03) on the PedsQL. Child-reported scores trended toward greater fatigue during non-use, though not statistically significant. Younger age and male sex were associated with higher fatigue in parent reports. Intraclass correlation coefficients indicated moderate to good parent-child agreement. CONCLUSION: Cochlear implantation alleviates listening-related fatigue in children with unilateral hearing loss, particularly in cognitive and physical domains as perceived by parents. Fatigue represents a clinically meaningful, non-audiological outcome in candidacy assessment and postoperative evaluation.
International braz j urol : official journal of the Brazilian Society of UrologyJoão Pedro Leal Puppin, Vinicius Ravena Lourenço, Anderson Pellanda, Alexandre Danilovic, Fabio Carvalho Vicentini, Carlos Alfredo Batagello, Fabio C M Torrice…
INTRODUCTION: Nephrolithiasis is a prevalent and recurrent condition affecting approximately 10-11% of the population. Percutaneous nephrolithotomy (PCNL) and mini-PCNL are established treatments for large renal stones. Outcomes are influenced by the choice of lithotripsy energy source. Available technologies include pneumatic, ultrasonic, Holmium:YAG (Ho:YAG), and thulium fiber laser (TFL), each with specific advantages and limitations. This review summarizes current evidence on these energy sources in PCNL and mini-PCNL. MATERIALS AND METHODS: A narrative review was performed using PubMed and Cochrane Library, including studies published between 2014 and 2024. The search included terms related to PCNL and lithotripsy energy sources. Studies involving pediatric populations, anomalous kidneys, or non-standard energy sources were excluded. After screening 95 articles, 32 studies were included, of which 13 provided comparative data on different energy sources and were analyzed. RESULTS: Differences were observed in operative time, stone-free rates (SFR), bleeding, transfusion rates, complications, and hospital stay. In PCNL, ultrasonic and Ho:YAG lithotripsy showed comparable outcomes, while pneumatic demonstrated slightly lower SFR. In mini-PCNL, ultrasonic and laser technologies yielded similar efficacy. TFL displayed shorter operative time and reduced bleeding and transfusion rates compared to Ho:YAG, although many differences did not reach statistical significance. CONCLUSION: Ultrasonic and Holmium:YAG lithotripsy provide comparable outcomes in PCNL, while pneumatic devices may correlate with slightly lower stone-free rates. In mini-PCNL, ultrasonic and laser modalities show similar outcomes. TFL demonstrates potential advantages in operative time and bleeding, however, evidence remains heterogeneous, and further high-quality studies are needed.
Journal of pediatric orthopedicsLara Cohen, Ryan Guilbault, Pratik Pradhan, Alfred P See, Grant Hogue
BACKGROUND: Intraoperative navigation improves screw placement accuracy in pediatric occipitocervical fusion. All reports of navigated occipitocervical fusion using occipital plates in any age patient describe navigation placed at case onset to guide occipital and cervical fixation, or navigation placed at case onset to guide cervical screw placement alone before occipital fixation. We describe a novel technique for navigated occipitocervical fusion and analyze short-term outcomes in a pediatric case series. METHODS: We describe a novel technique for occipitocervical fusion using intraoperative navigation with the reference array attached to the occipital plate after occipital plate fixation, before distal instrumentation. Navigation was used for subaxial fixation only, and not for occipital fixation. A retrospective review of cases treated with this technique was conducted to summarize patient and surgical variables. RESULTS: Three pediatric (median; 4 y) patients underwent occipitocervical fusion using the described technique. There were no intraoperative complications related to navigation, including the need for repeat spin, movement of the array, inaccurate navigation, or loss of navigation. There were no intraoperative complications related to occipital fixation, including dural leak, venous sinus penetration, or dislodgement of instrumentation. CONCLUSIONS: This technique is successful in obtaining occipitocervical fusion in complex patients, with no navigation-related or fixation-related complications in the intraoperative or postoperative period. This technique has the potential to reduce operative time and navigation-related complications, as well as improve patient safety and construct alignment. LEVEL OF EVIDENCE: Level IV.
Journal of pediatric urologyLai Van Chu, Quynh Thi Vu Huynh, Thach Ngoc Pham, Ho Tran Ban
BACKGROUND: The transscrotal approach has been considered a promising alternative for the management of palpable undescended testes in children; however, it has not been widely adopted. One major concern is whether this approach provides sufficient cord length to allow tension-free descent of the testis into the scrotum. This study aimed to evaluate the cord-lengthening efficacy of the transscrotal approach by comparing the pubo-testicular distance after high ligation of the patent processus vaginalis (PTd1) with the pubo-scrotal distance (PSd) in children with low palpable undescended testes. METHODS: This prospective longitudinal study included patients with low palpable undescended testes who underwent orchidopexy via the transscrotal approach from October 2022 to February 2023 at Children's Hospital 2, Ho Chi Minh City, Vietnam. Variables recorded included PSd, PTd1, preoperative testicular position, clinical inguinal hernia, presence of a patent processus vaginalis (PPV), level of PPV ligation, operative time, and surgical success indicators. RESULTS: A total of 53 undescended testes in 47 patients were included, with a median age of 24 months (IQR 14-45) and a median follow-up of 33 months (IQR 31.5-34). PTd1 was greater than PSd in 98 % of cases (6.2 ± 1.0 cm vs. 5.3 ± 0.7 cm; 95 % CI: 0.7-1.1; p < 0.05). There was no difference in PTd1 between inguinal and extra-inguinal testes (6.2 ± 0.9 cm vs. 6.2 ± 1.0 cm; 95 % CI: -0.6 to 0.7; p = 0.9). High ligation of the PPV near the internal ring was achieved in 88 % of cases, providing an average gain of 2.8 ± 1.3 cm in cord length. Postoperative testicular volume increased significantly compared to preoperative measurements [301 mm3 (IQR 204.7-354.3) vs. 224.6 mm3 (IQR 143-338.2); p < 0.05]. The overall success rate was 98 %. CONCLUSION: In cases of low palpable undescended testes, the transscrotal approach consistently provides adequate cord length for tension-free testicular descent after high PPV ligation. Moreover, this approach enables high ligation of the PPV near the internal inguinal ring in the majority of cases.