Journal of pediatric surgery
-
The objective of this study was to assess the mechanisms and patterns of injury and outcome in children with cervical (C) spine trauma. ⋯ These data, representing the largest series to date, confirm that blunt C-spine injuries in children are rare. Patterns of injury vary significantly according to child age. Major neurologic sequelae in survivors is uncommon, does not correlate well with cord level, and rarely is complete.
-
Randomized Controlled Trial Clinical Trial
Malignant mediastinal germ cell tumors: an intergroup study.
This review was conducted to determine clinical characteristics and response to therapy in this rare pediatric neoplasm. ⋯ Malignant MGCT is a complex tumor of varied histology with frequent coexistence of benign elements. Lesions often have incomplete regression with chemotherapy alone. Tumor resection may be undertaken at diagnosis or after attempted shrinkage with chemotherapy. Aggressive attempt at complete tumor resection should be offered to all patients even if bulky tumor persists after induction chemotherapy with expectation of a significant salvage rate. Boys > or =15 years may be a high-risk subgroup for mortality from tumor progression.
-
Adverse effects from narcotics complicate pain management in children. Ketorolac, a potent nonsteroidal antiinflammatory agent can be used as an adjuvant analgesic, yet concerns of bleeding and nephrotoxicity have limited routine use. The authors hypothesized that postoperative use of ketorolac in healthy pediatric surgical patients would limit narcotic requirements without increasing morbidity. ⋯ Ketorolac exhibits significant opiate-sparing effects in the immediate postoperative period without introducing additional morbidity to pediatric surgical procedures.
-
Children with closed head injuries diagnosed as concussion alone or concussion with brief loss of consciousness are admitted routinely for observation despite a normal central nervous system finding, negative computed tomography (CT) scan, and a Glasgow Coma Score (GCS) of 15. Recent studies have questioned the necessity of such an admission. The purpose of this study was to review a large pediatric database and study the length of stay as well as any required procedures or complications in these children. The hypothesis was that routine admission is unnecessary in this population. ⋯ These findings indicate that routine admission may not be necessary for children with isolated mild closed head injuries with a negative CT scan and a normal neurologic finding and allows for a prospective randomized trial to confirm this.
-
The aim of this study was to describe the characteristics, nature, severity and outcome of injuries from horse-related trauma in pediatric patients, aged of 19 years or younger. ⋯ Horse-related trauma is frequent in children and can cause severe injuries resulting in death and long-term disability. Awareness of the nature of injuries is important to avoid underestimation of their severity.