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Pediatric Surgery International
Is tubularization of the mobilized urethral plate a better alternative to tubularization of an incised urethral plate for hypospadias repair?
Fri, 19 Dec 2008 08:13:57 -0000
Abstract Introduction Trial of a new procedure of hypospadias repair based on the incorporation of the entire available innate urethral tissue for the formation of neo-urethra in patients with hypospadias. Materials and methods Fifteen consecutive children, nine with distal hypospadias and six with proximal hypospadias (all with severe chordee), whose parents consented to application of a new procedure of hypospadias repair, were the study subjects. This procedure is inspired by Cantwell Ransley procedure for epispadias repair and Snodgras procedure for hypospadias repair. The entire urethral plate was mobilized (i.e., lifted off the corpora) distal to the urethral meatus and was tubularized in two layers; inner urethral skin and outer spongiosal tissue, in Duplay fashion. The repair was reinforced with dartos vascularized flap. The skin incisions on the urethral strip are guided by the disposition of the spongiosal tissue underlying the urethral plate (rather than the conventional U-shaped incision on either side of hypospadiac urethral meatus). In the patients with proximal hypospadias with severe chordee urethral advancement was combined to achieve orthoplasty and a single stage hypospadias repair. The catheter was removed on tenth postoperative day. Results Even in patients with proximal hypospadias with severe chordee, good single staged repair was achieved without resorting to dorsal plication that would have been necessary had any other methods based on the preservation of urethral plate was performed in these subjects. Therefore, the procedure was found to have an extended applicability to even those patients where tubularized incised urethral plate urethroplsty is not advised. All patients had good results (in 1 year follow-up), except in three early subjects of the series; two of whom developed minor urethrocutaneous fistulae (probably due to frank urinary leak secondary to repeated catheter blockade) and one developed partial glanular wound dehiscence. Conclusions Though the authors have an initial limited experience with this procedure, the procedure is likely to have a promising future due to its versatility and utilization of the entire urethral tissue. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2312-8Authors Simmi K. Ratan, PGIMS Rohtak Haryana IndiaJohn Ratan, Sitaram Bhartiya Institute of Science and Research New Delhi IndiaKamal Nain Rattan, PGIMS Rohtak Haryana India Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Dismembered pyeloplasty using double ‘J’ stent in infants and children
Wed, 17 Dec 2008 07:54:53 -0000
Abstract Purpose The purpose of the present study was to comprehensively assess the results of dismembered pyeloplasty in pelvi-ureteric junction obstruction (PUJO) using double ‘J’ ureteric stent. Materials and methods Records of 61 dismembered pyeloplasties in 60 consecutive patients with PUJO who underwent pyeloplasty in a 5-year period were reviewed retrospectively. In 58 cases, a double ‘J’ stent was passed in an antegrade fashion during the operation. No other mode of drainage was used. Stent was not placed on three occasions. Records were reviewed for age at diagnosis, age at surgery, post-operative complication, post-operative drainage and length of hospital stay. Results There were no episodes of urinary leak or re-obstruction in the stented group. Median post-operative stay in stented patients was 2 days. The use of this stent was associated with no serious complications. There were no episodes of post-operative urinary tract infection or stent displacement. Conclusions We recommend double ‘J’ stent as the safest mode of drainage in pyeloplasty in infants and children. Keeping a double-J stent across the anastomosis reduces the complications and the hospital stay in these patients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2313-7Authors George K. Ninan, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UKChandrasen Sinha, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UKRamnik Patel, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UKRajendra Marri, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Immunological investigation of the hepatic tissue from infants with biliary atresia
Wed, 17 Dec 2008 07:54:49 -0000
Abstract Purpose Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors [tissue inhibitors of metalloproteinases (TIMPs)] have been implicated in tissue injury and remodeling in many organs. The objective of this study was to evaluate the expression of MMP-3 and -9, and TIMP-1, -2, and -3 and their relationship to liver fibrosis in infants with biliary atresia. Methods The expression of MMP-3 and-9 and TIMP-1, -2 and -3 was investigated in liver tissue samples of nine patients with biliary atresia. In addition, the expression of CCR-4 and CCR-5 was analyzed to investigate the activation of Th1 and Th2 cells. The mRNA levels were measured by semiquantitative reverse transcriptase polymerase chain reaction. Results The expression of MMP-3 was higher than that of MMP-9 in all samples (P < 0.01). The expression of TIMP-1 was higher than that of TIMP-2 and -3 in all samples (P < 0.01). The expression of CCR-5 was higher than that of CCR-4 (P < 0.05), which implied higher activation of Th1 cells relative to Th2 cells. Conclusion Our findings suggest that MMP-3, possibly induced by Th1 cytokines, and its balance with TIMP-1, may be one of the factors involved in the pathogenesis of biliary atresia. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2311-9Authors Haruna Baba, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanYoshikazu Ohtsuka, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanTohru Fujii, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanHidenori Haruna, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanSatoru Nagata, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanHiroyuki Kobayashi, Juntendo University School of Medicine Department of General Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanAtsuyuki Yamataka, Juntendo University School of Medicine Department of Pediatric General and Urogenital Surgery 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanToshiaki Shimizu, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanTakeshi Miyano, Juntendo University School of Medicine Department of Pediatric General and Urogenital Surgery 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanYuichiro Yamashiro, Juntendo University School of Medicine Division of Probiotics Research 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Liver abscess in neonates
Wed, 17 Dec 2008 07:54:49 -0000
Abstract Introduction Liver abscesses are rare in neonates with the majority resulting from an ascending infection via the umbilical and portal veins, haematogenous spread, or via the biliary tree, or via direct contiguous spread from neighbouring structures. They may present in unusual ways often presenting with ongoing sepsis and resulting in diagnostic difficulties. We present the clinical and radiological findings on six neonates with hepatic abscesses and underline the association with misplacement of umbilical line, association with hypertonic glucose infusions and TPN. Methods A retrospective chart review made of six patients diagnosed with hepatic abscesses between 2000 and 2006. Methods included clinical and radiological review as well as evaluation of potential risk factors. Results Five of the six patients with neonatal liver abscess were of low birth weight and low gestational age (range 30–34 weeks), but one was post mature (42 weeks). Sex distribution was equal and two were HIV exposed (mother positive), two HIV negative with two having an unknown HIV status. Clinical signs included raised infective markers (CRP) (6) and non-specific signs of septicaemia (4), but a tender hepatomegaly (1) and abdominal distension with ileus (1) were also noted. Five were right-sided abscesses (2 associated with malposition of umbilical line) and one central in position. Predisposing factors included association with a misplaced umbilical line with high concentration glucose infusions (2) and tuberculosis was later diagnosed in one. Infective markers (CRP) remained high with positive blood cultures persisting in all. Causative organisms included Klebsiella (3) Staphylococcus (3) [one a multi-resistant staphylococcus (MRSA)], Gonococcus (1) and Enterobacter (1). Abdominal X-ray demonstrated a mal-positioned umbilical line in three patients (50%). Ultrasound (US) proved a reliable method of diagnosis although some difficulty was encountered in interpreting resolving abscesses and trans-diaphragmatic spread occurred in one. Three patients (50%) responded to antibiotic therapy alone, but interventional drainage was required in the remainder. Needle aspiration was successful in two of these, but one further patient had a radiologically placed pigtail drainage, but later required open drainage. This patient then developed trans-diaphragmatic spread and empyema requiring thoracoscopic decortication. Conclusion Neonatal hepatic abscesses are rare but should enter the differential diagnosis of a neonate with ongoing sepsis. This study serves to draw attention to their association with misplaced central (umbilical) catheters. Failure to respond to antibiotic therapy necessitates interventional drainage. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2307-5Authors E. Simeunovic, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South AfricaM. Arnold, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South AfricaD. Sidler, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South AfricaS. W. Moore, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South Africa Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Impact of wait time on outcome for inguinal hernia repair in infants
Tue, 16 Dec 2008 07:56:32 -0000
Abstract Background Prolonged surgical wait times are a problem in many health care systems. We used data from two pediatric surgical centers, one Canadian and one American, in order to determine if increased wait times are related to rates of incarceration and adverse outcomes. Methods Data were collected for children under the age of 2 who presented with an inguinal hernia to either the emergency department or clinic in the two hospitals in 2002 and 2003. Results Infants in the Canadian center were older at presentation and were more likely to present to the emergency department. Wait time for hernia repair was longer in the Canadian than the American hospital (99 ± 103 vs. 27 ± 53 days, P < 0.001). The incidence of incarceration was higher in the Canadian hospital, and infants in the Canadian center were more likely to have episodes of recurrent incarceration. Emergency department usage was greater in the Canadian hospital both at the time of diagnosis as well as during the waiting period for surgery. Discussion Prolonged wait time for inguinal hernia repair in infants is associated with a higher rate of incarceration as well as greater usage of emergency department resources. These data are important for those surgeons working in systems with limited resources in which strategies to shorten wait times are necessary. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2306-6Authors Li Ern Chen, St. Louis Children’s Hospital and Washington University School of Medicine Saint Louis MO USAMohammed Zamakhshary, The Hospital for Sick Children, University of Toronto Toronto ON CanadaRobert P. Foglia, St. Louis Children’s Hospital and Washington University School of Medicine Saint Louis MO USADouglas E. Coplen, St. Louis Children’s Hospital and Washington University School of Medicine Saint Louis MO USAJacob C. Langer, The Hospital for Sick Children, University of Toronto Toronto ON Canada Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Penoplasty for buried penis in infants and children: report of 100 cases
Sun, 14 Dec 2008 09:15:52 -0000
Penoplasty for buried penis in infants and children: report of 100 cases Content Type Journal ArticleCategory ErratumDOI 10.1007/s00383-008-2308-4Authors Lena Perger, University of New Mexico Health Sciences Center Department of Surgery Albuquerque NM USARobert S. Hanley, Tufts University School of Medicine Department of Urology, Lahey Clinic Burlington MA USANeil R. Feins, Children’s Hospital Boston, Harvard Medical School Department of Surgery Fegan 3, 300 Longwood Avenue Boston MA 02115 USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
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Is tubularization of the mobilized urethral plate a better alternative to tubularization of an incised urethral plate for hypospadias repair?
Fri, 19 Dec 2008 08:13:57 -0000
Abstract Introduction Trial of a new procedure of hypospadias repair based on the incorporation of the entire available innate urethral tissue for the formation of neo-urethra in patients with hypospadias. Materials and methods Fifteen consecutive children, nine with distal hypospadias and six with proximal hypospadias (all with severe chordee), whose parents consented to application of a new procedure of hypospadias repair, were the study subjects. This procedure is inspired by Cantwell Ransley procedure for epispadias repair and Snodgras procedure for hypospadias repair. The entire urethral plate was mobilized (i.e., lifted off the corpora) distal to the urethral meatus and was tubularized in two layers; inner urethral skin and outer spongiosal tissue, in Duplay fashion. The repair was reinforced with dartos vascularized flap. The skin incisions on the urethral strip are guided by the disposition of the spongiosal tissue underlying the urethral plate (rather than the conventional U-shaped incision on either side of hypospadiac urethral meatus). In the patients with proximal hypospadias with severe chordee urethral advancement was combined to achieve orthoplasty and a single stage hypospadias repair. The catheter was removed on tenth postoperative day. Results Even in patients with proximal hypospadias with severe chordee, good single staged repair was achieved without resorting to dorsal plication that would have been necessary had any other methods based on the preservation of urethral plate was performed in these subjects. Therefore, the procedure was found to have an extended applicability to even those patients where tubularized incised urethral plate urethroplsty is not advised. All patients had good results (in 1 year follow-up), except in three early subjects of the series; two of whom developed minor urethrocutaneous fistulae (probably due to frank urinary leak secondary to repeated catheter blockade) and one developed partial glanular wound dehiscence. Conclusions Though the authors have an initial limited experience with this procedure, the procedure is likely to have a promising future due to its versatility and utilization of the entire urethral tissue. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2312-8Authors Simmi K. Ratan, PGIMS Rohtak Haryana IndiaJohn Ratan, Sitaram Bhartiya Institute of Science and Research New Delhi IndiaKamal Nain Rattan, PGIMS Rohtak Haryana India Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Dismembered pyeloplasty using double ‘J’ stent in infants and children
Wed, 17 Dec 2008 07:54:53 -0000
Abstract Purpose The purpose of the present study was to comprehensively assess the results of dismembered pyeloplasty in pelvi-ureteric junction obstruction (PUJO) using double ‘J’ ureteric stent. Materials and methods Records of 61 dismembered pyeloplasties in 60 consecutive patients with PUJO who underwent pyeloplasty in a 5-year period were reviewed retrospectively. In 58 cases, a double ‘J’ stent was passed in an antegrade fashion during the operation. No other mode of drainage was used. Stent was not placed on three occasions. Records were reviewed for age at diagnosis, age at surgery, post-operative complication, post-operative drainage and length of hospital stay. Results There were no episodes of urinary leak or re-obstruction in the stented group. Median post-operative stay in stented patients was 2 days. The use of this stent was associated with no serious complications. There were no episodes of post-operative urinary tract infection or stent displacement. Conclusions We recommend double ‘J’ stent as the safest mode of drainage in pyeloplasty in infants and children. Keeping a double-J stent across the anastomosis reduces the complications and the hospital stay in these patients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2313-7Authors George K. Ninan, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UKChandrasen Sinha, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UKRamnik Patel, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UKRajendra Marri, University Hospitals of Leicester NHS Trust Department of Paediatric Urology, Children’s Hospital, Leicester Royal Infirmary Infirmary Road Leicester LE1 5WW UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Immunological investigation of the hepatic tissue from infants with biliary atresia
Wed, 17 Dec 2008 07:54:49 -0000
Abstract Purpose Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors [tissue inhibitors of metalloproteinases (TIMPs)] have been implicated in tissue injury and remodeling in many organs. The objective of this study was to evaluate the expression of MMP-3 and -9, and TIMP-1, -2, and -3 and their relationship to liver fibrosis in infants with biliary atresia. Methods The expression of MMP-3 and-9 and TIMP-1, -2 and -3 was investigated in liver tissue samples of nine patients with biliary atresia. In addition, the expression of CCR-4 and CCR-5 was analyzed to investigate the activation of Th1 and Th2 cells. The mRNA levels were measured by semiquantitative reverse transcriptase polymerase chain reaction. Results The expression of MMP-3 was higher than that of MMP-9 in all samples (P < 0.01). The expression of TIMP-1 was higher than that of TIMP-2 and -3 in all samples (P < 0.01). The expression of CCR-5 was higher than that of CCR-4 (P < 0.05), which implied higher activation of Th1 cells relative to Th2 cells. Conclusion Our findings suggest that MMP-3, possibly induced by Th1 cytokines, and its balance with TIMP-1, may be one of the factors involved in the pathogenesis of biliary atresia. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2311-9Authors Haruna Baba, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanYoshikazu Ohtsuka, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanTohru Fujii, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanHidenori Haruna, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanSatoru Nagata, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanHiroyuki Kobayashi, Juntendo University School of Medicine Department of General Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanAtsuyuki Yamataka, Juntendo University School of Medicine Department of Pediatric General and Urogenital Surgery 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanToshiaki Shimizu, Juntendo University School of Medicine Department of Pediatrics and Adolescence Medicine 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanTakeshi Miyano, Juntendo University School of Medicine Department of Pediatric General and Urogenital Surgery 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 JapanYuichiro Yamashiro, Juntendo University School of Medicine Division of Probiotics Research 2-1-1, Hongo, Bunkyo-ku Tokyo 113-8421 Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Liver abscess in neonates
Wed, 17 Dec 2008 07:54:49 -0000
Abstract Introduction Liver abscesses are rare in neonates with the majority resulting from an ascending infection via the umbilical and portal veins, haematogenous spread, or via the biliary tree, or via direct contiguous spread from neighbouring structures. They may present in unusual ways often presenting with ongoing sepsis and resulting in diagnostic difficulties. We present the clinical and radiological findings on six neonates with hepatic abscesses and underline the association with misplacement of umbilical line, association with hypertonic glucose infusions and TPN. Methods A retrospective chart review made of six patients diagnosed with hepatic abscesses between 2000 and 2006. Methods included clinical and radiological review as well as evaluation of potential risk factors. Results Five of the six patients with neonatal liver abscess were of low birth weight and low gestational age (range 30–34 weeks), but one was post mature (42 weeks). Sex distribution was equal and two were HIV exposed (mother positive), two HIV negative with two having an unknown HIV status. Clinical signs included raised infective markers (CRP) (6) and non-specific signs of septicaemia (4), but a tender hepatomegaly (1) and abdominal distension with ileus (1) were also noted. Five were right-sided abscesses (2 associated with malposition of umbilical line) and one central in position. Predisposing factors included association with a misplaced umbilical line with high concentration glucose infusions (2) and tuberculosis was later diagnosed in one. Infective markers (CRP) remained high with positive blood cultures persisting in all. Causative organisms included Klebsiella (3) Staphylococcus (3) [one a multi-resistant staphylococcus (MRSA)], Gonococcus (1) and Enterobacter (1). Abdominal X-ray demonstrated a mal-positioned umbilical line in three patients (50%). Ultrasound (US) proved a reliable method of diagnosis although some difficulty was encountered in interpreting resolving abscesses and trans-diaphragmatic spread occurred in one. Three patients (50%) responded to antibiotic therapy alone, but interventional drainage was required in the remainder. Needle aspiration was successful in two of these, but one further patient had a radiologically placed pigtail drainage, but later required open drainage. This patient then developed trans-diaphragmatic spread and empyema requiring thoracoscopic decortication. Conclusion Neonatal hepatic abscesses are rare but should enter the differential diagnosis of a neonate with ongoing sepsis. This study serves to draw attention to their association with misplaced central (umbilical) catheters. Failure to respond to antibiotic therapy necessitates interventional drainage. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2307-5Authors E. Simeunovic, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South AfricaM. Arnold, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South AfricaD. Sidler, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South AfricaS. W. Moore, University of Stellenbosch Division of Paediatric Surgery, Faculty of Health Sciences P.O. Box 19063 Tygerberg 7505 South Africa Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Impact of wait time on outcome for inguinal hernia repair in infants
Tue, 16 Dec 2008 07:56:32 -0000
Abstract Background Prolonged surgical wait times are a problem in many health care systems. We used data from two pediatric surgical centers, one Canadian and one American, in order to determine if increased wait times are related to rates of incarceration and adverse outcomes. Methods Data were collected for children under the age of 2 who presented with an inguinal hernia to either the emergency department or clinic in the two hospitals in 2002 and 2003. Results Infants in the Canadian center were older at presentation and were more likely to present to the emergency department. Wait time for hernia repair was longer in the Canadian than the American hospital (99 ± 103 vs. 27 ± 53 days, P < 0.001). The incidence of incarceration was higher in the Canadian hospital, and infants in the Canadian center were more likely to have episodes of recurrent incarceration. Emergency department usage was greater in the Canadian hospital both at the time of diagnosis as well as during the waiting period for surgery. Discussion Prolonged wait time for inguinal hernia repair in infants is associated with a higher rate of incarceration as well as greater usage of emergency department resources. These data are important for those surgeons working in systems with limited resources in which strategies to shorten wait times are necessary. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2306-6Authors Li Ern Chen, St. Louis Children’s Hospital and Washington University School of Medicine Saint Louis MO USAMohammed Zamakhshary, The Hospital for Sick Children, University of Toronto Toronto ON CanadaRobert P. Foglia, St. Louis Children’s Hospital and Washington University School of Medicine Saint Louis MO USADouglas E. Coplen, St. Louis Children’s Hospital and Washington University School of Medicine Saint Louis MO USAJacob C. Langer, The Hospital for Sick Children, University of Toronto Toronto ON Canada Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Penoplasty for buried penis in infants and children: report of 100 cases
Sun, 14 Dec 2008 09:15:52 -0000
Penoplasty for buried penis in infants and children: report of 100 cases Content Type Journal ArticleCategory ErratumDOI 10.1007/s00383-008-2308-4Authors Lena Perger, University of New Mexico Health Sciences Center Department of Surgery Albuquerque NM USARobert S. Hanley, Tufts University School of Medicine Department of Urology, Lahey Clinic Burlington MA USANeil R. Feins, Children’s Hospital Boston, Harvard Medical School Department of Surgery Fegan 3, 300 Longwood Avenue Boston MA 02115 USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Sites:
Center for Fetal Diagnosis and Treatment: Division of The Children's Hospital of Philadelphia specializes in open and fetoscopic surgery. Features news, case studies, parent resources, publications, and research.Children's Surgery, Ltd: Practice of Dr. Walton K.T. Shim. Information on specific conditions including hernias, pectus excavatum, and Hirschsprung's disease. [Hawaii]
Craniofacial Group Paris France: Craniofacial Group Paris-France: Management of anomalies of skull and face: craniostenosis, craniosynostosis, facial clefts, hypertelorism, Crouzon, Apert, tumors and trauma
Pediatric Neurosurgery of South Texas: Pediatric neurosurgery - brain surgery
Riley Hospital for Children: Cardiovascular Surgery: Specializes in pediatric cardiothoracic surgery and treatment of congenital heart defects, including valve repairs and complete heart transplantation. Site includes complete profile and credentials of current practicing surgeons.
Rocky Mountain Pediatric Surgery: Rocky Mountain Pediatric Surgery provides pediatric surgery for sick children as well as minimally invasive surgery. Rocky Mountain Pediatric Surgery is located in Denver, Colorado and serves the Denver metro area.
Ronald Lewis M.D.: Provides information about pediatric and adolescent orthopaedic surgery, including scoliosis, developmental dysplasia of the hip, fractures, tumors, and sports injuries. [New York]
Texas Pediatric Surgical Associates: Surgical group at the University of Texas Medical School at Houston, with specialists in pediatric general surgery, urology, ENT (otolayngology), plastic surgery, and neurosurgery. Site has many patient education files on pediatric surgical conditions for families and physicians.
Yale University Pediatric Surgery: Offers full range of general and specialized pediatric surgical services, as well as support to parents of chronically ill children. Affiliated with Yale-New Haven's Children's Hospital.
This directory is based on the Open Directory and may have been modified