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Hosokawa T, Uchiyama M. Complete Remission of Renal Scarring in Follow-Up DMSA Renal Scintigraphy After Urinary Tract Infection. Clin Pediatr (Phila) 2023:99228231206707. [PMID: 37850651 DOI: 10.1177/00099228231206707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Our study aimed to investigate the association between the characteristics of patients/images and complete remission of renal scarring shown in the first chronic phase Technetium-99m dimercaptosuccinic acid (DMSA) renal scintigraphy images in children with urinary tract infection (UTI). Fifty children, who underwent the chronic phase of DMSA scintigraphy more than twice following UTI diagnosis and had renal scarring in the first chronic phase DMSA renal scintigraphy, were enrolled. They were classified into 2 groups: with and without complete remission of renal scarring on the second chronic phase DMSA renal scintigraphy. Renal scarring was classified into 3 grades based on severity per the image findings. Seven cases had complete remission from renal scarring. There were significant differences in age and severity. Renal scarring might be completely reversed in young children without severe findings on DMSA renal scintigraphy. Additional chronic phase examination may aid in follow-up completion and patients' peace of mind.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Mayuki Uchiyama
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
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Manchanda V, Kumar P, Jadhav A, Goel AD. Can Neonatal Pull-through Replace Staged Pull-through for the Management of Anorectal Malformation? A Systematic Review and Meta-analysis. J Indian Assoc Pediatr Surg 2023; 28:357-368. [PMID: 37842219 PMCID: PMC10569272 DOI: 10.4103/jiaps.jiaps_28_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 10/17/2023] Open
Abstract
Anorectal malformations (ARMs) are managed classically in three stages - colostomy at birth, anorectal pull-through after 2-3 months, and stoma closure. Single-stage pull-through has been contemplated in neonatal age aimed to reduce the number of procedures, better long-term continence, the better psycho-social status of the child, and reduced cost of treatment, especially in resource-strained countries. We conducted a systematic review comparing neonatal single-stage pull-through with stage pull-through and did a meta-analysis for the outcome and complications. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PubMed and Scopus databases were searched and RevMan 5.4.1 was used for the meta-analysis. Fourteen comparative studies including one randomized controlled trial were included in the systematic review for meta-analysis. The meta-analysis included 1845 patients including 866 neonates undergoing single-stage pull-through. There was no statistically significant difference for the occurrence of surgical site infection (odds ratio [OR] 0.82, 95% confidence interval [CI]: 0.24-2.83), urinary tract injury (OR 1.82, 95% CI: 0.85-3.89), rectal prolapse (OR 0.98, 95% CI: 0.21-5.04), anal stenosis/stricture, voluntary bowel movements (OR 0.97, 95% CI: 0.25-3.73), constipation (OR 1.01, 95% CI: 0.61-1.67), soiling (OR 0.89, 95% CI: 0.52-1.51), mortality (OR 1.19, 95% CI: 0.04-39.74), or other complications. However, continence was seen to be better among patients undergoing neonatal pull-through (OR 1.63, 95% CI: 1.12-2.38). Thus, we can recommend single-stage pull-through for managing patients with ARMs in the neonatal age.
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Affiliation(s)
- Vivek Manchanda
- Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Parveen Kumar
- Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Avinash Jadhav
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Hosokawa T, Tanami Y, Sato Y, Deguchi K, Takei H, Oguma E. Role of ultrasound in the treatment of pediatric infectious diseases: case series and narrative review. World J Pediatr 2023; 19:20-34. [PMID: 36129633 PMCID: PMC9490683 DOI: 10.1007/s12519-022-00606-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/05/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Infectious diseases are common in pediatric patients. In these patients, ultrasound is a useful imaging modality that involves no irradiation or sedation and can be performed repeatedly at the patient's bedside. The purpose of this review was to show pediatric cases with infectious disease that used ultrasound to decide the methods of treatment. DATA SOURCES Literature review was performed using Pubmed as the medical database source. No year-of-publication restriction was placed. The mesh terms used were: "ultrasound", "sonography", "infectious disease", "treatment", "antibiotics", "surgical intervention", "pediatric", "children", "deep neck abscess", "pyothorax", "empyema", "pneumonia", "urinary tract infection", "intra-abdominal abscess", "soft tissue infection", "septic arthritis", "osteomyelitis", and "surgical site infection". RESULTS We presented pediatric case series with infectious diseases, including deep neck abscess, pyothorax and empyema, pneumonia, urinary tract infection, intra-abdominal abscess, soft tissue infection, septic arthritis and osteomyelitis, and surgical-site infection. Ultrasound was useful for evaluating the extent and location of inflammation and abscess and for decision-making concerning surgical intervention. CONCLUSION Knowledge of these sonographic findings is important for sonographers during examinations and for physicians when determining the treatment plan and period of antibiotic therapy for infected lesions.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777, Japan.
| | - Yutaka Tanami
- Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777 Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777 Japan
| | - Kuntaro Deguchi
- Department of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, Japan
| | - Haruka Takei
- Department of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777 Japan
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Imaging of anorectal malformations: where are we now? Abdominal imaging task force of the European Society of Paediatric Radiology. Pediatr Radiol 2022; 52:1802-1809. [PMID: 35648164 PMCID: PMC9360087 DOI: 10.1007/s00247-022-05395-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/11/2022] [Accepted: 05/03/2022] [Indexed: 10/31/2022]
Abstract
Anorectal and cloacal malformations are a broad mix of congenital abnormalities related to the distal rectum and anus. Confusion exists between all the forms in this large and heterogeneous group. The spectrum includes everything from anal stenosis, ventral anus, anal atresia (with and without fistula) and the full spectrum of cloacal malformations. Imaging in these conditions is done through the whole armamentarium of radiologic modalities, with very different imaging strategies seen across the centres where these conditions are managed. In 2017, the European Society of Paediatric Radiology (ESPR) abdominal imaging task force issued recommendations on the imaging algorithm and standards for imaging anorectal malformations. This was followed by further letters and clarifications together with an active multispecialty session on the different imaging modalities for anorectal malformations at the 2018 ESPR meeting in Berlin. Through this paper, the abdominal task force updates its guidelines and recommended imaging algorithm for anorectal malformations.
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Tofft L, Salö M, Arnbjörnsson E, Stenström P. Accuracy of pre-operative fistula diagnostics in anorectal malformations. BMC Pediatr 2021; 21:283. [PMID: 34134660 PMCID: PMC8207737 DOI: 10.1186/s12887-021-02761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics. Methods Ethical approval was obtained. Diagnostic accuracy of pre-PSARP symptoms (stool in urine, urine in passive ostomy, urinary tract infection) and examination modalities (voiding cystourethrogram (VCUG), high-pressure colostogram, cystoscopy and ostomy endoscopy) were compared to final intra-operative ARM-type classification in all male neonates born with ARM without a perineal fistula treated at a tertiary pediatric surgery center during 2001–2020. Results The 38 included neonates underwent reconstruction surgery through PSARP with diverted ostomy. Thirty-one (82%) had a recto-urinary tract fistula and seven (18%) no fistula. Ostomy endoscopy yielded the highest diagnostic accuracy for fistula presence (22 correctly classified/24 examined cases; 92%), and pre-operative symptoms the lowest (21/38; 55%). For pre-operative fistula level determination, cystoscopy yielded the highest diagnostic accuracy (14/20; 70%), followed by colostogram (23/35; 66%), and VCUG (21/36; 58%). No modality proved to be statistically superior to any other. Conclusions Ostomy endoscopy has the highest diagnostic accuracy for fistula presence, and cystoscopy and high-pressure colostogram for fistula level determination. Correct pre-operative ARM-typing reached a maximum of 60–70%.
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Affiliation(s)
- Louise Tofft
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden. .,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden.
| | - Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden
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Hosokawa T, Tanami Y, Sato Y, Oguma E. Comparison of imaging findings between acute focal bacterial nephritis (acute lobar nephronia) and acute pyelonephritis: a preliminary evaluation of the sufficiency of ultrasound for the diagnosis of acute focal bacterial nephritis. Emerg Radiol 2020; 27:405-412. [DOI: 10.1007/s10140-020-01771-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
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Midrio P, van Rooij IALM, Brisighelli G, Garcia A, Fanjul M, Broens P, Iacobelli BD, Giné C, Lisi G, Sloots CEJ, Fascetti Leon F, Morandi A, van der Steeg H, Giuliani S, Grasshoff-Derr S, Lacher M, de Blaauw I, Jenetzky E. Inter- and Intraobserver Variation in the Assessment of Preoperative Colostograms in Male Anorectal Malformations: An ARM-Net Consortium Survey. Front Pediatr 2020; 8:571. [PMID: 33072661 PMCID: PMC7531276 DOI: 10.3389/fped.2020.00571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: Male patients with anorectal malformations (ARM) are classified according to presence and level of the recto-urinary fistula. This is traditionally established by a preoperative high-pressure distal colostogram that may be variably interpreted by different surgeons. The aim of this study was to evaluate the inter- and intraobserver variation in the assessment by pediatric surgeons of preoperative colostograms with respect to the level of the recto-urinary fistula. Materials and Methods: Sixteen pediatric surgeons from 14 European centers belonging to the ARM-Net Consortium twice scored 130 images of distal colostograms taken in sagittal projection at a median age of 66 days of life (range: 4-1,106 days). Surgeons were asked to classify the fistula in bulbar, prostatic, bladder-neck, no fistula, and "unclear anatomy" example. Their assessments were compared with the intraoperative findings (kappa) for two scoring rounds with an interval of 6 months (intraobserver variation). Agreement among the surgeons' scores (interobserver variation) was also calculated using Krippendorff's alpha. A kappa over 0.75 is considered excellent, between 0.40 and 0.75 fair to good, and below 0.40 poor. Surgeons were asked to score the images in "poor" and "good" quality and to provide their years of experience in ARM treatment. Results: Agreement between the image-based rating of surgeons and the intraoperative findings ranges from 0.06 to 0.45 (mean 0.31). Interobserver variation is higher (Krippendorff's alpha between 0.40 and 0.45). Years of experience in ARM treatment does not seem to influence the scoring. The mean intraobserver variation between the two rounds is 0.64. Overall, the quality of the images is considered poor. Images categorized as having a good quality result in a statistically significant higher kappa (mean: 0.36 and 0.37 in the first and second round, respectively) than in the group of bad-quality images (mean: 0.25 and 0.23, respectively). Conclusions: There is poor agreement among experienced pediatric colorectal surgeons on preoperative colostograms. Techniques and analyses of images need to be improved in order to generate a homogeneous series of patients and make comparison of outcomes reliable.
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Affiliation(s)
- Paola Midrio
- Pediatric Surgery Unit, Cà Foncello Hospital, Treviso, Italy
| | - Iris A L M van Rooij
- Department of Health Evidence, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Giulia Brisighelli
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda- Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pediatric Surgery, Chris Hani Baragwanath Hospital and University of Witwatersrand, Johannesburg, South Africa
| | - Aracelli Garcia
- Pediatric Surgery Unit, Doce de Octubre Universitary Hospital, Madrid, Spain
| | - Maria Fanjul
- Pediatric Surgery Unit, Gregorio Marañón Universitary Hospital, Madrid, Spain
| | - Paul Broens
- Division of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Barbara D Iacobelli
- Department of Medical and Surgical Neonatology, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Carlos Giné
- Department of Pediatric Surgery, Hospital Universitary Vall d'Hebron, Barcelona, Spain
| | - Gabriele Lisi
- Pediatric Surgery Unit, Department of Aging Science, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Erasmus Medical Center (MC)-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda- Ospedale Maggiore Policlinico, Milan, Italy
| | - Herjan van der Steeg
- Division of Pediatric Surgery, Department of Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, Netherlands
| | - Stefan Giuliani
- Department of Pediatric Surgery, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sabine Grasshoff-Derr
- Pediatric Surgery Unit, Buergerhospital and Clementine Kinderhospital, Frankfurt, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Ivo de Blaauw
- Division of Pediatric Surgery, Department of Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, Netherlands
| | - Ekkehart Jenetzky
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg-University, Mainz, Germany
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