Journal of pediatric surgery
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Modern techniques available for the relief of pain following major surgical procedures or trauma in childhood receive scant attention in pediatric surgical textbooks. A range of options for pain relief have been offered to children in our hospital, which include: regional analgesia; appropriate use of intermittent intramuscular narcotic injections; and variable-rate intravenous narcotic infusions. Since 1982 regional analgesia has been used in more than 2,000 patients following operations on the penis and in the inguinoscrotal region. ⋯ Assessment of effective pain relief has been made on the basis of observation and comment by parents and patients and by medical and nursing staff. The steady increase in demand for the use of this technique is an index of its value. It is concluded that there is a real need to improve pain relief for children by better education of medical and nursing staff and inclusion of this important subject in pediatric surgical text books.
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With improved rapid transportation systems, an increasing number of children may arrive at the emergency room (ER) without detectable vital signs and may undergo vigorous resuscitation, including emergency room thoracotomy, aortic cross clamping, and open cardiac massage. Of 1,287 pediatric trauma admissions between 1980 and 1985, 101 deaths were recorded. Fifty (50%) of the deaths occurred in the ER. ⋯ Despite maximal conventional resuscitation and ER thoracotomy, none of the 17 patients survived. In this group of pediatric blunt trauma victims who appear initially salvageable, and present in the ER with no detectable vital signs, ER resuscitative thoracotomy did not influence survival. ER thoracotomy in children, therefore, should be reserved for patients presenting with penetrating thoracic injuries or blunt injuries associated with detectable vital signs and deterioration despite maximal conventional therapy.
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Scrotal involvement occurs in between 2% and 38% of patients with Henoch-Schönlein purpura. We report on a child in whom acute scrotal swelling was the initial presentation of this syndrome. In only four previous cases have the initial symptoms of Henoch-Schönlein purpura been suggestive of testicular torsion.
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It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusceptions were caused by lead points but which were reduced by hydrostatic barium enema. ⋯ However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.