Hamidreza Foroutan

Background: Progressive ventriculomegaly and the resulting irreversible brain damage may be mitigated through timely diversion prenatal intervention. While ventriculosubgaleal shunt (VSGS) is commonly performed postnatally in premature infants, in utero placement is unexplored. Objectives: We evaluated the feasibility of intrauterine placement of VSGS using a fetal lamb obstructive hydrocephalus model. Study Design: Hydrocephalus was induced in 14 fetal lambs by injecting 1–1.5 mL of BioGlueⓇ into the cisterna magna between Days 80 and 90 of gestation. Ten to 16 days later, ultrasound was performed to confirm hydrocephalus. Afterward, VSGS was surgically placed by creating a fetal subgaleal pocket, inserting a standard ventricular catheter, tunneling under the scalp, and securing with a silk suture, with the other end into a lateral ventricle. Near term, the ewes were sacrificed. Hysterotomy was performed to extract the lambs. Lambs were evaluated through gross inspection. Postmortem magnetic resonance imaging and pathology evaluations were performed. To assess the presence of activated microglia and astroglia, selected brain sections were immuno‐stained with ionized calcium‐binding adaptor molecule 1 (Iba1) and glial fibrillary acidic protein (GFAP), respectively. Results: Ten ewes with 14 fetuses (four twins) underwent hydrocephalus induction (median 86 days) by maternal laparotomy and either hysterotomy (two out of 14) or transuterine (12 out of 14) methods. Two fetuses were found demised at the time of shunt placement; hydrocephalus was confirmed in 11/12 surviving fetuses (three severe, four moderates, and four mild). A VSGS was successfully placed in all 12 surviving fetuses (median 104 days) employing open uterus fetal surgery. After shunt placement, one case died immediately from severe hydrocephalus, three were aborted, and one intrauterine fetal demise was found during cesarean delivery. Of the remaining seven lambs, seven out of seven VSGS remained under the scalp without catheter migration, and all demonstrated full scalp healing. Pathologic analyses by gross and histological methods confirmed typical hydrocephalic changes, including altered and denuded ependyma. However, more than half of the catheters were macroscopically obstructed with tissue debris and fibrin (four out of seven). Conclusion: Prenatal placement of the VSGS was technically successful in all cases, meaning the shunt could be inserted in 100% of fetuses. Survival to cesarean delivery was 58% (seven out of 12). Among survivors, no hardware migration or scalp breakdown occurred. Future studies should further explore the safety of the shunt.

Aim: This study aimed to introduce a 3D printed, flexible esophageal stent, which is useful in personalized treatment of patients with esophageal strictures and also reduce the adverse effects of t...

Background: The management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. Herein, along with describing the features of caustic injury, we described how to utilize a chest tube for esophageal stenting in pediatrics.Methods: Data regarding the etiology, treatment, and complications of caustic injury pediatrics during 10 years was collected retrospectively. Furthermore, data regarding the patient’s follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patients’ cheek.Results: Data from 57 patients with an average age of 2.5 years was collected. The most common cause of esophageal burn appertained to alkaline agents (89%). Twenty-nine patients (50.8%) recovered with dilatation alone, 16 ones needed esophageal repair, and ECT was inserted for 7 patients. None of the 7 ECT cases required gastrostomy or jejunostomy.Conclusion: The ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.