Journal of pediatric surgery
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Clinical Trial
Continuous noninvasive monitoring of cardiac performance and tissue perfusion in pediatric trauma patients.
The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. ⋯ Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.
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Clinical Trial
The antegrade continence enema successfully treats idiopathic slow-transit constipation.
Antegrade continence enemas (ACEs) are successful for constipation and/or fecal incontinence caused by anorectal malformations or spina bifida but have been thought to be less successful in the treatment for patients with colonic dysmotility. We studied the long-term efficacy of ACE in a large group of patients with idiopathic slow-transit constipation (STC). ⋯ Antegrade continence enemas were successful in 34 (81%) of 42 children with STC, contradicting views that ACEs are less effective in patients with colonic dysmotility.
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Since 1998, the use of advanced radiographic imaging with computed tomography (CT) and/or diagnostic ultrasound (US) has increased dramatically for the diagnosis of acute appendicitis in children. This study investigates the impact of this imaging on the evaluation, management, and outcome of pediatric patients who underwent appendectomy for suspected appendicitis. ⋯ More than half of pediatric patients with suspected appendicitis now undergo advanced imaging and experience a significant delay in surgical treatment with a 26% increase in hospital charges and no clear-cut improvement in diagnostic accuracy nor outcome, when compared with evaluation by the treating surgeons.
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The current treatment of splenic injury in children is conservative. The common concern with nonoperative management of splenic injury involves increased risk of posttraumatic splenic complications. ⋯ The treatment of splenic AVF is indicated to avoid portal hypertension, high output cardiac failure, and related complications. To preserve the splenic immune function and to avoid the risk of surgery and splenectomy complications, splenic pseudoaneurysm and AVF were successfully occluded by transcatheter embolization.
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Small children are vulnerable to serious accidents when a motor vehicle is placed in motion in a driveway. We describe a series of such accidents, consider the predisposing factors, and analyze the outcomes. ⋯ Driveway injuries are an underrecognized often severe form of auto-pedestrian accidents. To prevent these family tragedies, drivers of large vehicles with children younger than 12 years old should be extremely attentive and account for children outside the vehicle before moving.