Characterization of natural killer and natural killer-like T cells derived from ex vivo expanded and activated cord blood mononuclear cells: implications for adoptive cellular immunotherapy.

Objective: Cord blood (CB) is limited by the absence of available donor effector cells for post-unrelated CB transplantation adoptive cellular immunotherapy. We reported the ability to ex vivo expand (EvE) CB mononuclear cells (MNC) after short-term incubation with anti-CD3, interleukin (IL)-2, IL-7, and IL-12 (antibody/cytokine [AB/CY]) into subpopulations of CD3(-)/56(+) natural killer (NK) cells with enhanced in vitro and in vivo tumor cytotoxicity.

Materials And Methods: We compared 2- vs 7-day EvE of rethawed CB MNCs in AB/CY and activation of NK and NK-like T (NKT) cell (CD3(+)/56(+)) subsets expressing specific NK-cell receptors along with IL-15, IL-18, and interferon-gamma production.

Gastric tube-pericardial fistula: a remote complication of esophageal replacement for long gap esophageal atresia.

Several short and long-term complications of esophageal replacement have been described in the literature. We report the case of a gastric tube-pericardial fistula occurring 20 years after initial repair of long gap esophageal atresia with a reversed gastric tube.

Parental presence on pediatric intensive care unit rounds.

Objective: To comprehensively evaluate the effect of parental presence on pediatric intensive care unit rounds.

Study Design: A prospective, observational and survey-based study comprised of (1) observation of rounds (2) "rounding event assessments" (brief surveys specific to 1 rounding event, completed by health care providers [HCPs] n = 375) (3) qualitative interviews with parents (36 who joined rounds and 16 who elected not to join), and (4) qualitative written surveys from HCPs (63 nurses, 39 doctors).

Results: Eighty-one percent of parents who chose to join rounds reported that participation increased their overall satisfaction with their child's care.

Multivariate model for predicting recurrence in congenital diaphragmatic hernia.

Purpose: Risk factors that predispose children with congenital diaphragmatic hernia (CDH) to recurrence remain poorly defined. We report a large series of recurrent CDH and ask whether prenatal patient factors or postnatal treatment variables better predict recurrence.

Methods: Two hundred thirty-eight neonates with unilateral CDH underwent repair from 1990 to 2006.

Respiratory microbiology of patients with cystic fibrosis in the United States, 1995 to 2005.

Background: Numerous improvements in diagnostic and therapeutic strategies for patients with cystic fibrosis (CF) have occurred during the past 2 decades. We hypothesized that these changes could impact trends in respiratory microbiology.

Methods: Data from the Cystic Fibrosis Foundation Patient Registry were used to examine trends in the incidence and prevalence of bacterial pathogens isolated from patients with CF in the United States from 1995 to 2005.

Comparison of fluconazole and nystatin oral suspensions for prophylaxis of systemic fungal infection in very low birthweight infants.

We compared the efficacy and safety of fluconazole and nystatin oral suspensions for the prevention of systemic fungal infection (SFI) in very low birthweight infants. A prospective, randomized clinical trial was conducted over a 15-month period, from May 1997 through September 1998, in 80 preterm infants with birthweights <1500 g. The infants were randomly assigned to receive oral fluconazole or nystatin, beginning within the first week of life.

A practical algorithm for accurate diagnosis and treatment of perinatally identified biliary ductal dilation: three cases that underscore the importance of an individualised approach.

Choledochal cysts (CDCs) identified during the prenatal or immediate postnatal period are unusual with a majority being identified in older children and adults. Although authors advocate surgical resection of these presumed CDCs with reconstruction, there has been no agreement on the optimal timing of such an intervention when the initial diagnosis of CDC is made prenatally or during the newborn period. We present the cases of three children with biliary ductal dilation who were presumed to have CDC by ultrasound and/or magnetic resonance imaging during the perinatal period and who ultimately required different approaches to treatment.

Nonneurogenic voiding disorders: what's new?

Purpose Of Review: Increased interest in pediatric nonneurogenic voiding disorders (NNVDs), urodynamic testing and therapeutic options make this a timely topic for review.

Recent Findings: The major themes covered this year included diagnosis of NNVD by symptomatology and relationship to subsequent urodynamic findings and treatment outcomes; effect of bladder volumes and overdistention, test position, catheter size, catheter in or out during voiding and sex on flow rate, flow pattern, voiding pressures, presence of overactivity and interpretation of findings on both urodynamic studies and uroflow testing; associations between bowel disorders (constipation and encopresis) and NNVD, associations between behavioral disorders and bowel disorders as reflected by treatment response and effect on behavior; efficacy studies on symptom-directed therapies in NNVD, comparison of different biofeedback programs for treating dysfunctional voiding, Botox injections for overactive bladder and an adult anticholinergic for overactive bladder that underwent testing in children; enuresis topics included anticholinergics for treating monosyptomatic enuresis refractory to desmopressin, prevalence of enuresis when screening large numbers of healthy school-age children and its association with certain family characteristics and other bowel and bladder complaints and an update on the association of fluctuation of vasopressin and nightly urine output and its role in patient selection for desmopressin therapy.

Summary: While some studies simply validated the past work of others, there were several that dispelled beliefs by demonstrating the inaccuracy of predicting voiding disorders on the basis of uroflow alone or the minimal effect of catheter and test position on urodynamic results; behavior disorders require special care but are not an impediment to successful treatment.

Recipient genotype is a predictor of allograft cytokine expression and outcomes after pediatric cardiac transplantation.

Objectives: This study sought to investigate the influence of recipient renin-angiotensin-aldosterone system (RAAS) genotype on cardiac function, rejection, and outcomes after heart transplantation.

Background: The RAAS influences cardiac function and up-regulates inflammatory/immune pathways. Little is known about the effect of recipient RAAS polymorphisms in pediatric cardiac transplantation.

Iatrogenic esophageal perforation in children.

Esophageal perforation is most commonly iatrogenic in origin with nasogastric tube insertion, stricture dilation, and endotracheal intubation, being the most frequent sources of the injury in infants and children. Clinical presentation depends on whether the cervical, thoracic, or abdominal esophagus is injured. Any patient complaining of chest pain after an upper endoscopy has esophageal perforation until proven otherwise.

Peak retrograde flow: a novel predictor of persistent, progressive and new onset asymmetry in adolescent varicocele.

Purpose: The major indication for adolescent left varicocelectomy is testicular asymmetry. However, a period of observation is often recommended preoperatively to determine if the asymmetry resolves, persists or progresses. We investigated whether varicocele grade or the duplex Doppler ultrasound measurements of peak retrograde flow and mean vein diameter could be used as predictors of persistent, progressive or new onset asymmetry.

Noninvasive ventilation during pediatric interhospital ground transport.

Objective: We report our use of noninvasive ventilation (NIV) during pediatric interhospital ground transport.

Methods: We retrospectively reviewed transport and hospital records for nonneonatal patients View Article and Find Full Text PDF

Reference range of urinary neutrophil gelatinase-associated lipocalin in very low-birth-weight infants: preliminary data.

We sought to determine the reference range for urinary neutrophil gelatinase-associated lipocalin (UNGAL) in very low-birth-weight (VLBW) infants with uncomplicated clinical courses. Samples of urine from 53 VLBW infants between 3 and 28 days of life were prospectively collected weekly for measurement of UNGAL. A subset of 22 infants with uncomplicated medical courses without risk factors for renal impairment was selected for study.

Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management.

The complex and sometimes controversial subject of malrotation and midgut volvulus is reviewed commencing with the 19th-century Bohemian anatomist, Václav Treitz, who described the suspensory muscle anchoring of the duodenal-jejunal junction in the left upper quadrant, and continuing with William Ladd, the 20th-century American "father of pediatric surgery" who pioneered the surgical treatment of midgut volvulus. In this review, we present the interesting history of malrotation and discuss the current radiologic and surgical controversies surrounding its diagnosis and treatment. In the symptomatic patient with malrotation and possible midgut volvulus, prompt diagnosis is critical.

Percutaneous distal perfusion of the lower extremity after femoral cannulation for venoarterial extracorporeal membrane oxygenation in a small child.

Femoral cannulation in pediatric patients requiring extracorporeal membrane oxygenation (ECMO) is commonly associated with distal limb ischemia. Authors have previously reported successful lower limb perfusion using various open techniques to cannulate a distal lower extremity artery at the time of initial ECMO cannulation. These procedures include open femoral artery antegrade cannulation and distal posterior tibial artery retrograde cannulation in older children and adults.

Surgical correction of pectus excavatum.

Pectus deformities arise from overgrowth of the cartilagenous portion of the ribs. Traditional resective/open procedures have been almost entirely replaced by video assisted retrosternal bar placement with excellent outcomes. This review considers the comprehensive evaluation and care of a pectus patinet as well as technical details regarding conduct of the surgery.

Neurocognitive impairment in children and adolescents with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, in which neuropsychiatric manifestations are a common cause of significant morbidity. The American College of Rheumatology has identified 19 distinct neuropsychiatric syndromes associated with SLE, although the 1982 American College of Rheumatology classification criteria for SLE recognize only two: seizures and psychosis. Neurocognitive impairment (NCI) is one of the most common and clinically challenging manifestations of SLE, but its pathophysiology remains poorly understood.

Neonatal outcomes associated with intestinal abnormalities diagnosed by fetal ultrasound.

Purpose: Intestinal abnormalities are sometimes seen during antenatal testing; however, the postnatal importance of these findings has not been well established. We evaluated whether abnormal intestinal appearance on fetal ultrasound (US) was ultimately related to neonatal outcome.

Methods: Fetal US examinations from 2003 to 2006 were evaluated.

Adolescent varicocelectomy--is the potential for catch-up growth related to age and/or Tanner stage?

Purpose: Adolescent varicocelectomy is associated with a 70% incidence of postoperative catch-up growth in boys with ipsilateral testicular hypotrophy. We determined whether preoperative patient age and Tanner stage were related to subsequent catch-up growth. In other words if patients are followed with a period of observation, will a window of opportunity be lost for achieving catch-up growth?

Materials And Methods: We studied a total of 163 boys (mean age 15.

Right ventricle in congenital heart disease: is it just a "weaker" left ventricle?

The RV is the dominant ventricle during fetal life. Postnatally, the RV rapidly loses its ability to sustain systemic load. In several forms of congenital heart disease, the RV is the dominant or systemic ventricle.

Button-loop feeding jejunostomy.

Introduction: Post-pyloric feeding via a surgical jejunostomy allows for enteral nutrition in patients that cannot receive oral or gastric feeding. Regardless of the technique used to create a jejunostomy, complications such as tube dislodgement, jejunostomy closure, or bowel obstruction can occur.

Surgical Technique: We present a simple and efficient jejunostomy technique that does not require a sewn anastomosis and employs an easily exchangeable feeding button.

Total body bone measurements: a cross-sectional study in children with acute lymphoblastic leukemia during and following completion of therapy.

Background: Abnormalities in bone mineral density (BMD) occur in children treated for acute lymphoblastic leukemia (ALL). However, BMD estimates have been performed using varied instruments, reference data, and interpretations. This exploratory cross sectional study to evaluate bone mass in children with ALL, uses an algorithm that serially adjusts for variables known to affect pediatric bone measures by dual energy X-ray absorptiometry (DXA), based on models developed in 1,218 healthy children and adolescents.

Adolescent varicocelectomy: postoperative catch-up growth is not secondary to lymphatic ligation.

Purpose: The major indication for adolescent varicocelectomy is testicular asymmetry with the left testicle smaller than the right. Catch-up growth following surgery is one of the parameters used to assess efficacy of surgery. However, it is not clear whether this represents true tissue growth or increased interstitial fluid secondary to lymphatic obstruction.