The prevalence and natural history of patent processus vaginalis (PPV) are unknown. An interim analysis was performed of a multi-institutional, prospective, observational study in neonates undergoing ...laparoscopic pyloromyotomy during which bilateral inguinal canals were evaluated.
Infants under 4 months undergoing laparoscopic pyloromyotomy were enrolled at 8 children's hospitals. The presence of a PPV was evaluated and measurements recorded. Patients with a PPV are undergoing annual phone follow-up to 18 years of age. Interim analysis was performed.
In a cohort of 610 patient, 80 did not have a PPV examined, 4 had consent issues and were excluded, leaving 526 patients. Of these, 433 (82%) were male, median age 1.2 months (IQR 0.9, 1.6), median weight 3.89 kg (IQR 3.4, 4.46), and EGA 39 weeks (IQR 37, 40). There were 283 PPVs, 132 bilateral (47%), 116 right (41%), and 35 left (12%). Patients with a PPV were significantly younger (1.1 months (IQR 0.9, 1.5) vs 1.3 months (IQR 0.9, 1.7), p=0.02), weighed less (3.76kg (IQR 3.35, 4.26) vs 3.9kg (IQR 3.4, 4.5) p=0.03) and had a significantly lower EGA at birth (38 weeks (IQR 37, 40) vs 39 weeks (IQR 38, 40) p=0.003). Of 246 eligible infants, 208 (85%) responded to at least one annual follow-up. Two patients had an inguinal hernia repair for a symptomatic hernia, 49- and 51-days post pyloromyotomy. One had an orchiopexy and incidental inguinal hernia repair 120 days post pyloromyotomy; for a total of 3 (1.2%) hernia repairs. No additional hernias were identified in 116 patients with the PPV patients who have been followed for > 1 year.
The presence of a PPV at the time of pyloromyotomy is common but the need for hernia repair is rare within the first year of life. Continued long-term longitudinal follow-up of this cohort is needed.
II
Disparities in surgical management have been documented across a range of disease processes. The objective of this study was to investigate sociodemographic disparities in young females undergoing ...excision of a breast mass.
A retrospective study of females aged 10-21 y who underwent surgery for a breast lesion across eleven pediatric hospitals from 2011 to 2016 was performed. Differences in patient characteristics, workup, management, and pathology by race/ethnicity, insurance status, median neighborhood income, and urbanicity were evaluated with bivariate and multivariable regression analyses.
A total of 454 females were included, with a median age of 16 y interquartile range (IQR: 3). 44% of patients were nonHispanic (NH) Black, 40% were NH White, and 7% were Hispanic. 50% of patients had private insurance, 39% had public insurance, and 9% had other/unknown insurance status. Median neighborhood income was $49,974, and 88% of patients resided in a metropolitan area. NH Whites have 4.5 times the odds of undergoing preoperative fine needle aspiration or core needle biopsy compared to NH Blacks (CI: 2.0, 10.0). No differences in time to surgery from the initial imaging study, size of the lesion, or pathology were observed on multivariable analysis.
We found no significant differences by race/ethnicity, insurance status, household income, or urbanicity in the time to surgery after the initial imaging study. The only significant disparity noted on multivariable analysis was NH White patients were more likely to undergo preoperative biopsy than were NH Black patients; however, the utility of biopsy in pediatric breast masses is not well established.
•No disparities were found in time to surgery for pediatric breast masses.•No disparities were found in size of lesion or pathology type.•White patients were 4.5x more likely to undergo biopsy than Black patients.
The objective of our study was to describe the workup, management, and outcomes of pediatric patients with breast masses undergoing operative intervention.
A retrospective cohort study was conducted ...of girls 10-21 y of age who underwent surgery for a breast mass across 11 children's hospitals from 2011 to 2016. Demographic and clinical characteristics were summarized.
Four hundred and fifty-three female patients with a median age of 16 y (IQR: 3) underwent surgery for a breast mass during the study period. The most common preoperative imaging was breast ultrasound (95%); 28% reported the Breast Imaging Reporting and Data System (BI-RADS) classification. Preoperative core biopsy was performed in 12%. All patients underwent lumpectomy, most commonly due to mass size (45%) or growth (29%). The median maximum dimension of a mass on preoperative ultrasound was 2.8 cm (IQR: 1.9). Most operations were performed by pediatric surgeons (65%) and breast surgeons (25%). The most frequent pathology was fibroadenoma (75%); 3% were phyllodes. BI-RADS scoring ≥4 on breast ultrasound had a sensitivity of 0% and a negative predictive value of 93% for identifying phyllodes tumors.
Most pediatric breast masses are self-identified and benign. BI-RADS classification based on ultrasound was not consistently assigned and had little clinical utility for identifying phyllodes.
•Most pediatric and adolescent breast masses are benign.•The most common reasons for pediatric lumpectomy are lesion size and growth.•BI-RADS classification may not be useful in evaluation of pediatric breast masses.•It is safe to monitor most breast masses for growth prior to surgical excision.
Purpose
It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). ...There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD.
Methods
A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection. Exclusion criteria were comorbid surgical conditions and other causes of GIB. The primary outcome was post-operative bleeding during the initial hospitalization. Secondary outcomes were bleeding after discharge, transfusion or additional procedure requirement, re-admission, and overall complications.
Results
There were 59 patients who met study criteria (42 diverticulectomy, 17 SBR). One patient in the SBR group had early post-operative bleeding (
p
= 0.288). There was one re-admission (
p
= 0.288) and three total complications in the SBR group (
p
= 0.021). There were no cases of bleeding or other complications in the diverticulectomy group.
Conclusion
This study suggests that simple diverticulectomy is adequate for treatment of GIB caused by MD. Furthermore, diverticulectomy appears to have a lower overall complication rate.
Abstract
Immunology is typically first encountered by students in advanced college or graduate courses. Additional challenges to teaching immunology exist in the developing world, where limited ...resources require curricula balancing state-of-the-art knowledge with region-specific practical considerations. Project-based teaching is especially difficult to execute due to lack of infrastructure and teacher training. Here, we report the results of implementing short hands-on low-cost microbiology and immunology courses for high school and college students in Bolivia. This initiative, “Clubes de Ciencia Bolivia”, brings graduate students and postdoctoral fellows from research institutions in developed nations to teach weeklong intensive courses in Bolivia. These courses (“clubes”) feature project-based and active learning components and are designed and taught with local Bolivian science instructors. Our approach was effective at transmitting concepts in microbiology and immunology, as measured by subject-specific test scores before and after course completion. Importantly, student learning was not significantly affected by their background, education level, socioeconomic status, or initial interest in the specific course taken. Moreover, participants reported a heightened interest in scientific careers after course completion. Strikingly, participants scored higher in subject-specific tests than Bolivian college students who had taken related semester-long college courses. Altogether, these data indicate that participatory learning for immunology in a developing nation can be used to effectively transmit knowledge. Similar approaches are likely to drive scientific engagement in other developing economies.
Abstract
Particular challenges exist for science education in the developing world, where limited resources require curricula designed to balance state-of-the-art knowledge with practical and ...political considerations in region-specific contexts. Project-based biology teaching is especially difficult to execute due to high infrastructural costs and limited teacher training. Here, we report the results of implementing short, challenging, and low-cost biology courses to high school and college students in Bolivia, designed and taught in collaboration between scientists from developed nations and local science instructors. We find our approach to be effective at transmitting advanced topics in disease modeling, microscopy, genome engineering, neuroscience, microbiology, and regenerative biology. We find that student learning through this approach was not significantly affected by their background, education level, socioeconomic status, or initial interest in the course. Moreover, participants reported a heightened interest in pursuing scientific careers after course completion. These results demonstrate efficacy of participatory learning in a developing nation, and suggest that similar techniques could drive scientific engagement in other developing economies.
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