Journal of pediatric surgery
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Three infants presented with acute scrotal swelling, erythema, and a tender irreducible firm mass within the scrotum. All patients were operated upon with the preoperative diagnosis of testicular torsion. ⋯ A variety of bacterial organisms were cultured and responded readily to antibiotics. Follow-up has documented survival of the testes without apparent atrophy. "Idiopathic" infant pyocele is rarely described and consequently, not included in the differential diagnosis of patients with acute surgical conditions of the inguinoscrotal region.
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A 16-month-old infant presented with bilateral diaphragmatic paralysis and respiratory failure after removal of a thoracic teratoma. Right diaphragmatic function recovered after end-to-end anastomosis of a transected phrenic nerve. We conclude that phrenic nerve repair can restore diaphragmatic function and should be attempted in selected cases of diaphragmatic paralysis due to phrenic nerve injury.
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Comparative Study Clinical Trial
Early excision of major burns in children: effect on morbidity and mortality.
The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). ⋯ The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.
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Infants are well known to be sensitive to the myocardial depressant effects of halothane. In this study of more than 300 infants, 0 to 24 weeks of age, who received halothane anesthesia, preoperative risk factors were correlated with intraoperative outcome and postoperative recovery. Possible risk factors considered were age, history of respiratory distress syndrome (RDS), preoperative fasting time, and anemia. ⋯ Infants younger than 8 weeks of age (particularly newborns), infants 9-16 weeks of age (fasting eight or more hours), and RDS survivors 0-16 weeks of age were found to be most susceptible to hypotension. Only age and history of RDS, however, proved to be statistically significant risk factors in predicting the probability of intraoperative circulatory depression. Though circulatory depression during halothane inhalation was common, it was not associated with significant intraoperative or postoperative morbidity in terms of cardiorespiratory arrests, serious dysrhythmias, prolonged postanesthetic recovery, or delayed feeding times.
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Acid ingestion occurs relatively rarely and produces a spectrum of injury that is markedly different from the more commonly encountered alkaline burns of the oropharynx and esophagus. Gastric damage results from pylorospasm with pooling of the ingested caustic in a dependent location. ⋯ Perforation and/or strictures may require extensive gastric surgery. Early fiberoptic endoscopy is essential.