Tuesday, January 21st, 2014
Hospitals vary greatly in how they treat children who are undergoing surgery to have their tonsils out, according to a new study published in the journal Pediatrics. More from NBC News:
Getting your tonsils out: It’s a rite of passage for hundreds of thousands of U.S. kids every year.
Yet a study released Monday shows hospitals vary greatly in just how they handle this common procedure. And kids fare differently depending on which hospital they go to. At the best hospitals, just three percent of kids came back for complications like bleeding. But at others, close to 13 percent did.
It is the latest in a series of studies showing that Americans get vastly different care depending on where they live.
It’s not clear why, but the researchers who did the study say it will be worth looking into so that all hospitals can make sure children recover well from the operations. New guidelines issued in 2011 may help get all hospitals and pediatric surgeons on the same page, other experts said.
….Dr. Sanjay Mahant of the University of Toronto and the Hospital for Sick Children in Toronto, and colleagues across the United States, looked at the records of nearly 140,000 children who got simple, uncomplicated tonsillectomies at 36 children’s hospitals between 2004 and 2010. All got same-day operations and were sent home on the day of their procedure.
Over that time, about 8 percent had to go back to the hospital within a month, usually for bleeding.
The researchers also looked at the use of two common drug types — dexamethasone, which can reduce complications such as nausea, and antibiotics.
New guidelines issued in 2011 advise giving dexamethasone to children before the operation, and they recommend against giving any antibiotics.
In the study before the guidelines came out, 76 percent of the children got dexamethasone, and at some hospitals almost none did. And 16 percent of children got antibiotics, although at some hospitals 90 percent of patients did.
“More than 500,000 tonsillectomies are performed each year in children in the United States, most commonly for sleep-disordered breathing and recurrent throat infections,” the researchers wrote. There shouldn’t be such variation from one hospital to another, they said.
Image: Child recovering in bed, via Shutterstock
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Tuesday, October 1st, 2013
A 30-year-old Japanese woman who had been told she was infertile gave birth last December to a healthy baby boy after undergoing a highly experimental surgical procedure in which her ovaries were removed, and tissues were re-implanted in her body after being treated in a lab. The case was published this week in the journal Proceedings of the National Academy of Sciences, detailing how the procedure could help women who have poorly functioning ovaries due either to age or premature menopause. More from MSNBC.com:
The new mother gave birth to a son in Tokyo last December, and she and the child continue to be healthy, said Dr. Kazuhiro Kawamura of the St. Marianna University School of Medicine in Kawasaki, Japan. He and others describe the technique in a report published online Monday by the Proceedings of the National Academy of Sciences.
The mother, who was not identified, had been diagnosed with primary ovarian insufficiency, an uncommon form of infertility sometimes called premature menopause. It appears in about 1 percent of women of childbearing age. The cause of most cases is unknown, but the outcome is that the ovary has trouble producing eggs.
That leaves women with only a 5 percent to 10 percent chance of having a baby unless they get treated. The standard treatment is using donor eggs.
After the experimental procedure, Kawamura and colleagues were able to recover eggs from five of their 27 patients. One woman went on to have a miscarriage, one did not get pregnant, and two more have not yet attempted pregnancy, Kawamura said in an email.
The approach differs from what has been done to preserve fertility in some cancer patients, who had normal ovarian tissue removed and stored while they underwent cancer treatments, and then put back. The new work involved ovaries that were failing to function normally.
In the ovary, eggs mature in structures called follicles. For women with the condition the new study targeted, the follicles are either missing or failing to produce eggs. The experimental treatment was designed to stimulate dormant follicles.
Image: Pregnant woman’s belly, via Shutterstock
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Monday, August 12th, 2013
The number of children who went to the emergency room or were treated elsewhere because they had swallowed magnets–a highly dangerous situation that can lead to emergency surgery–quintupled between the years 2002 and 2011, according to a new study published online in the journal Annals of Emergency Medicine. More from ScienceDaily.com:
“It is common for children to put things in their mouth and nose, but the risk of intestinal damage increases dramatically when multiple magnets are swallowed,” said lead study author Jonathan Silverman, MD, of the Department of Pediatrics at the University of Washington in Seattle, Wash. “The ingestion of multiple magnets can severely damage intestinal walls to the point that some kids need surgery. The magnets in question were typically those found in kitchen gadgets or desk toys marketed to adults but irresistible to children.”
Over a 10-year period, 22,581 magnetic foreign body injuries were reported among children. Between 2002 and 2003, incidence of injury was 0.57 cases per 100,000 children; between 2010 and 2011, that jumped to 3.06 cases per year out of 100,000 children. The majority of the cases occurred in 2007 or later.
In cases where children ingested multiple magnets, 15.7 percent were admitted to the hospital (versus 2.3 percent of single magnet ingestions). Nearly three-quarters (74 percent) of magnets were swallowed; twenty-one percent were ingested through the nose. Nearly one-quarter (23.4 percent) of the case reports described the magnets as “tiny,” or other variants on the word “small.”
Image: Magnets, via Shutterstock
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Tuesday, July 2nd, 2013
The first clinical guidelines ever created regarding the use of ear tubes—medically named tympanostomy tubes—were released yesterday by the American Academy of Otolargyngology-Head and Neck Surgery Foundation (AAO-HNSF).
These tiny tubes, about 1/20th of an inch, may be the best treatment for children suffering from ear aches, ear infections and middle ear fluid build-up. They work by allowing air to pass through the ear canal, which helps the fluid drain. The tubes are inserted into a child’s ear canal under light general anesthesia and will fall out naturally over time from wax and debris build-up in the ears.
According to Dr. Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, New York, the insertion of ear tubes is the number-one ambulatory surgery in children and the number-one reason they undergo anesthesia. However, until yesterday, “no national society has ever published evidence-based guidelines on the best way to do this,” he told CNN Health.
Written by a panel of pediatricians, ear, nose, and throat specialists, and an anesthesiologist, among others, these new guidelines address the implantation of ear tubes in children ages 6 months to 12 years. The guidelines suggest that children who have frequent ear infections that hold onto fluid (in other words, don’t clear up quickly) are good candidates for ear tubes. Children experiencing fluid build-up in both ears for 3-months or more may also need tubes since the clogged hearing affects their balance, motor skills, and quality of life in group settings—such as in the classroom or social situations. Additionally, children at risk for fluid build-up related delays, such as those with autism, Down syndrome, or other developmental delays, should also be given ear tubes according to the guidelines.
Interestingly, the guidelines dictate that tubes should not be given to those children with frequent ear infections that do not have fluid build-up, which is a deviation from standard medical practice. Ask your doctor if your child has fluid build-up in his or her ears. If your child does not, ear tubes should be avoided according to these guidelines.
Image: Doctor looking at child’s ear, via Shutterstock
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Wednesday, June 19th, 2013
A hand transplant program is under development at Boston Children’s Hospital, and researchers say it will lead the field in offering face transplants and other radical surgeries that can greatly improve the quality of life for children. More from NBC News:
The move shows the growing willingness to do transplants to enhance a patient’s life rather than to save it as donated hearts, livers and other organs have done in the past. More than 70 hands and at least 20 faces have been transplanted in adults, and doctors say it’s clear these operations are safe enough to offer to children in certain cases, too.
“We feel that this is justifiable,” said Dr. Amir Taghinia, who will lead the pediatric hand program at Boston Children’s Hospital.
“Children will potentially benefit even more from this procedure than adults” because they regrow nerves more quickly and have more problems from prosthetic hands, he said.
Only one hand transplant is known to have been done in a child — a baby in Malaysia in 2000. Because the donor was a twin who died at birth, her sister did not need to take drugs to prevent rejection.
That’s the main risk in offering children hand transplants — the immune-suppressing drugs carry side effects and may raise the risk of cancer over the long term.
However, one independent expert thinks the gains may be worth it in certain cases.
“We understand so much more about immune suppression” that it’s less of a risk to put children on the drugs, said Dr. Simon Horslen, medical director of the liver and intestine transplant program at Seattle Children’s Hospital. “This is never going to be done as an emergency procedure, so the families will have plenty of opportunity to weigh the options.”
Also, a hand can be removed if rejection occurs, and that would not leave the child worse off than before the transplant, Horslen said.
Image: Child’s hand in hospital, via Shutterstock
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