Pediatric surgery international
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Pediatr. Surg. Int. · Jan 2000
Comparative StudyThe effect of the availability of laparoscopic techniques on the treatment of appendicitis in children.
The use of laparoscopic surgery for acute appendicitis (AA) in children has increased over recent years. The aim of this study was to determine what effect the availability of laparoscopic appendicectomy (LA) has had on children admitted with suspected AA. A retrospective review of children admitted between January 1994 and June 1999 inclusive who underwent appendicectomy for suspected AA was conducted. ⋯ There was a decrease in the proportion of laparoscopic procedures converted to open appendicectomy from 50 to 6% during the period reviewed. The ready availability of laparoscopy and increased confidence in its use has resulted in more children, especially females, with suspected AA undergoing laparoscopy. There was a corresponding higher rate of normal appendix removal in this group, but the overall rate of normal histology has not changed, suggesting that the laparoscopic approach is more likely to be employed where the clinical diagnosis is less certain, particularly in older girls.
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To investigate the value of Doppler ultrasound scan (USS) assessment of internal jugular vein (IJV) patency after previous open central-venous cannulation (CVC), a prospective study of 66 consecutive children (median age 4.5 years; range 4 months-17 years) who had previously undergone open insertion of at least one indwelling IJV line and required further CVC for completion of therapy was undertaken. All underwent Doppler USS examination prior to surgery. Where patency of the previously cannulated vein was suggested ultrasonographically, the accuracy of this finding was confined at open surgical exploration. ⋯ Overall, successful recannulation was possible in 74.6% of all previously accessed veins. In children requiring repeated CVC, Doppler USS of neck veins is a valuable but not entirely reliable guide to the presence of underlying vessel patency and should be interpreted with caution. At least three-fourths of previously cannulated IJVs remain patent after catheter removal and can be reused for CVC.
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Pediatr. Surg. Int. · Jan 2000
Plasma superoxide dismutase activity and malondialdehyde level correlate with the extent of acute appendicitis.
Although the mechanism of acute appendicitis (AA) is partly understood, the progression following the onset of inflammation has not yet been clarified. To determine oxidative activities in the plasma of patients with AA, superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured in samples from 31 patients diagnosed as having AA and 10 otherwise healthy children with inguinal pathologies. The patients with AA were divided into three subgroups: acute focal (AFA) (n = 8), acute suppurative (ASA) (n = 9), and acute perforated appendicitis (APA) (n = 14), according to the intraoperative findings and histopathologic examination. ⋯ The mean leukocyte numbers of the ASA and APA groups were significantly higher compared to the AFA group. Based to these results, it may be speculated that oxygen free radicals (OFR) may play an important role in the extent of AA. To prevent the hazardous effects of OFR, the organism may increase SOD and other antioxidant enzyme levels and/or activities.
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We review our experience and the literature in treating 4 patients with Wilms' tumor (WT) with intracardiac extension among 92 patients with this neoplasm. Cardiopulmonary bypass with circulatory arrest and profound hypothermia was used. There were 3 boys (3 years, 4 years 5 months, and 15 years) and 1 girl (6 years). ⋯ We propose that preoperative chemotherapy should be used, as it shrinks the thrombus and causes desirable adherence of the thrombus to the venous wall, reducing the probability of thromboembolism during the surgical procedure. We also find this method safer than in our 1st case, where neither cardiac arrest nor hypothermia was used. Our results agree with the literature that intracardiac extension of WT does not worsen its prognosis when a rational surgical approach is used.
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The possibility of sustaining ovarian damage as a consequence of an inguinal hernia becoming strangulated is well recognised. However, the mechanism by which this gonadal damage occurs is rarely stated; it is assumed that the injury is secondary to compression of ovarian vessels by an entrapped bowel loop. ⋯ In all cases the primary aetiological event was torsion of the ovary and tube on its pedicle whilst suspended from the neck of the hernial sac. This mechanism constituted the major cause of ovarian damage within irreducible herniae in our series.