Notes

Drop finish associated with cylinders using Newtonian liquids.
Opioid consumption was decreased in 50% of the trials assessing ketamine-based infusions and 75% of the studies comparing intercostal and paravertebral nerve blocks. Nausea was decreased in several of the ketamine-based infusion and intercostal and paravertebral nerve block studies. CONCLUSION Ketamine-including infusions or paravertebral and intercostal nerve blocks may represent superior methods of postoperative pain control for MIRPE. Further work is needed to confirm results. LEVEL OF EVIDENCE 2A [1]. BACKGROUND Nonneurological organ dysfunction (NNOD) occurs after traumatic brain injury (TBI) and is associated with mortality. The aim of our study was to evaluate the prevalence of NNOD and its association with outcomes in pediatric patients with TBI. We hypothesized that NNOD is associated with worse outcomes in pediatric patients with severe TBI. METHODS We performed a 4-year (2013-16) analysis of our prospectively maintained TBI database. All patients (age  less then  18) with an isolated-severe TBI (head-abbreviated injury scale AIS ≥ 3 & extracranial-AIS  less then  3) were included. NNOD was measured using the pediatric multiple organ dysfunction (P-MOD) score. Outcomes were in-hospital mortality, Glasgow Outcome Scale-Extended (GOS-E), and adverse discharge disposition rehabilitation or skilled nursing facility (SNF). Regression analysis was performed. RESULTS We analyzed 292 patients. Mean age was 11 ± 6 years, 57% were male and the mortality rate was 18.1%. The incidence of NNOD was 35%. The most common dysfunctional organ system was the respiratory (25%) followed by the cardiovascular (12%). On regression analysis, the presence of at least one NNOD was independently associated with in-hospital mortality (OR 2.1 [1.7-2.9]; p  less then  0.01), low GOS-E (OR 1.8 [1.5-2.3]; p  less then  0.01), and SNF disposition (OR 1.7 [1.2-2.1]; p  less then  0.01). CONCLUSION NNOD develops in one of every three severe TBI pediatric patients and is independently associated with adverse outcomes. Identification of NNOD in pediatric TBI and focusing on management of NNOD could improve outcomes. LEVEL OF EVIDENCE III Prognostic. PURPOSE The purpose of this study was to evaluate the management of thyroid nodules in children and assess clinical practice variation (CPV) using the 2015 American Thyroid Association (ATA) guidelines as a standard. METHODS Pediatric patients presenting to a tertiary care pediatric centre with a thyroid nodule from 2007 to 2017 were retrospectively analyzed. Demographic and disease specific information were collected. CPV and adherence to ATA guidelines were explored. RESULTS Of 86 patient records reviewed, 47 (55%) were managed operatively (mean age 14.4, 59F27M). Fifteen patients (17%) had malignant pathology, and 11/15 (73%) were papillary carcinoma. Of the 47 operative patients, 7 (15%) had no preoperative ultrasound, and 12 patients (26%) did not have preoperative cytology. All patients with low TSH had scintigraphy appropriately performed, and 1 patient with high/normal TSH did not have a preoperative FNA obtained. All differentiated thyroid cancers were appropriately managed with hemithyroidectomy or total thyroidectomy based on pathology. Where CPV from the guidelines was noted, it was associated with complex presentation, the surgeon's decision to proceed to surgery directly, and/or rare pathologies. CONCLUSION The ATA guidelines provide a valuable framework for the management of pediatric thyroid nodules, but CPV persists given patient/disease complexity and heterogeneity. TYPE OF STUDY Case Series with No Comparison Groups. LEVEL OF EVIDENCE Level VI Case series with no comparison groups. PURPOSE The widespread use of laparoscopy has brought forth the question of how to manage a macroscopically normal-appearing appendix in cases of clinically suspected appendicitis. This study aimed to determine the current practices of pediatric general surgeons in Canada regarding this matter. METHODS An online survey was created following the American Pediatric Surgical Association (APSA) guidelines and distributed via email to the Canadian Association of Pediatric Surgeons (CAPS) staff surgeons. The questions assessed clinician characteristics, standard practice, and rationale. Results were analyzed using descriptive statistics. RESULTS A total of 54/72 (75%) CAPS members practicing in Canada completed the survey. All (100%) agreed they would remove a normal-appearing appendix during laparoscopy for suspected acute appendicitis. The most common reasons were possibility of microscopic appendicitis (39/54, 72.2%), avoiding future diagnostic confusion (28/54, 51.9%), and patient preference/consent discussion (21/54, 38.9%). Most (53/54, 98.1%) had performed a negative appendectomy and 49/54 (90.7%) agreed there were no sufficient guidelines. CONCLUSIONS The majority of pediatric surgeons agree sufficient guidelines do not exist to support decision making when a normal-appearing appendix is found during laparoscopy for suspected acute appendicitis. This survey shows that removal of the appendix in this case would be supported by the majority of Canadian pediatric surgeons. TYPE OF STUDY Survey LEVEL OF EVIDENCE VII (Expert Opinion). OBJECTIVE To analyze predictors of survival involved in liver retransplantation (LRT), including the Rosen Model (RM). MATERIALS AND METHODS This was a descriptive, observational, and unicentric study based on predictors of survival including patients who underwent LRT in a tertiary medical center between April 2002 and December 2018. Recipient, donor, and transplant data were collected, and RM score was calculated for every patient. FDA-approved Drug Library in vitro Fisher exact test and Student t test were used for qualitative and quantitative variables, respectively. The Shapiro-Wilks test was applied to verify the normality of the sample. Survival differences between subgroups were checked using the log-rank test. Statistical significance was stated at P less then .05. RESULTS Among 32 retransplanted patients in this period, 17 (53.1%) survived more than 12 months after LRT. The results of statistical associations between prognostic factors and overall survival highlighted that an older recipient age was significantly correlated with a lower overall survival.
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