Surgical synergy: Assessing care coordination in pediatric surgical referral programs.

Background: Specialized pediatric surgical referral programs (PSPs) for complex conditions are increasing across the United States, resulting in care rendered geographically distant from patients' homes. We explored care coordination gaps across differing stakeholder perspectives to identify opportunities to optimize post-discharge practices in this evolving landscape.

Methods: We reviewed published literature for guidelines and consensus statements on ideal care coordination practices.

Leveraging NSQIPP testicular torsion process measures: Initial survey of the NSQIPP testicular torsion collaborative.

Background: Testicular torsion is a pediatric emergency that poses a time-sensitive risk to the testicle. Best practices for testicular torsion protocols remain unclear. We convened the Testicular Torsion Collaborative, leveraging National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Process Measure collection to assess factors associated with favorable metrics.

Factors Associated With Delay to Care in Pediatric and Adolescent Adnexal Torsion.

Background And Objectives: Diagnosis of adnexal torsion is challenging due to variable clinical presentations and often inconclusive imaging results. We hypothesized that diagnostic delays are common, leading to prolonged ischemia and subsequent tissue loss. We aimed to identify factors associated with diagnostic delays in pediatric patients with adnexal torsion.

Reducing Blood Draws in Pediatric Patients With Solid Organ Injury Through Protocolized Transcutaneous Hemoglobin Monitoring.

Background: Management of pediatric solid organ injuries continues to evolve, decreasing the need for serial hemoglobin measurements, repeat imaging, and operative intervention. Transcutaneous continuous hemoglobin monitoring (TCHM) has been shown to effectively monitor hemoglobin levels in children with solid organ trauma.

Methods: A 6-year, single-center, retrospective chart review was conducted of pediatric solid organ injury patients aged 30 days to <18 years admitted to a quaternary children's hospital following implementation of a highly protocolized TCHM system.

Facultatively ectoparasitic mites as vectors for entomopathogenic bacteria in Drosophila.

Opportunistic bacterial infections are common in insect populations but there is little information on how they are acquired or transmitted. We tested the hypothesis that Macrocheles mites can transmit systemic bacterial infections between Drosophila hosts. We found that 24% of mites acquired detectable levels of bacteria after feeding on infected flies and 87% of infected mites passed bacteria to naïve recipient flies.

Pediatric Surgery from the Roads Less Traveled: Challenges, Communication, and Collaboration from a Community Nonteaching Hospital.

Unique challenges face pediatric surgeons at community-based nonteaching hospitals. Communication and collaboration among and between healthcare providers, hospital administrators, and quaternary referral programs is crucial for the success of these smaller hospitals as they care for children.

Life history of Macrocheles muscaedomesticae (Parasitiformes: Macrochelidae): new insights on life history and evidence of facultative parasitism on Drosophila.

Macrocheles muscaedomesticae is a cosmopolitan macrochelid mite whose populations have likely diverged considering the many locations they inhabit, but most of the work published on this mite species has been on the basis of their association with the house fly, Musca domestica. Here, we studied several aspects of the biology of M. muscaedomesticae associated with drosophilid flies collected in Alberta, Canada.

Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury.

Background/purpose: Hemoglobin monitoring is required in pediatric trauma patients with solid organ injury. We hypothesized that noninvasive hemodynamic monitoring (NIHM) represents an effective, safe alternative to laboratory hemoglobin (LabHb) monitoring in clinically stable patients.

Methods: A retrospective cohort study was conducted regarding pediatric trauma patients (<18 years old) with blunt solid organ injury over six consecutive months.

Mechanisms underlying parasite infection: influence of host body mass and age on chewing louse distribution among brown-headed cowbirds.

Animal populations exhibit various patterns in ectoparasite distribution across different sexes and age classes, and numerous factors can potentially contribute to ectoparasite abundance and distribution. We examined the influence of host body size and age on the distribution of a chewing louse among brown-headed cowbirds. Differences in louse prevalence (males 62.

Passing the baton: The pediatric surgical perspective on transition.

Background/purpose: Transition of care from pediatric to adult providers is garnering intense national interest in pediatrics but is largely driven by nonsurgeons. We sought to describe the preferences of pediatric surgeons and their current transition practice patterns for various populations and wondered whether gender, experience, or practice setting affected surgeons' perspectives.

Methods: All American Pediatric Surgical Association (APSA) members were surveyed electronically.

Operative indications in recurrent ileocolic intussusception.

Background: Air-contrast enema (ACE) is standard treatment for primary ileocolic intussusception. Management of recurrences is less clear. This study aimed to delineate appropriate therapy by quantifying the relationship between recurrence and need for bowel resection, pathologic lead points (PLP), and complication rates.

Trogocytosis as a mechanistic link between chimerism and prenatal tolerance.

In utero hematopoietic cellular transplantation (IUHCT) holds great promise for the treatment of congenital diseases of cellular dysfunction such as sickle cell disease, immunodeficiency disorders and inherited metabolic disorders. However, repeated failures in clinical cases of IUHCT that do not involve an immunodeficiency disease force a closer examination of the fetal immune system. While the mechanisms regulating T cell tolerance have been previously studied, the educational mechanisms leading to NK cell tolerance in prenatal chimeras remain unknown.

Pediatric blunt abdominal aortic injury and the use of intra-operative aortic ultrasound for surgical decision making.

Traumatic injury has been the most common cause of morbidity and mortality in the pediatric population, but injuries to the abdominal aorta are rare. We reviewed 2 children who underwent exploratory laparotomy for blunt aortic injury in which intra-operative ultrasound guided the surgical approach. Intra-operative ultrasound allowed us to minimize resection of normal aorta and achieve primary repair.

Enlarging unilateral breast mass in an adolescent male: an unusual presentation of intraductal papilloma.

Breast masses presenting in adolescent boys are rare and are almost uniformly owing to gynecomastia. Although surgical referral for breast masses in adolescent boys is common, intervention is typically for cosmesis. We report the case of a 14-year-old boy who presented with an enlarging unilateral breast mass, which was found to be owing to an intraductal papilloma at the time of surgical excision.

Regulation of the earliest immune response to in utero hematopoietic cellular transplantation.

In Utero Hematopoietic Cellular Transplantation (IUHCT) is a promising intervention to treat a wide range of congenital disease. Through the presentation of donor cells to the immature immune system, mixed hematopoietic chimerism and donor-specific tolerance can be achieved. However, the failure of engraftment in prenatal recipients in which no immunodeficiency exists suggests the existence of a fetal immune barrier to transplantation.

KIR receptor-ligand incompatibility predicts killing of osteosarcoma cell lines by allogeneic NK cells.

Background: The effectiveness of killer immunoglobulin-like receptor (KIR) incompatible, alloreactive natural killer (NK) cells has been primarily documented in hematological malignancies following stem-cell transplant. This effect has not been thoroughly evaluated for pediatric solid tumors. In this study, we evaluated KIR receptor-ligand incompatibility of NK cells against osteosarcoma cell lines.

What is the optimal treatment for children with primary hyperparathyroidism?

Purpose: Little information exists regarding the optimal surgical treatment of pediatric primary hyperparathyroidism. We hypothesized that primary hyperparathyroidism in children, in the absence of a family history, is caused by single-gland disease and is amenable to minimally invasive parathyroidectomy (MIP).

Methods: We reviewed the records of individuals younger than 25 years who underwent parathyroidectomy in a prospectively collected database at a single tertiary hospital from 2003 to 2009.

Surgical resident's training in colonoscopy: numbers, competency, and perceptions.

Background: There is currently great discrepancy in the training requirements between medical societies regarding the recommended threshold number of colonoscopies needed to assess for technical competence. Our goal was to determine the number of colonoscopies performed by surgical residents, rate of cecal intubation, as well as trainee perceptions of colonoscopy training after completion of their training period.

Methods: This study consisted of a 12-item electronic survey completed by 21 surgical residents after their 2-month endoscopy rotation at a tertiary care, urban referral center.

Commonly encountered surgical problems in the fetus and neonate.

Neonatal surgical care requires a current understanding of pre- and postnatal intervention for a myriad of congenital anomalies. This article includes an update of the recent information on commonly encountered fetal and neonatal surgical problems, highlighting specific areas of controversy and challenges in diagnosis. The authors hope that this article is useful for trainees and practitioners involved in any aspect of fetal and neonatal care.

Early laparoscopic fundoplication and gastrostomy in infants with spinal muscular atrophy type I.

Background/purpose: Spinal muscular atrophy (SMA) in children leads to progressive muscle weakness, dysphagia, aspiration, and death. We hypothesized that early laparoscopic fundoplication and gastrostomy in infants with SMA type I could be performed safely perhaps leading to fewer aspiration events and improved nutritional status.

Methods: Children diagnosed with SMA type I from 2002 through 2005 were included (n = 12).

Early chimerism threshold predicts sustained engraftment and NK-cell tolerance in prenatal allogeneic chimeras.

The failure of engraftment in human cases of in utero hematopoietic cell transplantation (IUHCT) in which no immunodeficiency exists suggests the presence of an unrecognized fetal immune barrier. A similar barrier in murine IUHCT appears to be dependent on the chimerism level and is poorly explained by a lack of T-cell tolerance induction. Therefore, we studied the effect of the chimerism level on engraftment and host natural killer (NK)-cell education in a murine model of IUHCT.

Recent advances and controversies in pediatric laparoscopic surgery.

Children represent a unique group of patients who are likely to greatly benefit from minimally invasive surgery (MIS). The promise of less postoperative pain, smaller scars, shorter hospital stays, and a faster return to school continues to drive growth in this area. The development of pediatric-specific techniques and documentation of improved outcomes form a critical gateway to widespread application of pediatric MIS.

Donor major histocompatibility complex class I expression determines the outcome of prenatal transplantation.

Purpose: The failure of in utero transplantation in immune-competent recipients suggests the existence of a fetal immune barrier. The importance of donor major histocompatibility complex (MHC) class I expression in the induction of prenatal tolerance remains undefined. We hypothesized that donor cell MHC class I expression facilitates engraftment in prenatal allogeneic recipients rather than promoting immune rejection.

Age-related differences in diagnosis and morbidity of intestinal malrotation.

Background: Intestinal malrotation in adulthood may present with a variety of chronic symptoms. Surgical intervention frequently leads to other complications in these patients. We hypothesized that the chronic nature of malrotation in adults could cause a delay in diagnosis and increased perioperative complications.