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Background: Consequences of extrahepatic portal vein obstruction (EHPVO) include variceal bleeding and hypersplenism due to portal hypertension, as well as metabolic abnormalities secondary to impaired portal venous circulation. The purpose of this study was to compare the effectiveness of meso-Rex bypass and portosystemic shunt (PSS) for reversing these symptoms in children with EHPVO., Study Design: All children with idiopathic EHPVO evaluated for potential meso-Rex bypass at a single institution between 1997 and 2010 were reviewed. Portosystemic shunt was performed in patients with refractory portal hypertension when meso-Rex bypass was not technically feasible. Outcomes of meso-Rex bypass and PSS were compared, including resolution of portal hypertensive bleeding and hypersplenism, as well as changes in liver synthetic function, ammonia levels, and somatic growth., Results: Sixty-five children with EHPVO underwent successful meso-Rex bypass, while 16 required PSS. Nearly all patients experienced complete relief of variceal bleeding after meso-Rex (96%) bypass and PSS (100%). The improvements in platelet count (+82.1 ± 60.0 vs +32.4 ± 56.3 thousand/μL; p=0.004), internal normalized ratio (-0.22 ± 0.27 vs 0.01 ± 0.14; p=0.022), and serum ammonia level (-26.8 ± 36.8 vs +19.4 ± 33.1 μM/L; p=0.002) were greater after meso-Rex bypass than PSS. Among patients with below average (standard deviation z-score<0) preoperative weight for age, the improvement in weight-for-age z-score was greater after meso-Rex bypass (+0.84 ± 0.98) than PSS (+0.17 ± 0.79, p=0.044). Median duration of follow-up was 4.45 years after meso-Rex bypass and 1.8 years after PSS., Conclusions: Both meso-Rex bypass and PSS effectively relieve symptoms of portal hypertensive bleeding in children with EHPVO, although the meso-Rex better relieves hypersplenism. By restoring normal portal venous circulation, the meso-Rex bypass has additional metabolic benefits., (Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to determine if the postgraduate level of resident in the operating room correlates with outcomes for pediatric patients undergoing laparoscopic appendectomy., Subjects and Methods: The charts of all children who underwent laparoscopic appendectomy for appendicitis from 2007 to 2011 at a free-standing children's hospital were reviewed. Outcomes of interest were compared between patient groups based on postgraduate level of the junior-most surgeon in the operating room: (1) junior resident (postgraduate year [PGY]-1, -2, and -3); (2) senior resident (PGY-4 or -5); (3) fellow (PGY-6 or -7); or (4) attending surgeon only., Results: Junior resident (n=327), senior resident (n=129), fellow (n=246), and attending (n=73) groups were similar in terms of age (P=.69), gender distribution (P=.51), race (P=.08), and perforation status (P=.30). Operative time was shorter for senior residents (P=.002), fellows (P<.001), and attending surgeons operating without a resident (P<.001) compared with cases with junior residents. The rate of conversion to an open operation was similar among groups (P=.46). Resident level was not predictive of complications, which occurred in 26 junior resident cases (8.0%; referent), 17 senior resident cases (13.2%; odds ratio [OR] 1.73; P=.11), 33 fellow cases (13.4%; OR 1.71; P=.06), and 8 attending cases (11.0%; OR 1.62; P=.27). Fellow involvement was associated with an increased rate of postoperative percutaneous abscess drainage or re-operation for abscess or bowel obstruction (9.8%; OR 2.31; P=.020)., Conclusions: Involvement of junior residents in pediatric laparoscopic appendectomy is associated with increased operative time but no higher rate of complications.

Background: Histone deacetylase (HDAC) inhibitors have shown promise in the treatment of resistant and refractory tumors including neuroblastoma. The goal of the study was to compare the efficacy of a class III HDAC inhibitor (cambinol) to a class I and II inhibitor (vorinostat)., Methods: In vitro efficacy of vorinostat and cambinol, alone or in combination with doxorubicin, was assessed by 2-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide calorimetric assay using both wild-type (WT) and doxorubicin-resistant (DoxR) SK-N-SH neuroblastoma cells. In vivo efficacy was determined using the same drug combinations in nude mice bearing xenograft implants of WT and DoxR cells on opposite flanks., Results: Vorinostat and cambinol were efficacious against WT and DoxR neuroblastoma cells in vitro. In WT cells, the potency of the doxorubicin itself overshadowed any effect of cotherapy with vorinostat or cambinol. The effect of vorinostat and/or cambinol on the DoxR cells was constant across progressively increasing doses of doxorubicin. In the in vivo model, the efficacy of doxorubicin itself (88% reduction in tumor volume) again overshadowed any effect of cotreatment with vorinostat or cambinol on the WT tumors. However, in the DoxR tumors, doxorubicin alone had no efficacy, but cotreatment with either cambinol or vorinostat suppressed tumor growth (70% and 91% reduction in tumor volume, respectively)., Conclusions: Both the class III HDAC inhibitor cambinol and the class I/II HDAC inhibitor vorinostat have efficacy against SK-N-SH neuroblastoma cells, including those resistant to doxorubicin., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Previous studies in children with acute pancreatitis have demonstrated that clinical scoring systems such as the Ranson, modified Glasgow, and pediatric acute pancreatitis scores are of value in predicting severity of the disease. The aim of this study was to determine the predictive value of the computed tomography severity index (CTSI or Balthazar score) in pediatric patients., Methods: All children (≤ 18 years) admitted to our institution with acute pancreatitis from 2000 through 2009 were reviewed. Contrast-enhanced computed tomographic (CT) images at presentation were retrospectively reviewed by 2 pediatric radiologists. Peripancreatic fluid and the extent of necrosis were assessed to determine the CTSI. The predictive value of the CTSI was calculated and compared with clinical scoring systems., Results: Of 211 children with acute pancreatitis, 64 underwent contrast-enhanced CT at presentation. The median age was 12.3 years. Etiology of pancreatitis was idiopathic (35.9%), gallstone (17.2%), medication-induced (20.3%), posttransplant (9.4%), traumatic (6.3%), structural (1.6%), and other (9.4%). The sensitivity, specificity, positive predictive value, and negative predictive value of the CTSI (using a cutoff score of 4+) were 81%, 76%, 62%, and 90%, respectively, which compared favorably to the results of the pediatric acute pancreatitis (53%, 72%, 41%, 80%), Ranson (71%, 87%, 67%, 89%), and modified Glasgow (71%, 87%, 67%, 89%) scores., Conclusion: The CTSI is superior to clinical scoring systems for identifying children with acute pancreatitis at heightened risk for developing serious complications., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: To determine outcomes in children with extrahepatic portal vein obstruction who underwent percutaneous intervention for anastomotic stenosis after meso-Rex bypass., Materials and Methods: Eighty-six patients who underwent meso-Rex bypass between 1997 and 2009 were retrospectively reviewed, and 15 who underwent transhepatic portal venography for graft stenosis were identified. Technical success and clinical outcomes were analyzed., Results: Nine of 15 patients (60%) with anastomotic stenosis were successfully treated by endovascular techniques and remain symptom-free with patent shunts, three (20%) underwent technically successful interventions but currently have recurrent stenosis, and three (20%) underwent failed attempts at percutaneous intervention. All three in whom percutaneous intervention failed required surgical revision, including two with near-occlusive lesions that prevented traversal of the stenosis and one who developed postprocedure shunt thrombosis. In total, patients underwent 27 endovascular procedures, including 17 balloon venoplasties, four cutting balloon venoplasties, five stent placements, and one balloon venoplasty with thrombolysis. The mean pressure gradient across the stenosis decreased from 11 mm Hg ± 3 to 5 mm Hg ± 3 (P < .001) after technically successful intervention. Platelet count improved (from 97,000/μL ± 41,000 to 165,000 ± 67,000/μL; P = .002) and ammonia levels decreased (from 40 μmol/L ± 11 to 24 μmol/L ± 13; P = .05) after intervention. Patients were followed for a median duration of 39 months after the last intervention., Conclusions: Percutaneous interventions allow for long-term vein graft patency and clinical resolution of symptoms in the majority of patients with anastomotic stenosis after meso-Rex bypass., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)

Histone deacetylase (HDAC) inhibitors, especially vorinostat, are currently under investigation as potential adjuncts in the treatment of neuroblastoma. The effect of vorinostat co-treatment on the development of resistance to other chemotherapeutic agents is unknown. In the present study, we treated two human neuroblastoma cell lines [SK-N-SH and SK-N-Be(2)C] with progressively increasing doses of doxorubicin under two conditions: with and without vorinsotat co-therapy. The resultant doxorubicin-resistant (DoxR) and vorinostat-treated doxorubicin resistant (DoxR-v) cells were equally resistant to doxorubicin despite significantly lower P-glycoprotein expression in the DoxR-v cells. Whole genome analysis was performed using the Ilumina Human HT-12 v4 Expression Beadchip to identify genes with differential expression unique to the DoxR-v cells. We uncovered a number of genes whose differential expression in the DoxR-v cells might contribute to their resistant phenotype, including hypoxia inducible factor-2. Finally, we used Gene Ontology to categorize the biological functions of the differentially expressed genes unique to the DoxR-v cells and found that genes involved in cellular metabolism were especially affected.

Purpose: Testicular torsion causes considerable morbidity in the pediatric population but the societal burden is poorly quantified. We determined the modern incidence of testicular torsion as well as the current rates of orchiectomy and attempted testicular salvage, and identified the risk factors for testicular loss., Materials and Methods: A cohort analysis was performed of 2,443 boys (age 1 month to less than 18 years) and 152 newborns who underwent surgery for testicular torsion in the 2000, 2003 and 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database. Patient and hospital characteristics predictive of orchiectomy vs attempted testicular salvage were analyzed., Results: There was a bimodal distribution of testicular torsion with peaks in the first year of life and in early adolescence. The overall mean age ± SD at presentation was 10.6 ± 5.8 years. The estimated yearly incidence of testicular torsion for males younger than 18 years old was 3.8 per 100,000. Orchiectomy was performed in 41.9% of boys undergoing surgery for torsion. The adjusted odds ratio for orchiectomy was highest for children in the youngest age quartile (younger than 10 years old, OR 1.58, 95% CI 1.25-2.00). Additional independent predictors of orchiectomy included Medicaid insurance (OR 1.39, 95% CI 1.14-1.69), black race (OR 1.33, 95% CI 1.04-1.71), nonemergency room admission source (OR 1.97, 95% CI 1.60-2.42) and surgery at a children's hospital or unit (OR 1.64, 95% CI 1.36-1.98)., Conclusions: Testicular torsion is uncommon but the rate of orchiectomy is high, especially in the youngest patients., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The readmission rate after pediatric appendectomy is frequently reported in clinical outcomes studies and quality improvement initiatives without proper description. Our aim was to delineate the context and significance of these encounters., Methods: Patients (<18 years old) who underwent appendectomy for acute appendicitis at a tertiary children's hospital from January 2007 through June 2010 were reviewed. Emergency department (ED) visits and inpatient readmissions within 90 days were identified and classified as unrelated, related surgical complications, or potentially avoidable visits for minor related concerns., Results: Of 629 patients, 119 (18.9%) had 141 ED visits or readmissions within 90 days after discharge. Eighty-three (58.9%) encounters were limited to the ED, and 58 (41.1%) required inpatient hospitalization. Eighty-seven percent of encounters within the first 30 days after discharge, but only 26% of those occurring beyond 30 days, were related to the operation (P < .001). Overall, 45 (31.9%) ED visits or readmissions were totally unrelated to the appendectomy, 36 (25.5%) represented true surgical complications requiring inpatient hospitalization, and 60 (42.6%) were minor, potentially avoidable visits related to the appendectomy. Potentially avoidable encounters were more common in Spanish-speaking patients (P < .01)., Conclusions: Emergency department visits and inpatient readmissions after pediatric appendectomy are frequent but not uniformly indicative of surgical complications or suboptimal care. Opportunities exist to reduce avoidable ED visits related to minor postoperative concerns., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus., Methods: The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression., Results: Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P < .001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P < .001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006., Conclusion: The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to describe the spectrum of disease in children with acute pancreatitis and assess predictors of severity., Methods: Children (≤ 18 years) admitted to a single institution with acute pancreatitis from 2000 to 2009 were included. The accuracy of the Ranson, modified Glasgow, and pediatric acute pancreatitis severity (PAPS) scoring systems for predicting major complications was assessed., Results: The etiology of pancreatitis in these 211 children was idiopathic (31.3%), medication-induced (19.9%), gallstones (11.8%), trauma (7.6%), transplantation (7.6%), structural (5.2%), and hemolytic-uremic syndrome (3.3%). Fifty-six patients (26.5%) developed severe complications. Using the cutoff thresholds in the PAPS scoring system, only admission white blood cell count more than 18,500/μL (odds ratio [OR], 3.1; P = .010), trough calcium less than 8.3 mg/dL (OR, 3.0; P = .019), and blood urea nitrogen rise greater than 5 mg/dL (OR, 4.1; P = .004) were independent predictors of severe outcome in a logistic regression model. The sensitivity (51.8%, 51.8%, 48.2%) and negative predictive value (83.2%, 83.5%, 80.5%) of the Ranson, modified Glasgow, and PAPS scores were, respectively, insufficient to guide clinical decision making., Conclusion: Commonly used scoring systems have limited ability to predict disease severity in children and adolescents with acute pancreatitis. Careful and repeated evaluations are essential in managing these patients who may develop major complications without early signs., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Liver transplantation is increasingly advocated as primary surgical therapy for children with hepatoblastoma involving 3 or 4 sectors of the liver after neoadjuvant chemotherapy. This study evaluated the results of nontransplant hepatectomy in children who might otherwise have been considered for liver transplantation., Methods: All children who underwent resection at a single institution from 1998 to 2009 for POST-TEXT IV or centrally located POST-TEXT III hepatoblastoma after neoadjuvant chemotherapy were reviewed., Results: Fourteen children (7 boys) with a median age of 8 months at diagnosis met study criteria. Pulmonary metastases in 3 patients were resected in 2 and resolved with chemotherapy in 1 patient. Preoperative grouping after neoadjuvant chemotherapy was POST-TEXT IV in 3 patients and POST-TEXT III in 11 patients. Thirteen of 14 (93%) children who underwent aggressive resection despite being potential candidates for primary transplantation were alive and tumor-free with a median follow-up of 57 months. Observed survival rates at 1, 2, and 5 years were 93%, 91%, and 88% respectively. Event-free survival rates at 1, 2, and 5 years were 93%, 91%, and 75%, respectively., Conclusions: Excellent survival (93%) was obtained with aggressive resection in children with POST-TEXT III and IV hepatoblastoma meeting criteria for transplant referral. The 1 death occurred in a patient with unfavorable small cell histology. These children should be managed at institutions experienced in both advanced pediatric hepatobiliary surgery and transplantation. Operative exploration was frequently required to ultimately determine which tumors can be resected and which require transplantation., (Copyright © 2010 American Cancer Society.)

Background: Adhesive small bowel obstruction (ASBO) develops in ~5% of children and adolescents after major abdominal surgery. The aims of this study were to: 1) describe the current use of operative management in children and adolescents with ASBO and 2) investigate the association between operative delay and the rate of small bowel resection., Study Design: All patients 2 to 20 years of age admitted with ASBO in the 2003 and 2006 Kids' Inpatient Database (KID) were identified. Rates of operative intervention were described, and factors associated with small bowel resection were analyzed in a logistic regression model., Results: Of 2,089 patients admitted with ASBO, 1,786 (85.5%) underwent operative intervention with lysis of adhesions (LOA; n = 1,493; 83.6%) or small bowel resection (SBR; n = 293; 16.4%). Factors associated with the use of operative intervention in univariate analysis included younger age (p < 0.001), race (p = 0.034), and management at a children's hospital (p < 0.001). The time from admission until operation (mean ± SD) was significantly longer in patients who underwent SBR (2.1 ± 2.6 days) compared with LOA (1.5 ± 2.0 days; p < 0.001). Compared with patients who underwent surgery within the first day after admission, the adjusted odds of SBR were similar on the second day after admission (odds ratio [OR] 1.40, 95% confidence interval [CI] 0.94 to 2.09) but increased when surgery was performed on days 3-14 (OR 1.67, 95% CI 1.19 to 2.34)., Conclusions: The majority of children and adolescents admitted with ASBO currently undergo operative management, and 16.4% of these patients receive small bowel resections. Operative intervention should be considered in patients who do not exhibit signs of improvement by the second day after admission to avoid potentially increasing the risk for bowel loss., (Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the incidence of inguinal hernia in premature neonates and identify risk factors for incarceration., Study Design: The 2003 and 2006 Kids' Inpatient Databases were queried for diagnoses indicative of premature birth and inguinal hernia., Results: Inguinal hernia was diagnosed during the birth hospitalization in 1463 ± 87 of 49 273 ± 1561 premature neonates (3%). Male sex, gestational age, birth weight, and prolonged mechanical ventilation were associated with inguinal hernia (all P < .01). Incarceration occurred in 176 of 1123 premature neonates (16%) who underwent hernia repair during the birth hospitalization. Delaying repair beyond 40 weeks post-conceptual age doubled the risk of incarceration (21%), as compared with 36 to 39 weeks (9%) or <36 weeks (11%, P = .002). Sex, race, and insurance were not associated with incarceration., Conclusion: The risk of incarceration is doubled in premature neonates with inguinal hernia when repair is delayed beyond 40 weeks post-conceptual age. This increased incarceration risk should be one of the factors considered when deciding on the optimal timing of inguinal hernia repair., (Copyright © 2011 Mosby, Inc. All rights reserved.)

A 3-year-old girl with idiopathic extrahepatic portal vein obstruction undergoing mesenterico-left portal vein bypass (MLPVB), or Rex shunt, for recurrent variceal bleeding was intraoperatively discovered to have duplicated round ligaments and Rex recessi. The left and right portal veins connected to their respective round ligaments but had minimal communication within the liver. Intraoperative venography identified a better preserved portal system on the left, and standard MLPVB resulted in excellent shunt flow. The shunt remains patent and the patient asymptomatic 9 months after her operation. Abnormal portal anatomy is not a contraindication to MLPVB., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Though rare, bile duct injuries (BDI) during laparoscopic cholecystectomy (LC) represent a major potential complication with significant associated morbidity. The objectives of this study were to (1) assess the national use of LC and incidence of BDI over time in the pediatric surgical population, (2) measure the added resource utilization burden associated with BDI, and (3) identify patient and hospital factors associated with BDI., Methods: All patients 0 to 20 years of age undergoing cholecystectomy were identified in the Kids' Inpatients Database from 1997 to 2006. National rates of LC use and BDI as well as overall costs were assessed using weighted estimates. Factors associated with BDI were analyzed with a logistic regression model., Results: Of 31,653 patients undergoing cholecystectomy, 28,243 (89.2%) underwent LC. Over time, the proportion of LC has risen from 81% in 1997 to 91% in 2006 (P < .001). Of patients undergoing LC, 0.44% had BDI with no significant change of BDI rate over time. Length of stay was 6.1 days for patients with BDI compared to 3.3 days for those without injury (P < .001). BDI patients had median costs of US $9550 as compared to US $6030 for non-BDI patients (P < .001). After taking patient, hospital, and disease-specific factors into consideration, BDI was more common in patients 5 years of age or less, nonwhite patients, and in patients admitted under an elective setting (all P < .01)., Conclusions: With increasing LC use, BDI remains a rare yet resource intense complication in children. Age, race, and admission related factors are associated with BDI and may provide guidance toward improving outcomes.

Background: Congenital portosystemic shunts (PSS) with preserved intrahepatic portal flow (type II) present with a range of clinical signs. The indications for and benefits of repair of PSS remain incompletely understood. A more comprehensive classification may also benefit comparative analyses from different institutions., Methods: All children treated at our institution for type II congenital PSS from 1999 through 2009 were reviewed for presentation, treatment, and outcome., Results: Ten children (7 boys) with type II PSS were identified at a median age of 5.5 years. Hyperammonemia with varying degrees of neurocognitive dysfunction occurred in 80%. The shunt arose from a branch of the portal vein (type IIa; n = 2), from the main portal vein (type IIb; n = 7), or from a splenic or mesenteric vein (type IIc; n = 1). Management included operative ligation (n = 6), endovascular occlusion (n = 3), or a combined approach (n = 1). Shunt occlusion was successful in all cases. Serum ammonia decreased from 130 ± 115 μmol/L preoperatively to 31 ± 15 μmol/L postoperatively (P = .03). Additional benefits included resolution of neurocognitive dysfunction (n = 3), liver nodules (n = 1), and vaginal bleeding (n = 1)., Conclusion: Correction of type II PSS relieves a wide array of symptoms. Surgery is indicated for patients with clinically significant shunting. A refined classification system will permit future comparison of patients with similar physiology., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To determine the incidence of isolated gastrocnemius and soleal vein thrombosis (IGSVT) and the effect of anticoagulation on venous thromboembolism (VTE) events in patients with IGSVT., Summary Background Data: Although IGSVT is diagnosed with increasing frequency, the clinical significance and optimal management remains unknown., Methods: Vascular laboratory studies from April 2002 to April 2007 were retrospectively reviewed to identify patients with IGSVT. Medical records were reviewed for demographic data, risk factors, treatment modalities, and VTE events. Univariate and multivariate analysis were performed., Results: Of 38,426 lower extremity venous duplex studies, 406 patients with IGSVT were included in this study. Mean follow-up was 7.5 +/- 11 months. The overall incidence of VTE among the entire cohort was 18.7%, which included 3.9% pulmonary embolism and 16.3% deep venous thrombosis, with 1.5% of patients having both pulmonary embolism and deep venous thrombosis. However, the incidence of VTE was 30% (36/119) and 27% (13/48) in patients who received no or prophylactic anticoagulation, respectively, but only 12% in patients treated with therapeutic anticoagulation (23/188; P = 0.0003). Multivariate analysis identified lack of therapeutic anticoagulation (P = 0.017) and history of VTE (P = 0.011) as independent predictors of subsequent VTE development. The rate of IGSVT resolution during follow up was 61.2% with therapeutic anticoagulation, but only 40.0% and 41.0% with prophylactic or no anticoagulation, respectively (P = 0.003)., Conclusions: IGSVT is associated with a clinically significant rate of VTE which is dramatically reduced with therapeutic anticoagulation. These data warrant further investigation, taking into account the risks and benefits of anticoagulation.

Background: Extrahepatic portal vein obstruction (EHPVO) has been associated with growth impairment in children. We hypothesized that growth parameters improve after reversal of portal hypertension and restoration of mesenteric venous blood flow to the liver by the mesenterico-left portal vein bypass (MLPVB)., Methods: A retrospective review of 45 children with idiopathic EHPVO who underwent MLPVB between 1997 and 2007 and had follow-up data for analysis was carried out. Growth was assessed using SD scores (z scores) for height, weight, and body mass index (BMI) at the time of operation and at early (5-12 months) and late (13-24 months) follow-up., Results: The mean height and weight of children with EHPVO was significantly lower than the general population before surgery. Mean BMI was also lower, although statistically insignificant. All parameters increased significantly after MLPVB as follows: height from -0.42 before surgery to -0.12 (P = .027) at 5 to 12 months and -0.14 (P = .026) at 13 to 24 months; weight from -0.49 before surgery to 0.03 (P < .001) at 5 to 12 months and 0.35 (P < .001) at 13 to 24 months; and BMI from -0.22 before surgery to 0.17 (P = .001) at 5 to 12 months and 0.48 (P < .001) at 13 to 24 months., Conclusion: Restoration of portal blood flow to the liver by MLPVB improves growth in children with EHPVO.

An association between oxcarbazepine therapy and hepatic adenoma (HA) has been documented in animal models but not observed in humans. The authors report a case of a 16-year-old girl on oxcarbazepine therapy for seizure disorder who presented with a giant HA. Pathology of the HA was notable for marked periductal fibrosis and glycoprotein inclusions in the nontumor liver. The patient was not on oral contraceptives and has no other known risk factors for HA.

This erratum corrects the following: Lautz TB, Chi YY, Li M, et al. Benefit of delayed primary excision in rhabdomyosarcoma: a report from the Children's Oncology Group. [Extracted from the article]