Journal of pediatric surgery
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Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in support of neonates with respiratory failure but requires right common carotid artery ligation. While no short-term neurologic complications have resulted from neonatal carotid ligation, late complications may occur. For both VA ECMO and venovenous (VV) ECMO, blood is drained from the right atrium via a right internal jugular cannula, oxygenated by a membrane lung, and returned to the patient. ⋯ Differences among the patients were related to their primary disease rather than to the mode of ECMO support. The VV patients had cannulation of the femoral vein for perfusion of oxygenated blood. Late complications may occur from femoral vein ligation as well as from carotid ligation so long-term follow-up is needed to assess these two ECMO techniques.
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Acute suppurative thyroiditis is rare in childhood. It presented in two clinically euthyroid children over a 2-year period. Repeated drainage for recurrent abscesses was necessary in one child. ⋯ Administration of antibiotics, which are effective against oral flora, combined with initial drainage of suppuration control infection. Only then can the diagnosis be made by contrast study of the hypopharynx and upper esophagus. Operative excision of the entire epithelial tract and adjacent thyroid tissue is essential to prevent recurrent thyroiditis and abscess.
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Case Reports
The diagnosis of primary and recurrent tracheoesophageal fistulas: value of selective catheterization.
To avoid an unnecessary second thoracotomy, unequivocal demonstration of a recurrent tracheoesophageal fistula after repair of esophageal atresia with tracheoesophageal fistula is mandatory. Transesophageal selective catheterization of the fistula during cineesophagography may resolve the ambiguities of routine cineesophagography and rod lens telescopic bronchoscopy.
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Appendicitis remains the most common intraabdominal indication for surgery in children. Recently, barium enema has been helpful in increasing the accuracy of diagnosis in difficult cases. Experience with 202 barium enemas in children with abdominal pain entertaining the diagnosis of acute appendicitis revealed some of the problems encountered in using this procedure as a diagnostic tool. ⋯ In the group that had negative barium enemas, there were 3 false negatives and 2 of these children had early perforations by the time of their surgery. The third group were equivocal barium enemas and they pointed out the difficulty in obtaining a normal barium enema in a child who does not have appendicitis. It was felt that the use of barium enema as an adjunct was helpful especially if it were positive, but a negative barium enema could not be relied upon to delay surgery in the child with right lower quadrant peritoneal signs.
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Preoperative transfusion therapy is largely responsible for the recently improved morbidity and mortality in patients with sickle cell anemia undergoing surgery. The transfusion techniques recommended are several. ⋯ The complications encountered in patients receiving simple transfusion or partial exchange transfusion do not differ. There remains theoretic advantage in the use of preoperative partial exchange transfusion with quantitation of hemoglobin S.