Journal of pediatric surgery
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Traumatic spinal injury (TSI) is an uncommon source of morbidity and mortality in children. The aim of this study was to describe childhood TSI in a single level 1 urban pediatric trauma center. ⋯ TSI in children requires a different preventive and therapeutic logarithm compared with that of adults. The potential devastating nature of TSI warrants that the health care team always maintains a high index of suspicion for injury. Future prospective studies are needed to further elucidate injury patterns.
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Review
The effect of common origin of the carotid arteries in neurologic outcome after neonatal ECMO.
Common origin of the carotid arteries (COCA) is a normal anatomic variant reported to occur in approximately 11% of the general population. The objective of this study was to determine whether this variant places venoarterial extracorporeal membrane oxygenation (ECMO) patients at a higher risk for adverse neurologic sequelae owing to potential occlusion of both carotid arteries by the arterial cannula. ⋯ This study confirms that COCA is a common aortic arch variant (15%, n = 20 of 131) and that this variant does not appear to increase the risk of neurologic injury in infants undergoing venoarterial ECMO.
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Comparative Study
Which children could benefit from additional diagnostic tools in case of suspected appendicitis?
New diagnostic tools such as ultrasound scan, computed tomography (CT) scan, and diagnostic laparoscopy, have become available for children with suspected appendicitis but should be reserved for equivocal cases. The aim of this study was to develop a scoring system to identify this subgroup of children. ⋯ Children can be observed if leukocyte count is less than 10.10(9)/L and rebound tenderness is absent; a diagnostic laparoscopy should be performed if one of these is present, and if both are present one could perform an appendectomy.
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Giant omphalocele is associated with a high degree of visceroabdominal disproportion, which prohibits safe primary closure. Conventional treatment options include (1) topical therapy with epithelialization followed by secondary ventral hernia repair and (2) staged reduction using a SILASTIC(R) (Dow Corning, Midland, MI) chimney. The authors report a case in which staged reduction of a giant omphalocele was facilitated by the use of crescent-shaped tissue expanders positioned in the potential space between the internal oblique and transversus abdominis layers of the abdominal wall.
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It is frequently overlooked that child abuse may result in significant intraabdominal injury, particularly to the duodenum. The authors hypothesized that a significant number of duodenal injuries in young children would be the result of nonaccidental trauma. ⋯ Injury to the duodenum is unusual in the pediatric trauma patient but does result in significant injury severity and prolonged hospitalization. In the young child, one must maintain a high index of suspicion regarding the etiology of the injury, because a large percentage is potentially the result of child abuse.