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  1. Article ; Online: Current Management of Adhesive Small Bowel Obstructions in Children.

    Rubalcava, Nathan S / Speck, K Elizabeth

    Advances in pediatrics

    2022  Volume 69, Issue 1, Page(s) 243–257

    Abstract: Adhesive small bowel obstructions are a common cause of morbidity in children who underwent prior abdominal surgery. The concept of partial versus complete bowel obstruction is outdated and lacks precision to be clinically useful. Identifying patients ... ...

    Abstract Adhesive small bowel obstructions are a common cause of morbidity in children who underwent prior abdominal surgery. The concept of partial versus complete bowel obstruction is outdated and lacks precision to be clinically useful. Identifying patients with indications for immediate operative intervention is critical and must be recognized to limit morbidity. Clinical protocols and contrast challenge algorithms have attempted to identify patients that will resolve their bowel obstruction nonoperatively; there has been slow uptake in the pediatric patient population versus adults until recently. Incorporating predictive models and standardized contrast challenge protocols will help reduce interpractitioner variability and improve clinical outcomes.
    MeSH term(s) Adhesives ; Adult ; Child ; Contrast Media ; Diatrizoate Meglumine ; Humans ; Intestinal Obstruction/diagnosis ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Tissue Adhesions/complications ; Tissue Adhesions/surgery ; Treatment Outcome
    Chemical Substances Adhesives ; Contrast Media ; Diatrizoate Meglumine (3X9MR4N98U)
    Language English
    Publishing date 2022-06-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 210524-x
    ISSN 1878-1926 ; 0065-3101
    ISSN (online) 1878-1926
    ISSN 0065-3101
    DOI 10.1016/j.yapd.2022.03.002
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  2. Article ; Online: Inflammatory Bowel Disease in Children and Adolescents.

    Rubalcava, Nathan S / Gadepalli, Samir K

    Advances in pediatrics

    2021  Volume 68, Page(s) 121–142

    MeSH term(s) Adolescent ; Child ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/epidemiology ; Inflammatory Bowel Diseases/therapy
    Language English
    Publishing date 2021-06-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 210524-x
    ISSN 1878-1926 ; 0065-3101
    ISSN (online) 1878-1926
    ISSN 0065-3101
    DOI 10.1016/j.yapd.2021.05.005
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  3. Article ; Online: From Ancient Texts to Digital Imagery: A Brief History on the Evolution of Anatomic Illustrations.

    Rubalcava, Nathan S / Gadepalli, Samir K

    The American surgeon

    2020  Volume 87, Issue 8, Page(s) 1259–1266

    Abstract: In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching ...

    Abstract In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching of surgery. Illustrations after all are the basis of all anatomical atlases and are quintessential tools that allow for an expedient and thorough understanding of concepts underlying the fabric of the human body. Yet, surgery has not always been taught with an atlas. Illustrations, much like surgery, have seen an incredible transformative process spanning across the ages to achieve their status in modern medicine. Through this brief review, we will not only glean an understanding of the evolution of anatomical illustrations but also the social context in which surgery has also evolved throughout history.
    MeSH term(s) Anatomy, Artistic/history ; Atlases as Topic/history ; Digital Technology/history ; History, 15th Century ; History, 16th Century ; History, 17th Century ; History, 18th Century ; History, 19th Century ; History, 20th Century ; History, 21st Century ; History, Ancient ; History, Medieval ; Humans ; Medical Illustration/history
    Language English
    Publishing date 2020-12-19
    Publishing country United States
    Document type Historical Article ; Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/0003134820956307
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  4. Article ; Online: Current Image-Guided Interventions in Pediatric Surgery.

    Rubalcava, Nathan S / Jarboe, Marcus D

    European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie

    2020  Volume 30, Issue 2, Page(s) 164–171

    Abstract: Traditionally, surgical technique has not included imaging modalities. Image guidance had largely been left to radiology specialties. However, in recent years, tremendous advances in imaging have taken place with improvements in image quality, ... ...

    Abstract Traditionally, surgical technique has not included imaging modalities. Image guidance had largely been left to radiology specialties. However, in recent years, tremendous advances in imaging have taken place with improvements in image quality, portability, and accessibility. With these advances, surgeons have begun to realize the benefits of fusing image guidance with traditional surgical approaches. Subsequently, many novel surgical approaches utilizing image guidance have been developed that allow for precise, safe, and minimally invasive management of conditions that previously required open surgical intervention.
    MeSH term(s) Child ; Fetoscopy/methods ; Fluoroscopy/methods ; Humans ; Image-Guided Biopsy/methods ; Magnetic Resonance Imaging, Interventional/methods ; Magnetic Resonance Imaging, Interventional/trends ; Thoracic Surgery, Video-Assisted/methods ; Tomography, X-Ray Computed/instrumentation ; Ultrasonography, Interventional/methods ; Ultrasonography, Interventional/trends
    Language English
    Publishing date 2020-04-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1065043-x
    ISSN 1439-359X ; 0939-7248 ; 0939-6764 ; 0930-7249
    ISSN (online) 1439-359X
    ISSN 0939-7248 ; 0939-6764 ; 0930-7249
    DOI 10.1055/s-0040-1703013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Paediatric surgeons' current knowledge and practices of obtaining assent from adolescents for elective reconstructive procedures.

    Lai, Krista / Rubalcava, Nathan S / Weidler, Erica M / van Leeuwen, Kathleen

    Journal of medical ethics

    2022  Volume 49, Issue 9, Page(s) 602–606

    Abstract: Purpose: Adolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In ... ...

    Abstract Purpose: Adolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In this research, we aim to define the current knowledge of AAP recommendations and surgeon practices regarding assent for elective reconstructive procedures.
    Methods: An anonymous electronic survey was distributed to North American paediatric surgeons and fellows through the American Pediatric Surgical Association (n=1353).
    Results: In total, 220 surgeons and trainees responded (16.3%). Fifty per cent of the surgeons who are familiar with the concept of assent had received formal training; 12% of the respondents had not heard of assent before the survey. Forty-seven per cent were aware of the 2016 AAP policy statement regarding assent in paediatric patients. Eighty-nine per cent always include adolescents as part of the consent discussion. Seventy-seven per cent solicit an expression of willingness to accept the proposed care from the patient. The majority (74%) of the surgeons perceived patient cooperation/understanding as the biggest barrier to obtaining assent. Over half of the respondents would consider proceeding with elective surgery despite the adolescent patient's refusal. Reasons cited for proceeding with elective surgery include surgeons' perception of medical necessity, perceptions of disease urgency, and lack of patient maturity.
    Conclusion: Paediatric surgeons largely acknowledge the importance of assent, but variably practice the principles of obtaining assent from adolescent patients undergoing elective reconstructive procedures. Fewer surgeons are explicitly aware of formal policy statements or received formal training. Additional surgeon education and institutional policies are warranted to maximise inclusion of adolescents in their medical care.
    MeSH term(s) Child ; Humans ; Adolescent ; Young Adult ; Decision Making ; Surgeons ; Surveys and Questionnaires ; Elective Surgical Procedures ; Informed Consent
    Language English
    Publishing date 2022-12-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 194927-5
    ISSN 1473-4257 ; 0306-6800
    ISSN (online) 1473-4257
    ISSN 0306-6800
    DOI 10.1136/jme-2022-108525
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    Zs.A 1163: Show issues Location:
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  6. Article: From the Cecum to the Sigmoid: Twisted Colon in the Pediatric Population.

    Parrado, Raphael H / Rubalcava, Nathan S / Davenport, Katherine P

    Cureus

    2021  Volume 13, Issue 9, Page(s) e17974

    Abstract: Colonic volvulus (CV) is the third leading cause of colonic obstruction in adults. In infants and children, this is exceedingly rare, with only sporadic cases reported so far. We present two cases of CV to highlight the differences in etiology, ... ...

    Abstract Colonic volvulus (CV) is the third leading cause of colonic obstruction in adults. In infants and children, this is exceedingly rare, with only sporadic cases reported so far. We present two cases of CV to highlight the differences in etiology, presentation, diagnosis, and treatment of this condition. The first patient is a 12-year-old boy with no previous surgeries who presented with four days of abdominal pain. Imaging showed a sigmoid volvulus that was decompressed endoscopically, and he was discharged. He had a contrast enema showing an abnormal rectosigmoid ratio. At the time of the rectal biopsy four weeks later, he was found to have a recurrence, at which point definitive operative treatment was pursued. The second patient is a 17-year-old boy who presented with five days of abdominal pain and CT findings concerning for ischemic volvulus. This prompted emergent operative intervention, where a cecal volvulus was discovered as the result of a congenital band. The band was divided without complication.  Pediatric CV is a rare condition that might be severe in some cases. High suspicion, prompt diagnosis, and treatment are essential to prevent early and long-term morbidity.
    Language English
    Publishing date 2021-09-14
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.17974
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  7. Article: Current Image-Guided Interventions in Pediatric Surgery

    Rubalcava, Nathan S. / Jarboe, Marcus D.

    European Journal of Pediatric Surgery

    2020  Volume 30, Issue 02, Page(s) 164–171

    Abstract: Traditionally, surgical technique has not included imaging modalities. Image guidance had largely been left to radiology specialties. However, in recent years, tremendous advances in imaging have taken place with improvements in image quality, ... ...

    Abstract Traditionally, surgical technique has not included imaging modalities. Image guidance had largely been left to radiology specialties. However, in recent years, tremendous advances in imaging have taken place with improvements in image quality, portability, and accessibility. With these advances, surgeons have begun to realize the benefits of fusing image guidance with traditional surgical approaches. Subsequently, many novel surgical approaches utilizing image guidance have been developed that allow for precise, safe, and minimally invasive management of conditions that previously required open surgical intervention.
    Keywords imaging ; image-guided ; surgery ; ultrasound ; MRI
    Language English
    Publishing date 2020-04-01
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 1065043-x
    ISSN 1439-359X ; 0939-7248 ; 0939-6764 ; 0930-7249
    ISSN (online) 1439-359X
    ISSN 0939-7248 ; 0939-6764 ; 0930-7249
    DOI 10.1055/s-0040-1703013
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  8. Article ; Online: Central line placement at ECMO decannulation: A missed opportunity.

    Rubalcava, Nathan S / Overman, Richard E / Hirschl, Ronald B / Thirumoorthi, Arul S

    Journal of pediatric surgery

    2021  Volume 56, Issue 11, Page(s) 2069–2072

    Abstract: Introduction: ECMO is a support modality for refractory critical illness. This study reviews the incidence and utility of central venous line (CVL) placement at pediatric ECMO decannulation.: Methods: A single-institution retrospective study of ... ...

    Abstract Introduction: ECMO is a support modality for refractory critical illness. This study reviews the incidence and utility of central venous line (CVL) placement at pediatric ECMO decannulation.
    Methods: A single-institution retrospective study of patients undergoing open neck decannulation from 2015 to 2019. Patients were divided into two groups:  ≤ 28-days and > 28-days.
    Results: Of 65 patients, 31% had a CVL placed at decannulation. Sepsis and pneumonia were the most common indications for ECMO in the older-group compared to CDH in neonates. The most common indications for CVL were hemodialysis (45%), monitoring (25%), and access (25%). 89% of neonates had an access line placed, whereas 73% of the older group received hemodialysis catheters. Median CRRT requirement was 20 days. 85% of lines were functional at time of removal or death. None were removed for infection. 40% of the patients not receiving a CVL at decannulation required one within 30 days.
    Conclusion: 69% of patients did not have a CVL placed at decannulation, however 40% required a CVL within 30 days. Most lines placed at decannulation remained functional and none were removed for infection. Decannulation removes the circuit as a route for vascular access, but it also presents an opportunity to safely place an essential CVL.
    MeSH term(s) Catheterization, Central Venous ; Child ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Humans ; Incidence ; Infant, Newborn ; Retrospective Studies
    Language English
    Publishing date 2021-02-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2021.02.050
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  9. Article ; Online: Implementation Science Fundamentals: Pediatric Surgery Enhanced Recovery After Surgery Protocol for Pectus Repair.

    Thompson, Allison R / Glick, Hannah / Rubalcava, Nathan S / Vernamonti, Jack P / Speck, K Elizabeth

    The Journal of surgical research

    2022  Volume 283, Page(s) 313–323

    Abstract: Introduction: Surgical repair of pectus excavatum and carinatum in children has historically been associated with severe postoperative pain and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, multimodal approach ...

    Abstract Introduction: Surgical repair of pectus excavatum and carinatum in children has historically been associated with severe postoperative pain and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, multimodal approach designed to fast-track surgical care. However, obstacles to implementation have led to very few within pediatric surgery. The aim of this study is to outline the process of development and implementation of an ERAS protocol for pectus surgical repair using fundamental principles of implementation science.
    Methods: A multidisciplinary team of providers worked collaboratively to develop an ERAS protocol for surgical repair of pectus excavatum and carinatum and methods for identifying eligible patients. The surgical champion collaborated with all end users to review and revise the ERAS protocol, assessing all foreseeable barriers and facilitators prior to implementation.
    Results: Our entire pediatric surgery team, nurses at every stage (clinic/preoperative/recovery/floor), physical therapy, and information technology contributed to the creation and implementation of an ERAS protocol with seven phases of care. The finalized version was implemented by end users focusing on four main areas: pain control, ambulation, diet, and education. Barriers and facilitators were continually addressed with an iterative process to improve the success of implementation.
    Conclusions: This is one of the first studies in children which details the step-by-step process of developing and implementing an ERAS protocol for pectus excavatum and carinatum. The process of development and implementation of an ERAS protocol as outlined in this manuscript can serve as a model for future ERAS protocols in pediatric surgery.
    MeSH term(s) Child ; Humans ; Enhanced Recovery After Surgery ; Funnel Chest/surgery ; Implementation Science ; Pain, Postoperative ; Specialties, Surgical ; Length of Stay
    Language English
    Publishing date 2022-11-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.10.018
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  10. Article ; Online: Ultrasound-Guided Gastrostomy Tube Placement: An Evaluation of Postoperative Complications in the Pediatric Population.

    Dougherty, Danielle / Rubalcava, Nathan S / Janke, Olivia G / Speck, K Elizabeth / Johnson, Kevin N / Jarboe, Marcus D

    Journal of laparoendoscopic & advanced surgical techniques. Part A

    2022  Volume 32, Issue 8, Page(s) 902–906

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Child ; Enteral Nutrition/methods ; Gastrostomy/adverse effects ; Gastrostomy/methods ; Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Ultrasonography, Interventional/adverse effects
    Language English
    Publishing date 2022-06-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1381909-4
    ISSN 1557-9034 ; 1092-6429
    ISSN (online) 1557-9034
    ISSN 1092-6429
    DOI 10.1089/lap.2021.0752
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