Adolescent varicocele: A large multicenter analysis of complications and recurrence in academic programs.

Objective: After varicocelectomy a wide range of recurrence rates have been reported from 0 to 18%, and rates of post-operative hydrocele formation between 0 and 29%. Controversy exists as to the appropriate approach for varicocele treatment, whether open, laparoscopic, or percutaneous embolization (PE) is best for young men. The literature on treatment of adolescent varicocele is limited to high-volume single surgeon, single institution, or small multi-institution series.

The role of telemedicine in pediatric critical care.

Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedsides of critically ill children. Telemedicine use is increasing and will be a common in remote emergency departments, inpatient wards, and intensive care units for pediatric care. Hospitals and physicians that use telemedicine technologies provide higher quality of care, are more efficient in resource use with improved cost-effectiveness, and have higher satisfaction among patients, parents, and remote providers.

Noninvasive inhaled nitric oxide does not prevent bronchopulmonary dysplasia in premature newborns.

Objective: To assess the efficacy and safety of early, noninvasive inhaled nitric oxide (iNO) therapy in premature newborns who do not require mechanical ventilation.

Study Design: We performed a multicenter randomized trial including 124 premature newborns who required noninvasive supplemental oxygen within the first 72 hours after birth. Newborns were stratified into 3 different groups by birth weight (500-749, 750-999, 1000-1250 g) prior to randomization to iNO (10 ppm) or placebo gas (controls) until 30 weeks postmenstrual age.

Videoconferencing to reduce stress among hospitalized children.

Objectives: Family-Link is a videoconferencing program that allows hospitalized children and their parents to virtually visit family members and friends using laptops, webcams, and a secure Wi-Fi connection. We evaluated the association of Family-Link use on the reduction in stress experienced by children during hospitalization.

Methods: We offered Family-Link to pediatric patients who had an expected length of hospitalization equal to or greater than 4 days.

Inhaled nitric oxide increases urinary nitric oxide metabolites and cyclic guanosine monophosphate in premature infants: relationship to pulmonary outcome.

Objective: Inhaled nitric oxide (iNO) has been tested to prevent bronchopulmonary dysplasia (BPD) in premature infants, however, the role of cyclic guanosine monophosphate (cGMP) is not known. We hypothesized that levels of NO metabolites (NOx) and cGMP in urine, as a noninvasive source for biospecimen collection, would reflect the dose of iNO and relate to pulmonary outcome.

Study Design: Studies were performed on 125 infants who required mechanical ventilation at 7 to 14 days and received 24 days of iNO at 20-2 ppm.

Association between Down syndrome and in-hospital death among children undergoing surgery for congenital heart disease: a US population-based study.

Background: The prevalence of Down syndrome (DS)-affected births has increased during the past 30 years; moreover, children with DS have a higher incidence of congenital heart disease compared with their peers. Whether children with DS have better or worse outcomes after repair of congenital heart disease is unclear. We sought to identify differences in in-hospital mortality after cardiac surgery in pediatric patients with and without DS using a large national database.

Pediatric pulmonary hypertension.

Pulmonary hypertension (PH) is a rare disease in newborns, infants, and children that is associated with significant morbidity and mortality. In the majority of pediatric patients, PH is idiopathic or associated with congenital heart disease and rarely is associated with other conditions such as connective tissue or thromboembolic disease. Incidence data from the Netherlands has revealed an annual incidence and point prevalence of 0.

Telemedicine consultations and medication errors in rural emergency departments.

Objective: To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs).

Methods: We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children's hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument.

Diagnosis and treatment of pulmonary hypertension in infancy.

Normal pulmonary vascular development in infancy requires maintenance of low pulmonary vascular resistance after birth, and is necessary for normal lung function and growth. The developing lung is subject to multiple genetic, pathological and/or environmental influences that can adversely affect lung adaptation, development, and growth, leading to pulmonary hypertension. New classifications of pulmonary hypertension are beginning to account for these diverse phenotypes, and or pulmonary hypertension in infants due to PPHN, congenital diaphragmatic hernia, and bronchopulmonary dysplasia (BPD).

The financial impact of a pediatric telemedicine program: a children's hospital's perspective.

Introduction: This study evaluates the financial impact of telemedicine outreach in a competitive healthcare market from a tertiary children's hospital's perspective. We compared the number of transfers, average hospital revenue, and average professional billing revenue before and after the deployment of telemedicine.

Materials And Methods: This is a retrospective review of hospital and physician billing records for patients transferred from 16 hospitals where telemedicine services were implemented between July 2003 and December 2010.

Telemedicine in the pediatric intensive care unit.

Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedside of any critically ill child. Telemedicine use is increasing and will be a common technology in remote emergency departments, inpatient wards, and pediatric intensive care units. There is mounting data that demonstrate that the use of telemedicine technologies can result in higher quality of care, more efficient resource use and improved cost-effectiveness, and higher satisfaction among patients, parents, and remote providers compared to current models of care.

Mothers' physical abusiveness in a context of violence: effects on the mother-child relationship.

The purpose of this study was to investigate the effects of mothers' physical abusiveness on the quality of the mother-child relationship, and note how it further varied by their exposure to interparental violence (IPV). The sample consisted of 232 clinic-referred children, aged 2 to 7 years, and their biological mothers. Slightly more than a quarter of the children (N = 63, 27.

Effect of pretransplant dialysis modality and duration on long-term outcomes of children receiving renal transplants.

Background: Adults receiving preemptive renal transplants have better allograft survival. Our study investigated differences in graft and patient survival based on need for, and duration of, pretransplant dialysis in pediatric renal transplant recipients.

Methods: Data on pediatric kidney transplants from January 1995 to December 2000 from the Organ Procurement and Transplantation Network were included.

Experience with tacrolimus in children with steroid-resistant nephrotic syndrome.

Children with steroid-resistant nephrotic syndrome (SRNS) are at risk of developing renal failure. We report here the results of a single-center retrospective observational study of the remission rate in pediatric patients with SNRS receiving tacrolimus. Serial renal biopsies from children on tacrolimus therapy were evaluated for tubulointerstitial fibrosis and transforming growth factor-beta immunostaining.

No more shoulders: Technical modification of Byars' flaps.

The repair of midshaft or more proximal hypospadias generally leads to a deficiency of ventral penile skin. Transposition of dorsal/lateral skin flaps may lead to redundant skin folds or shoulders. In most cases, redundant skin can be avoided by appropriate tailoring and positioning of the flaps.

The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit.

We examined records of all admissions to an isolated community neonatal intensive care unit (NICU) in California between 2001 and 2006. We also reviewed the echocardiograms for diagnosis, disposition of patient and necessity for transport. In 2004, a telemedicine link (mainly store-and-forward) was established to a university children's hospital (UCH) 290 km away.

Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions.

Objective: The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital.

Methods: We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13,017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality.

Review of the acuity scoring systems for the pediatric intensive care unit and their use in quality improvement.

Acuity scoring systems quantitate the severity of clinical conditions and stratify patients according to presenting patient condition. In the pediatric intensive care unit, the complexity and number of clinical scoring systems are increasing as their applications for clinicians, health services researches, and quality improvement broaden. This article is a review of acuity scoring systems for the pediatric intensive care unit, including examples of scoring systems available, the methods used in assessing these tools, the ways in which these systems are used, and the utility of acuity scoring systems in accurate benchmarking.

End-stage renal disease as the presenting manifestation of renal systemic lupus erythematosus.

About one-half of all children with systemic lupus erythematosus have clinical evidence of renal disease at initial presentation, such as proteinuria and acute renal failure. Herein, we report a case of a teenager who presented with end-stage renal disease (ESRD) of uncertain etiology, and who was subsequently determined to have lupus. The purpose of this report is to make health-care professionals aware of this unusual presentation of renal lupus, which has never been reported before.

Transverse myelitis in children: long-term urological outcomes.

Purpose: Urological complications are well documented in patients with traumatic spinal cord injury. We examined the long-term urological outcomes in a large population of children affected by transverse myelitis.

Materials And Methods: We retrospectively reviewed the medical history, imaging studies and urodynamic findings in 22 children with transverse myelitis.

Cardiac tamponade in a pediatric renal transplant recipient on sirolimus therapy.

Because of its lack of nephrotoxicity, the use of sirolimus, as an immunosuppressive agent, has increased considerably in solid-organ transplant (Tx) recipients. With its increased use, Tx professionals are encountering a variety of previously unreported side-effects such as angioedema and interstitial pneumonitis. We describe here the case of a pediatric renal Tx recipient who, while receiving sirolimus, developed a large pericardial effusion requiring pericardiocentesis.

Adverse reactions of nitrofurantoin, trimethoprim and sulfamethoxazole in children.

Purpose: Many children with urological disease require long-term treatment with antibiotics. In many cases the choice of medical instead of surgical management hinges on the implied safety of certain drugs. Recently some groups have advocated subureteral injection procedures to avoid long-term antibiotics for low grade reflux.

Hemi-T pouch modification for pediatric urinary diversion.

Purpose: When the appendix is unavailable, there are limited reliable methods for continent urinary diversion. After successful application of double-T pouch urinary diversion in adults we modified the technique for bladder augmentation and continent diversion.

Materials And Methods: A 10-year-old male underwent bladder augmentation and continent urinary diversion with a hemi-T augment.

Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma.

Trauma triage scores, severity of illness measures, and mortality prediction models quantitate severity of injury and stratify patients according to a specified outcome. Triage scoring systems are typically used to assist prehospital personnel determine which patients require trauma center care, but they are not recommended as the sole determinant of triage. Severity of illness measures and mortality prediction models are used in clinical and health services research for risk-adjusted outcomes analyses and institutional benchmarking.