Pediatric surgery international
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Pediatr. Surg. Int. · Jul 2001
Clinical appraisal of Ascaris lumbricoides, with special reference to surgical complications.
Over a period of 4 years (January 1993-December 1997), 509 patients were treated for abdominal colic with or without intestinal obstruction and a history of passage of adult roundworms either in the stool or in vomitus. All patients were below the age of 10 years, the youngest 6 months old, and were treated successfully with antispasmodics and normal saline enemas. When the pain subsided, an anthelminthic drug was given. ⋯ Five patients died in the postoperative period due to various complications. There were no deaths among those treated by conservative management. Early recognition of the condition can prevent serious surgical complications and morbidity.
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Pediatr. Surg. Int. · Mar 2001
Pediatric renal transplantation: anesthesia and perioperative complications.
The appropriate choice of anesthesia for patients (pts) undergoing renal transplantation (Ktx) requires minimal toxicity and accurate monitoring for pts at high risk for metabolic, cardiovascular, and respiratory perioperative complications. We evaluated the anesthetic management and postoperative follow-up in pediatric Ktx performed in the last 12 years in our institution. From 1988 to 1999, 75 ASA class II-III pts (45 males, 22 females) younger than 18 years scheduled for Ktx were studied: 49 received a graft from a cadaveric donor (CD) and 26 from a living donor (LD). ⋯ Recent advances in surgery, anesthesia, immunosuppression, and antimicrobial prophylaxis have made Ktx a more predictable procedure even in pediatric pts. For high-risk pts, mortality and morbidity can be controlled by accurate surgical, anesthetic, and postoperative management. Pts younger than 12 years and with BW less than 25 kg are more likely to develop peri- and postoperative complications.
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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.
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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 describe our experience using the laryngeal mask airway (LMA) in children to facilitate diagnostic procedures in fiberoptic bronchoscopy (FOB). Two cases of stridor, two cases of protracted pneumonia, and one case of laryngotracheomalacia were studied. Intravenous atropine (0.02 mg/kg) was given, and induction was carried out by either inhalation of a mixture of halothane-nitrous oxide-oxygen (n = 3) or IV injection of propofol (n = 2). ⋯ A 2.7-mm-OD flexible fiberoptic bronchoscope was introduced through the LMA and the diagnostic procedure was performed. Ventilation and oxygenation were maintained, and no serious morbidity was associated with the procedure. We found the use of the LMA to facilitate FOB to be useful, easy to perform, and safe, avoiding nasal trauma and providing a patent airway.