Search

Introduction: The combination of a patent omphalomesenteric duct in the setting of an omphalocele is rare and has an unusual physical appearance on presentation. Case presentation: We share the case of a neonate who presented with omphalocele and a concurrent patent omphalomesenteric duct with intestinal prolapse. We report the early diagnosis and operative management of this presentation with intestinal resection and anastomosis, and primary closure of the omphalocele. The patient had no other abnormalities and after uncomplicated recovery, was able to discharge uneventfully tolerating oral feeds. Conclusion: Because the initial appearance of a patent omphalomesenteric duct in an omphalocele is unusual with visible bowel mucosa and an intact omphalocele membrane, this variation of an abdominal wall defect is at risk of being misdiagnosed as a ruptured omphalocele, gastroschisis, or another complex abdominal wall defect. Expeditious surgical management is indicated.

Background Oral candidiasis (OC) is an oral mucosal disorder due to Candida genus. Its predisposing factor among patients with HIV/AIDS is mainly decreasing CD4 count. OC is commonly caused by Candida albicans. As CD4 decreases, the shift to C. non-albicans has been observed. Objective To evaluate the association of Candida species with CD4 count and clinical features in HIV/AIDS patients with OC. Patients and methods This is a cross-sectional study. A total of 114 oral rinse solution samples from HIV/AIDS patients with OC were collected. Candida species identification was done by culture in Chromagar followed by VITEK 2. The association of Candida species with CD4 count and clinical features was analyzed using Pearson’s χ2 and Kruskal–Wallis tests. Results There was growth of 149 isolates in culture from 114 patients. C. albicans was found in 104 (69.7%) isolates. Candida non-albicans were found in 45 (30.3%) isolates, namely Candida krusei in 22 (14.85%), Candida glabrata in 12 (8.1%), Candida tropicalis in six (4.05%), Candida dubliniensis in two (1.3%), Candida parapsilosis in two (1.3%), and Candida lipolytica in one (0.7%) isolate. Candida species was significantly associated with clinical types, episode types, pain on swallowing, CD4 count, and antiretroviral (ARV) use among all patients. Conclusion Among HIV/AIDS patients with OC, growth of C. albicans only was more common in higher CD4 count, while mixed growth of C. albicans and C. non-albicans was more common in lower CD4 count. Clinical features associated with growth of C. albicans only were pseudomembranous type, recurrent OC, absence of pain on swallowing, and patients on ARV, whereas those associated with mixed growth of C. albicans and C. non-albicans were cheilitis type, first-episode OC, presence of pain on swallowing, and ARV-naive patients.

Primary hyperparathyroidism (PHPT) is an endocrine disorder that is commonly diagnosed in adults. PHPT is less commonly seen in the pediatric age range, and when identified, non-syndromic disease is unusual. PHPT caused by an ectopic parathyroid gland is rare, especially in the adolescent population, and may contribute to disease persistence. Because parathyroidectomy is the only known curative treatment for PHPT, localization of the abnormal gland(s) preoperatively is often attempted, and is critical prior to re-operation. Recurrent or persistent PHPT continues to be a surgical challenge because parathyroidectomy via traditional cervical incision may not be feasible for parathyroid adenomas located in an ectopic location. When identified in the thymus, minimally invasive approaches are preferred over sternotomy or thoracotomy because of decreased morbidity rates and improved patient outcomes. Recently, parathyroidectomy via video-assisted thoracoscopic surgery (VATS) for mediastinal parathyroid adenomas has been described in the literature. We report a case of a non-syndromic adolescent with persistent PHPT who was cured after undergoing mediastinal parathyroidectomy via VATS approach while utilizing intraoperative parathyroid hormone guidance and frozen-section pathologic analysis.

IntroductionData examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.MethodsThis retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications.ResultsOf 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications.ConclusionsPostoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients.Level of evidenceIii, Respiratory complications.

Background: The authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines. Methods: The authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed. Results: Thirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B–D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections. Conclusions: There is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease. [ABSTRACT FROM AUTHOR]