Multicenter Assessment of Cryoanalgesia Use in Minimally Invasive Repair of Pectus Excavatum: A 20-center Retrospective Cohort Study.

Objective: To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE).

Background: MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct.

Retracing our STEPs: Four decades of progress in intestinal lengthening procedures for short bowel syndrome.

The surgical management of intestinal failure secondary to short bowel syndrome has undergone tremendous evolution in the last several decades. From the landmark description of an intestinal lengthening procedure by Bianchi in 1980 to the multidisciplinary modern care paradigm known as intestinal rehabilitation, innovative new treatments in this field have vastly improved patient outcomes. Initial attempts to treat short bowel syndrome surgically saw the birth of reversed intestinal segments, artificial valves and colonic transposition, all aimed at decreasing transit time and thus increasing absorption.

Antibiotic stewardship in the newborn surgical patient: A quality improvement project in the neonatal intensive care unit.

Background: There is significant diversity in the utilization of antibiotics for neonates undergoing surgical procedures. Our institution standardized antibiotic administration for surgical neonates, in which no empiric antibiotics were given to infants with surgical conditions postnatally, and antibiotics are given no more than 72 hours perioperatively.

Methods: We compared the time periods before and after implementation of antibiotic protocol in an institution review board-approved, retrospective review of neonates with congenital surgical conditions who underwent surgical correction within 30 days after birth.

Does the American College of Surgeons NSQIP-Pediatric Accurately Represent Overall Patient Outcomes?

Background: The National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) collects data for institutional quality benchmarking of surgery performed on children using a sampling algorithm. The Pediatric and Infant Case Log and Outcomes (PICaLO) is a database of all general and thoracic pediatric surgery (GTPS) procedures performed at our institution with the attendant complications. This study compared postsurgical occurrences in a NSQIP-P sample with all postoperative occurrences at a single institution to test the hypothesis that a sample of higher risk procedures represents the actual event rate for all higher risk procedures.

Neuronal serotonin regulates growth of the intestinal mucosa in mice.

Background & Aims: The enteric abundance of serotonin (5-HT), its ability to promote proliferation of neural precursors, and reports that 5-HT antagonists affect crypt epithelial proliferation led us to investigate whether 5-HT affects growth and maintenance of the intestinal mucosa in mice.

Methods: cMice that lack the serotonin re-uptake transporter (SERTKO mice) and wild-type mice were given injections of selective serotonin re-uptake inhibitors (gain-of-function models). We also analyzed mice that lack tryptophan hydroxylase-1 (TPH1KO mice, which lack mucosal but not neuronal 5-HT) and mice deficient in tryptophan hydroxylase-2 (TPH2KO mice, which lack neuronal but not mucosal 5-HT) (loss-of-function models).

The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) support is often used to support infants and children with hemodynamic or respiratory failure. One of the major obstacles of safely treating a child with ECMO is balancing the risk of hemorrhage with the potential for thrombus development. Managing thrombosis in the setting of ECMO is challenging and has no defined algorithm.

Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study.

Introduction: Experience in thoracoscopic congenital diaphragmatic hernia (CDH) repair has expanded, yet efficacy equal to that of open repair has not been demonstrated. In spite of reports suggesting higher recurrent hernia rates after thoracoscopic repair, this approach has widely been adopted into practice. We report a large, single institutional experience with thoracoscopic CDH repair with special attention to recurrent hernia rates.

Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem.

Purpose: Extracorporeal Life Support Organization Registry data confirm that the number of pediatric patients being supported by extracorporeal membrane oxygenation (ECMO) is increasing. To minimize the potential neurologic effects of carotid artery ligation, the common femoral artery (CFA) is frequently being used for arterial cannulation. The cannula has the potential for obstructing flow to the lower limb, thus increasing ischemia and possible limb loss.

Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction.

Purpose: There are numerous published reports of laparoscopic resection of choledochal cysts (CDCs), but almost all involve extracorporeal reconstruction of a biliary drainage system. We describe and evaluate the technique of laparoscopic CDC resection with total intracorporeal reconstruction.

Methods: We reviewed all patients who underwent a laparoscopic CDC resection from March 2005 to January 2010 at Rocky Mountain Children's Hospital and Children's Hospital of New York-Presbyterian.

The role of fiberoptic endoscopy in the evaluation and management of long gap isolated esophageal atresia.

Accurate measurement of gap length is useful for operative planning in cases of esophageal atresia (EA) without distal fistula. This paper demonstrates how fiberoptic endoscopy of the distal esophagus enables measurement of the gap in the case of isolated EA, and compares other commonly practiced techniques.

Post-appendectomy visits to the emergency department within the global period: a target for cost containment.

Background: Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost.

Hypothesis: Postoperative ED visits can be avoided.

Setting: Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine.

Fulminant pH1N1-09 influenza-associated myocarditis in pediatric patients.

Objective: To report an atypical presentation of pH1N1-09 influenza infection in children as fulminant myocarditis and tamponade and the successful treatment with extracorporeal membrane oxygenation.

Design: Case report.

Setting: Pediatric cardiac intensive care unit in a quarternary care children's hospital.

Spirometry testing standards in spinal cord injury.

Study Objectives: Because muscle paralysis makes it uncertain whether subjects with spinal cord injury (SCI) can perform spirometry in accordance with American Thoracic Society (ATS) standards, determinants of test failure were examined.

Design: Cross-sectional study.

Setting: Veterans Affairs (VA) medical center.