Miami, FL
Nov. 22, 2017
Volume VIII |  Issue No. 47

Laparoscopic pediatric inguinal hernia repair
Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children". The efficacy of laparoscopic repair in infants/children is apparently still being debated. Many techniques exist.
A prospective, randomized controlled, study of laparoscopic repair in 132 male patients (6 months - 3 years) with bilateral congenital inguinal hernia (CHI) compared laparoscopic ligation of the hernia sac at the internal inguinal ring (IIR) to disconnection of the hernia sac and suture of the proximal part at IIR.

Laparoscopic inguinal hernia repair by disconnection of the hernial sac at the IIR with peritoneal closure appears feasible, safe and has a lower recurrence rate than when the sac is left intact.

Comparison of the Nuss vs. Ravitch procedure for Pectus Excavatum (PE) repair
PE is thought to result from an abnormal overgrowth of cartilage adjacent to the sternum which displaces the sternum posteriorly. Most appear to be idiopathic in origin and 37% have a familial inheritance. The deformity wile diagnosed at birth may become more pronounced during adolescent growth.

Two surgical procedures are commonly utilized; the Ravitch surgical approach removes the abnormal cartilage preserving the perichondrium to allow for normal cartilage regrowth, and the Nuss procedure which is a minimally invasive technique involving internal bracing without cartilage resection.

An analysis from multiple databases comparing Nuss to Ravitch procedures for PE reveals that the Nuss procedure has significantly shorter operative time and less blood loss (though post-operative hospitalization times are similar).

Predicted value of procalcitonin (PCT) for intestinal ischemia and/or necrosis in adhesive small bowel obstruction (ASBO)
A prospective cohort of 47 children with ASBO medically (32%) or surgically (68%) managed with postoperative adhesive small bowel obstruction evaluated PCT level as a predictor of intestinal ischemia or necrosis.

PCT levels closely correlate to the presence of intestinal ischemia and necrosis in children with ASBO.

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Childhood asthma: Mode and type of infant feeding  
Data from 3,296 children from a longitudinal study was assessed to examine the association between different modes of infant feeding at age 3 months and the presence of asthma at 3 years.

At 3 years of age 12% of children are diagnosed with possible or probably asthma. Any mode other than direct breastfeeding (i.e. breast feeding with expressed breast milk, breast milk and formula or formula alone) is associated with an increased risk of asthma.

Childhood hoverboard injuries 
Hoverboards (a self-balancing two-wheel board, and self-balancing electric scooters) are increasingly being reported as causing injuries in children/adolescents in spite of their danger being publicized and guidance for their use being available. Injuries have resulted from falls, collisions, finger entrapment and smoke inhalation.

"Hoverboards pose a significant risk of musculoskeletal injuries to pediatric riders". A prospective study of injuries revealed that most involve the upper (predominantly) or lower extremity (similar to skate board injuries). Injuries in children occur in those who do not wear helmets or protective padding.

See related video HERE and HERE.
Long-term results after extensive soft tissue release in very severe congenital clubfeet 
While the Ponseti multiple casting system is the most frequently non-operative technique utilized for the management of idiopathic clubfoot, surgical soft tissue release of those structures that create the deforming forces is a common operative procedure for very severe congenital clubfeet.
A long-term study (following-up of 22 years) of 105 severe congenital idiopathic clubfeet treated with extensive soft tissue release in infancy evaluated pain and overall function of the lower extremities.
92% of post operative patients are satisfied, though no foot has excellent results (only 30% have a fair/good outcome) with female patients being less satisfied because of social constraints due mostly to calf atrophy.
Video Feature
Congenital Clubfoot
Congenital Clubfoot
Gene polymorphism and the severity of recurrent viral induced wheeze 
Viral induced wheezing commonly occurs in children <3 years of age and may recur with each viral infection potentially lasting many weeks. Many (>50%) will outgrow it by pre-school age though some may go on to develop asthma.

A study of 317 children (mean age: 21.5 months) examined the 16 single nucleotide polymorphisms (SNPs) linked to asthma or atopy and examined groupings associated with clinical presentation (phenotypes).

Of 3 phenotypes described ("Cluster 1: "nonatopic uncontrolled severe viral-induced wheezing"; Cluster 2: "multiple wheezing with multiple atopic allergic comorbidities" and Cluster 3: "mild episodic viral-induced wheeze"), the TT-genotype (homozygous/dominant) of IL-4 rs2070874 (Interkeukin-4 inflammatory cytokine - rs gene variant polymorphism) is the only one significantly associated with the Cluster 1 clinical presentation of non-atopic severe viral-induced wheezing indicating the importance of this group of cytokines in the mediation of the immune system's inflammatory response to viral infections.

Remote Controlled Transport Cars at Nicklaus Children's
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