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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Current healthcare reform efforts have highlighted the potential impact of insurance status on patient outcomes. The influence of primary payer status (PPS) within the pediatric surgical patient population remains unknown. The purpose of this study was to examine risk-adjusted associations between PPS and postoperative mortality, morbidity, and resource utilization in pediatric surgical patients within the United States. ⋯ Primary payer status is associated with risk-adjusted postoperative mortality, morbidity, and resource utilization among pediatric surgical patients. Uninsured patients are at increased risk for postoperative mortality while Medicaid patients accrue greater morbidity, hospital lengths of stay, and total charges. These results highlight a complex interaction between socioeconomic and patient-related factors, and primary payer status should be considered in the preoperative risk stratification of pediatric patients.
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To characterize variation in practice patterns and resource utilization associated with the management of intussusception at Children's Hospitals. ⋯ Significant variation in practice patterns and resource utilization exists between Children's Hospitals in the management of intussusception. Prospective analysis of practice variation and appropriately risk-adjusted outcomes through a collaborative quality-improvement platform could accelerate the dissemination of best-practice guidelines for optimizing cost-effective care.
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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.