Pediatric surgery international
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This article helps to outline the scope of emergency paediatric operations in Tanzania by quantifying the nature of cases seen over a 12 month period in a teaching hospital. Data collected at the Kilimanjaro Christian Medical Centre (KCMC) showed that operative paediatric surgical emergencies represented 4% of all paediatric admissions. Of emergency procedures, 47 (43%) were for congenital abnormalities, 32 (29%) for infections, 19 (17%) for trauma and 12 (11%) for other reasons. ⋯ The challenges to meet patient needs in the African setting include: a scarcity of surgeons with training in paediatric surgery, the variety of conditions which all surgeons must manage, a lack of equipment (e.g., neonatal ventilators) and educational resources. Potential avenues for overcoming these challenges are discussed, including the promotion of paediatric surgery as a profession, by the expansion of existing facilities, promoting African associations of paediatric surgery and highlighting the need for resources and continued education and training. We argue that surgical training in developing countries should include the skills needed to treat those paediatric conditions most likely to require urgent surgical intervention.
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Pediatr. Surg. Int. · Feb 2008
Comparative StudyThe prognostic importance of serum IL-1beta, IL-6, IL-8 and TNF-alpha levels compared to trauma scoring systems for early mortality in children with blunt trauma.
The purpose of the present study was to determine whether a correlation exits between the main trauma scoring systems and the activation of inflammatory cells and mediators such as interleukin-(IL-) 1beta, IL-6, IL-8 and tumor necrosis factor alpha (TNF-alpha) after trauma, and moreover to assess if any of these can be used to predict the outcome in patients under care at a trauma center. Forty-seven children (37 boys, 10 girls) presenting with blunt trauma, were evaluated by an analysis of the relationship between overall mortality and potential risk factors. Admission data, including serum IL-1beta, IL-6, IL-8, TNF-alpha, pediatric trauma score (PTS), and injury severity score (ISS), were collected and analyzed. ⋯ There was also a correlation with ISS and IL-8 (r = 0.32, P = 0.02). ISS, and the serum IL-8 level are the most important determinants of clinical outcome in critically injured patients. A correlation exits between IL-8 and mortality and between ISS and IL-8.
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Pediatr. Surg. Int. · Feb 2008
Three-dimensional computed tomography for detection of tracheobronchial foreign body aspiration in children.
Foreign body aspiration (FBA) into the tracheobronchial tree is a frequent and serious cause of respiratory problems in children. Chest X-ray (CXR) is often inaccurate in diagnosing FBA when the object is radiolucent. Three-dimensional computed tomography (CT) is a noninvasive technique that can detect the narrowing of the airway resulting from the presence of a foreign body. ⋯ In our study, three-dimensional chest CT scan was more sensitive than CXR in detecting the presence of aspirated foreign bodies in children. The superior sensitivity and short time required for CT should help to reduce delays in diagnosis. These benefits may prompt further studies to determine whether CT could be used to reduce the number of unnecessary bronchoscopies performed in children being evaluated for FBA.
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To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at São Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. ⋯ Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated.
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Pediatr. Surg. Int. · Jan 2008
Comparative StudyHepatic microcirculation in murine sepsis: role of lymphocytes.
Sepsis is a leading cause of death in pediatric intensive care units. There is growing evidence that lymphocytes play a pivotal role in mediating the microvascular dysfunction during sepsis. The objective of this study was to define the role of different subsets of lymphocytes in mediating the hepatic microvascular alterations elicited by cecal ligation and puncture (CLP), an experimental model of sepsis. ⋯ In SCID mice, the adhesion of blood cells in terminal hepatic venules was significantly decreased compared to WT-CLP mice, whereas the values in CD3+ cell-reconstituted SCID-mice, B-cell-deficient and CD4+- and CD8+-T-cell deficient mice did not differ from WT-CLP mice. ALT levels were significantly elevated only in the SCID group, when compared to WT-sham and WT-CLP mice. These findings indicate that lymphocytes mediate the microvascular dysfunction, but protect against the hepatocellular injury associated with murine sepsis.