Pediatric surgery international
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Pediatr. Surg. Int. · Jan 1999
Comparative StudyComparison of venoarterial versus venovenous access in the cerebral circulation of newborns undergoing extracorporeal membrane oxygenation.
This study was designed to compare venoarterial (VA) with venovenous (VV) access in the cerebral circulation of newborn infants during extracorporeal membrane oxygenation (ECMO). Among 14 infants with VA ECMO, 7 had no intracranial complications (group 1), while the others (group 2) developed intracranial hemorrhage (ICH). In contrast, among 19 infants with VV ECMO, only 1 developed ICH. ⋯ However, in the infants on VV ECMO the CBF was either maintained or gradually increased before and during ECMO. Their cardiac parameters were: EF 46.1%-53.0%, CO 0.43-0.52 l/min, and SV 2.72-3.84 ml during ECMO. It is concluded that in VA ECMO CBF velocities, particularly in infants who developed ICH, decreased after the onset of ECMO in association with poor cardiac function, while in VV ECMO they were stable, probably due to normal systemic hemodynamics and cardiac function.
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Pediatr. Surg. Int. · Jan 1999
Gastric perforation in infants with oesophageal atresia and distal tracheo-oesophageal fistula.
Gastric perforation (GP) is a well-recognised complication of oesophageal atresia (OA) with distal tracheo-oesophageal fistula (TOF), and is usually associated with extreme prematurity, hyaline membrane disease, and the requirement for assisted ventilation. The presentation is sudden, and leads to further deterioration in respiratory function because of increasing abdominal distension from pneumoperitoneum and splinting of the diaphragm. Unrelieved, the infant becomes increasingly hypoxic and may die. A review of six infants with OA and distal TOF in whom GP occurred has enabled us to develop the following guidelines for the appropriate initial surgical management of this complication: (1) Needle paracentesis of the abdomen en route to surgery if the infant continues to deteriorate; (2) Urgent laparotomy to decompress the abdomen and to occlude the lower oesophagus with a catheter introduced through the GP; (3) Thoracotomy and division of the fistula; (4) Oesophageal anastomosis if the infant's condition improves sufficiently and the anatomy is favourable; and (5) Repair of the GP and formation of a gastrostomy.
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Pediatr. Surg. Int. · Jan 1999
Case ReportsExtensive epidural teratoma in early infancy treated by multi-stage surgery.
We report a rare case of extensive extradural teratoma successfully treated by multi-stage laminotomy and thoracotomy. A 34-day-old, dyspneic infant had a large posterior mediastinal mass identified on a chest X-ray radiograph. Imaging studies disclosed that the mass originated from the extradural space at the level of the lower thoracic spine, extending cephalad to C4 and caudad to L4 and severely compressing the spinal cord anteriorly, causing paraplegia. ⋯ The upper half of the teratoma was removed utilizing a laminotomy from T3 through T9; 2 months later the lower half was excised via a laminotomy from T11 to L3. An additional procedure was required to resect recurrent tumor through a laminotomy from T8 to T12. The reconstructed vertebral arches were well-preserved in shape, with an almost normal spinal canal.
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Pediatr. Surg. Int. · Jan 1999
Case ReportsSewing-pin perforation of the appendix into the bladder.
We report a 2.5-year-old child who presented with an acute abdomen caused by the perforation of a sewing pin through her appendix that had started to penetrate the wall of the bladder.
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Pediatr. Surg. Int. · Jan 1999
Transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis in children and adolescents.
Primary hyperhidrosis (PH) often starts in childhood and adolescence and can be a troublesome condition. In Taiwan, there is a high incidence in childhood (1.6%-2.0%) and adolescence (2.2%-2.6%). There are few reports regarding transthoracic endoscopic sympathectomy (TES) for PH in children and adolescents. ⋯ The result was highly satisfactory in 408 patients (93.2%), although 377 (86%) developed compensatory sweating of the trunk and lower limbs, the distribution affecting the back (86%), abdomen (48%), lower limbs (78%), and soles (1.4%). The recurrence rate of palmar hyperhidrosis was 0.6% in the 1st, 1.1% in the 2nd, and 1.7% in the 3rd year. TES is thus a safe and effective method for treating palmar and axillary hyperhidrosis in children and adolescents.