Journal of pediatric surgery
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The purpose of this study was to determine the outcome of "minor resuscitation" trauma patients managed without the immediate presence of a surgeon. ⋯ Pediatric emergency medicine physicians discharged more patients than the surgeons, but also upgraded more to level 1 status. Level 2 trauma patients can be safely managed without immediate surgeon presence.
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Rectal seed bezoars in children seem to present an uncommon problem that necessitates some operative intervention. ⋯ Fecal impaction owing to rectal seed bezoars is more common than previously believed. Its occurrence among Arab children alone in this study might indicate a high proportion of fecal seed bezoars throughout the Middle East. We propose that the preferred treatment should include disimpaction and irrigation of the rectal content under anesthesia. Greater awareness by primary care practitioners and parents might be beneficial in its prevention in the future.
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Nonoperative management (NOM) of blunt splenic trauma is the standard of care in hemodynamically stable children. The long-term risk of this strategy remains unknown. The object of this study was to investigate the incidence of long-term complications after NOM of pediatric splenic injury. ⋯ The incidence of long-term complications after NOM of pediatric splenic injury was 1 (0.44%) in 228 patients. Nonoperative management of pediatric blunt splenic trauma in children is associated with a minimal risk of long-term complications.
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We set out to examine whether pediatric trauma care resulted in a financial burden. ⋯ Pediatric trauma care is a profitable enterprise. Inadequate reimbursement remains for Medicaid and self-pay patients, which could result in financial losses should this proportion of the patient mix be more than 55%.
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Peritoneal sepsis is a significant cause of mortality in infants with necrotizing enterocolitis, caused in part by impaired bacterial clearance. Recent studies have identified toll-like receptor-4 (TLR4) as a receptor for endotoxin (lipopolysaccharide [LPS]). We hypothesized that TLR4 regulates bacterial clearance from the peritoneal cavity and sought to investigate whether macrophage phagocytosis was involved. ⋯ We conclude that TLR4 plays a critical role in the response to intraperitoneal E. coli through effects on phagocytosis by macrophages, suggesting the possibility of using TLR4 as a therapeutic target in diseases of peritoneal sepsis.