Benign Multicystic Peritoneal Mesothelioma Presenting as a Colonic Mass.

Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum).

How Safe Is the Safety Net? Comparison of Ivor-Lewis Esophagectomy at a Safety-Net Hospital Using the NSQIP Database.

Background: Recent data suggest that surgical outcomes at hospitals caring for low-income, vulnerable populations are suboptimal compared with outcomes from nonsafety-net hospitals. Therefore, the purpose of our study was to compare outcomes for patients who underwent an Ivor-Lewis esophagectomy at a safety-net hospital with the National Surgical Quality Improvement Program (NSQIP) database.

Study Design: We retrospectively reviewed the medical records of consecutive patients who underwent an Ivor-Lewis esophagectomy, between September 2013 and January 2017, at a single safety-net hospital.

Operative wound classification: an inaccurate measure of pediatric surgical morbidity.

Background: Wound classification has catapulted to the forefront of surgical literature and quality care discussions. However, it has not been validated in laparoscopy or children. We analyzed pediatric infection rates based on wound classification and reviewed the most common noninfectious complications which could be a more appropriate measure for quality assessment.

Pelvic Angiography for Trauma in Children: A Rare but Useful Adjunct.

 Pelvic angiography with embolization can successfully control hemorrhage in adults with pelvic fractures. However, evidence to support similar application in children is sparse. We describe our experience using angiography for pediatric pelvic fractures to further highlight the safety and efficacy of this treatment approach.

The impact of developing a pectus center for chest wall deformities.

Purpose: In 2011, we established a dedicated center for patients with chest wall deformities. Here, we evaluate the center's effect on patient volume and management.

Methods: A retrospective review of 699 patients with chest wall anomalies was performed.

Effect of timing of cannulation on outcome for pediatric extracorporeal life support.

Purpose: Literature reports worse outcomes for operations performed during off-hours. As this has not been studied in pediatric extracorporeal life support (ECLS), we compared complications based on the timing of cannulation..

Chest radiograph after fluoroscopic guided line placement: No longer necessary.

Purpose: Historically, a chest radiograph was obtained after central line placement in the operating room. Recent retrospective studies have questioned the need for this radiograph. The prevailing current practice at our center is to order chest radiograph only for symptomatic patients.

Understanding parental refusal of permission for child participation in surgical prospective trials.

Purpose: The success of prospective randomized trials relies on voluntary participation, which has been perceived as a barrier for successful trials in children who rely on parental permission. We sought to identify the reasons parents decline child participation to understand potential limitations in the consent process.

Methods: A prospective observational study was conducted in 92 patients asked to participate in prospective randomized trials between 2012 and 2015.

Optimizing fluid resuscitation in hypertrophic pyloric stenosis.

Background: Hypertrophic pyloric stenosis (HPS) is the most common diagnosis requiring surgery in infants. Electrolytes are used as a marker of resuscitation for these patients prior to general anesthesia induction. Often multiple fluid boluses and electrolyte panels are needed, delaying operative intervention.

Transition of Techniques to Treat Choledochal Cysts in Children.

Introduction: Traditionally open resection with hepaticojejunostomy (HJ) reconstruction has been the surgical treatment for cases of choledochal cyst. Our center has recently transitioned from open to laparoscopic and HJ to hepaticoduodenostomy (HD) as our preferred method of excision and biliary reconstruction. Our initial experience is presented here.

Inflammatory myofibroblastic tumors in children.

Background: Inflammatory myofibroblastic tumor (IMFT) is an uncommon neoplasm in children.

Methods: Retrospective review from 1993 to 2014 of patients ≤18years of age with a histopathologic diagnosis of IMFT treated at two tertiary centers.

Results: Thirty-two patients were diagnosed with IMFT.

Review of the Experience with Re-Operation After Laparoscopic Nissen Fundoplication.

Introduction: The risk of redo fundoplication has been demonstrated to be significantly higher in patients of younger age, those with ongoing retching, and those who underwent more extensive dissection of the esophageal hiatus at the initial operation. The purpose of this study was to review the management and outcomes of patients who required one or more re-operations for recurrence after laparoscopic fundoplication.

Materials And Methods: After obtaining Institutional Review Board approval, we performed a retrospective review of all patients who underwent laparoscopic Nissen fundoplication from 2000 to 2013 and subsequently required a redo operation for recurrence.

The anatomic findings during operative exploration for non-palpable testes: A prospective evaluation.

Background: We conducted a randomized trial comparing 1 and 2-stage laparoscopic orchiopexy for intra-abdominal testes. During recruitment, it became apparent that most patients with non-palpable testes do not require vascular division. In this report, we outline the location and quality of testes found during operative exploration in patients who consented for the study but were not randomized.

Utility of Preoperative Upper Gastrointestinal Series in Laparoscopic Gastrostomy Tube Placement.

Introduction: An upper gastrointestinal (UGI) series is a standard preoperative test for patients being evaluated for gastrostomy tube placement. We have recently begun to question the value of the radiation-exposing series in patients who tolerate gastric feeds.

Materials And Methods: A retrospective review was conducted in patients who underwent laparoscopic gastrostomy tube placement between 2000 and 2012.

Pectus excavatum: Benefit of randomization.

Background: Minimally invasive bar repair for pectus patients produces substantial pain which dictates the post-operative hospital course. We have data from 2 randomized trials comparing epidural catheter placement to patient controlled analgesia. The purpose of this study was to compare the outcomes of patients who were enrolled in the trials to those that did not participate in the trials.

Epidural versus Patient-Controlled Analgesia after Pediatric Thoracotomy for Malignancy: A Preliminary Review.

Introduction The use of thoracic epidural is standard in adult thoracotomy patients facilitating earlier mobilization, deep breathing, and minimizing narcotic effects. However, a recent randomized trial in pediatric patients who undergo repair of pectus excavatum suggests patient-controlled analgesia (PCA) produces a less costly, minimally invasive postoperative course compared with epidural. Given that thoracotomy is typically less painful than pectus bar placement, we compared the outcomes of epidural to PCA for pain management after pediatric thoracotomy.

Antibiotic utilization based on primary treatment of pediatric empyema.

Background: Chemical fibrinolysis has been shown to be as effective as surgical debridement for the treatment of pediatric empyema. However, no studies effectively evaluate antibiotic treatment. We evaluated antibiotic utilization among different treatments of pediatric empyema.

Same day discharge after laparoscopic cholecystectomy in children.

Background: Although the safety of same day discharge (SDD) after laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis (SC) and biliary dyskinesia (BD) in adults has been well documented in the literature, the same data in the pediatric population are lacking. We have recently instituted a protocol for SDD after LC for SC and BD, and this study is an analysis of our initial experience.

Methods: A retrospective chart review of all patients who underwent LC for BD and SC in our institution from January 2011-July 2014 was performed.

Hemorrhagic Shock.

Hemorrhagic shock has been studied extensively in the adult population, but evidence is lacking in the pediatric population. Unlike adults, pediatric patients tolerate hypovolemia with less hypotension until they have reached significant blood volume loss. It is imperative they receive prompt intravenous access, crystalloid resuscitation, followed by blood product transfusion.

Case report: delayed perforation after definitive treatment of focal intestinal perforation with a peritoneal drain.

Focal intestinal perforation (FIP) has long been described in the pediatric literature. Peritoneal drainage (PD) is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP.

Synthesis of a peptidocalix[4]arene library and identification of compounds with hydrolytic activity.

A 120 member library of peptidocalix[4]arenes was synthesized and screened for catalysis of the hydrolysis of p-nitrophenyl acetate. His-Ser-His-calix[4]arene was found to catalyze this reaction with v(0)=3.24 x 10(-8)M/s, an increase of 1520% above background and 30% above the tripeptide (His-Ser-His) alone.