Journal of pediatric surgery
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During a recent prospective nonrandomized comparison of noninvasive imaging techniques in 100 children with suspected major blunt abdominal injury, an interesting subset of patients was defined. Of 95 hemodynamically stable patients, 44 were found to have immediate elevation of hepatic enzymes (SGOT, SGPT greater than 30 IU). Nineteen of these children (43%) were subsequently shown to have significant liver injuries. ⋯ Our study has allowed definition of a group of children who are at significant risk for liver injury based on immediately available serum determinations of GOT and GPT. We have begun to use this information in our institution to select children for further noninvasive imaging. We recommend that these studies be obtained emergently in all children with suspected upper abdominal trauma.
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Preterm labor and late gestation fetal loss remain significant barriers to clinical fetal surgery. To investigate the response of the gravid uterus to anesthetic and tocolytic agents and surgical procedures, 27 chair-restrained pregnant rhesus monkeys from 123 to 152 days gestation (term 168 days) underwent implantation of electrodes to monitor uterine electromyographic (EMG) activity. Seven had electrodes placed at the time of hysterotomy for placement of intraamniotic pressure catheters, without disturbing the fetus; 12 at the time of hysterotomy for placement of fetal carotid and jugular catheters. ⋯ The difference between those undergoing minimal uterine manipulation and those undergoing hysterotomy (with and without fetal surgery; fetal loss in 14 of 28, 50%) is statistically significant (P = 0.01). In animals undergoing hysterotomy, frequent coordinated contractions (type I EMG pattern) emerged as the animal awoke. The uterine activity was inhibited by halothane anesthesia, but not by either preoperative indomethacin or postoperative ritodrine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)