Language：Japanese   Publisher：(一社)日本小児救急医学会  

Publisher：東京医学社  

DOI： 10.24479/ps.0000000873

CiNii Research

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(一社)日本小児外科学会  

Language：Japanese   Publisher：(一社)日本小児外科学会  

Language：English   Publisher：Journal of Pediatric Surgery  

Background: There is no standard timing for switching to surgical management for children with adhesive small bowel obstruction (ASBO) who initially receive conservative treatment. We hypothesized that an increased gastrointestinal drainage volume may indicate the need for surgical intervention. Methods: The study population included 150 episodes in the patients less than 20 years of age who received treatment for ASBO in our department from January 2008 to August 2019. Patients were divided into two groups: the successful conservative treatment group (CT) and the eventual surgical treatment group (ST). Following the analysis of all episodes (Study 1), we limited our analysis to only first ASBO episodes (Study 2). We retrospectively reviewed their medical records. Results: There were statistically significant differences in the volume on the 2nd day in both Study 1 (9.1 ml/kg vs. 18.7 ml/kg; p < 0.01) and study 2 (8.1 ml/kg vs. 19.7 ml/kg; p < 0.01). The cut-off value was the same for both Study 1 and Study 2 (11.7 ml/kg). Conclusions: The gastrointestinal drainage volume on the 2nd day in ST was significantly larger than that in CT. Accordingly, we considered that the drainage volume may predict eventual surgical intervention for children with ASBO who initially receive conservative treatment. Level of evidence: Level IV.

DOI： 10.1016/j.jpedsurg.2023.01.052

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本小児救急医学会  

Language：English  

DOI： 10.1186/s40792-023-01618-7

Web of Science

PubMed

Language：English   Publisher：(一社)日本外科学会  

症例は7歳男児。父親に新型コロナウイルス感染症(SARS-CoV-2)の既往があった。2日前からの下腹部痛のため救急医療部へ搬送された。搬送時の体温は39.1度で、血圧は102/61mmHg、心拍数は101bpmであった。受診時に腹部膨満を認め、下腹部にびまん性の圧痛を認めた。臨床検査で白血球数は9900/μL、C反応性蛋白は12.3mg/dLであった。造影CTで腫大した虫垂を認めた。虫垂根部に異常はなく、虫垂内部に糞石と穿孔を認めた。穿孔性虫垂炎と診断し、腹腔鏡下虫垂切除術を施行した。サージカルマスク、N95マスク、フェイスシールド等の個人防護具を装着し、緊急手術を施行した。手術時間は93分であった。術後の培養検査で大腸菌、Streptococcus constellatus、Bacteroides fragilisが検出された。抗菌剤をタゾバクタム/ピペラシリンからメロペネムとメトロニダゾールに変更した。切除標本を用いたリアルタイムPCR法でSARS-CoV-2に陽性を認めた。術後経過は良好で、呼吸器症状もなく、17日後に退院となった。

Language：Japanese   Publisher：(一社)日本小児外科学会  

Publisher：東京医学社  

DOI： 10.24479/ps.0000000319

CiNii Research

Language：English   Publisher：Pediatric Surgery International  

Purpose: The number of accessible central veins (CVs) affects the prognosis of patients with intestinal failure (IF). The loss of residual CVs should be avoided. We, therefore, evaluated the efficacy of a new CV catheter-exchange technique using a subcutaneous fibrous sheath (FS) in pediatric IF patients. Methods: We retrospectively collected the CV catheter (CVC) data of pediatric IF patients managed from January 2009 to December 2019. The data were divided into two groups; Groups 1 (CVCs placed with the FS method) and Group 2 (CVCs placed by the primary or another insertion). The main outcome was the CVC indwelling time. Results: Eighty-five CVCs were analyzed. The FS method was attempted in 47 cases and succeeded in 40 (85%). No significant difference was observed between the groups regarding characteristics. A log-rank test revealed an equivalent CVC indwelling time between the two groups (Group 1: 268 [126–588] days vs. Group 2: 229 [126–387] days, p = 0.256). Conclusions: The FS method is highly recommended for pediatric IF patients, as its attempt showed a high success rate with an indwelling time equivalent to primary insertion. The FS method leads to the prolonged use of a single CV and thereby contributes to improving the outcomes of pediatric IF patients.

DOI： 10.1007/s00383-022-05233-9

Web of Science

Scopus

PubMed

Language：English   Publisher：Pediatric Surgery International  

Purpose: The prenatal diagnosis of the stomach position in congenital diaphragmatic hernia (CDH) has been a reliable prognostic factor, but few studies have focused on the postnatal position. We therefore evaluated the significance of the nasogastric (NG) tube position just after birth. Methods: The Japanese CDH Study Group database enrolled 1037 CDH neonates over 15 years. In our multicenter retrospective study, 464 cases of left-sided isolated CDH with prenatal diagnoses were divided into two groups: NG tube below the diaphragm (BD; n = 190) or above the diaphragm (AD; n = 274). The primary outcome was the 90-day survival rate, and the secondary outcomes were mechanical ventilation duration, hospitalization duration, and recurrence rate. Results: The BD group had a significantly higher 90-day survival rate (98.4 vs. 89.4%, p < 0.001), shorter mechanical ventilation (11 vs. 19 days, p < 0.001), shorter hospitalization (38 vs. 59 days, p < 0.001), and lower recurrence rate (p = 0.002) than the AD group. A multivariate analysis showed that BD (adjusted odds ratio, 3.68; 95% confidence interval 1.02–13.30) was a favorable prognostic factor for the 90-day survival. Conclusion: The assessment of the NG tube position revealed it to be a reliable prognostic factor of left-sided isolated CDH. Therefore, it should be included as a routine assessment.

DOI： 10.1007/s00383-022-05226-8

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(一社)日本小児救急医学会  

Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

Language：Japanese   Publisher：(一社)日本小児放射線学会  

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