Journal of pediatric surgery
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Comparative Study
Hemodynamic effects of positive end-expiratory pressure during partial liquid ventilation in newborn lambs.
The aim of this study was to compare the effect of positive end-expiratory pressure (PEEP) application on hemodynamics, lung mechanics, and oxygenation in the intact newborn lung during conventional ventilation (CV) and partial liquid ventilation (PLV) at functional residual capacity (FRC). CV or PLV modes of ventilation do not affect hemodynamics nor the optimum PEEP for oxygenation. ⋯ Hemodynamically, CO is impaired at a PEEP above 12 cm H(2)O in intact lungs. PFC at FRC does provide an advantage in lung mechanics more than 10 to 12 cm H(2)O of PEEP by decreasing the amount PIP needed to achieve the similar levels of gas exchange and minute ventilation, implying a reduced risk for barotrauma with chronic ventilation. Thus, selection of the appropriate level of PEEP appears to be important if PLV is to be utilized at FRC. The best strategy for PLV, including the selection of PEEP, remains to be determined.
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Comparative Study
Three quantitative approaches to the diagnosis of abdominal pain in children: practical applications of decision theory.
The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints. ⋯ Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer.
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This case describes a 3-month-old infant who swallowed multiple straight sewing needles that were removed at laparotomy. A motherhood psychiatric disorder was suspected.
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Comparative Study
Minimal pelvic fluid in blunt abdominal trauma in children: the significance of this sonographic finding.
The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid after blunt abdominal trauma in children as a predictor of an abdominal organ injury. ⋯ A normal ultrasound examination or the presence of pelvic fluid are associated with a low probability of an organ injury. In the presence of peritoneal fluid outside the pelvis, the probability of an organ injury is very high.
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Acetylcholinesterase (AChE) staining of rectal mucosal biopsy specimens is the most important and popular examination for making a definite diagnosis of Hirschsprung's disease. This examination often is performed for patients with constipation in the daily clinic. The results of this examination are reflected immediately in the treatment. However, the authors sometimes encountered difficult cases to diagnose, especially in neonates. Therefore, a retrospective investigation was conducted on the benefits and problems of AChE staining of rectal mucosal biopsy specimens in neonates. ⋯ The specificity of AChE staining was high (100%), but its sensitivity was slightly low (91%). Careful long-term follow-up is required for any cases diagnosed as normal. Mucosal biopsies should be repeated in cases of persistent clinical symptoms.