Journal of pediatric surgery
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Necrotizing fasciitis is a rapidly spreading soft tissue infection affecting the subcutaneous tissue and underlying fascial layers. Although this infection pattern is commonly seen in adults, it is rarely seen in the neonatal population. Herein, we describe a patient who developed extensive necrotizing fasciitis of the abdominal wall after intestinal resection for necrotizing enterocolitis (NEC).
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A 12-year-old girl was admitted after a bicycle accident, and a grade 4 splenic injury was diagnosed. She became hemodynamically unstable within the first hours after arrival and remained so despite fluid resuscitation and transfusions. ⋯ Nonoperative management of blunt splenic trauma remains the gold standard in pediatric trauma care. In hemodynamically unstable patients, splenic artery embolization should be considered as an adjunct to that strategy.
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Clinical Trial
Effects of surgical repair of congenital diaphragmatic hernia on cerebral hemodynamics evaluated by near-infrared spectroscopy.
Cardiorespiratory stabilization is recommended before surgical repair of congenital diaphragmatic hernia (CDH) because surgery may induce a transitory deterioration of chest compliance and gas exchange. It is not known if surgical intervention can affect cerebral circulation and oxygenation. ⋯ Notwithstanding the initial cardiorespiratory stabilization, surgical repair of CDH was associated with a rise in HR and oxygen requirement and a drop in cerebral tHb and O2Hb, suggesting a reduction in cerebral blood volume and oxygenation. These events were probably due to the combined effects of an increase in right to left shunting (as indicated by the increased oxygen requirement) and a decrease in venous return (possibly due to compression of the inferior vena cava by the viscera positioned into the abdomen). These preliminary results reinforce the importance of achieving a good cardiorespiratory stability before undertaking surgical correction of CDH to minimize the possible interference of the procedure with cerebral circulation and oxygenation.
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In young children, high cervical spine injuries (HCSI) can result in inaugural reversible, cardiac arrest or apnea. We noted in children sustaining such injuries an unusual incidence of associated brain stem injuries and defined a special pattern of combined lesions. ⋯ Combined HCSI and brain stem injuries must be suspected in young children sustaining a severe distracting injury to the craniocervical junction. Early recognition of these catastrophic injuries by systematic spiral cervical spine and brain stem computed tomographic scan evaluation is mandatory.
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The aim of this study was to determine if the presence of an appendicolith is associated with an increased risk for recurrent appendicitis after nonoperative treatment of pediatric ruptured appendix with inflammatory mass or abscess. ⋯ We conclude that the patients with appendicolith should have an interval appendectomy.