Papers by Steven Stylianos
Maternal and child health journal, Jan 8, 2015
Objectives To determine the temporal patterns and the difference in trends by race/ethnicity of p... more Objectives To determine the temporal patterns and the difference in trends by race/ethnicity of pediatric firearm hospitalizations (FH) among those aged 15 years or younger in the United States. Methods Data on pediatric FH was retrieved from the Nationwide Inpatient Sample between 1998 and 2011 (n = 16,998,470) using external cause of injury codes (E-codes) of the International Classification of Diseases, Ninth Revision, Clinical modification, (assault: E9650-E9654, unintentional: E9220-E9224, E9228, and E9229, suicide: E9550-E9554, E9556, and E9559, undetermined: E9850-E9854, and E9856 and legal: E970). Meta-regression was used to determine the significance of temporal trends. Survey logistic regression adjusted for survey year was used to examine association of pediatric FH with social and demographic characteristics. Results An annual reduction of 1.07 per 100,000 hospitalizations (p-trend = 0.011) was observed between 1998 and 2011. There was reduction in rate of unintentional-...
International Journal of Clinical Medicine, 2013
Some children with previously undiagnosed Hirschprung's disease present severely ill at an advanc... more Some children with previously undiagnosed Hirschprung's disease present severely ill at an advanced age with markedly dilated bowel and enterocolitis. In this manuscript, the authors propose the following treatment algorithm: 1) a diverting transverse loop colostomy, 2) a transanal Soave endorectal pull-through, and 3) colostomy closure. The authors report their experience with five patients.
Journal of neurosurgical anesthesiology, 2014
The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center D... more The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved technologies against potential anesthetic risks, practice changes while awaiting definitive answers, and importance of continued interprofessional dialogue.
Minimally Invasive Surgery, 2014
Purpose. To compare narcotic versus nonnarcotic outpatient oral pain management after pediatric l... more Purpose. To compare narcotic versus nonnarcotic outpatient oral pain management after pediatric laparoscopic appendectomy.Methods. In a prospective study from July 1, 2010, to March 30, 2011, children undergoing laparoscopic appendectomy on a rapid discharge protocol were treated with either nonnarcotic or narcotic postoperative oral analgesia. Two surgeons in a four-person faculty group employed the nonnarcotic regimen, while the other two used narcotics. Days of medication use, time needed for return to normal activity, and satisfaction rate with the pain control method were collected. Student’st-test was used for statistical analysis.Results. A total of 207 consecutive children underwent appendectomy for acute, nonperforated appendicitis or planned interval appendectomy. The age and time to discharge were equivalent between the nonnarcotic (n=104) and narcotic (n=103) groups. Both had an equivalent number of medication days and similar times of return to normal activity. Ninety-s...
Pediatric Radiology, 1995
Gastrointestinal (GI) duplications contain tissue resembling several portions of the GI tract and... more Gastrointestinal (GI) duplications contain tissue resembling several portions of the GI tract and are associated with vertebral and genitourinary (GU) abnormalities [14]. We report a newborn with low, imperforate anus and lumbosacral dysraphism, who presented with a large cystic mass in the left renal fossa and pelvis. The flank mass (felt initially to be a dysplastic kidney and ureter) proved to be a complex GI duplication with histologic evidence of gastric, small bowel, and colonic mucosa, as well as respiratory epithelium and pancreatic tissue.
Pediatric Radiology, 1999
Journal of Pediatric Surgery, 1991
Splenic salvage following blunt injury can fail when parenchymal bleeding is uncontrollable. To d... more Splenic salvage following blunt injury can fail when parenchymal bleeding is uncontrollable. To define the usefulness of an argon beam coagulator for hemostasis, we used the instrument in a laboratory trial of partial splenic resection. New Zealand white rabbits, weighing 4 to 5 kg, had sharp excision of the lower half of the spleen. No sutures were used to control hemorrhage from the cut splenic surface or the hilar vessels. Hemostasis was achieved with 2 to 4 seconds of electrocoagulation delivered by a beam of argon gas. All animals survived the procedure and were in good health when killed between the fourth and sixth week following the procedure. At necropsy, the spleen was viable in all animals with no abscess or hematoma. Minimal adhesions from the treated splenic surface to the omentum were found. The scar at the cut surface was 1 mm in depth, and the histology of the remainder of the spleen was normal. In this simulated splenic injury model, argon beam coagulation was uniformly successful in achieving hemostasis. Minimal tissue destruction and lack of infection were noted. The argon beam coagulator may be useful in patients with severe splenic injuries and other situations requiring partial splenectomy.
Journal of Pediatric Surgery, 2014
Background: Initial antibiotics with planned interval appendectomy (interval AP) have been used t... more Background: Initial antibiotics with planned interval appendectomy (interval AP) have been used to treat patients with complicated perforated appendicitis; however, little experience exists with this approach in children with suspected acute perforated appendicitis (SAPA). We sought to determine the outcome of initial antibiotics and interval AP in children with SAPA. Methods: Over an 18-month period, 751 consecutive patients underwent appendectomy including 105 patients with SAPA who were treated with initial intravenous antibiotics and planned interval AP ≥8 weeks after presentation. All SAPA patients had symptoms for ≤96 hours. Primary outcome variables were rates of readmission, abscess formation, and need for interval AP prior to the planned ≥ 8 weeks. Results: Intraabdominal abscess rate was 27%. Appendectomy prior to planned interval AP was 11% and readmission occurred in 34%. All patients underwent eventual appendectomy with pathologic confirmation confirming the previous appendiceal inflammation. White blood cell (WBC) count N 15,000, WBC N 15,000 plus fecalith on imaging, and WBC N15,000 plus duration of symptoms N 48 hours were all significantly associated with higher rates of readmission (p = 0.01, p = 0.04, p = 0.02) and need for interval AP prior to the planned ≥ 8 weeks (p = 0.003, p = 0.05, p = 0.03). Conclusions: Treatment of SAPA with antibiotics and planned interval AP is successful in the majority of patients; however, complications such as abscess formation and/or readmission prior to planned interval AP occur in up to one-third of patients. Certain clinical variables are associated with increased treatment complications.
Current Opinion in Pediatrics, 2005
Purpose of review Recent advances in the delivery of trauma and critical care in children have re... more Purpose of review Recent advances in the delivery of trauma and critical care in children have resulted in improved outcome following major injuries. It is imperative that physicians who treat injured children familiarize themselves with current treatment algorithms for abdominal trauma. Important contributions have been made in the diagnosis and treatment of children with abdominal injury by radiologists and endoscopists. Recent findings This report examines the impact of consensus guidelines in the treatment of blunt abdominal solid organ injuries. Consensus guidelines for treatment of children with isolated spleen and liver injury are reviewed demonstrating conformity of care and significant reduction of resource utilization without adverse sequelae. Review of large datasets indicate contrasting rates of splenectomy depending on the expertise of the institution, emphasizing the need for wide dissemination of guidelines. Summary Clinical experience and published reports addressing specific concerns about the nonoperative treatment of children with solid organ injuries and recent radiologic and endoscopic contributions have made pediatric trauma care increasingly nonoperative. Although the trend is in this direction, the pediatric surgeon should remain the physician-of-record in the multidisciplinary care of critically injured children.
Journal of Pediatric Surgery, 2000
This study is intended to resolve the disparity and reach consensus on issues regarding the treat... more This study is intended to resolve the disparity and reach consensus on issues regarding the treatment of children with isolated spleen or liver injuries. To maximize patient safety and assure efficient, cost-effective utilization of resources, it was essential to determine current practice. Methods: Data from the case records of 856 children with isolated spleen or liver injury treated at 32 pediatric surgical centers from July 1995 to June 1997 were collected. The severity of injury was classified by computed tomography (CT) grade and the data analyzed for intensive care unit (ICU) stay, length of hospital stay, transfusion requirement, need for operation, pre-and postdischarge imaging, and restriction of physical activity. Patients with grade V injuries (2.8%) were excluded leaving 832 patients for detailed review. These data and available literature were analyzed for consensus by the 1998 APSA Trauma Committee.
Journal of the American College of Surgeons, 2006
Intraoperative placement of transpyloric jejunal feeding catheters in children
Pediatric surgery …, 1991
... of transpylorie jejunal feeding catheters in children Kerry S. Bergman, Mark A. Hoffman, Stev... more ... of transpylorie jejunal feeding catheters in children Kerry S. Bergman, Mark A. Hoffman, Steven Stylianos, and Nabil N. Jaeir ... McArdle AH, Palmason C, Morency I, Brown RA (1981) A rationale for enteral feeding as the preferable route for hyperalimentation. ...
Pediatric surgeons and anesthesiologists expand the dialogue on the neurotoxicity question, rationale for early and delayed surgeries, and practice changes while awaiting definitive evidence
Journal of neurosurgical anesthesiology, 2014
The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center D... more The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved technologies against potential anesthetic risks, practice changes while awaiting definitive answers, and importance of continued interprofessional dialogue.
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Papers by Steven Stylianos