Journal of pediatric surgery
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Contemporary neonatal intensive care has resulted in survival of many seriously ill preterm and older infants that frequently present with symptomatic inguinal hernia. Controversy exists concerning timing and safety of early repair in prematures or other neonates, especially those hospitalized with concurrent illness. This study examines this topic by evaluating predisposing factors, presentation, and postoperative complications in 100 recent consecutive hernia repairs in previously hospitalized infants less than 2 months of age. ⋯ Three subsequently required a second hernia repair. Two infants with incarceration and cryptorchid testis or ovarian slider had gonadal infarction. There were eight postoperative complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Urokinase was used to clear occluded silastic central venous catheters in 14 pediatric patients. The catheters, which had been placed into a neck vein and tunnelled out through the skin of the anterior chest wall, were being used for either long-term parenteral nutrition or chemotherapy. Occluded catheters that could not be cleared by simple flushing with heparinized saline were filled with a solution of urokinase, which was left in place for 2 hours before the catheter was flushed a second time. ⋯ Two catheters remained partially occluded. Only four catheters were removed because of persistent occlusion. When simpler techniques fail, urokinase instillation appears a safe and effective alternative to the more common practice of removing occluded central venous catheters in children.
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During a recent prospective nonrandomized comparison of noninvasive imaging techniques in 100 children with suspected major blunt abdominal injury, an interesting subset of patients was defined. Of 95 hemodynamically stable patients, 44 were found to have immediate elevation of hepatic enzymes (SGOT, SGPT greater than 30 IU). Nineteen of these children (43%) were subsequently shown to have significant liver injuries. ⋯ Our study has allowed definition of a group of children who are at significant risk for liver injury based on immediately available serum determinations of GOT and GPT. We have begun to use this information in our institution to select children for further noninvasive imaging. We recommend that these studies be obtained emergently in all children with suspected upper abdominal trauma.
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Preterm labor and late gestation fetal loss remain significant barriers to clinical fetal surgery. To investigate the response of the gravid uterus to anesthetic and tocolytic agents and surgical procedures, 27 chair-restrained pregnant rhesus monkeys from 123 to 152 days gestation (term 168 days) underwent implantation of electrodes to monitor uterine electromyographic (EMG) activity. Seven had electrodes placed at the time of hysterotomy for placement of intraamniotic pressure catheters, without disturbing the fetus; 12 at the time of hysterotomy for placement of fetal carotid and jugular catheters. ⋯ The difference between those undergoing minimal uterine manipulation and those undergoing hysterotomy (with and without fetal surgery; fetal loss in 14 of 28, 50%) is statistically significant (P = 0.01). In animals undergoing hysterotomy, frequent coordinated contractions (type I EMG pattern) emerged as the animal awoke. The uterine activity was inhibited by halothane anesthesia, but not by either preoperative indomethacin or postoperative ritodrine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Twenty-five adolescents receiving chronic steroid therapy for inflammatory bowel disease underwent major intestinal surgery and each experienced vasodilation during induction of anesthesia. Systemic hypotension occurred in each patient and was treated by large volumes of intravenous crystalloid solution which caused intraoperative and postoperative water retention with resultant hypertension as well as occasional pulmonary edema and seizures. ⋯ Intravenous fluid administration in excess of maintenance requirements and calculated fluid losses should be given with caution to children receiving high-dose steroids who undergo major intestinal surgery. Perioperative fluid retention under those circumstances may be best treated with early diuretic administration.