Journal of pediatric surgery
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Comparative Study Clinical Trial Controlled Clinical Trial
Prospective evaluation of nonsurgical versus surgical management of appendiceal mass.
Prospective evaluation was undertaken of surgical findings, complications, morbidity, and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass. ⋯ Early surgical intervention was beneficial over nonoperative management in this cohort of patients. Interval appendectomy is recommended after nonsurgical management of an appendicular mass.
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Case Reports
Recurrent intrathecal baclofen pump catheter leakage: A surgical observation with recommendations.
Intrathecal baclofen pump catheter complications are the most common cause for failure in drug delivery. A 4-year-old boy presented with repeated signs of baclofen tolerance despite progressive increases in dosing. External computerized interrogation of the pump and radiograph evaluation of the pump-catheter-intrathecal sac system were normal. ⋯ The catheter cut was in the least flexible portion, the pump-catheter neck, which was found to be overlying the iliac crest in both surgeries. The authors hypothesize that the repetitive compressive forces of the catheter overlying the iliac crest led to catheter breakdown. Surgical placement of the pump-catheter neck should be superio-medial to reduce the likelihood of either internal or external compressive forces.
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Various factors can influence the metabolism of surgical neonates. These include prematurity, operative stress, critical illness, and sepsis. The nutritional management of surgical infants with congenital or acquired intestinal abnormalities has improved after the introduction of parenteral nutrition. ⋯ Nutritional support in surgical neonates has a profound impact on outcome. Exogenous glutamine can modulate immune, metabolic, and inflammatory responses. Further investigations are needed to clarify the clinical benefit of parenteral or enteral glutamine administration in surgical neonates.
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Comparative Study Clinical Trial
Neonates with congenital diaphragmatic hernia have smaller neck veins than other neonates-An alternative route for ECMO cannulation.
The aim of this study was to compare the size of the right internal jugular vein between neonates with congenital diaphragmatic hernia (CDH) who need extracorporeal membrane oxygenation (ECMO) and non-CDH neonates. The purpose also was to describe a method for cannulation of the right brachiocephalic vein if the internal jugular vein was too small for ECMO cannulation. ⋯ Severely affected neonates with CDH have significantly smaller right internal jugular veins than other neonates. If the patient needs ECMO and if the internal jugular vein is too small for cannulation, the right brachiocephalic vein can be successfully cannulated from the neck instead.
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Postnatal cystic adenomatoid malformations (CAMs) are managed by surgical excision. Asymptomatic CAMs have decreased in size with initial observation. This is the first reported case of complete resolution of a postnatal CAM. Premature infants with asymptomatic CAMs may benefit from careful observation as their initial treatment.