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Juan Bass

Publications and source records attributed to Juan Bass.

8 recordsLinked to original sources
PubMed2006

Interval appendectomy: an old new operation.

A retrospective chart review of 32 patients who underwent laparoscopic interval appendectomy at the Children's Hospital of Eastern Ontario between May 1999 and December 2003 was performed. The age range was 0.5 to 18 years (mean, 11.8 years; median, 11.5 years). The interval time from the acute episode to the laparoscopic interval appendectomy ranged from 1 to 16 weeks (median, 6 weeks). The initial presentations were 11 patients with appendiceal abscess, 9 with appendiceal masses/phlegmons, and 12 patients with an acute but resolving clinical picture with ultrasonographic evidence of appendicitis. There were no wound infections or recurrent intra-abdominal abscesses. The average length of stay was 1.38 days, ranging from same-day discharge (1 patient) to a three-night stay (2 patients). There were no complications related to the laparoscopic technique, confirming reports that laparoscopic interval appendectomy is a technically safe procedure. Pathologic analysis of the appendices demonstrated acute or subacute changes in 14 patients (interval time = 7.9 weeks), chronic changes in 8 (interval time = 8.1 weeks), both acute and chronic changes in 5 (interval time = 8.2 weeks), and no pathologic diagnosis in 6 (interval time = 4.28 weeks). These findings support the need for interval appendectomy, and suggest that laparoscopy is a safe alternative to open appendectomy.

Adolescent↗
PubMed2005

Unusual case of mesenteric venous thrombosis associated with oral contraceptive use in an adolescent girl.

A 16-year-old girl presented with hematochezia and abdominal pain. The patient developed a small bowel obstruction that required a laparotomy, which showed a segment of grossly infarcted small bowel with 3 perforations, localized abscesses, and creeping fat. Resection and an end-to-end anastomosis were performed. Pathologic examination showed underlying mesenteric venous thrombosis with no evidence of Crohn's disease. Hematology workup showed no evidence of a congenitally inherent hypercoagulable state. The use of oral contraceptives was the only predisposing factor identified.

Adolescent↗
PubMed2005

Empyema management: twelve years' experience since the introduction of video-assisted thoracoscopic surgery.

We reviewed empyema management at our center since video-assisted thoracoscopic surgery (VATS) was introduced. Between 1991 and 2003, 58 patients (34 male, 24 female) ages 1 day to 17 years (median, 6 years) were identified. The median interval from the onset of symptoms to presentation was 7 days; 31% of patients received inpatient care at another hospital, and 24% were from northern communities, including the Arctic. Symptoms included fever (100%), cough (66%), shortness of breath (46%), chest pain (38%), and abdominal pain (17%). Most patients (96%) had pneumonia. The most common organisms were Streptococcus pneumoniae (22%), group A streptococcus (8%), and Mycobacterium tuberculosis (3%). No organisms were identified in 31% of patients. One empyema was trauma-related and one was due to complications of esophageal stricturoplasty. All patients received intravenous antibiotics (median, 17 days). Three patients had thoracentesis, 17 had chest tubes, 3 had thoracentesis and chest tubes, 26 had VATS, 6 had thoracotomy, and 3 had minithoracotomy. Median operative times were 86 minutes for VATS, 90 minutes for thoracotomy, and 75 minutes for minithoracotomy. Median total length of stay (LOS) was 15 days for VATS, 20.5 days for thoracotomy, and 21 days for minithoracotomy. The median preoperative LOS was longer for thoracotomy (10 days) than for VATS (5 days) or minithoracotomy (1 day). The median postoperative LOS was 14 days for VATS, 9.5 days for thoracotomy, and 8 days for minithoracotomy. Our experience shows that VATS is a safe and effective approach to managing children with empyema. The shorter preoperative LOS for VATS is likely due to earlier surgical referral and intervention using less invasive surgical procedures.

Adolescent↗
PubMed2005

Caregiver attitudes towards gastrostomy removal after renal transplantation.

Gastrostomy tube (G-tube) removal has been suggested at 3 months following successful renal transplantation (Tx). We noticed a delay in the removal of G-tubes in our pediatric patients following Tx and therefore conducted a cross-sectional single center survey on all renal transplant recipients to assess the causes of delayed G-tube removal. In total, 17 of 23 patients completed the survey, including all patients with G-tubes (n = 10) and seven patients without G-tubes. Median age at Tx of gastrostomy patients was significantly lower than that of patients without a G-tube (median 3.0 yr, range 1.2-4.7 yr vs. median 14 yr, range 6-17 yr, p < 0.0001) and significantly younger than in previous studies on gastrostomies. At the time of the survey, only three of 10 patients had their G-tube removed at 22, 41 and 61 months after Tx at the ages of 3, 5.5 and 9 yr, respectively. The median age at recent follow up of the remaining seven patients was 4.7 yr (range 2.6-8.75 yr). The most important reason for continued use was fluid intake and medication. Results of our survey showed appropriate concern regarding the risk of prolonged use of the gastrostomy. Caregivers felt that benefits of the gastrostomy in the post-transplant period outweighed the risks. Caregivers felt pressured towards removal by the physicians. Our findings support the decision to remove gastrostomies based on individual patient needs and total fluid intake rather than a fixed time following successful Tx.

Adolescent↗
PubMed2004

Wilms' tumor at the Children's Hospital of Eastern Ontario: 1990-2001.

BACKGROUND: Wilms' Tumor is the most common malignant neoplasm of the urinary tract in children. Since 1969, the National Wilms' Tumor Study Group (NWTSG) has contributed to improving the clinical management and outcome of children affected by Wilms' Tumor. We have managed our patients according to NWTSG protocols and report our results herein. METHODS: Retrospective chart review of consecutive patients presenting at the Children's Hospital of Eastern Ontario (CHEO) with a diagnosis of Wilms' Tumor between April 1990 and March 2001. RESULTS: Forty patients with Wilms' Tumor (18 M/22 F) were diagnosed at CHEO during this interval. Mean age at diagnosis was 28.5 months. The most common presenting feature was a palpable abdominal mass in 85%. An overgrowth syndrome was noted in 10%. Metastatic disease was present at diagnosis in 20%, with the lungs (75%) the most common site of involvement. Distribution of clinical stage: I = 40%, II = 20%, III = 20%, IV = 15%, V = 5%. Favorable histology (FH) was diagnosed in 82.5%, anaplasia in 12.5% and clear cell sarcoma (CCSK) in 5%. Nephrogenic rests were present in 43% (perilobar (PL) = 20%, intralobar (IL) = 18%, PL + IL = 5%). Recurrence of disease occurred in 10%, with lungs (100%) the most frequent site of relapse. Survival was significantly greater in stage I disease and in those patients with FH. Patient 4-year survival data: stage I (FH), 100%; stage II (FH), 80%; stage III (FH), 100%, stage IV (FH), 67%; stages I-IV (CCSK), 100%; stage V, 0%. Overall 4-year survival rates of patients with FH were 92% and of all patients in the study was 86%. CONCLUSIONS: The presentation of Wilms' Tumor at our institution mirrors that described in the literature. Importantly, by following NWTSG protocols we have achieved an outcome of overall 4-year patient survival comparable to the "gold standard". This demonstrates the utility of the NWTSG protocols as regards patient management of this relatively uncommon disease.

Child↗