Journal of pediatric surgery
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Case Reports
Duodenal perforation because of swallowed ballpoint pen and its laparoscopic management: report of a case.
Accidental ingestion of foreign objects by teenagers or young adults without mental impairment is a rare event. We present a case of a patient who unintentionally swallowed a ballpoint pen several days before seeking medical attention. ⋯ At times, they need to be removed operatively. This report describes the laparoscopic removal of a ballpoint pen that perforated the duodenum.
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The aim of this study is to describe geographic proximity to and quantify relative supply of 7 pediatric surgical specialties in the United States. ⋯ Although the practice locations of pediatric surgical subspecialties parallel the geographic distribution of children in the United States, large percentages of the younger than 18 years population must travel long distance to receive care from these providers. Large coefficients of variation reveal substantial maldistribution. These findings lay the groundwork for workforce assessments of the pediatric surgical subspecialties and underscore the need for future studies that assess access barriers for children in need of surgical care.
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Tracheobronchial injuries are uncommon after pediatric blunt trauma. Because they are easily missed and potentially life-threatening, surgeons caring for pediatric patients with trauma should be aware of this spectrum of injuries. ⋯ This injury was diagnosed in a timely fashion with computed tomography scan, and operative repair was accomplished. A discussion of the management of tracheobronchial injury with brief literature review follows.
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Glutamine may have benefits during neonatal sepsis, but its effects on systemic inflammation are unknown. Our aim was to determine whether glutamine affects inflammation in neonatal endotoxemia. Eleven-day rat pups were given intraperitoneal injections of saline (control; C), endotoxin (300 microg/g Escherichia coli lipopolysaccharide) (E), saline with glutamine (2 mmol/g; G), or endotoxin with glutamine (EG). ⋯ The effect of glutamine was more pronounced at 6 hours (C, 32 +/- 27; E, 799 +/- 193; EG, 219 +/- 75, C vs E mean difference, 767; 95% CI, 346-1188; P < .001; E vs EG mean difference, 580; 95% CI, 159-1001; P < .01). The IL-10 levels were also greatly increased by 2-hour endotoxemia (C = 55 +/- 21, E = 2429 +/- 58, EG = 1989 +/- 177; C vs E mean difference, 2374; 95% CI, 2740-2008; P < .001; E vs EG mean difference, 440; 95% CI, 74-807; P < .05). Glutamine administration partially prevents the sepsis-induced fall in plasma glutamine levels and reduces the concentration of both proinflammatory and antiinflammatory cytokines.