Journal of pediatric surgery
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Multicenter Study Comparative Study
Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes.
Nonoperative management (NOM) is an accepted treatment of pediatric solid organ injuries and is typically successful. Blunt pancreatic trauma tends to require operative intervention more frequently. We sought to identify predictors of failure of NOM and compare the outcome of operative management against NOM. ⋯ Patients with pancreatic injuries had a NOM failure rate of 26.0%. ISS and injury grades III to V were predictors of NOM failure. Patients with pancreatic ductal injury require more aggressive management.
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Despite much clinical experience, there are few published accounts of the surgical manifestations of HIV/AIDS in children and still fewer guidelines for the best or most appropriate treatment. Our primary objective was to document the incidence of HIV infection in children who presented with a surgical emergency to a major pediatric surgical unit in South Africa. If possible, we aimed to provide a description of the impact of the disease in a surgical pediatric population and to raise awareness of the mode of presentation of HIV to the pediatric surgeon in a developing nation, now that specific antiretroviral therapies are available. ⋯ It is likely that the incidence of HIV/AIDS infection is higher than the 4% identified in our study group. The surgical manifestations in these HIV-positive children are dominated by sepsis, often severe in nature and with opportunistic pathogens. Despite increased knowledge about the disease and widening therapeutic opportunities, our results suggest that many children with HIV infection are not being recognized, despite entry into the healthcare system. Prompt recognition and surgical management of the complications of pediatric HIV infection can sometimes result in a good outcome. Further studies are therefore required to define the true incidence of HIV/AIDS infection in children presenting as a surgical emergency case. These patients may benefit from early antiretroviral therapy. Surgeons are well placed to identify children who are HIV positive and should do more to ensure HIV testing and enrollment into antiretroviral treatment programs.