• Title/Summary/Keyword: Pediatric approach

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Pediatric facial reanimation: An algorithmic approach and systematic review

  • Deramo, Paul J.;Greives, Matthew R.;Nguyen, Phuong D.
    • Archives of Plastic Surgery
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    • v.47 no.5
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    • pp.382-391
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    • 2020
  • Facial palsy has a broad clinical presentation and the effects on psychosocial interaction and facial functions can be devastating. Pediatric facial palsy, in particular, introduces unique familial and technical considerations as anatomy, future growth potential, and patient participation influence treatment planning. Though some etiologies of pediatric facial palsy are self-limiting, congenital and long-standing facial palsies pose difficult challenges that require a combination of surgical, adjunctive, and rehabilitative techniques to achieve facial reanimation. Given the spectrum of ages and symptom severity, as well as the various surgical options available for facial palsy, a tailored approach needs to be developed for each child to restore facial balance and function. Here, we review the etiologies, workup, and treatment of pediatric facial palsy and present our novel algorithmic approach to treatment.

Unexpected Complications and Safe Management in Laparoscopic Pancreaticoduodenectomy

  • Yuichi Nagakawa;Yatsuka Sahara;Yuichi Hosokawa;Chie Takishita;Tetsushi Nakajima;Yousuke Hijikata;Kazuhiko Kasuya;Kenji Katsumata;Akihiko Tsuchida
    • Journal of Digestive Cancer Research
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    • v.5 no.1
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    • pp.23-27
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    • 2017
  • Although laparoscopic pancreaticoduodenectomy (LPD) is considered as minimally invasive surgery, an advanced level of laparoscopic skill is still required. LPD comprises various procedures including reconstruction. Therefore, establishment of a safe approach at each step is needed. Prevention of intraoperative bleeding is the most important factor in safe completion of LPD. The establishment of effective retraction methods is also important at each site to prevent vascular injury. I also recommend the "uncinate process first" approach during initial cases of LPD, in which the branches of the inferior pancreaticoduodenal artery are dissected first, at points where they enter the uncinate process. This approach is performed at the left side of the superior mesenteric artery (SMA) before isolating the pancreatic head from the right aspect of the SMA, which allows safe dissection without bleeding. Safe and reliable reconstruction is also important to prevent postoperative complications. Laparoscopic pancreatojejunostomy requires highly skilled suturing technique. Pancreatojejunostomy through a small abdominal incision, as in hybrid-LPD, facilitates reconstruction. In LPD, the surgical view is limited. Therefore, we must carefully verify the position of the pancreaticobiliary limb. A twisted mesentery may cause severe congestion of the pancreaticobiliary limb following reconstruction, resulting in severe complications. We must secure the appropriate position of the pancreaticobiliary limb before starting reconstruction. We describe the incidence of intraoperative and postoperative complications and appropriate technique for safe performance of LPD.

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Anterior Sagittal Transrectal Approach (ASTRA) for Urethrovaginal Fistula after Total Repair of Persistent Cloaca - 1 Case Report - (잔존 총배설강 기형 수술 후 발생한 요도-질 누공에 대한 전방 시상 경직장적 접근 술식 (Anterior Sagittal Transrectal Approach, ASTRA) 1 례보고)

  • Kim, Seong-Min;Kim, Chang-Woo;Kim, Byoung-Kyu;Oh, Jung-Tak;Han, Seok-Joo
    • Advances in pediatric surgery
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    • v.13 no.1
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    • pp.76-80
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    • 2007
  • The authors applied anterior sagittal transrectal apporach (ASTRA) for the repair of urethrovaginal fistula which developed after total repair of persistent cloaca. The patient had been diagnosed to have persistent cloaca, double uterus and double vagina, and received PSARP, excision of right-side uterus and vagina, and left vaginal switch operation at 22 months old. After operation, the patient admitted several times due to frequent urinary tract infection and ectopic stone formation in bladder and neovagina. Urethro-neovaginal fistula was confirmed by cystoscopy and corrected with ASTRA. Postoperative voiding cystourethrogram showed no fistula tract. ASTRA showed improved surgical field, minimized ureterocystic damage, and preserved perirectal nerve due to limited incision of rectum.

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Endoscopic Management of Large Peripancreatic Fluid Collections in Two Pediatric Patients by Endoscopic Ultrasound-guided Transmural Drainage

  • Walsh, Leonard T.;Groff, Andrew;Mathew, Abraham;Moyer, Matthew T.
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.1
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    • pp.105-109
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    • 2020
  • The incidence of acute pancreatitis (AP) has increased in the pediatric population over the past few decades and it stands to follow that the complications of severe AP, including symptomatic pancreatic fluid collections (PFCs) will increase as well. In adults, the therapeutic options for this situation have undergone a dramatic evolution from mainly surgical approaches to less invasive endoscopic approaches, mainly endoscopic ultrasound-guided transmural drainage (EUS-TD) followed be direct endoscopic necrosectomy if needed. This has proven safe and effective in adults; however, this approach has not been well studied or reported in pediatric populations. Here we demonstrate that EUS-TD seems to offer a safe, efficacious and minimally invasive approach to the management of large PFCs in pediatric patients by reviewing two representative cases at our institution.

Acoustic-Phonetic Phenotypes in Pediatric Speech Disorders;An Interdisciplinary Approach

  • Bunnell, H. Timothy
    • Proceedings of the KSPS conference
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    • 2006.11a
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    • pp.31-36
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    • 2006
  • Research in the Center for Pediatric Auditory and Speech Sciences (CPASS) is attempting to characterize or phenotype children with speech delays based on acoustic-phonetic evidence and relate those phenotypes to chromosome loci believed to be related to language and speech. To achieve this goal we have adopted a highly interdisciplinary approach that merges fields as diverse as automatic speech recognition, human genetics, neuroscience, epidemiology, and speech-language pathology. In this presentation I will trace the background of this project, and the rationale for our approach. Analyses based on a large amount of speech recorded from 18 children with speech delays will be presented to illustrate the approach we will be taking to characterize the acoustic phonetic properties of disordered speech in young children. The ultimate goal of our work is to develop non-invasive and objective measures of speech development that can be used to better identify which children with apparent speech delays are most in need of, or would receive the most benefit from the delivery of therapeutic services.

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Enteral Nutrition in Pediatric Patients

  • Yi, Dae Yong
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.21 no.1
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    • pp.12-19
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    • 2018
  • Pediatric patients require specialized attention and have diverse demands for proper growth and development, and thus need a different approach and interest in nutritional assessment and supply. Enteral nutrition is the most basic and important method of nutritional intervention, and its indications should be identified. Also, the sites, modes, types, and timing of nutritional intervention according to the patient's condition should be determined. In addition, various complications associated with enteral nutrition supply should be identified, and prevention and treatment are required. This approach to enteral nutrition and proper administration can help in the proper growth and recovery of pediatric patients with nutritional imbalances or nutritional needs.

Change in the treatment strategy for pediatric Crohn's disease

  • Kim, Mi-Jin;Choe, Yon-Ho
    • Clinical and Experimental Pediatrics
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    • v.53 no.9
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    • pp.830-833
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    • 2010
  • Crohn's disease is characterized by chronic inflammation involving any portion of the gastrointestinal tract. Treating Crohn's disease is a major challenge for clinicians, as no curative therapy currently exists. Pediatric Crohn's disease is characterized by frequent relapses, a wide extent of disease, a high prevalence of extraintestinal manifestations, and a severe clinical course. The classic therapeutic approach is known as the 'step-up' strategy, and follows a progressive course of treatment intensification as disease severity increases. Although this approach is usually effective for symptom control, many patients become either resistant to or dependent on corticosteroids. The efficacy of infliximab suggests that, rather than a progressive course of treatment, early intense induction may reduce complications associated with conventional treatment and improve quality of life. Intensive early therapy with infliximab is known as the 'top-down' strategy. Such therapy offers the potential for altering the natural history of Crohn's disease, and is changing treatment paradigms. However, the relatively new concept of an early aggressive or 'top-down' treatment approach is not yet widely accepted, especially in pediatric patients. The results of our current study demonstrate that early and intensive treatment of pediatric Crohn's disease patients with infliximab, at initial diagnosis, was more effective for maintaining remission and reducing flares.

A literature study of pediatric pneumonia in traditional chinese medicine (소아폐렴(小兒肺炎)의 한의학적(韓醫學的) 연구(硏究)에 대한 고찰(考察) -중의학(中醫學) 문헌(文獻)을 중심(中心)으로-)

  • Kim, Jang-Hyun;Kwon, Hyuk-Ran
    • The Journal of Pediatrics of Korean Medicine
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    • v.17 no.1
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    • pp.99-115
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    • 2003
  • Pneumonia is an acute or recurrent infection of the parenchyma of the lung causing cough, fever, and respiratory distress. Pneumonia was named 'Feiyanchuansou(肺炎喘嗽)' in chinese medicine. This study was progressed for oriental medical treatment for pediatric pneumonia in china. The purpose of this study is current oriental medical approach to pediatric pneumonia In this study, the authors tried to figure out the cause of the pediatric pneumonia and its treatment and came to the conclusion as follows: 1. The study for pediatric pneumonia consists of basic, clinical and experimental study. 2. Basic study consists of etiology and pathogenesis(病因病耭), the rule of treatment(治療原則) and method of treatment(治法). 3. Clinical study consists of symptoms-based treatment(辨證論治), adequate prescription treatment(專病專方), acupuncture(鍼灸治療), and western diagnosis based treatment. 4. The majority of experimental study was pharmacology that consists of antiviral and antibacterial effect, removing heat(淸熱), releasing pulmonary qi(宣肺), dissipating phlegm(化痰).

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