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Objectives Abdominal wall thickness (AWT) is a key measurement when placing or replacing low profile gastrostomy devices. This measurement varies, depending on nutritional status and body habitus. We developed a mathematical model to estimate AWT using a compendium of body measurements. Methods Ultrasonography was used to measure AWT at the initial gastrostomy site in subjects aged 22 days to 24 years old. Other body measurements (height, weight, waist circumference and distance from xiphisternum to pubis) were also obtained. Multiple linear regression was used to develop two separate models using age of 2 years to separate the groups. For analysis, AWT is log transformed. Results Data from 97 subjects were used for analysis. The final model for those ≤ 24 months old is the following: ln(Estimated AWT) = − 1.255 + 0.082*(1 if age 3–24 months, 0 if The final model for those > 24 months old is the following: ln(Estimated AWT) = − 1.335 + 0.271*(1 if age >84 months, 0 if 24–84 months) + 0.082*(BMI) Conclusion This model to estimate AWT is useful for determining the length of a gastrostomy device at initial placement and with subsequent changes. More data are needed to refine and further validate the model. Level of evidence Level IV, study of prognostic test.

Background & Aims Evaluation and treatment of children with eosinophilic esophagitis (EoE) requires serial endoscopic, visual, and histologic assessment by sedated esophagogastroduodenoscopy (EGD). Unsedated transnasal endoscopy (TNE) was reported to be successful in a pilot study of children. We evaluated video goggle and virtual reality–based unsedated TNE in children with EoE, collecting data on rates of completion, adverse events, and adequacy of visual and histologic findings. Methods We performed a retrospective study of 190 children and young adults (age, 3–22 y) who underwent video goggle or virtual reality–based unsedated TNE from January 2015 through February 2018. We analyzed data on patient demographics, procedure completion, endoscope type, adverse events, visual and histologic findings, estimated costs, and duration in the facility. Esophageal biopsies from the first 173 subjects who underwent TNE were compared with those from previous EGD evaluations. Results During 300 attempts, 294 TNEs were performed (98% rate of success). Fifty-four patients (age, 6–18 y) underwent multiple TNEs for dietary or medical management of EoE. There were no significant adverse events. Visual and histologic findings were adequate for assessment of EoE. TNE reduced costs by 53.4% compared with EGD (TNE $4393.00 vs EGD $9444.33). TNE was used increasingly from 2015 through 2017, comprising 31.8% of endoscopies performed for EoE. The total time spent in the clinic (front desk check-in to check-out) in 2018 was 71 minutes. Conclusions In a retrospective study of 190 children and young adults (age, 3–22 y) who underwent video goggle or virtual reality–based unsedated TNE, TNE was safe and effective and reduced costs of EoE monitoring. Advantages of TNE include reduced risk and cost associated with anesthesia as well as decreased in-office time, which is of particular relevance for patients with EoE, who require serial EGDs.

Metabolic liver disorders cause chronic liver disease and liver failure in childhood. Many of these disorders share the histologic features of steatosis and cholestasis, or steatocholestasis. In this study we sought to (1) develop an in vitro model of steatocholestasis, (2) determine the mechanisms of cell death in this model, and (3) determine the role of mitochondrial disturbances in this model. Methods: Hepatocytes were isolated from 8-week-old obese (fa/fa) and lean Zucker rats. Cell suspensions were treated with glycochenodeoxycholic acid (GCDC), after which reactive oxygen species (ROS) generation, oncotic necrosis, apoptosis, and ATP content were assessed. Isolated liver mitochondria were exposed to GCDC and analyzed for ROS generation, mitochondrial membrane-permeability transition (MPT), and cytochrome c release. Oncotic necrosis was significantly increased and apoptosis reduced in fa/fa hepatocytes exposed to GCDC compared with that in lean hepatocytes. Necrosis occurred by way of an ROS- and MPT-dependent pathway. Basal and dynamic ATP content did not differ between fa/fa and lean hepatocytes. GCDC stimulated ROS generation, MPT, and cytochrome c release to a similar extent in purified mitochondria from both fa/fa and lean rats. These findings suggest that fat-laden hepatocytes favor a necrotic rather than an apoptotic cell death when exposed to low concentrations of bile acids. The protective effects of antioxidants and MPT blockers suggest novel therapeutic strategies for the treatment of steatocholestatic metabolic liver diseases.

Objective To test the hypothesis that there is an improved response to interferon in children with chronic hepatitis B (HBV) who are ≤5 years of age. Study design Retrospective chart review of 22 consecutive children with chronic HBV (ages 17 months to 17 years; median, 83.9 months; 14 male, 8 female) treated with interferon-α2b. Results Ten patients (48%) responded to treatment [HBeAg (−), Anti-HBe (+), HBV DNA (−), HBsAg (+) and normal alanine aminotransferase/aspartate aminotransferase (ALT/AST) at 6 months after treatment], and 5 seroconverted HBsAg [above plus HBsAg negative and anti-HBs (+)]. Seven of 9 patients (78%) ≤5 years of age responded (5 cleared HBsAg). Three of 13 patients (23%) >5 years of age responded. Patient age at treatment was significantly lower in responders (63 ± 70 months) versus nonresponders (104 ± 55 months, P = .005). AST, ALT, and HBV DNA at the start of treatment were not different between responders and nonresponders or between patients ≤5 and >5 years old. Conclusions Interferon treatment may be more effective in younger children with chronic hepatitis B.

Background: Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children. Methods: The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis. Results: Fifty-four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H 2 -antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean ± SE of 20.6 ± 3.6 months, range 11-31 months vs. 11.1 ± 1.3 months, range 1-35 months; P < 0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups. Conclusions: These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.

An experience with using autologous bone marrow mononuclears for regeneration of the heart was analyzed in 97 patients in whom the intracoronary transplantation of autologous mononuclear bone marrow cells was performed. The results were estimated in terms up to 5 years and compared with a group of 37 patients who underwent only conservative treatment. A distinct positive dynamic of clinical and echocardiographic indices in the main group was noted in a subgroup of patients with a decreased ejection fraction (EF less than 50%) as compared with an analogous subgroup of patients in the control group. Substantial influence is exerted by regeneration therapy upon remote lethality. Thus, as a whole in the main group lethality over 5 years was 13.4% and in the group of control it was 21.6%. In the subgroup with a decreased ejection fraction and symptoms of heart failure lethality was 22.6% in the main group and 54.5%--in the control group. The intracoronary administration of the autologous bone marrow mononuclear fraction to inoperable patients with ischemic heart disease and a severe lesion of the coronary arteries and a decreased ejection fraction of the left ventricle is a safe and useful procedure resulting to substantially decreased lethality followed-up during 5 years against the background of conservative treatment.

The main group included 17 patients with distal lesion of the coronary bed in whom the performance of complete direct myocardium revascularization was not possible. The autologous bone marrow mononuclears were administered to the main group patients at the period from 2008 to 2010. The control group consisted of 10 patients given standard medicamentous therapy. A year later in the main group patients there was a decrease of median of the functional stenocardia class, median of metabolic units by the data of loading tests, median of the number of nitroglycerin pills for a week taken by the patients as compared with the control group. By the data of OECT and PECT a year later in the main group there was an improved perfusion in all the myocardium segments. In the control group on the contrary there was negative dynamics in all the indices in question.

The authors analyzed postoperative complications after 4174 pulmonectomies for tuberculosis in the period of 1982-2004. The verified cases of acute venous circulatory disorders in the remnants of the lung after partial resections were observed in 12 (0.3%) patients. The main causes of hemorrhagic infarct of the part of the lung were erroneous ligation of the vein or its rupture; thrombosis of the venous trunk; partial removal of a pulmonary portion with devascularized tissue left; extensive intrapulmonary hematomas. In case of acute circulatory disorder developed in the resected lung, mortality may amount to as high as 58% due to secondary complications (sepsis in the presence of generalized gangrene and lung tissue decay, purulent pleurisy with bronchopleurothoracic fistulas, arrosion profuse hemorrhage). The above complication is a rare, but extremely severe iatrogenic abnormality largely associated with shortcomings of surgical techniques.

Peptic ulcer of the stomach and duodenum is the most common (10-18%) concomitant gastrointestinal pathology in phthisiosurgical patients. Treatment of these patients presents a challenge due to a drastic reduction in the efficiency of oral antibacterial therapy resulted from poor tolerability of chemical drugs and to a risk for surgical complications particularly in the early period after lung surgery. In 1996-2002, a total of 495 patients with tuberculosis at various sites were endoscopically studied; peptic ulcer in different phases was detected in 30.9% of the patients. There has been a considerable increase in the incidence of peptic ulcer among phthisiosurgical patients in the past 3 years (up to 16-17% among those undergone lung surgery for tuberculosis). A package of measures has been developed to reduce the incidence of life-threatening complications due to peptic ulcer in the postoperative period. It is concluded that peptic ulcer is a significant risk factor in phthisiosurgery as a serious contraindication to planned surgery and as a source of postoperative complications.

50 patients with carcinomas or corrosive strictures of the esophagus were operated upon with the simultaneous esophagogastroplasty. At the same time the primary provisional jejunostomy after Witzel was performed on 20 of them in order to ensure an adequate decompression and nutrition at the early postoperative period. In cases of dangerous complications (fistulas of esophagogastrostomies--in 37%, purulent mediastinitis or empyemas--in 14% etc.) the use of jejunostomy allows enteral nutrition to be prolonged up to the moment of the independent oral feeding. It is concluded that the formation of primary jejunostomy for curative and prophylactic purposes is expedient in the simultaneous reconstructive esophageal operations for tumors and strictures.