Journal of pediatric surgery
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Implantable vascular access devices (ports) are well accepted in the management of many pediatric conditions. Modifications have improved port function, patient satisfaction, and enhanced compatibility with imaging studies. We reviewed our experience with a port system and identified unique mechanical complications. ⋯ This study identifies that (1) mechanical port complications (5.1%) are not rare for this device; (2) regardless of port age, the thin plastic base may result in a risk of perforation not seen in other devices; (3) the extended period before embolization likely indicates device wear rather than faulty assembly; and (4) complications could be successfully managed including retrieval of embolized catheters.
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Management of bile leaks after blunt abdominal trauma remains controversial. Conventionally, open surgery has been considered necessary, but new modalities of treatment, including endoscopic biliary stenting and laparoscopy, offer a minimally invasive alternative. ⋯ A minimally invasive, multidisciplinary approach to traumatic bile leaks, as an alternative to open surgery, is practical and safe. It requires flexibility, particularly if the diagnosis has been delayed, and may still involve a prolonged hospital stay.
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Case Reports
Kaposiform hemangioendothelioma of the mediastinum in a 7-month-old boy: a case report.
Kaposiform hemangioendothelioma is an aggressive vascular proliferation that has been recognized as a separate entity from other childhood vascular tumors. The authors present an unusual case of hemangioendothelioma arising in the mediastinum of a 7-month-old male infant with acute respiratory distress and Kasabach-Merritt syndrome. This patient with life-threatening lesion showed a dramatic response to interferon alfa-2a. This case had many histologic and clinical features consistent with kaposiform hemangioendothelioma.
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Comparative Study
Video-assisted thoracoscopic versus open surgery for persistent ductus arteriosus.
The aim of this study is to compare the experience with video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus (PDA) since 1995 with the results of conventional open surgery from the preceding 10 years. ⋯ VATS PDA ligation gave results equal to traditional open surgery with a shorter operative time, faster recovery, and shorter hospital stay. More complications, especially recurrent laryngeal nerve injuries, occurred in the VATS group.
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Portosystemic shunt operations are indicated in patients with extrahepatic portal hypertension owing to portal vein thrombosis (EPH-PVT) suffering from recurrent variceal bleeding despite endoscopic sclerotherapy. Mesenterico left portal bypass procedure (MLPB) is an alternative procedure to the portosystemic shunt operations in patients with EPH-PVT. MLPB operation reestablishes hepatopetal portal blood flow. We herein present our experience with MLPB in children with EPH-PVT. ⋯ Based on a review of the literature, the MLPB functions well in patients with portal hypertension caused by portal vein thrombosis and appears to have a physiologic advance over shunts that decompress but do not return blood directly to the liver. Because intra-abdominal veins appear to function well as a conduit in this operation, it may be favored by eliminating additional incision and increased risk in such patients.