Journal of pediatric surgery
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Case Reports
Tracheoesophageal fistula following button battery ingestion: successful non-operative management.
The incidence of devastating complications from button battery ingestions is increasing. Battery impactions may result in erosive esophagitis, tracheoesophageal fistula (TEF), esophageal strictures, spondylodiscitis, vocal cord paralysis due to paralysis of recurrent laryngeal nerve(s), and aortoesophageal fistulas with significant morbidity and mortality. ⋯ Serial limited CT imaging with 3-D reconstruction was helpful in noninvasive assessment of healing and clinical decision making. Of special interest are the negative initial esophagram and the healing of the fistula without the need for surgical intervention.
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To examine changes in authorship patterns in the articles published in the Journal of Pediatric Surgery (JPS) over the last three decades (1981-2010), and to analyze why they took place. ⋯ This striking increase in the number of authors per article was evident in other medical journals as well, and reflects a progressive complexity in academic work along with the need for building resumes rich in publications. It can be anticipated that this tendency will continue in the future.
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Intravenous fish oil (FO) has changed the management of intestinal failure associated liver disease (IFALD). This report describes two IFALD patients who received FO for 5 and 10 months, respectively and reports on their 3-year follow-up.
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Heterotaxy syndrome is associated with intestinal abnormalities. We sought to define the gastrointestinal anatomy and determine both the risk of volvulus and benefit of screening upper gastrointestinal fluoroscopy (UGI) in these patients. ⋯ While rotational abnormalities are common in heterotaxy, risk of volvulus is low. Following operation, the risk of bowel obstruction and of need for reoperation is higher. We advocate avoiding operation in the asymptomatic patient.
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Perioperative services require the orchestration of multiple staff, space and equipment. Our aim was to identify whether the implementation of operations management and an electronic health record (EHR) improved perioperative performance. ⋯ The use of operations management and EHR resulted in improved processes, credible data, promptly sharing the metrics, and pinpointing individual provider performance. Implementation of these strategies allowed us to shift cases between facilities, reallocate OR blocks, increase first case on time starts four fold and operative cases by 35%, and these changes were associated with a 53% increase in operating revenue. The fact that revenue increase was greater than case volume (53% vs. 35%) speaks for improved performance.