Journal of pediatric surgery
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Comparative Study
Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients.
The Canadian C-spine (cervical spine) Rule (CCR) and the National Emergency X-Radiography Utilization Low-Risk Criteria (NLC) are criteria designed to guide C-spine radiography in trauma patients. It is unclear how these 2 rules compare with young children. ⋯ Although CCR and NLC criteria may reduce the need for C-spine imaging in children 10 years and younger; they are not sensitive or specific enough to be used as currently designed.
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The purpose of the study was to assess the treatment strategies and outcome of right-sided congenital diaphragmatic hernia (R-CDH), particularly extracorporeal membrane oxygenation (ECMO). ⋯ Our data suggest that patients with R-CDH have high ECMO utilization and may experience greater relative benefit from ECMO as evidenced by their higher-than-expected overall survival. Extracorporeal membrane oxygenation may be found to have a distinctive role in managing R-CDH. More high-powered series are needed to elucidate differences between R-CDH and left-sided CDH that may dictate alternate forms of management.
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Patent ductus arteriosus (PDA) ligation is a potentially lifesaving procedure that is frequently performed in very low-birth-weight (VLBW) infants. Video-assisted thoracoscopic surgery (VATS) PDA ligation has many advantages; however, this approach has not been widely used in these extremely small patients. We present a technique using a novel retractor that allows safe VATS PDA ligation in the VLBW neonate. ⋯ The technique is minimally invasive and provides superior visualization of the PDA and surrounding anatomical landmarks. Using this novel retractor, VATS PDA ligation is practical in even the smallest infants. This retractor may facilitate the performance of more advanced thoracoscopic procedures in VLBW infants.
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The aim of the study was to compare the self-reported practice patterns of Canadian general surgeons (GSs) and pediatric general surgeons (PGSs) in treating blunt splenic injuries (BSIs) in children. ⋯ Differences exist between PGSs and GSs in the management of pediatric BSIs, resulting in higher operative rates, use of resources, and radiation exposure. Further education of GSs in NOM and establishment of management guidelines are indicated.
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Clinical Trial
Operative innovation to the "Nuss" procedure for pectus excavatum: operative and functional effects.
The "Nuss" procedure for repair of pectus excavatum is performed with increasing frequency worldwide. We describe a technique of performing relaxing or "kerf" incisions along the cartilaginous ribs at the point of maximal chest wall concavity to facilitate retrosternal dissection and to reduce chest wall tension. The effects on operative parameters and long-term changes in cardiopulmonary function and appearance were evaluated prospectively. ⋯ The addition of sternocostal relaxing incisions to the standard Nuss procedure appears to facilitate retrosternal dissection and bar placement, but no changes in long-term function or cosmesis were noted. The use of relaxing incisions appears to be safe and may facilitate operative visualization of retrosternal structures.