Journal of pediatric surgery
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Comparative Study
Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?
Gastrostomy tube insertion is frequently performed in children. Percutaneous endoscopic gastrostomy (PEG) insertion, considered by many to be the "gold standard," is unavoidably associated with a risk of intestinal perforation and frequently requires a second anesthetic for its replacement with a low-profile "button." We hypothesized that a laparoscopic technique with low-pressure insufflation would yield comparable outcomes, a lower procedural complication rate, and require fewer anesthetics per patient. ⋯ Laparoscopic gastrostomy tube insertion is safe and easy to perform, with outcomes comparable to that of PEG tube insertion. It obviates the need for a second procedural anesthetic and may emerge as the gold standard for gastrostomy tube placement.
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The authors had noted a number of children who had sustained burn injuries from the exhaust systems of recreational vehicles and wished to document the incidence of pediatric burn injury sustained from the exhaust systems of a wide scope of motorized vehicles. ⋯ Pediatric health care providers should be aware that exhaust system contact burns in children are not rare events and they do tend to be significant. Surgical consultation should be requested early in the management of these particular burn injuries in children.
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Aspiration of Timothy grass in the airway is a well-recognized cause of bronchiectasis, and management often requires pulmonary resection. The authors describe 2 cases of Timothy grass aspiration with established pulmonary infection that were successfully managed by bronchoscopic removal with subsequent improvement. Every effort should be made to accomplish this goal, and pulmonary resection should be considered a last resort in these cases.
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Lipoma is a rare benign neoplasm of mature fat cells. Asymptomatic abdominal mass, progressive abdominal distension, and intraperitoneal radiolucent fat density mass on computed tomography are the main clinical symptoms and signs. An unusual case is presented in this report. A complete excision was performed on an 11-month-old boy with a giant omental lipoma, and no recurrence was found in the 12-month follow-up.
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This report describes the authors' experience using a vacuum to pull the abnormal chest wall outward in patients with pectus excavatum. ⋯ This vacuum method holds promise as a valuable adjunct treatment in both surgical and nonsurgical correction of pectus excavatum.