European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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Comparative Study
A biomechanical study of bicycle helmets' effectiveness in childhood.
The authors present the results of a series of impact tests on pedal cycle helmets. 10 helmets were tested using a drop test under three different test conditions: Left frontal/temporal from 1 m, right frontal/temporal from 1.5 m and left occipital from 1 m. Impact force and the acceleration of the headform's centre of gravity in three axes were measured. As a result of the authors' field research on pedal cycle helmets in Australia the 1.5 m drop height was considered to be more representative of a "real" accident than the less severe 1 m height fall. ⋯ In comparison a fall without helmet from 0.5 m produced a maximal resultant acceleration of 282 g. Head injury criteria values were for 1 m drops between 201 and 630; from 1.5 m 547 to 1078; and without helmet from 0.5 m 906. The individual helmets are compared on these figures and their merits discussed.
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Comparative Study
Postoperative vomiting in children. A persisting unsolved problem.
Nausea and vomiting after anaesthesia and surgery in children remains a major problem. The following survey studies the frequency of postoperative vomiting and relates it to the anaesthetic technique, the surgical procedure, and postoperative analgesia. During one year, September 1989 until September 1990, 2370 surgical patients requiring anaesthesia were studied prospectively with the following protocol: 1) patient data, surgery and anaesthesia technique; and 2) postoperative follow-up were registered. ⋯ Furthermore, postoperative opioid administration on the ward increased the risk of vomiting. Despite the low overall incidence of vomiting in our study, we still found a high frequency after certain surgical procedures. The use of regional anaesthesia, prophylactic antiemetic medication, and the introduction of new anaesthetics, may help to reduce the sometimes high incidence of postoperative nausea and vomiting in paediatric patients.
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Nonoperative management of blunt liver injuries has become standard care for children, in the absence of hemodynamic instability. However, attention has to be drawn to biliary complications which can manifest themselves after a latent period, even in the presence of rupture of main biliary ducts. Peripheral bile duct lesions are easily treated by wide drainage. ⋯ Resection of the segment cured the patient. These two cases illustrate the occurrence of intrahepatic main bile duct lesions, clinically apparent after a latent period, following blunt trauma of the liver treated by nonsurgical or conservative surgical management. Intrahepatic biliary reconstruction is an alternative to liver resection when viable vascularization of the involved sector justifies its preservation.
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Infants with congenital diaphragmatic hernia (CDH) die, because their lungs are hypoplastic and their pulmonary vascular resistance remains elevated after birth. In human newborns, it is difficult to appreciate the benefit of new therapeutic approaches, because the pathological findings are not uniform, the disease is rare and the clinical criteria for poor prognosis with conventional therapy are uncertain. To study the benefit of high-frequency ventilation (HFV) the use of Tolazoline in CDH, we created a diaphragmatic defect in sheep fetuses at 0.6 gestation and studied full-term newborns after a caesarian section. ⋯ Clinical and pathological findings of the lambs with CDH were very similar to severe CDH in humans with bilateral lung hypoplasia, severe respiratory distress, high pulmonary vascular resistance and severe hypoxemia. HFV dramatically improved CO2 elimination, allowed less aggressive ventilation, and was associated with higher flows and lower systemic and pulmonary vascular resistance. However, HFV did not improve oxygenation leaving the newborn with severe hypoxemia associated with massive intrapulmonary foramen ovale shunting from right to left.
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Comparative Study
Totally implantable central venous access devices in pediatric oncology--our experience in 46 patients.
Between 1986 and 1990, 50 venous access devices have been implanted in 45 children with various types of cancer and in one patient with Langerhans cell histiocytosis. Twenty-five devices were of the so-called "pediatric" type (Port-A-Cath: 24, Vascuport: 1) and 25 were "adult" ports (Port-A-Cath: 8, Vascuport: 6, Infuse-A-Port: 6, Theraport: 5). The catheters (in silicone elastomer or polyurethane) were inserted percutaneously or surgically. ⋯ Seven of the 11 complications, including all 3 port occlusions, were encountered with "pediatric" systems. All the adult access devices tested were safe and allowed long-standing access to the central venous system in this series of pediatric cancer patients. With proper placement technique and adequate nursing care, they represent a definite improvement in child cancer therapy.