European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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Case Reports
Thrombosis of the arterial cannula during extracorporeal membrane oxygenation in a full-term newborn infant.
The authors report a rare case of cannula thrombosis during extracorporeal membrane oxygenation (ECMO). A full-term newborn infant was successively placed on single-cannula veno-venous extracorporeal lung support and then on veno-arterial ECMO, because of persistent pulmonary hypertension. At 140 hours of ECMO, the infant displayed general cyanosis except in the right arm. ⋯ It showed an opacification of the whole cannula but for the last distal centimeter, and of the vascular bed extending from the right subclavian artery. Cannula thrombosis was suspected and confirmed by removal of the arterial cannula. Demonstration of cannula thrombosis by opacification of the arterial line of the circuit indicates catheter removal.
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Comparative Study
Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA).
To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morphine requirements between 2 comparable groups of children aged 4-8 years and 9-15 years were compared. ⋯ In this study children aged 4-8 years had significantly higher total postoperative morphine requirements compared to children aged 9-15 years, i.e. 11.6 microgram/kg/hour and 7.5 microgram/kg/hour respectively (p = 0.037). Hence, we conclude that children of this age group may have a higher total postoperative morphine requirement following major surgery than older children and adolescents.
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Comparative Study
Interest of umbilical fold incision for pyloromyotomy.
We report the results of a study concerning 80 infants undergoing a pyloromyotomy over a 3-and-a-half-year period. 40 infants had a right upper quadrant transverse rectus incision and 40 infants had an umbilical fold incision. Morbidity and cosmetic aspect of the two techniques were compared. We insist on the umbilical fold incision which presents the same advantages as the classic one and a better cosmetic result.
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Paraphimosis in uncircumcised or incompletely circumcised children is a serious and painful condition requiring prompt reduction to prevent possible necrosis of the glans or urinary obstruction. Techniques described to reduce oedema distal to the constricting ring include application of ice packs, compressive elastic bandages, and making a dorsal slit which necessitates later circumcision. ⋯ This resulted in rapid diminution of the swelling, permitting easy manual reduction of the prepuce. Circumcision can then be performed if so desired.
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Comparative Study
Initial evaluation of children sustaining blunt abdominal trauma: ultrasonography vs. diagnostic peritoneal lavage.
A prospective clinical study was performed to compare ultrasonography (US) with a modality having 96-99% accuracy like diagnostic peritoneal lavage (DPL) to find the accuracy of US in the initial evaluation of children sustaining blunt abdominal trauma (BAT). Sixty-eight children with BAT were initially evaluated by US, then DPL. All patients with pathologic US findings underwent computerized tomographic examination before DPL to confirm the pathologies. ⋯ The present study has shown that US can detect FIF with a high rate of accuracy comparable to DPL in children. In addition, US has advantages over DPL in the detection of intraperitoneal organ injuries with or without concomitant FIF, retroperitoneal injuries and intrathoracic injuries. Thus US is thought to be superior to DPL and recommended as a routine first choice screening tool in the initial evaluation of children sustaining BAT.