Pediatric surgery international
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Pediatr. Surg. Int. · Jul 2009
Pyeloplasty in children: is there a difference in patients with or without crossing lower pole vessel?
Most of the children with hydronephrosis do not require any surgical intervention. However, in individual cases, irreversible loss of renal function can develop. Predictive criteria have been proven ineffective so far in determining in which children obstruction will lead to renal damage. The aim of our retrospective study was to determine the role of a crossing lower pole vessel (CV) in children undergoing pyeloplasty. ⋯ Children with ureteropelvic junction obstruction and CV received a delayed surgical treatment and showed a greater reduction in differential renal function preoperatively, in contrast to patients without CV. Our data show that CV is a risk factor for deterioration of renal function in children with hydronephrosis and we advocate for an early pyeloplasty in these children, especially if they have a high-grade dilatation and equivocal washout patterns in diuretic renographies. Further prospective studies are necessary in order to understand the natural history of CV and to reveal the importance of the crossing lower pole vessel as a structural anomaly lacking maturation.
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Pediatr. Surg. Int. · Jun 2009
Comparative StudyComparison of implantable central venous ports with catheter insertion via external jugular cut down and subclavian puncture in children: single center experience.
The purpose of this study is to demonstrate the efficacy, safety and long-term advantages of catheter insertion via external jugular vein (EJV) cut down for implantable central venous port in children. ⋯ Insertion of the catheter via the EJV cut down for implantable central venous port is significant better than insertion of the catheter via subclavian puncture in children.
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Pediatr. Surg. Int. · Jun 2009
Review Case ReportsPerforated Meckel's diverticulum in a micropremature infant and review of the literature.
A 28-week estimated gestational age infant presented to our neonatal intensive care unit at 6 days of life with intestinal perforation. Urgent surgical exploration revealed a perforated Meckel's diverticulum (MD) with no other intestinal abnormalities. ⋯ In the English literature, there have been a total of seven reported cases of perforated MD in the last 25 years. This report summarizes those cases and characterizes the presentation, prognosis and management of this very rare complication in neonates.
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Pediatr. Surg. Int. · Mar 2009
Review Case ReportsStroma-predominant Wilms tumor with teratoid features: report of a rare case and review of the literature.
We describe the case of a 4-year-old boy with a unilateral right-sided Wilms tumor with stromal predominance and teratoid features, which was localized to the kidney and hence, was completely resected. The pediatric surgeon and pathologist, both should be aware of this rare appearance of nephroblastoma so as to avoid the highly toxic chemotherapy and radiotherapy in such patients.
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Pediatr. Surg. Int. · Mar 2009
Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis.
The aim of this study was to determine whether the admission and active observation of children where the diagnosis of acute appendicitis is uncertain is a safe and effective way to improve the diagnostic accuracy of appendicitis and safely reduce the incidence of negative laparotomies without increasing complications. ⋯ Both the features and results and the complication rates and costs of the group operated on after observation were the same as the directly operated on group. However, patients undergoing a negative appendectomy stayed as inpatients longer than only observation patients with higher treatment charges. We could therefore decrease the negative appendectomy rate, the associated cost and duration of hospitalization without causing extra complications if we observe and investigate patients with right lower quadrant pain with a doubtful diagnosis and did not operate on them directly.