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Dellenmark-Blom M, Reilly C, Öst E, Örnö Ax S, Svensson JF, Kassa AM, Jönsson L, Abrahamsson K, Gatzinsky V, Tollne AM, Omling E, Stenström P, Engstrand Lilja H. Schooling experiences in children with long-gap esophageal atresia compared with children with esophageal atresia and primary anastomosis: a Swedish study. Orphanet J Rare Dis 2023; 18:233. [PMID: 37550744 PMCID: PMC10408199 DOI: 10.1186/s13023-023-02846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Children with long-gap esophageal atresia (LGEA) risk living with aerodigestive morbidity and mental health difficulties. No previous study has investigated their experiences of schooling, despite the importance of schools in children's development, learning and social relationships. We aimed to describe experiences of schooling in children with LGEA in Sweden in comparison with children with EA who had primary anastomosis. METHOD Children with LGEA aged 3-17 were recruited nationwide in Sweden. One parent completed a survey on their child's school-based supports (according to definitions from the Swedish National Agency for Education), school absence, school satisfaction, school functioning (PedsQL 4.0), mental health (Strength and Difficulties Questionnaire) and current symptomatology. School data were compared between 26 children with LGEA to that from 95 children with EA who had PA, a hypothesized milder affected group. Mental health level was determined using validated norms; abnormal ≥ 90 percentile. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05. RESULTS Formal school-based support was reported in 17 (65.4%) children with LGEA and concerned support with nutritional intake (60%), education (50%) and medical/special health needs (35%). The prevalence of school-based support was significantly higher compared to children with PA overall (36.8%, p = 0.013) and regarding nutritional intake support (20%, p < 0.001). In children with LGEA, school-based support was related to low birth weight (p = 0.036), young child age (p = 0.014), height ≤ -2SD for age/sex (p = 0.024) and an increased number of aerodigestive symptoms (p < 0.05). All children with LGEA who had abnormal mental health scores had school-based support, except for one child. Nine children with LGEA (36%) had school absence ≥ 1times/month the past year, more frequently because of colds/airway infections (p = 0.045) and GI-specific problems compared to PA (p = 0.003). School functioning scores were not significantly different from children with PA (p = 0.34) but correlated negatively with school-based support (< 0.001) and school absence (p = 0.002). One parent out of 26 reported their child's school satisfaction as "not good". CONCLUSIONS Children with LGEA commonly receive school-based support, reflecting multifaceted daily needs and disease severity. School absence is frequent and related to poorer school functioning. Future research focusing on academic achievement in children with EA is needed.
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Affiliation(s)
- M Dellenmark-Blom
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.
| | - C Reilly
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - E Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - S Örnö Ax
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - J F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - A-M Kassa
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - K Abrahamsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - V Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - A M Tollne
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Omling
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - P Stenström
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - H Engstrand Lilja
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Stenström P, Kyrklund K, Bräutigam M, Engstrand Lilja H, Juul Stensrud K, Löf Granström A, Qvist N, Söndergaard Johansson L, Arnbjörnsson E, Borg H, Wester T, Björnland K, Pakarinen MP. Total colonic aganglionosis: multicentre study of surgical treatment and patient-reported outcomes up to adulthood. BJS Open 2020; 4:943-953. [PMID: 32658386 PMCID: PMC7528515 DOI: 10.1002/bjs5.50317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background Surgery for total colonic aganglionosis (TCA) is designed to preserve continence and achieve satisfactory quality of life. This study evaluated a comprehensive group of clinical and social outcomes. Methods An international multicentre study from eight Nordic hospitals involving examination of case records and a patient‐reported questionnaire survey of all patients born with TCA between 1987 and 2006 was undertaken. Results Of a total of 116 patients, five (4·3 per cent) had died and 102 were traced. Over a median follow‐up of 12 (range 0·3–33) years, bowel continuity was established in 75 (73·5 per cent) at a median age of 11 (0·5–156) months. Mucosectomy with a short muscular cuff and straight ileoanal anastomosis (SIAA) (29 patients) or with a J pouch (JIAA) (26) were the most common reconstructions (55 of 72, 76 per cent). Major early postoperative complications requiring surgical intervention were observed in four (6 per cent) of the 72 patients. In 57 children aged over 4 years, long‐term functional bowel symptoms after reconstruction included difficulties in holding back defaecation in 22 (39 per cent), more than one faecal accident per week in nine (16 per cent), increased frequency of defaecation in 51 (89 per cent), and social restrictions due to bowel symptoms in 35 (61 per cent). Enterocolitis occurred in 35 (47 per cent) of 72 patients. Supplementary enteral and/or parenteral nutrition was required by 51 (55 per cent) of 93 patients at any time during follow‐up. Of 56 responders aged 2–20 years, true low BMI for age was found in 20 (36 per cent) and 13 (23 per cent) were short for age. Conclusion Reconstruction for TCA was associated with persistent bowel symptoms, and enterocolitis remained common. Multidisciplinary follow‐up, including continuity of care in adulthood, might improve care standards in patients with TCA.
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Affiliation(s)
- P Stenström
- Department of Paediatric Surgery, Children's Hospital in Lund, Skane University Hospital Lund, Lund, Sweden
| | - K Kyrklund
- Department of Paediatric Surgery, Paediatric Research Centre, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - M Bräutigam
- Department of Paediatric Surgery, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - H Engstrand Lilja
- Department of Paediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden
| | - K Juul Stensrud
- Department of Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - A Löf Granström
- Division of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Qvist
- Department of Paediatric Surgery, Odense University Hospital, Research Unit Surgery, University of Southern Denmark, Odense
| | | | - E Arnbjörnsson
- Department of Paediatric Surgery, Children's Hospital in Lund, Skane University Hospital Lund, Lund, Sweden
| | - H Borg
- Department of Paediatric Surgery, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - T Wester
- Division of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Björnland
- Department of Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - M P Pakarinen
- Department of Paediatric Surgery, Paediatric Research Centre, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
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Kassa A, Dahl M, Strinnholm M, Engstrand Lilja H. Attention difficulties and physical dysfunction common in children with complex congenital malformations: a study of preschool children with VACTERL association. Acta Paediatr 2020; 109:783-789. [PMID: 30187514 PMCID: PMC7154541 DOI: 10.1111/apa.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/24/2018] [Accepted: 09/03/2018] [Indexed: 12/02/2022]
Abstract
Aim Knowledge on the neurodevelopmental and physical function in children with vertebral defects, anorectal malformations, cardiac defects, tracheo‐oesophageal fistula, renal and limb malformations (VACTERL) is scarce. We evaluated Swedish preschool children with VACTERL and identified whether they would need extra support in school. Methods From 2015 to 2017, we recruited children aged 5–7 with VACTERL association from the paediatric surgical centre at the University Children's Hospital at Uppsala. Neurodevelopmental function was assessed by age‐appropriate intelligence and visual and auditory attention tests, and the children's behaviour and attention were observed by an experienced psychologist. Physical function was evaluated through parental interviews and examinations. Data on patient characteristics, including any surgery and anaesthesia, were extracted from medical records. Results Of the 13 eligible families, 10 agreed to participate. Intelligence was within the normal range for all children, but attention difficulties were found in eight of the children, requiring adjustments at school, and two of these were later diagnosed with attention deficit hyperactivity disorder. All children had physical dysfunctions that affected their daily nutrition, bowel or bladder functions. Conclusion Attention difficulties and physical dysfunction were common in Swedish preschool children aged 5–7 with VACTERL and they would need support and adjustments when they started school.
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Affiliation(s)
- A‐M Kassa
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Section of Paediatric Surgery University Children's Hospital Uppsala Sweden
| | - M Dahl
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - M Strinnholm
- Folke Bernadotte Regional Habilitation Centre University Children's Hospital Uppsala Sweden
| | - H Engstrand Lilja
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Section of Paediatric Surgery University Children's Hospital Uppsala Sweden
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Fredriksson F, Engstrand Lilja H. Survival rates for surgically treated necrotising enterocolitis have improved over the last four decades. Acta Paediatr 2019; 108:1603-1608. [PMID: 30825252 PMCID: PMC6767135 DOI: 10.1111/apa.14770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/03/2019] [Accepted: 02/27/2019] [Indexed: 12/12/2022]
Abstract
Aim Improved survival rates for premature infants have also increased the population at risk of necrotising enterocolitis (NEC). This study evaluated the outcomes of surgically treated NEC and identified risk factors for mortality, intestinal failure (IF) and IF associated liver disease (IFALD). Methods This was a retrospective observational study of 131 infants with surgically treated NEC from 1976 to 2016 in a Swedish tertiary referral centre: 20 in 1976–1996, 33 in 1997–2006 and 78 in 2007–2016. Data were extracted from medical records, and the Cox regression model was used to identify risk factors. Results When the first and last periods were compared, they showed decreases in both gestational age, from 30 to 26 weeks, and mortality rates, from 45% to 29%. IF was found in 67 patients (56%), IFALD in 41 patients (34%) and short bowel syndrome (SBS) in 13 (19%). The incidence of IF was high, even in infants without SBS. Low gestational age was an independent risk factor for mortality. No risk factors were identified for IF or IFALD. Conclusion Survival rates for NEC improved from 1976–2016, despite a decrease in gestational age. Clinicians should be particularly aware of the risk of infants without SBS developing IF.
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Affiliation(s)
- F Fredriksson
- Department of Women's and Children's Health Section of Pediatric Surgery Uppsala University Uppsala Sweden
| | - H Engstrand Lilja
- Department of Women's and Children's Health Section of Pediatric Surgery Uppsala University Uppsala Sweden
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Fredriksson F, Sellberg F, Bowden T, Engstrand T, Berglund D, Lilja HE. Sutures impregnated with carbazate-activated polyvinyl alcohol reduce intraperitoneal adhesions. J Pediatr Surg 2017; 52:1853-1858. [PMID: 28196659 DOI: 10.1016/j.jpedsurg.2017.01.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/26/2016] [Accepted: 01/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intraperitoneal adhesions cause significant morbidity. They occur after peritoneal trauma, which induces oxidative stress with production of inflammatory cytokines, peroxidized proteins (carbonyls) and lipids (aldehydes). This study aimed to investigate if carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl inhibitor, can reduce intraperitoneal adhesions in an experimental model. MATERIAL AND METHODS Male Sprague-Dawley rats (n=110) underwent laparotomy, cecal abrasion and construction of a small bowel anastomosis. They either were treated with intraperitoneal instillation of PVAC or were sutured with PVAC-impregnated sutures. Thromboelastography analysis was performed using human blood and PVAC. The lipid peroxidation product malondialdehyde (MDA) and inflammatory cytokines IL-1β and IL-6 were quantified in peritoneal fluid. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly scored. RESULTS PVAC in human blood decreased the production of the fibrin-thrombocyte mesh without affecting the coagulation cascade. MDA, IL-1β and IL-6 were increased after 6h without significant difference between the groups. PVAC-impregnated sutures reduced intraperitoneal adhesions compared to controls (p=0.0406) while intraperitoneal instillation of PVAC had no effect. Anastomotic bursting pressure was unchanged. CONCLUSIONS Intervention with an aldehyde-carbonyl inhibitor locally in the wound by PVAC-impregnated sutures might be a new strategy to reduce intraperitoneal adhesions.
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Affiliation(s)
- F Fredriksson
- Department of Women's and Children's Health, Section of Pediatric Surgery, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - F Sellberg
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85 Uppsala, Sweden
| | - T Bowden
- Department of Materials Chemistry, Uppsala University, SE-751 21 Uppsala, Sweden
| | - T Engstrand
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital and Karolinska Institute, SE-171 76 Stockholm, Sweden
| | - D Berglund
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85 Uppsala, Sweden
| | - H E Lilja
- Department of Women's and Children's Health, Section of Pediatric Surgery, Uppsala University, SE-751 85 Uppsala, Sweden
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Kassa AM, Engvall G, Engstrand Lilja H. Young children with severe congenital malformations (VACTERL) expressed mixed feelings about their condition and worries about needles and anaesthesia. Acta Paediatr 2017; 106:1694-1701. [PMID: 28672091 DOI: 10.1111/apa.13973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 12/16/2022]
Abstract
AIM Our knowledge of the perceptions that children with severe congenital malformations have of their health, treatment and how to improve hospital care is limited. This study focused on patients with vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL). METHODS We interviewed 10 children aged five to eight years with VACTERL association who were treated in a Swedish tertiary paediatric surgical centre, using a computer-assisted technique called In My Shoes. The interviews were analysed by qualitative content analysis. RESULTS The children described their awareness of their health history and said they felt proud but different due to their physical dysfunction. They were happy to visit the hospital to meet familiar staff, but expressed negative feelings about missing normal life. They were afraid of needle-related procedures and not wakening up after anaesthesia. Various ways of coping with difficult situations were expressed, and suggestions to improve hospital care were voiced. CONCLUSION Careful follow-up of these children by multidisciplinary teams is crucial to optimise their health and functional status. Fear of medical procedures may be reduced by carefully delivered information, listening to the children, providing continuity of care and creating individual care strategies.
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Affiliation(s)
- A-M Kassa
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Department of Paediatric Surgery; University Children's Hospital; Uppsala Sweden
| | - G Engvall
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - H Engstrand Lilja
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Department of Paediatric Surgery; University Children's Hospital; Uppsala Sweden
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Fredriksson F, Christofferson RH, Lilja HE. Adhesive small bowel obstruction after laparotomy during infancy. Br J Surg 2015; 103:284-9. [DOI: 10.1002/bjs.10072] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/12/2015] [Accepted: 11/03/2015] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Intra-abdominal adhesions can cause adhesive small bowel obstruction, chronic abdominal pain and female infertility. Reports on long-term outcomes following laparotomy during infancy are scarce. The aims of this study were to investigate the incidence of and risk factors for long-term adhesive small bowel obstruction and associated morbidity after laparotomy during infancy.
Methods
Infants who underwent laparotomy between 1976 and 2011 were identified. Data were extracted from medical records and a questionnaire was sent to the patients.
Results
Some 898 of 1185 eligible patients were included, with a median follow-up time of 14·7 (range 0·0–36·0) years. Median age at first laparotomy was 6 (range 1·0–365·0) days. There were 113 patients (12·6 per cent) with adhesive small bowel obstruction who underwent relaparotomy, 79 (69·9 per cent) occurring during the first 2 years after the initial laparotomy. The highest incidence of small bowel obstruction was found in patients with Hirschsprung's disease (19 of 65, 29 per cent), malrotation (13 of 45, 29 per cent), intestinal atresia (11 of 40, 28 per cent) and necrotizing enterocolitis (16 of 64, 25 per cent). Lengthy duration of surgery (hazard ratio (HR) 1·25, 95 per cent c.i. 1·07 to 1·45), stoma formation (HR 1·72, 1·15 to 2·56) and postoperative complications (HR 1·81, 1·12 to 2·92) were independent risk factors. Chronic abdominal pain was reported in 180 (24·0 per cent) of 750 patients, and 17 (13·8 per cent) of 123 women reported infertility.
Conclusion
The incidence of adhesive small bowel obstruction after laparotomy in infants is high.
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Affiliation(s)
- F Fredriksson
- Department of Women's and Children's Health, Section of Paediatric Surgery, Uppsala University, SE-751 85, Uppsala, Sweden
| | - R H Christofferson
- Department of Women's and Children's Health, Section of Paediatric Surgery, Uppsala University, SE-751 85, Uppsala, Sweden
| | - H E Lilja
- Department of Women's and Children's Health, Section of Paediatric Surgery, Uppsala University, SE-751 85, Uppsala, Sweden
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Wester T, Borg H, Naji H, Stenström P, Westbacke G, Lilja HE. Serial transverse enteroplasty to facilitate enteral autonomy in selected children with short bowel syndrome. Br J Surg 2014; 101:1329-33. [PMID: 25043139 PMCID: PMC4282069 DOI: 10.1002/bjs.9583] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/10/2014] [Accepted: 05/08/2014] [Indexed: 12/25/2022]
Abstract
Background Serial transverse enteroplasty (STEP) was first described in 2003 as a method for lengthening and tapering of the bowel in short bowel syndrome. The aim of this multicentre study was to review the outcome of a Swedish cohort of children who underwent STEP. Methods All children who had a STEP procedure at one of the four centres of paediatric surgery in Sweden between September 2005 and January 2013 were included in this observational cohort study. Demographic details, and data from the time of STEP and at follow-up were collected from the case records and analysed. Results Twelve patients had a total of 16 STEP procedures; four children underwent a second STEP. The first STEP was performed at a median age of 5·8 (range 0·9–19·0) months. There was no death at a median follow-up of 37·2 (range 3·0–87·5) months and no child had small bowel transplantation. Seven of the 12 children were weaned from parenteral nutrition at a median of 19·5 (range 2·3–42·9) months after STEP. Conclusion STEP is a useful procedure for selected patients with short bowel syndrome and seems to facilitate weaning from parenteral nutrition. At mid-term follow-up a majority of the children had achieved enteral autonomy. The study is limited by the small sample size and lack of a control group. Good results in selected children
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Affiliation(s)
- T Wester
- Department of Paediatric Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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Sammalisto S, Hiekkalinna T, Suviolahti E, Sood K, Metzidis A, Pajukanta P, Lilja HE, Soro-Paavonen A, Taskinen MR, Tuomi T, Almgren P, Orho-Melander M, Groop L, Peltonen L, Perola M. A male-specific quantitative trait locus on 1p21 controlling human stature. J Med Genet 2005; 42:932-9. [PMID: 15827092 PMCID: PMC1735962 DOI: 10.1136/jmg.2005.031278] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many genome-wide scans aimed at complex traits have been statistically underpowered due to small sample size. Combining data from several genome-wide screens with comparable quantitative phenotype data should improve statistical power for the localisation of genomic regions contributing to these traits. OBJECTIVE To perform a genome-wide screen for loci affecting adult stature by combined analysis of four previously performed genome-wide scans. METHODS We developed a web based computer tool, Cartographer, for combining genetic marker maps which positions genetic markers accurately using the July 2003 release of the human genome sequence and the deCODE genetic map. Using Cartographer, we combined the primary genotype data from four genome-wide scans and performed variance components (VC) linkage analyses for human stature on the pooled dataset of 1417 individuals from 277 families and performed VC analyses for males and females separately. RESULTS We found significant linkage to stature on 1p21 (multipoint LOD score 4.25) and suggestive linkages on 9p24 and 18q21 (multipoint LOD scores 2.57 and 2.39, respectively) in males-only analyses. We also found suggestive linkage to 4q35 and 22q13 (multipoint LOD scores 2.18 and 2.85, respectively) when we analysed both females and males and to 13q12 (multipoint LOD score 2.66) in females-only analyses. CONCLUSIONS We strengthened the evidence for linkage to previously reported quantitative trait loci (QTL) for stature and also found significant evidence of a novel male-specific QTL on 1p21. Further investigation of several interesting candidate genes in this region will help towards characterisation of this first sex-specific locus affecting human stature.
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Affiliation(s)
- S Sammalisto
- Department of Molecular Medicine, National Public Health Institute, Helsinki, Finland
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