Pediatric surgery international
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Pediatr. Surg. Int. · Jan 1999
Transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis in children and adolescents.
Primary hyperhidrosis (PH) often starts in childhood and adolescence and can be a troublesome condition. In Taiwan, there is a high incidence in childhood (1.6%-2.0%) and adolescence (2.2%-2.6%). There are few reports regarding transthoracic endoscopic sympathectomy (TES) for PH in children and adolescents. ⋯ The result was highly satisfactory in 408 patients (93.2%), although 377 (86%) developed compensatory sweating of the trunk and lower limbs, the distribution affecting the back (86%), abdomen (48%), lower limbs (78%), and soles (1.4%). The recurrence rate of palmar hyperhidrosis was 0.6% in the 1st, 1.1% in the 2nd, and 1.7% in the 3rd year. TES is thus a safe and effective method for treating palmar and axillary hyperhidrosis in children and adolescents.
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Pediatr. Surg. Int. · Sep 1998
Fentanyl analgesia increases the incidence of postoperative hypothermia in neonates.
Postoperative hypothermia remains a clinical problem in neonates undergoing surgery. Intraoperative analgesia can blunt the metabolic and hormonal response to operative stress in neonates. However, its effects on heat production and thermoregulation are not known. ⋯ The drop in temperature between preoperative and initial postoperative values was significantly greater in patients who received fentanyl intraoperatively (median drop 0.8 degreesC, range 0.6 - 2.4) when compared with patients who received morphine (P = 0.02) or epidural bupivacaine (P = 0.01). These data suggest that intraoperative fentanyl modulates the postoperative body temperature in neonates. We hypothesise that fentanyl blocks metabolic heat production, which results in a reduction in postoperative body temperature.
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Pediatr. Surg. Int. · Jul 1998
Case ReportsMultidisciplinary evaluation of the distended abdomen in critically ill infants and children: the role of bedside sonography.
Abdominal distention and metabolic acidosis are common in critically ill infants and children, and can be manifestations of an intra-abdominal catastrophe. This series demonstrates the value of bedside sonography (US) in this difficult assessment. Eight infants and children presented with the above situation. ⋯ Four patients survived: two had segmental ileal necrosis, one had localized gangrene of the jejunum (twice), and one had necrotic bowel from a closed-loop obstruction. The four who died had malrotation with volvulus (two), superior mesenteric venous thrombosis, and one was immunocompromised with pulmonary aspiration. We conclude that bedside US can be extremely valuable as an adjunct in assessing the abdomen and diagnosing gangrenous bowel in critically ill infants and children.
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Pediatr. Surg. Int. · Jul 1998
Case ReportsAn unusual domestic accident: a penetrating abdominal wound with intestinal evisceration in a child.
We report a penetrating abdominal injury due to a piece of glass, a very unusual domestic accident, in a 2-year-old boy who was admitted to the emergency department with an evisceration through the umbilicus. His mother reported that she was asleep when the boy came to her room, and did not know how it had happened. ⋯ He had poured himself a glass of water, and then fell on the glass. We could not find a similar case in the literature on domestic accidents.
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A retrospective clinical study was performed to evaluate the etiology, diagnosis, and management of gastrointestinal tract perforation (GITP) due to blunt abdominal trauma (BAT) in order to find a predictor to avoid delay in diagnosis. Thirty-five children with GITP out of 805 BAT victims (4.3%) over a 21-year period formed the study group. Different parameters including preoperative (mechanism of injury, abdominal and X- ray findings at presentation, diagnostic modalities), operative (type and site of GITP, intra-abdominal associated injuries, surgical method), and postoperative (complications, mortality) status were analyzed. ⋯ Two deaths (5.7%) were directly due to head injuries. Our experience revealed that in spite of advanced imaging and laboratory modalities, frequent evaluation of the patient by an experienced surgeon is still the most important tool for early diagnosis and appropriate treatment. A child with BAT should be an inpatient and a high index of suspicion is always required, even in the presence of normal abdominal findings.