Embedded Files
Page 8
Twenty years’ experience for reduction of ileocolic intussusceptions by saline enema under sonography control. J Pediatr Surg. 2016;51:179–82. 5. Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol. 2012;85(1019):e1018–31. https://doi.org/10.1259/bjr/28871143. 6. Coté CJ, Wilson S, American Academy Of Pediatrics, American Academy Of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics. 2016;138(1):e20161212. 7. Purenne E, Franchi-Abella S, Branchereau S, et al. General anesthesia for intussusception reduction by enema. Pediatr Anesth. 2012;22:1211–5. 8. Chatterjee US, Ghosh A, Basu AK, et al. Intraoperative hydrostatic reduction of intussusception. J Indian Assoc Pediatr Surg. 2008;13:107. 9. Collins DL, Pinckney LE, Miller KE, et al. Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia. J Pediatr. 1989;115:204–7. 10. Digant SM, Rucha S, Eke D. Ultrasound guided reduction of an ileocolic intussusception by a hydrostatic method by using normal saline enema in paediatric patients: a study of 30 cases. J Clin Diagnostic Res JCDR. 2012;6: 1722. 11. Bai YZ, Bin QR, Da Wang G, et al. Ultrasound-guided hydrostatic reduction of intussusceptions by saline enema: a review of 5218 cases in 17 years. Am J Surg. 2006;192:273–5. 12. Liu S. Enema reduction of intussusception by hydrostatic pressure under ultrasound guidance: a report of 377 cases. J Pediatr Surg. 1988;23:814–8. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional Robot-assisted excision of urachal cyst: case report in a child Salvatore Arena1 , Marta Rossanese2 , Donatella Di Fabrizio1*, Carmelo Romeo1 , Vincenzo Ficarra2 and Pietro Impellizzeri1 Abstract Background: The urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and then remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder. An early laparoscopic procedure could trigger a quiescent urachal remnant to become symptomatic, causing a lesion or infection either during carbon oxide contamination or insufflation or a periumbilical or suprapubic port placement. Case presentation: A 15-year-old girl complaining of supra-pubic abdominal pain. About 2 months previously, she had undergone laparoscopic appendectomy for acute appendicitis, and early postoperative period was uneventful. She underwent a robotic-assisted excision of a urachal cyst. Conclusions: It has been suggested that early laparoscopic procedures could trigger previously asymptomatic urachal remnants to become symptomatic. Robot-assisted excision of a urachal cyst is a safe, effective alternative to open surgery in children. Keywords: Urachal remnants, Urachal cyst, Robotics, Case report Background The urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and then remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder [1–3]. Abnormalities in involution of the urachus may result in patent urachus, umbilical urachal sinus, vesico-urachal diverticulum, and urachal cyst [1]. In particular, a urachal cyst is reported to occur in 0.02% of live births but is symptomatic in just 0.00067% of the population [4]. field in which mortality is not a prime concern, these issues of satisfaction or quality of life are of the utmost importance. The WHO defines health as the state of “complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” [2]. In this way, the well-being of the individual defines the ultimate goal of any treating physician. This well-being is intimately related not only to the physical health of the patient but the individual’s mental or emotional satisfaction and social functioning as well. The facial form, and the mental, emotional, and social consequences of this form, thus contribute greatly to the overall well-being or health of the facial plastic surgery patient. For this reason, measuring the outcomes of facial plastic surgery in a more comprehensive manner naturally follows from the clinical focus on this overall well-being, and the specific attention that is paid to the satisfaction of the individual. Outcomes research is performed in order to provide a quantitative assessment of otherwise subjective results. The steps in performing this form of evaluation include: 1. Identify the specific procedure or illness to be studied (e.g., rhinoplasty results). 2. Determine the key factors that contribute to the satisfaction following the treatment modality. Physical (e.g., nasal appearance, nasal airway function) Mental/Emotional (e.g., confidence, desire for change) Social (e.g., family/friend, social/professional acceptance) 3. Develop a quality of life instrument (questionnaire) to measure the outcome of interest (Figs. 1–4). 4. Test the instrument in the appropriate clinical setting. Reliability (consistency, reproducibility) Validity (responsiveness to change, accuracy) 5. Revise or amend the instrument for better quality of life assessment. 6. Use the final instrument for outcomes studies. Evaluation of individual patient satisfaction. Comparisons between different procedures. There are many instruments that have been developed for the measurement of other nonfacial plastic outcomes in the head and neck. Illnesses such as otitis media, sinusitis, obstructive sleep apnea, and head and neck cancer have all been evaluated with outcomes questionnaires that have been shown to be reliable and valid measures of patient-related satisfaction or quality of life [4–8]. Unfortunately, there are no current instruments that have been tested for use in the realm of facial plastic and reconstructive surgery, despite the dependence of outcomes in this field on these primarily subjective factors. In fact, the endpoints of many studies in the facial plastic surgery literature are presented as the proportion of patients who are “satisfied” with their results, without any standardized method of comparison between various treatment outcomes. One issue that may contribute to the lack of formal outcomes research in facial plastic surgery, particularly the realm of aesthetic rather than reconstructive surgery, is the difficulty in attempting to organize and collect data in a prospective fashion in the community outpatient setting. This difficulty has been addressed in other fields of Otolaryngology outcomes research, as the community setting may lack the dedicated resources, time, and support for research that are found in the academic setting [9]. If the goal of a standardized, reliable, and valid means of assessing patient outcomes is to be achieved, however, the facial plastic surgeon must overcome these obstacles. In order to address this issue, Isenberg and Rosenfeld [9] have outlined five major problems faced in community-based outcomes research, as surveyed from the private practice Otolaryngologists in their own study: 1. An overly long and complex survey. 2. Lack of time during office hours. 3. Cumbersome data collection requirements. 4. Inadequate ongoing communication between the principal investigator and participating physicians. 5. Lack of enthusiasm for the project. Recommendations for conducting outcomes research in the community setting include simple to use, streamlined questionnaires that require little time to complete. The instruments provided in this paper attempt to meet these criteria, and provide the facial plastic surgery with a quick and easy method of data collection in the community practice setting. Outcomes in Facial Plastic Surgery In order to measure outcomes such as patient satisfaction and quality of life in the facial plastic surgery patient, R. Alsarraf 193 one must first identify the key aspects that constitute such satisfaction for each treatment modality of interest. Four common facial plastic surgery procedures include rhinoplasty, rhytidectomy (facelift), blepharoplasty, and the various skin resurfacing procedures [laser, chemical peels (Figs. 1–4)]. Certainly there are factors that influence quality of life that are common to each of these specific interventions. For instance, acceptance by friends and family is an important component of the patient’s quality of life. Similarly, the manner in which the individual’s appearance affects his or her social or professional life is also a common concern. There are also certain common emotional or mental qualities that transcend the satisfaction with any of these procedures. The individual’s confidence and happiness with her appearance, and whether or not she desires some change are qualities that are important components of satisfaction, whether it is
Google Sites
Report abuse