POSTOPERATIVE CONGENITAL ESOPHAGEAL ATRESIA COMPLICATIONS

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RESEARC H Open Access HIV, appendectomy and postoperative complications at a reference hospital in Northwest Tanzania: cross-sectional study Geofrey C Giiti 1 , Humphrey D Mazigo 2* , Jorg Heukelbach 3,4 , William Mahalu 1 Abstract Background: Appendicitis is a frequent surgical emergency worldwide. The present study was conducted to determine the prevalence of HIV, and the association of infection with clinical, intraoperative and histological findings and outcome, among patients with appendicitis. Methods: We performed a cross sectional study at Weill-Bugando Medical Centre in northwest Tanzania. In total, 199 patients undergoing appendectomy were included. Demographic characteristics of pat ients, clinical features, laboratory, intraoperative and histopathological findings, and HIV serostatus were recorded. Results: In total, 26/199 (13.1%) were HIV-seropositive. The HIV-positive population was significantly older (mean age: 38.4 years) than the HIV-negative population (25.3 years; p < 0.001). Leukocytosis was prese nt in 87% of seronegative patients, as compared to 34% in seropositive patients (p = 0.0001), and peritonitis was significantly more frequent among HIV-positives (31% vs. 2%; p < 0.001). The mean (SD) length of hospital stay was significantly longer in HIV- positives (7.12 ± 2.94 days vs. 4.02 ± 1.14 days; p < 0.001); 11.5% of HIV patients developed surgical site infections, as compared to 0.6% in the HIV-negative group (p = 0.004). Conclusion: HIV infections are common among patients with append icitis in Tanzania, and are associated with severe morbidity, postoperative complications and longer hospital stays. Early diagnosis of appendicitis and prompt appendectomy are crucial in areas with high prevalence of HIV infection. Routine pre-test counseling and HIV screening for appendicitis patients is recommended to detect early cases who may benefit from HAART. Introduction Appendicitis is the most frequent abdominal emergency worldwide [1-4], and also the most common cause of sur- gical emerg ency admissions in many parts of Africa [2,5]. Interestingly, the occurrence of appendicitis appears to be increasing in many low and middle income c ountries [6-8]. This may partly be explained by the increasing num- ber of HIV/AIDS cases in the sub-Saharan region, as com- pared to high income countries [9]. In the e arly years of the HIV e pidemic it was noted that HIV-infected patients had a higher risk of appendi- citis, even beyond the risks accounted for by opportunis- tic infections [10]. However, little is known about the interactions between HIV infection and surgical diseases like appendicitis. Some reports have suggested that the higher occurrence of appendicitis in HIV/AIDS patients was related to the fact that the appendix is a target site for infection due to its predominant supply by terminal arteries [11]. Other studies have reported higher rates of surgical complications such as postoperative infections, impaired wound healing and higher mortality among HIV-seropositive patients [12-14]. This may lead to withholding surgery in some circumstances [15]. How- ever, other studies did not find any difference in surgical outcomes between HIV-infected patients and the gen- eral population [16,17]. In Tanzania, limited data are available on the associa- tion between appendicitis and HIV infection, and the short-term outcome among HIV patients attending referral hospitals. In the northwest of the country, HIV prevalence in the adult population ranges from 6.7% * Correspondence: humphreymazigo@gmail.com 2 Department of Medical Parasitology and Entomology, Faculty of Medicine, Weill-Bugando University College of Health Sciences, P. O. Box 1464, Mwanza, Tanzania Full list of author information is available at the end of the article Giiti et al. AIDS Research and Therapy 2010, 7:47 http://www.aidsrestherapy.com/content/7/1/47 © 2010 Giiti et al; licensee BioMed Central Ltd. This is an Open Access article CHILDREN’S HOSPITAL II POSTOPERATIVE CONGENITAL ESOPHAGEAL ATRESIA COMPLICATIONS: A REVIEW Dr Nguyen Thuy Hanh Ngan Neonatal Department CONTENTS Background Classification Management Complications Conclusion Background  Esophageal atresia (EA) is a congenital defect of the esophagus with or without connection to the trachea (TEF)  Incidence: per 3500 - 4000 live births  EA/TEF may occur as an isolated anomaly or may develop within the context of a known syndrome or association (VACTERL association)  EA and TEF are classified according to their anatomic configuration Classification Management  Surgical ligation of the fistula → Primary anastomosis → Staged procedures  Methods → Thoracoscopy → Open thoracotomy COMPLICATIONS  Anastomotic leak  Esophageal stricture  Recurrent fistulae  Dysphagia  GERD with esophagitis  GERD without esophagitis  Respiratory tract infections  Tracheomalacia  Asthma  Wheeze  Persistent cough  Barrett esophagus  Esophageal cancer (squamous cell) Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of million C Dingemann et al , Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany •The aim of this study was to evaluate the early postoperative results after repair of esophageal atresia •All patients who had undergone esophageal atresia repair from January 2007 to August 2012 •The incidences of anastomotic leak (3%) and recurrent tracheoesophageal fistula (7%) •Anastomotic stricture required dilatation 57% •93% of the patients were readmitted at least once •A correlation between the complication rate and characteristics of the treating institutions was not identified (“Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of million”, C Dingemann, 2015) Table 2: Incidence of postoperative complications (“Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of million”, C Dingemann, 2015) Outcomes at One-Year Post Anastomosis from a National Cohort of Infants with Oesophageal Atresia Benjamin Allin et al, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom, 2014 • We aimed to provide an assessment of outcomes at oneyear post EA-TEF repair, focussing particularly on postoperative complications We also aimed to assess the efficacy of prophylactic anti-reflux medication (PARM) in reducing stricture formation • A prospective, multi-centre cohort study of all infants liveborn with oesophageal atresia in the United Kingdom and Ireland in 2008- 2009 was performed The effect of PARM on stricture formation in infants with the type-c anomaly was assessed using logistic regression analysis • 151 infants with oesophageal atresia One-year follow-up information was returned for 105 infants (70%); the mortality rate was 8.6% (95% CI 4.7–14.3%) • Post-operative complications included anastomotic leak (5.4%), recurrent fistula (3.3%) and oesophageal stricture (39%) • This study provides a benchmark for current outcomes and complication rates following OA-TOF repair • No statistically significant difference in stricture rate between those infants who received PARM and those who did not Need further investigation such as a randomised controlled trial Long-term esophageal and respiratory outcomes in children with esophageal atresia and tracheoesophageal fistula Richard H et al, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA, 2015 •The aim of our study was to characterize the esophageal and respiratory morbidity of EA/TEF •43 patients with congenital EA/TEF evaluated from 2011 to 2014 were included •Heartburn (48,8%), acid regurgitation (44.1%), dysphagia (72.1%), dysmotility (76.9%) •Cough and choking in 72.1% patients and dyspnea and wheezing (53.4%) Recurrent respiratory infections (44.2%) •Tracheomalacia (86.7%) and restrictive lung disease(54.5%) •Thirty patients underwent endoscopy, of which 70.0% had a stricture, and 20.0% had recurrent fistula requiring surgical intervention •There is a high burden of residual esophageal and pulmonary pathology in patients with EA/TEF Ongoing followup is required to monitor both the clinical symptoms and treatment responses Morbidity and Mortality in Patients with Esophageal Atresia Jason P Sulkowski et al, Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, 2014 •This study reports characteristics and outcomes for patients with EA/TEF •Patients admitted within 30 days of life who had ICD-9-CM diagnosis and procedure codes relevant to EA/TEF during 1999–2012 Post-operative outcomes were examined up to years following EA/TEF repair • 3479 patients with EA/TEF treated at 43 children’s hospitals Within two years of discharge, 54.7% were readmitted, 5.2% had a repeat TEF ligation, 11.4% had a repeat operation for ...CASE REP O R T Open Access Congenital aplasia of the optic chiasm and esophageal atresia: a case report Stefano Pensiero 1 , Paolo Cecchini 2 , Paola Michieletto 2 , Gloria Pelizzo 2 , Maurizio Madonia 1 and Fulvio Parentin 1,3* Abstract Introduction: The complete absence of the chiasm (chiasmal aplasia) is a rare clinical condition. Hypoplasia of the optic nerve and congenital nystagmus are almost invariably associated characteristics. Microphthalmos or anophthalmos are common features in chiasmal aplasia, while central nervous system abnormalities are less frequent. Esophageal atresia can be isolated or syndromic. In syndromic cases, it is frequently associated with cardiac, limb, renal or vertebral malformations and anal atresia. More rarely, esophageal atresia can be part of anophthalmia-esophageal-genital syndrome, which comprises anophthalmia or microphthalmia, genital abnormalities, vertebral defects and cerebral malformations. Here, a previously unreported case of chiasmal aplasia presenting without microphthalmos and associated with esophageal atresia is described. Case presentation: Aplasia of the optic chiasm was identified in a Caucasian Italian 8-month-old boy with esophageal atresia. An ultrasound examination carried out at 21 weeks’ gestation revealed polyhydramnios. Intrauterine growth retardation, esophageal atresia and a small atrial-septal defect were subsequently detected at 28 weeks ’ gestation. Repair of the esophageal atresia was carried out shortly after birth. A jejunostomy was carried out at four months to facilitate enteral feeding. The child was subsequently noted to be visually inattentive and to be neurodevelopmentally delayed. Magnetic resonance imaging revealed chiasmal aplasia. No other midline brain defects were found. His karyotype was normal. Conclusion: If achiasmia is a spectrum, our patient seems to depict the most severe form, since he appears to have an extremely severe visual impairment. This is in contrast to most of the cases described in the literature, where patients maintain good–or at least useful– visual function. To the best of our knowledge, the association of optic nerve hypoplasia, complete chiasmal aplasia, esophageal atresia and atrial-septal defect, choanal atresia, hypertelorism and psychomotor retardation has never been described before. Introduction Complete absence of the chiasmal struc ture, often asso- ciated with optic nerve aplasia, is termed chiasmal apla- sia, while the term achiasmia is used to identify the abnormality of crossing fibers [1]. In fact, while in albin- ism the temporal retinal fibers erroneously decussate at the optic chiasm (OC), in achiasmia the majority of fibers fail to cross at the O C and project ipsilaterally . This condition is als o termed ‘non-decussating retinal- fugal fiber syndrome’ (NDRFFS) [2,3]. Both albino and achiasmatic anatomical and developmental abnormalities can be functionally demonstrated by means of flash visual evoked potentials (F-VEPs) [4,5]. In achiasmia, F- VEPs show a higher positive component ipsilateral to the stimulated eye, while in albinos the response is greater contralaterally [4,1]. Congenital nystagmus is a consistent feature in achias- mia, as well as in certain cases of optic nerve hypoplasia [2,6]. Central nervous system (CNS) abnormalities, such as septo-optic dysplasia, hypopituitarism, encephalocele or corpus callosum agenesia are associated with achiasmia [1]. The complete absence of the chiasm (chiasmal aplasia) is a rarer clinical condition. Hypoplasia of the optic nerve and congenital nystagmus are almost invariably associated characteristics [6,7]. Microphthalmos or anophthalmo s are common features in chiasmal aplasia, while CNS abnormalities are less frequent [6,7]. * Correspondence: parentin@burlo.trieste.it 1 Ophthalmology Unit, Department of Surgery, Institute for Maternal and Child Health, Burlo Garofolo Trieste, Via dell’Istria 65/1, I-34100 Trieste, Italy Full list of author information JOURNAL OF MEDICAL CASE REPORTS DiScioscio et al. Journal of Medical Case Reports 2010, 4:164 http://www.jmedicalcasereports.com/content/4/1/164 Open Access CASE REPORT © 2010 DiScioscio et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case report Congenital cystic adenomatoid malformation of the lung associated with bronchial atresia involving a different lobe in an adult patient: a case report Valerio DiScioscio*, Paola Feraco, Alberto Bazzocchi, Rayka Femia, Chiara Romeo, Luca Fasano, Angela M Pacilli and Maurizio Zompatori Abstract Introduction: Congenital cystic adenomatoid malformation of the lung is an uncommon cause of respiratory distress in neonates and babies. The disorder is usually diagnosed in the neonatal period and the first two years of life. This anomaly has been described in association with bronchopulmonary sequestration, extralobar intra-abdominal sequestration or bronchial atresia in live and stillborn babies. It is rarely encountered in adults, in whom the diagnosis is made incidentally from mass lesion features seen on chest radiographs. The oldest patients recorded with this malformation have been about 35 years old, and only 10% of primary diagnoses are made after the first year of life. Delayed diagnosis can be related to infection or serendipitous discovery. Case presentation: We describe the radiological findings of a 34-year-old Caucasian woman with a clinical history of recurrent pneumonia, intermittent anterior pleuritic chest pain and haemoptysis. Congenital cystic adenomatoid malformation of the lung associated with bronchial atresia involving a different lobe was discovered. Conclusion: Although rare in adults, congenital cystic adenomatoid malformation should be suspected in adult patients who suffer from recurrent or persistent non-productive coughs. The discovery of an association of congenital cystic adenomatoid malformation with bronchial atresia in adulthood is rare but possible, even in different lobes. Introduction Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare congenital pulmonary developmental malformation, found in terminal respiratory structures. It represents 25% of all congenital lung abnormalities and is characterized by a multicystic mass of pulmonary tissue with an abnormal proliferation of the bronchial structure [1]. About 46 cases of CCAM diagnosed in adulthood have been reported in the English literature up to now but none in association with bronchial atresia (BA) involving a different lobe [2]. We report a case of CCAM associated with BA discov- ered in an adult symptomatic patient and we describe the clinical features and radiological findings. Case presentation A 34-year-old Caucasian woman with a clinical history of recurrent pneumonia and intermittent anterior pleuritic chest pain without risk factors, was hospitalized for hemoptysis. Pulmonary function tests were performed and revealed only a mild obstruction of the small airways. Diffusing capacity of the lung for carbon monoxide (DLCO) and pulmonary volumes were within the normal ranges. Chest radiography was performed at admission and showed an oval opacity at the bronchial branch for the right upper lobe with an area of parenchymal oligemia downstream, which had not been present in previous * Correspondence: valeriodiscioscio@libero.it 1 Imaging Section, Department of Radiologic and Histocytopathologic Sciences, University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 9, 40100 Bologna, Italy Full list of author information is available at the end of the article DiScioscio et al. Journal of Medical Case Reports 2010, 4:164 http://www.jmedicalcasereports.com/content/4/1/164 Page 2 of 3 examinations (Figure Case report Open Access Recurrent late complications following congenital diaphragmatic hernia repair with prosthetic patches: a case series Basil Bekdash 1 , Baljit Singh 2 and Kokila Lakhoo 1 * Address: 1 Department of Paediatric Surgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK and 2 Nuffield Department of Surgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK Email: BB - basil.bekdash@gmail.com; BS - Baljit.singh@nds.ox.ac.uk; KL* - Kokila.lakhoo@paediatrics.ox.ac.uk * Corresponding author Published: 26 May 2009 Received: 10 January 2008 Accepted: 23 January 2009 Journal of Medical Case Reports 2009, 3:7237 doi: 10.1186/1752-1947-3-7237 This article is available from: http://jmedicalcasereports.com/jmedicalcasereports/article/view/7237 © 2009 Bekdash et al; licensee Cases Network Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction: Many different prosthetic materials have been used for repair of large posterolateral congenital diaphragmatic hernias, which cannot be primarily repaired. Almost 50% of patch repaired diaphragmatic hernias will recur. The ideal prosthetic material for congenital diaphragmatic hernia repair has yet to be established. We report on two cases with unusual (calcification) and late complications related to the prosthetic material used for diaphragmatic hernia repair. Case presentation: We report two cases of antenatally diagnosed left-sided diaphragmatic hernia that were repaired with a patch due to total absence of a diaphragm. Both Caucasian patients developed recurrent late graft complications. Case one was repaired on day 17 post-stabilisation and developed recurrence at 14½ months of age and again at 26 months of age. Case 2 underwent surgery on day 13 of life and developed recurrence at 4 months and again at 3 years of age. In the recurrent repairs, both synthetic and biomaterial patches were used. Both patients are well at long- term follow-up of 10 and 7 years, respectively. Conclusion: The ideal choice of patch material for diaphragmatic hernia repair remains a therapeutic challenge. Introduction Congenital diaphragmatic hernias (CDH) occur with an estimated incidence of 1/2-4000 live births [1] and almost invariably require surgical intervention. The majority of defects are left-sided and sufficiently small to permit primary closure. Larger defects or total agenesis require closure with a prosthetic patch or flap, the latter usually for recurrent hernias. The patch material used may be the major contributing modifiable factor determining the incidence of late complications well after the time of surgery. Case presentation Case report 1 A full-term Caucasian female neonate with antenatally diagnosed left-sided CDH underwent surgical repair of a large defect at 17 days with Gore-Tex (expanded poly- tetrafluoroethene (PTFE); WL Gore & Associates Inc). One Page 1 of 3 (page number not for citation purposes) month following Nissen fundoplication and Stamm gastrostomy aged 14½ months, she presented with a recurrence through a ~2 cm anteromedial dehiscence of the patch. The defect was later closed primarily via thoracotomy and the hemidiaphragm reinforced with Surgisis (porcine small intestine submucosa (SIS) col- lagen; Cook Inc). At 26 months of age, the child presented with an abscess at the site of the previous thoracotomy and computed tomography demonstrated an intrathoracic collection associated with the prostheses (Figure 1). After initial drainage of the external component, at thoracotomy both collections were found to be in continuity and the distorted Gore-Tex patch within the abscess cavity was excised. There was sufficient fibrous ‘neodiaphragm’ to permit primary closure of the defect with no need for a further Open Access Available online http://ccforum.com/content/8/6/R437 R437 December 200 4 Vol 8 No 6 Research Early postoperative hyperglycaemia is not a risk factor for infectious complications and prolonged in-hospital stay in patients undergoing oesophagectomy: a retrospective analysis of a prospective trial Titia M Vriesendorp 1 , J Hans DeVries 2 , Jan BF Hulscher 3 , Frits Holleman 2 , Jan J van Lanschot 4 and Joost BL Hoekstra 5 1 Research Physician, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands 2 Internist-Endocrinologist, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands 3 Surgical Resident, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands 4 Professor of Surgery, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands 5 Professor of Internal Medicine, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands Corresponding author: Titia M Vriesendorp, T.M.Vriesendorp@amc.uva.nl Abstract Introduction Treating hyperglycaemia in hospitalized patients has proven to be beneficial, particularly in those with obstructive vascular disease. In a cohort of patients undergoing resection for oesophageal carcinoma (a group of patients with severe surgical stress but a low prevalence of vascular disease), we investigated whether early postoperative hyperglycaemia is associated with increased incidence of infectious complications and prolonged in-hospital stay. Methods Postoperative glucose values up to 48 hours after surgery were retrieved for 151 patients with American Society of Anesthesiologists class I or II who had been previously included in a randomized trial conducted in a tertiary referral hospital. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis. Results In univariate regression analysis, postoperative glucose levels were associated with increased length of in-hospital stay (P < 0.001) but not with infectious complications (P = 0.21). However, postoperative glucose concentration was not found to be an independent risk factor for prolonged in- hospital stay in multivariate analysis (P = 0.20). Conclusion Our data indicate that postoperative hyperglycaemia is more likely to be a risk marker than a risk factor in patients undergoing highly invasive surgery for oesophageal cancer. We hypothesize that patients with a low prevalence of vascular disease may benefit less from intensive insulin therapy. Keywords: hyperglycaemia, infection, length of stay, oesophagectomy, risk factor Introduction Until recently hyperglycaemia after surgery was considered to be a benign phenomenon. However, in a landmark study, van den Berghe and coworkers [1] showed that treating transient postoperative hyperglycaemia with intensive insulin therapy in a surgical intensive care unit (ICU) dramatically reduces mor- tality and morbidity. Strict glucose control (target range between 4.4 mmol/l and 6.1 mmol/l) was responsible for a Received: 26 August 2004 Accepted: 2 September 2004 Published: 18 October 2004 Critical Care 2004, 8:R437-R442 (DOI 10.1186/cc2970) This article is online at: http://ccforum.com/content/8/6/R437 © 2004 Vriesendorp et al., licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is cited. ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; FEV 1 = forced expiratory volume in 1 s; FFA = free fatty acid; ICU = intensive care unit; OR = odds ratio; SE = standard error. Critical Care December 2004 Vol 8 No 6 Vriesendorp et al. R438 reduction in both ICU and in-hospital mortality, which was pri- marily attributed to the ... the management of neonates affected by esophageal atresia CONCLUSION Esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF) is a rare congenital malformation •The prognosis... (“Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of million”, C Dingemann, 2015) Table 2: Incidence of postoperative complications. .. for complications in children with esophageal atresia and tracheoesophageal fistula R Shah, University of New South Wales, Australia •The aim of this study was to describe the incidence of complications