Journal of pediatric surgery
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A 2-year retrospective review of 238 cases of acute scrotal pain encountered in a children's hospital emergency department is presented. The incidences of testicular torsion, torsion of a testicular appendage, and epididymitis were 16%, 46%, and 35%, respectively. Testicular salvage was critically dependent on the interval between onset of pain and surgical intervention. ⋯ With the exception of cases of far-advanced necrotic testes, both color Doppler ultrasound and radioisotope imaging were highly specific diagnostic modalities. Thirty-nine percent of the children with epididymitis who underwent investigation were found to have either structural or functional urinary tract abnormalities. Noninvasive urodynamic studies appear to be useful screening modalities in older children with epididymitis.
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Extracorporeal membrane oxygenation (ECMO) has become an established therapy for acute neonatal and pediatric respiratory failure. On an institutional level, once an ECMO program is well established, ECMO can be viewed as a logical extension of critical care for multisystem organ failure. The question left unanswered is "Should anyone die without being offered ECMO?" The authors reviewed a 10-year clinical experience with ECMO and its application as salvage therapy in pediatric surgical emergencies. ⋯ All survivors were neurologically intact at the time of discharge. The success of ECMO, coupled with improvements in technique, apparatus, and expertise, has allowed application of ECMO as an invasive extension of intensive care to diverse patient groups. These results have encouraged the authors to expand their indications and to push the "envelope" in offering ECMO to critically ill infants and children with life-threatening organ failure.
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Marine envenomations are the statistical price that humankind pays for intruding into the aquatic domain. Individual risk can be reduced by knowledge and prudence. If envenomations do occur, lives can be saved, complications prevented, and convalescence facilitated by knowledge of and interest in these fascinating creatures of the sea.
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Cardiopulmonary resuscitation (CPR) occasionally is necessary in the operating-room setting. In such instances, it may be difficult to perform CPR if the patient is in the prone position. ⋯ Successful CPR was performed with the patient in the prone position, with the use of "reversed precordial compressions," and the patient was resuscitated despite 7 minutes of asystole. Effective cardiac output was maintained and was confirmed by systolic blood pressure readings of 80 to 90 mm Hg on both the arterial catheter waveform and the noninvasive blood pressure cuff, by a waveform and the reading on the pulse oximeter, and by the presence of end-tidal carbon dioxide.
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Tracheobronchial tree injuries occur in a small number of patients after blunt chest trauma, and their occurrence is even more uncommon in the pediatric trauma population. The authors present the case of a 2-year-old boy who presented with rupture of the trachea and disruption of the right upper lobe bronchus and bronchus intermedius.