European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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Comparative Study Observational Study
Serum Concentrations of Interleukin-6, Procalcitonin, and C-Reactive Protein: Discrimination of Septical Complications and Systemic Inflammatory Response Syndrome after Pediatric Surgery.
Early differentiation between sepsis and systemic inflammatory response syndrome (SIRS) is useful for therapeutic management in neonates and infants after surgery. ⋯ IL-6 appears to be an early marker for severe bacterial infections with high sensitivity. IL-6 and CRP were the most reliable markers for the discrimination between SIRS and sepsis within the postoperative period.
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The mesoportal shunt (MPS) and liver transplantation (LT) have changed the scenario of extrahepatic portal vein obstruction (EHPVO) since the MPS, the only "curative" technique, can now be offered in asymptomatic patients and also thrombotic complications of LT have increased the incidence of EHPVO. ⋯ The MPS is the technique of choice in EHPVO for idiopathic thrombosis as well as secondary to LT. Not all cases are favorable for MPS, so the surgeon must consider the possibility of alternative techniques for EHPVO. The results in terms of shunt patency are much better in idiopathic cavernoma that posttransplant patients.
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One-lung anesthesia in infant is always a challenge to the pediatric anesthesiologist. Thoracoscopic diaphragmatic eventration repair requires high quality of lung isolation for proper surgical access. We are reporting a new technique of lung isolation by Fogarty embolectomy catheter alongside the endotracheal tube in four infants.
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For pediatric femoral shaft fractures, elastic stable intramedullary nailing (ESIN) is an accepted method of treatment. But problems regarding stability with shortening or axial deviation are well known in complex fracture types and heavier children. Biomechanical in vitro testing was performed to determine whether two modified osteosyntheses with an additional tension screw fixation or screw fixation alone without nails could significantly improve the stability in comparison to classical ESIN. ⋯ In this in vitro adolescence femur spiral fracture model, the stability of ESIN could be significantly improved by two modifications with additional tension screws. If transferred in clinical practice, these modifications might offer earlier weight bearing and less problems of shortening or axial deviation.
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Minor surgical interventions in children are often at times challenging due to the lack of cooperation by the child. Procedural sedation and analgesia is often appropriate, but unpleasant or painful applications of medication add additional discomfort to the child. A mixture of nitrous oxide (N2O)/oxygen (O2) in a ratio of 50:50, functioning as an inhalational sedative analgesic, may be a viable alternative, in particular in an emergency care setting because such mixtures require no fasting period and are self-administered. Therefore, in this study we investigated the feasibility and the effectiveness of N2O/O2 (50:50) as a sedative analgesic when performing minor surgical procedures. ⋯ The use of self-administered N2O/O2 (50:50) mixture for minor painful procedures in children is safe and adequate pain control can be achieved in most cases. The benefits of this approach for the child and its parents are its good acceptance and adequate pain control. The benefit for the health care provider is the lack of a fasting period before administration, good anxiolysis at minimum sedation, and a cooperative patient. Limitations are unsatisfying analgesia in some cases. Though not found in our study, potentially serious adverse events are a possibility and standard safety guidelines for minimal sedation should always be applied.