Journal of pediatric surgery
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In reviewing the records of almost 1000 infants and children with intussusception in two children's hospitals over the last 25 yr, there have been seven bowel perforations during attempted hydrostatic barium enema reduction of an intussusception. Except for one instance, these have all occurred during the last 6 yr. The infants were all 6 mo old or less and most had a preceeding viral illness. ⋯ Postoperatively, there were two wound infections, a volvulus which left the child with a short gut and another infant suffered severe brain damage. These babies seem to fit a pattern in which they are younger and sicker longer than the average infant with an intussusception, and have a complete small bowel obstruction. These facts may be a warning that such infants are at increased risk for a barium enema bowel perforation.
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A bronchopleural fistula (BPF) may complicate the management of patients with major pulmonary disease or thoracic surgery. Neonates with idiopathic respiratory distress syndrome and requiring ventilation are especially susceptible to pulmonary barotrauma, which may result in a BPF. Morbidity and mortality are consistently high. ⋯ When using equal increments of PIP and PEEP, PEEP will have over a sixfold greater effect on air leak than doses PIP. These data suggests that PIP should be increased preferentially when ventilating patients with BPF in order to minimize air leak. PEEP less than 6 cm H2O can be used without any significant increase in the volume of air lost.
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Of 156 children undergoing elective inguinal herniotomy under general anesthesia, 81 also had a regional nerve block using Bupivacaine. All were treated as outpatients and recovery was assessed by postanesthetic room nurses and by interrogating the parents as to the child's behavior at home. It was concluded that the use of supplemental regional anesthesia reduced the general anesthetic requirements and the need for postoperative analgesics, thereby providing more rapid recovery to normal activity.
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A 9-yr-old boy with polyarteritis nodosa presented a ruptured ileocolic arterial aneurysm that was resected and ligated at emergency operation. After angiographic examination showing multiple aneurysms of visceral arteries the inferior mesenteric and the common hepatic arteries were also ligated. One year postoperatively and on steroid medication the child is symptomfree with normal laboratory data.
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During the 11 years between July, 1967 and June, 1978, 35 children with a major hemoglobinopathy (SS, SC, S-thalassemia) underwent 46 operations without any mortality or unusual morbidity. All of these children were prepared for surgery by preoperative transfusion of 15-20 cc/kg packed erythrocytes and a hematocrit of at least 36%. ⋯ For elective patients, the operation was the following morning. The ease of application and the absence of morbidity and mortality suggest that this method of preoperative transfusion preparation of children with a major hemoglobinopathy is more desirable than a two-volume exchange or transfusions beginning 10-15 days prior to surgery.