Journal of pediatric surgery
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Review Case Reports
A unique case of a giant congenital pulmonary hemangioma in a newborn.
Congenital pulmonary hemangiomas are extremely rare lesions. We present a unique case of a giant congenital pulmonary hemangioma in an otherwise healthy newborn who presented with respiratory distress at birth. This was managed with resection after an unsuccessful trial of nonoperative management. The clinical, radiographic, and pathologic features of this unique case are discussed in the context of a review of the literature.
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Review Case Reports
Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature.
Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency. We describe a case of an 11-year-old girl who presented with a 4-day history of abdominal pain, nonproductive retching, cough, and shortness of breath. A chest radiograph revealed a large air-fluid level in left hemithorax and the presence of intestinal loops with marked mediastinal deviation. ⋯ Two weeks later, the wound was definitively closed; she recovered uneventfully and was discharged home 3 days later. To our knowledge, only 26 previous cases of acute gastric volvulus complicating a congenital diaphragmatic hernia in children have been reported in the literature. Our patient represents the 27th case and the first combined type acute gastric volvulus case.
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Despite the dramatic improvement in the outcome of somatically handicapped neonates, vexing ethical issues remain. In which fetuses would termination be indicated? In which neonates are the malformations so serious that surgery and intensive care should not be initiated (withholding or not starting treatment)? Conversely, in which neonates should the initiated treatment be stopped (withdrawal of treatment)? These questions pose huge medical, legal, ethical, moral, and financial problems for doctors, lawyers, ethicists, and families. ⋯ The decision making should be tailored to each of these groups. The pediatric surgeon, besides taking into consideration the quantity and quality of the rescued life, should lower the anxiety of the parents, should follow the morals of a civilized society, should act according to the law, and finally, should convince himself to be a solution to a problem and not to be a cause of any.
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The timing and need of resection of asymptomatic congenital lung lesions are controversial. The morbidity of such surgery needs to be considered in the decision analysis. We analyzed the contemporary outcome of infants and neonates undergoing lung resection. ⋯ Lung resection is safe and well tolerated in infancy. Surgery should be scheduled before the development of symptoms but likely after 3 months of age to improve the chances of postoperative extubation. The use of regional anesthesia may facilitate this.
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Comparative Study
Gastric electrical stimulation for children with intractable nausea and gastroparesis.
Gastric electrical stimulation (GES) has been performed in adults as a treatment of refractory nausea and vomiting in patients who have failed medical treatment, but has not been used in children. ⋯ Gastric electrical stimulation can be successfully applied to adolescents with intractable nausea and gastroparesis symptoms who fail medical therapy. There is a significant improvement in symptoms over a prolonged period, and there are no adverse effects of the GES. Long-term efficacy of this therapy in children needs to be established.