Outcomes of arterial vascular extremity trauma in pediatric patients.

Background: Vascular trauma in children, although rare, carries significant risk for repair. Here we report outcomes from a single trauma center for children with extremity vascular trauma, proximal to the digits.

Methods: Retrospective chart review of patients less than age 18years with an acute, non-iatrogenic traumatic arterial vascular injury of the upper and/or lower extremity between January 2008 and December 2013.

Outcomes of digital artery revascularization in pediatric trauma.

Background: Digit amputation is rare in pediatric trauma but can lead to functional morbidity. The true incidence of digital arterial injury is lacking in the literature, and revascularization techniques are not well-described.

Methods: Retrospective review of a pediatric trauma registry identified patients with a digital artery injury between July 2008 and December 2013.

Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee.

Objective: Variable management practices complicate the identification of optimal strategies for infants with congenital diaphragmatic hernia (CDH). This review critically appraises the available evidence to provide recommendations.

Methods: Six questions regarding CDH management were generated.

Asymptomatic malrotation: Diagnosis and surgical management: An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review.

Objective: Patients with malrotation, or an intestinal rotation abnormality (IRA), can experience serious adverse events. Increasingly, asymptomatic patients are being diagnosed with malrotation incidentally. Patients with symptomatic malrotation require surgery in an urgent or semiurgent manner to address their symptoms.

Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children.

Background: There are no published management schemes for blunt renal injuries. We are conducting a 2-center prospective observational study with a fixed management scheme.

Methods: Children with CT proven renal injuries were enrolled with permission.

OHVIRA with a twist: obstructed hemivagina ipsilateral renal anomaly with urogenital sinus in 2 patients.

Background: OHVIRA syndrome is a rare diagnosis involving the triad of obstructed hemivagina, uterine anomaly, and ipsilateral renal anomaly. OHVIRA syndrome can be associated with other anomalies due to abnormal embryologic development of the urogenital system.

Cases: A 14-year-old female with known left renal agenesis, long-standing urinary incontinence, and history of recurrent urinary tract infections presented with abdominal distention.

Laparoscopic adrenalectomy in children: a multicenter experience.

Introduction: Laparoscopic adrenalectomy is now being recognized as the standard approach for adrenalectomy for benign lesions in adults. The published experience in children and adolescents has been limited to sporadic small case series. Therefore, we conducted a large multicenter review of children who have undergone laparoscopic adrenalectomy.

Umbilical venous catheter complication in an infant with left-sided congenital diaphragmatic hernia: extravasation owing to hepatic vein catheterization.

Infants with left-sided congenital diaphragmatic hernia (CDH) are subject to possible intrahepatic placement of the umbilical venous catheter (UVC) during catheterization. A left-sided CDH containing the left lobe of the liver is subject to repositioned anatomy of the umbilical vein, ductus venosus, and hepatic vasculature. This substantially increases the risk of incidentally cannulating the shifted intrahepatic vessels of the liver when placing a UVC.

Two-stage basilic vein transposition-a new approach for pediatric dialysis access.

Purpose: The fistula first initiative has led to increased efforts to create arteriovenous fistulas (AVFs) as primary dialysis access. Two-stage basilic vein transposition (BVT) allows maturation of smaller veins, often a limiting factor in the pediatric population, before elevation and use. We sought to determine whether using 2-stage BVT improves maturation, use, and patency compared with other AVFs, including arteriovenous (AV) grafts.

Islet hypertrophy following pancreatic disruption of Smad4 signaling.

To investigate the role of transforming growth factor (TGF)-beta family signaling in the adult pancreas, a transgenic mouse (E-dnSmad4) was created that expresses a dominant-negative Smad4 protein driven by a fragment of the elastase promoter. Although E-dnSmad4 mice have normal growth, pancreas weight, and pancreatic exocrine and ductal histology, beginning at 4-6 wk of age, E-dnSmad4 mice show an age-dependent increase in the size of islets. In parallel, an expanded population of replicating cells expressing the E-dnSmad4 transgene is found in the stroma between the enlarged islets and pancreatic ducts.

Bilateral giant abdominoscrotal hydroceles complicated by appendicitis.

Abdominoscrotal hydrocele is a rare entity, with fewer than 100 cases reported in children. Bilateral abdominoscrotal hydroceles are even less common, with 14 cases reported in children. Various complications of abdominoscrotal hydrocele have been reported in the literature.

Increased MMP-9 expression and activity by aortic smooth muscle cells after nitric oxide synthase inhibition is associated with increased nuclear factor-kappaB and activator protein-1 activity.

Objective: To determine the mechanism underlying increased expression and activity of matrix metalloproteinase 9 (MMP-9) by rat aortic smooth muscle cells (RA-SMC) after inhibition of inducible nitric oxide synthase (iNOS).

Methods And Results: Treatment of interleukin-1beta-stimulated RA-SMC with aminoguanidine led to an increase of 96% in MMP-9 activity (P = 0.003) by gelatin zymography, a 40% increase in pro-MMP-9 protein (P = 0.

Carotid embolectomy in the treatment of a paradoxical embolus.

Development of a paradoxical embolus to the carotid circulation through a patent foramen ovale is uncommon but well documented. Previous surgical experience with this entity is limited. Treatment for this condition typically involves anticoagulation or the use of an inferior vena cava filter with concurrent closure of the patent foramen itself.

Vaginal reconstruction for ambiguous genitalia and congenital absence of the vagina: a 27-year experience.

Background/purpose: Gender assignment to a neonate with ambiguous genitalia is crucial. Patients with an absent vagina require the construction of an artificial vagina. In an effort to improve care, the authors have categorized their experience with this group of children.