Journal of pediatric surgery
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Case Reports
Treatment of giant omphalocele by enlargement of the abdominal cavity with a tissue expander.
Even in the absence of major associated anomalies, treatment of giant omphaloceles is difficult primarily because of the disproportion between the large volume of the omphalocele and the small volume of the intraabdominal cavity. The case of a child is presented in whom conservative treatment had to be abandoned. Reduction of the omphalocele contents and closure of the defect was successfully accomplished after a 19-day period of enlargement of the abdominal cavity by means of an intra-abdominally placed tissue expander.
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We evaluated why and how life support was withheld or withdrawn in surgical neonates. During the study period, January 1988 through December 1991, 529 neonates were admitted, 52 of whom died (10%). Twenty-eight deaths were due to the underlying disease. ⋯ We conclude that life-sustaining care is withheld or withdrawn relatively frequently from patients at our ICU. Such decisions are ethical ones, taken in the light of professional and technical expertise. Evaluation of withholding or withdrawal of treatment is difficult but necessary to evolve appropriate decision-making procedures and to formulate humane standards of intensive care.(ABSTRACT TRUNCATED AT 250 WORDS)