Journal of pediatric surgery
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The aim of this study is to review the current evidence-based data regarding strategies for prevention of central venous catheter (CVC) infections at the time of catheter insertion and as a part of routine care. ⋯ Grade A and B recommendations can be made based on available evidence in adult and limited pediatric studies for multiple components of proper CVC insertion practices and subsequent management. These strategies can minimize the risk of CVC infections in pediatric patients.
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Comparative Study Clinical Trial
A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children.
Soft tissue infections are increasingly being seen for surgical management, which is associated with painful dressing changes, lost days at school, time away from family, and scarring, which can have a great impact on both child and caretaker. We postulated that a drainage technique using a modified Pezzar catheter would be associated with shorter hospital stays and less wound care. ⋯ We conclude that catheter drainage of soft tissue abscesses in children is safe and effective. Catheter drainage is associated with a decreased hospital stay. Other factors related to shorter hospital stays include age of the patient and the site of soft tissue abscess.
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The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children. ⋯ Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting.
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Previous studies of recombinant human thrombin (rThrombin) enrolled adult and adolescent patients. This phase 4, open-label, single-group study was conducted in pediatric patients undergoing synchronous burn wound excision and skin grafting to provide information regarding the safety and immunogenicity of rThrombin (primary and secondary endpoints) in this population. ⋯ In pediatric patients undergoing burn wound excision and skin grafting, rThrombin was well tolerated and did not lead to the formation of anti-rThrombin product antibodies.
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Primary splenic flexure volvulus is a rare entity. We describe the first case of splenic flexure volvulus managed by a laparoscopic approach. A previously healthy 32-month-old girl presented with constipation, appetite loss, and nonbilious vomiting of 15 days of duration. ⋯ After detorsion of the volvulus, the splenic flexure and descending colon were fixed to the peritoneum. The postoperative course was uneventful, and there was no recurrence during the subsequent 16 months of follow-up. Laparoscopic colopexy is a minimally invasive and effective method of managing splenic flexure volvulus, especially in patients without an underlying disease that causes constipation.