Journal of pediatric surgery
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Expeditious care within minutes of severe injury improves outcome and is the driving force for development of trauma care systems. Transition from hospital care to rehabilitation is an important step in recovery after trauma-related injury. We hypothesize that delay in the transition from acute care to rehabilitation adversely affects outcome and diminishes recovery after traumatic brain injury (TBI). ⋯ These data demonstrate the price of delay of comprehensive rehabilitation, especially for the most vulnerable TBI children with best potential for salvage. The "golden hour," which has become the mantra for continued refinement of systems of emergency and trauma care, must progress without interruption to the "golden day," during which comprehensive critical care seamlessly transitions to timely and aggressive rehabilitation to effect the greatest functional recovery.
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Intestinal glutathione (GSH) levels are dramatically decreased after intestinal ischaemia and reperfusion (I/R) injury. Hypothermia has protective effects during I/R injury. The aim of this study was to determine the effects of intestinal I/R and hypothermia on GSH synthesis in erythrocytes and ileum. ⋯ Intestinal I/R leads to decreased ileal GSH synthesis, which could contribute to GSH depletion. Hypothermia preserves GSH synthesis during intestinal I/R injury, and this could protect from further tissue damage. We speculate that reactive species released during I/R injury impair the enzymes of GSH synthesis, whereas these enzymes are protected by moderate hypothermia.
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Typhlitis is clinically defined by the triad of neutropenia, abdominal pain, and fever. Radiologic evidence of colonic inflammation supports the diagnosis. We report a single United Kingdom tertiary center experience with management and outcome of typhlitis for 5 years. ⋯ The diagnosis of typhlitis was based on clinical features, supported by radiologic evidence in almost half of the study group. Surgical intervention should be reserved for specific complications or where another surgical pathologic condition cannot reasonably be ruled out.