European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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In developed countries, the availability of advanced imaging techniques has reduced the necessity for laparotomy following blunt abdominal trauma in children. Laparotomy rates still remain high in developing countries where these advanced imaging techniques are lacking. A simple management protocol to identify patients who require laparotomy could reduce the laparotomy rate in children with blunt abdominal trauma in these countries. ⋯ Blunt abdominal trauma in children resulted mainly from road traffic accidents. The use of a simple protocol supported by ultrasound scan could reduce the laparotomy rate in countries with limited facilities.
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The repair of pectus excavatum using minimally invasive surgery is widely gaining acceptance as an equal if not superior technique to the traditional open approach. A number of modifications to the original Nuss procedure have been proposed to avoid complications. ⋯ Bilateral thoracoscopic repair of pectus excavatum with left-to-right mediastinal dissection is a safe alternative to the traditional approach, as it allows a more complete visualization of the mediastinum and eliminates the need for additional safety measures such as subxiphoid dissection and elevation.
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Review Meta Analysis
Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia: a systematic review of the evidence.
The aim of this study was to evaluate the evidence supporting the use of extracorporeal membrane oxygenation (ECMO) in infants with congenital diaphragmatic hernia (CDH) and severe respiratory failure. ⋯ Non randomised studies suggest a reduction in mortality with ECMO. However, differences in the indications for ECMO and improvements in other treatment modalities may contribute to this reduction. The meta-analysis of RCTs indicates a reduction in early mortality with ECMO but no long-term benefit. A large RCT in infants with CDH and severe respiratory failure is warranted.
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Acute right-sided diaphragmatic ruptures are rare in children. We report a case of traumatic right-sided diaphragmatic rupture in a child that was managed by delayed repair. The clinical presentation and importance of making an accurate diagnosis and confirmation of any associated visceral injury before definitive surgery is highlighted.
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Bone scintigraphy was performed to elucidate the effects of the Nuss procedure for pectus excavatum on the bony thorax. ⋯ The Nuss procedure creates minute fractures at the sternum and the ribs, especially in older patients. The bar deforms the ribs and restrains the growth of the thorax. Furthermore, it constantly rubs against the ribs and can therefore cause late complications. Bone scintigraphy may determine the appropriate timing for bar removal.