Management of complicated biliary disease in the pediatric population.

Background: Cholesterol stones and biliary dyskinesia have replaced hemolytic disease as the primary indication for pediatric cholecystectomy. This study looks at the cohort of pediatric patients with complicated biliary disease, defined as choledocholithiasis and/or gallstone pancreatitis, to determine the incidence and best treatment options.

Methods: A retrospective review of all cholecystectomies performed over 15 years admitted to the surgical service at a single free-standing children's hospital was performed.

Radiographic Determination of Skeletal Maturity Guides Optimal Timing of Bar Removal After Minimally Invasive Repair of Pectus Excavatum.

Background: A small number of patients treated with minimally invasive correction of pectus excavatum recur after bar removal. This risk appears to be greater in younger children who continue to grow following bar removal.

Methods: We propose the use of wrist films to determine skeletal maturity and delay bar removal until it is completed.

Results of pectus excavatum correction using a minimally invasive approach with subxyphoid incision and three-point fixation.

Objectives: This study reviews the results of our previously described modification of the minimally invasive (Nuss) procedure for correction of pectus excavatum. It utilizes a subxyphoid incision with central fixation to maximize safe bar passage and minimize bar displacement.

Methods: Consecutive patients corrected with the modified Nuss procedure between 2010 and 2015 form the basis of this study.

Etiology and incidence of pediatric gallbladder disease.

Purpose: The spectrum of pediatric biliary tract disease is changing. The goal of this study was to examine the causes and comorbidities of pediatric gallbladder disease at our institution.

Methods: We performed a retrospective chart review on consecutive patient at Kosair Children's Hospital who underwent cholecystectomy over a 9-year time period ending in 2012.

Recurrent neutropenic enterocolitis in a pediatric patient.

Management of an 8-year-old boy with Hodgkin lymphoma is presented. The patient had several recurrences of neutropenic enterocolitis and eventually required ileocecectomy. A review of the literature on this difficult problem affecting pediatric oncology patients is presented.

Diverticulitis in a child with Williams syndrome: a case report and review of the literature.

Diverticulitis is rare in pediatric patients and often associated with a more complicated course than that seen with adult patients. Certain syndromes, such as Williams syndrome, have been associated with an increase incidence of diverticular disease. We describe a 9-year-old boy with Williams syndrome who presented with rectal bleeding secondary to sigmoid diverticulitis.

Lateral pediatric ectopic thyroid.

We present a case of a left-sided neck mass in an 8-year-old female that proved to be ectopic thyroid tissue. After excision, this patient continues to do well and is euthyroid without recurrence after 8-year follow-up. This is a very rare anomaly in a child, especially in conjunction with a normally located thyroid that is functional.

Gastric trichobezoar: abdominal mass in a child with sickle cell disease.

Abdominal pain is a frequent occurrence among the pediatric population and can be a diagnostic challenge. Trichobezoar is a differential diagnosis that is often neglected. Different from previously reported cases, we present a 3-year-old girl with sickle cell disease with complaints of acute abdominal pain, suspecting sickle cell splenic sequestration.

Laparoscopic Ladd procedure: a minimally invasive approach to malrotation without midgut volvulus.

The management of intestinal malrotation without midgut volvulus is controversial. Some advocate the Ladd procedure in all patients with malrotation, whereas others propose a more selective approach. We attempted the laparoscopic Ladd procedure on nine patients who were diagnosed with intestinal malrotation without volvulus.

Undescended ovaries: a clinical review.

Undescended ovaries are frequently seen in conjunction with uterine malformations and are typically found during the course of an infertility evaluation. Other important clinical signs may prompt evaluation in an adolescent patient, though this may also be an incidental finding. An understanding of embryologic features is critical for management.

Hirschsprung's disease in an infant with colonic atresia and normal fixation of the distal colon.

The coexistence of colonic atresia and Hirschsprung's disease presents a diagnostic and therapeutic challenge. Colonic atresia is quickly recognized, and the majority of patients are diverted shortly after birth. The diagnosis of coincident Hirschsprung's disease usually is made after anastomotic failure after restoration of intestinal continuity.

Primitive neuroectodermal tumor of the sternum in a child: resection and reconstruction.

Pediatric primary malignancies of the sternum are rare. They represent less than 1% of all bone tumors. Primitive neuroectodermal tumor of the chest wall or Askin's tumor is more often seen in the ribs than in the sternum.

Müllerian agenesis and ovarian torsion. A case report and review of literature.

A case report of a premenarcheal patient with an ovarian torsion and müllerian agenesis is presented. An 11-year-old prepubertal girl presented with severe left lower quadrant abdominal pain and mild rebound. A computed tomography showed a normal appendix; an ultrasound showed a left ovary measuring 3 x 2 cm with multiple 0.

University of Louisville experience and contributions to pediatric trauma care.

Care of the injured patient has been a focal point of surgical training at the University of Louisville. Under the direction of Dr. Hiram C.

Cathlink 20: a subcutaneous implanted central venous access device used in children with sickle cell disease on long-term erythrocytapheresis--a report of low complication rates.

Background: Experience with the use of central venous access device (CVAD) in children with sickle cell disease (SCD) on hypertransfusion is limited and published studies report wide variability in the rates of CVAD-associated complications.

Procedure: In this study, a total of 18 Cathlink 20 ports (Bard Access systems, Salt Lake City, UT) were implanted in 15 patients aged 7-20 years with SCD for 19, 230 catheter patient days.

Results: No peri-operative complications were observed.

Ruptured hemorrhagic cyst in an undescended ovary.

The authors report on a patient with an uncommon congenital anomaly of bilateral undescended ovaries and tubes. She presented with an acute abdomen at 13 years of age. A computed tomography scan showed a cystic mass suspicious for congenital intestinal duplication.

Sentinel lymph node biopsy in juvenile secretory carcinoma.

A 9-year-old girl presented with a 3-year history of a right breast mass. Excisional biopsy showed a secretory carcinoma. A treatment plan of simple mastectomy and axillary sentinel lymph node biopsy was chosen.

The effects of a broad-spectrum matrix metalloproteinase inhibitor on characteristics of wound healing.

This study investigates the effects of a broad-spectrum matrix metalloproteinase inhibitor (MMP-i) on the rate of closure, hydroxyproline deposition, and macrophage infiltration in healing wounds. Full-thickness excisional wounds were created on the dorsal surface of hairless mice. Two experimental groups were used to measure rates of wound closure: (a) MMP-i administration (0.