Journal of pediatric surgery
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Extrahepatic portal vein thrombosis (EPVT) in children can lead to severe bleeding from gastrointestinal varices, ascites, thrombocytopenia from hypersplenism, and other coagulation disorders. The authors have used the superior mesenteric vein to intrahepatic left portal vein (Rex) shunt in 5 children with symptomatic EPVT and report their results with this novel technique. ⋯ The Rex shunt has proven to be an effective method of resolving portal hypertension caused by EPVT including thrombosis after living donor transplantation. This shunt is preferable to other surgical procedures because it eliminates portal hypertension and its sequelae by restoring normal portal flow to the liver.
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Identifying major trauma patients in the prehospital setting is essential in determining management, destination, and best utilization of emergency department resources. Few methods of trauma triage have been accepted unanimously. This study prospectively evaluates the efficacy of comprehensive field triage using 12 criteria (simplified version of the American College of Surgeon's guidelines) in 1,285 pediatric trauma patients. ⋯ Physiological variables, anatomic site, and mechanism of injury provide a sensitive and safe system of triage. Continued education of prehospital personnel regarding pediatric trauma and stratification of the current triage tools are necessary to minimize overtriage in an era of shrinking resources.
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The aim of this article was to assess whether and to what extent pulmonary function recovered to normal degree postoperatively and to investigate the changes in pulmonary function after surgical correction and the value of surgical correction. ⋯ Preoperative symptoms obviously improved after operation. There was little airway obstruction in the patients postoperatively. The patients with pectus excavatum should be operated on as soon as possible.
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Review Case Reports
Intrahepatic fetus-in-fetu: a case report and review of the literature.
The authors report the third case since 1964 of fetus-in-fetu presenting at Red Cross Children's Hospital. A fetal liver abnormality was detected during routine antenatal ultrasound scan, and the postnatal diagnosis of an intrahepatic, multiple fetus-in-fetu was made with abdominal ultrasound scan, plain radiograph of the abdomen and computed tomography. The mass was removed surgically by hemihepatectomy when the patient was 4 months of age. ⋯ Two of the 3 nodules within the amniotic-lined cavity of the intrahepatic mass individually comply with the accepted criteria for fetus-in-fetu, and the third nodule has the accepted features of a benign teratoma. The existence of multiple fetus-in-fetu and fetus-in-fetu combined with a teratoma, is recorded in the medical literature. The imaging as well as the macroscopic and microscopic features are illustrated.
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Comparative Study
Clinical recognition and management of pediatric blunt abdominal trauma without ultrasound or computed tomography scan in community hospitals in Mexico.
The aim of this study was to characterize the evaluation and clinical course of children with blunt abdominal trauma in second-level hospitals. ⋯ Recognition of blunt abdominal trauma in children may be complicated by associated multisystem injury. Systematic evaluation minimizes missed diagnosis and facilitates rapid and effective treatment. The benefit of data acquired from a good ABCD assessment, PTS, GCS, clinical and radiological, and DPL evaluation, facilitates the decision to conduct a rapid laparotomy, and they help to predict the outcome of this kind of patient.