Seminars in pediatric surgery
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Semin. Pediatr. Surg. · Nov 1996
ReviewInnovative therapies in the management of newborns with congenital diaphragmatic hernia.
A number of innovative approaches have been explored in the hope of improving the outcome in newborns with congenital diaphragmatic hernia (CDH) and respiratory insufficiency. Among these are the techniques of delayed approach to the repair of the diaphragmatic hernia; permissive hypercapnia; nitric oxide and surfactant administration; intratracheal pulmonary ventilation; liquid ventilation; perfluorocarbon-induced lung growth; and lung transplantation. Although early in their clinical evolution, these interventions are developing rapidly and hold promise for improving the outcome in patients with CDH.
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Tumors of the genitourinary tract are heterogeneous and can be organized according to both site and specific histopathology. This article divides these neoplasms into primary tumor originating from the kidney, adrenal gland, collecting system, urinary bladder, and gonads. Primary renal tumors are further subdivided into Wilms' tumors and rare kidney tumors of childhood including clear cell sarcoma, rhabdoid tumors, mesoblastic nephromas, and renal cell carcinoma, sarcomas, and lymphomas. ⋯ Bladder and prostate rhabdomyosarcomas most frequently affect these organs and are discussed together. Finally, gonadal neoplasms with emphasis on germ cell tumors of these organs are presented. The multidisciplinary approach and importance of the pediatric surgical oncologist in the management of genitourinary tumors in childhood are emphasized.
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Unintentional injury is the leading cause of death for children less than 14 years of age. Optimal injury control includes prevention, acute care, and rehabilitation. When prevention efforts fail, a dedicated well-trained team must be prepared to resuscitate and treat the injured child. ⋯ The secondary survey completes the early resuscitation phase and consists of a systematic and complete physical examination. Resuscitation priorities specific to the multiply-injured child are also discussed. Finally, the importance of rehabilitation and prevention efforts are included.
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Thoracic injury is the second leading cause of death in pediatric trauma, second only to head injury in lethal potential. With the exception of lung contusion, serious injuries to vital thoracic structures are associated with mortality rates in excess of 50%. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Facility with management of thoracic injuries is therefore vital to optimal outcome in childhood trauma.
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Critical care of the injured child should be an effective extension of aggressive resuscitation, stabilization, and definitive care. In the hours and days after acute injury, initially unnoticed lesions may emerge, secondary organ dysfunction may develop, and complications of primary injury or initial management may occur. ⋯ We follow an organ system, problem oriented protocol, and attempt to anticipate problems before they occur. This article defines our approach in general terms, with specific emphasis on the more common problems encountered in caring for seriously injured children.