Pediatric surgery international
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Pediatr. Surg. Int. · Oct 2003
"Thoracic gastrostomy"--a new technique for feeding gastrostomy in wide-gap esophageal atresia and tracheo-esophageal fistula.
Initial management of wide-gap esophageal atresia and tracheo-esophageal fistula, especially in developing countries, often involves ligation of the fistula, proximal esophagostomy and a gastrostomy. The conventional gastrostomy requires an abdominal incision and has several complications. The authors present an alternative technique of 'gastrostomy' that does not require an abdominal incision. ⋯ This is an alternative technique for feeding 'gastrostomy'. We have named the procedure as "Thoracic Gastrostomy" because the stoma is located on the chest but functions as a gastrostomy. The advantages include avoidance of a laparotomy and its complications, easy feeding by intermittent intubation, and availability of a virgin stomach for future gastric transposition.
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Pediatr. Surg. Int. · Sep 2003
ReviewThe epidemiology of neonatal tumours. Report of an international working group.
Neonatal tumours occur every 12,500-27,500 live births and comprise 2% of childhood malignancies, but there is little clarity as to their real prevalence, sites of origin and pathological nature as reported series vary. As an entity, neonatal tumours provide a unique window of opportunity to study tumours in which minimal environmental interference has occurred. The majority of tumours present with a mass at birth (e.g., teratomas, neuroblastomas, mesoblastic nephroma, fibromatosis), which are not infrequently identified on antenatal ultrasound. ⋯ Certain constitutional chromosome anomalies, however, specifically favour tumours occurring in the foetal and neonatal period. In support of this hypothesis, certain cytogenetic anomalies appear to be specific to neonates, and a number of examples are explored. Other environmental associations include ionizing radiation, drugs taken during pregnancy, infections, tumours in the mother and environmental exposure.
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Pediatr. Surg. Int. · May 2003
Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar.
The Nuss procedure is a new, minimally invasive technique for the repair of pectus excavatum. We describe our experience with this operation, in a relatively large series in a single institution, and introduce our technical modification for stabilizing the pectus bar. In 107 patients (75 male and 32 female) with pectus excavatum who underwent the Nuss procedure, age at operation ranged from 3 to 23 years old (mean: 7.5+/-4.1) and Haller's CT index ranged from 33 to 2.6 (mean: 6.1+/-3.5). ⋯ The wire-fixation technique was safe, effective and time efficient to perform in young cases. Teen-aged patients, however, were at high risk of bar displacement. Therefore, the use of two bars and lateral stabilizing bars are recommended for these high-risk patients.
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Pediatr. Surg. Int. · May 2003
Case ReportsRecurrent tracheoesophageal fistula after foreign body impaction.
We describe a case of recurrent tracheoesophageal fistula in a child previously operated for esophageal atresia and tracheoesophageal fistula following impaction of a foreign body. After extracting the foreign body, the diagnosis of recurrence was confirmed by esophagogram and bronchoscopy. The fistula was approached through transpleural thoracotomy and repair effected without significant difficulty. The possibility of unrecognized foreign body impactions as the etiological factor for late recurrence of tracheoesophageal fistula is discussed.
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Pediatr. Surg. Int. · Apr 2003
Case ReportsBilateral phrenic-nerve paralysis treated by thoracoscopic diaphragmatic plication in a neonate.
Traditionally, diaphragmatic plication (DP) is performed via a thoracotomy that includes incision of the lower intercostal muscles, which are involved in respiratory movement. This may adversely affect ventilation by causing deterioration of respiratory function and making ventilation less efficient. These problems do not occur with thoracoscopic DP (TDP), since the lower intercostal muscles are left intact. We describe a full-term newborn infant with bilateral phrenic-nerve paralysis (PNP) who was treated by TDP and conclude that this method may be effective in the treatment of PNP even in small infants.