Journal of pediatric surgery
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Case Reports
The use of extracorporeal life support in pediatric burn patients with respiratory failure.
Respiratory failure is the most common cause of death after thermal injury and may be caused by inhalation injury, acute respiratory distress syndrome (ARDS) or pneumonia. ARDS is usually associated with sepsis; however, it may also occur during burn shock, especially in patients that have a delayed or inadequate fluid resuscitation. During the past 24 months, five pediatric burn patients underwent extracorporeal life support (ECLS) for respiratory failure unresponsive to optimal medical management. ⋯ The patients who expired developed significant hemodynamic instability, coagulopathy, and hemorrhage from their burn wounds. The extent and degree of burn injury did not seem to alter the outcome. Indications for considering ECLS in the pediatric burn patient are unmanageable, life threatening pulmonary insufficiency in patients that undergo a relative short course of pre-ECLS ventilator support.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acute respiratory failure (ARF) secondary to congenital diaphragmatic hernia (CDH), unresponsive to maximal medical management, has traditionally been treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Venovenous (VV) ECMO offers several benefits over VA ECMO including preserved pulmonary blood flow, preservation of the carotid artery, and pulsatile flow. However, use of the VV modality has not been widespread because of concerns of the cardiac instability during bypass, and because only one double-lumen (DL) catheter size is available in the United States. ⋯ Overall survival for this series was 64%: 66% in the VV group and 60% in the VA group. Two patients in the VV group were found to have congenital heart disease incompatible with life, were withdrawn from therapy and allowed to die, and are listed as treatment failures. The authors conclude that CDH patients receive adequate oxygenation and show hemodynamic stability on VV ECMO.(ABSTRACT TRUNCATED AT 250 WORDS)
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After 20 years of experience with the "open" transaxillary approach, the authors are presently performing the thoracoscopic technique for upper thoracic sympathectomy in severe primary hyperhidrosis. During a period of 14 months, 23 operations were performed and 22 patients had immediate and permanent relief of palmar sweating. ⋯ Hospitalization was short, and all patients returned to school and full activity 3 to 5 days after operation. These initial results compare favorably to the "open" method and, pending further experience, are actually better in terms of less pain, early discharge, quicker return to normal activity, and a smaller, less conspicuous scar.
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To define patterns of care and outcome for pediatric appendectomy. ⋯ This large series, from a large number of hospitals, with multiple practitioners, can serve as a community standard for pediatric appendectomy in the 1990s.
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Multicenter Study Comparative Study
Management of pediatric blunt splenic injury: comparison of pediatric and adult trauma surgeons.
The majority of injured children requiring hospitalization in the United States are cared for by nonpediatric surgeons. To determine whether there are differences in the management strategies (frequency of operative intervention) of pediatric and nonpediatric surgeons caring for children with blunt splenic injury, the data for children with this injury from the entire state of Vermont and the National Pediatric Trauma Registry were compared. From January 1, 1985 through December 31, 1991, 817 children (aged < 19 years) were entered into the study. ⋯ The management of children with splenic injury must take into consideration the long-term morbidity associated with splenectomy as well as the acute operative morbidity. Today, adult trauma surgeons appear to manage children with blunt splenic injury with practice standards more appropriate for adult patients. Outcome analysis must include methods of care and their long- and short-term consequences to be considered valid.