Journal of pediatric surgery
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We have previously reported the use of EC-CPR for the treatment of hypothermic cardiac arrest with an overall survival of 50%. As we have continued this protocol for an additional 5 years, we sought to update this information. ⋯ Cold water drowning and avalanche suffocations cause dramatic hypothermic cardiac arrests in previously robust children. A protocolized rapid response with EC-CPR can save some of these children despite prolonged periods of cardiac arrest prior to initiation of bypass. The overall survival rate is likely less than our prior more optimistic report suggested.
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Case Reports
Repair of a floating sternum with autologous rib grafts and polylactide bioabsorbable struts in an 18-year-old male.
Failed regeneration of costal cartilage after open repair of pectus chest wall deformities can result in a floating sternum. A floating sternum can be repaired by insertion of a rib graft between the rib and sternum, and stabilization with a metal strut. The metal implant is usually removed with a second operation. ⋯ He had an uncomplicated peri-operative course. One year later, the sternum had a normal appearance and was sturdy. A second operation for removal of hardware was not necessary.
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Medical and surgical approaches toward children with ulcerative colitis (UC) vary and have differing implications for health care use. The goal of this study was to define hospital use and complications for children with UC before and after staged restorative proctocolectomy. ⋯ Children with UC who undergo colectomy use a large number of hospital resources before surgery and exhibit decreased hospital use after surgical completion. Children undergoing colectomy at children's and high-volume hospitals experience fewer surgical complications and shorter hospitalization.
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Comparative Study
Ovarian torsion: diagnosis of inclusion mandates earlier intervention.
The treatment of ovarian torsion (OT) is often delayed because of diagnostic uncertainty and dependence on radiologic confirmation. In contrast, when testicular torsion (TT) is suspected, diagnosis and management are expedited despite lack of certainty, and operative exploration is not delayed by radiologic investigations. We compared the management of torsion in both sexes to define a better clinical pathway for suspected OT. ⋯ Girls with suspected OT waited 2.5 times as long for diagnostic imaging and 2.7 times as long to be taken to the operating room. In addition, the gonadal salvage rate was significantly worse for girls compared with boys with TT. More urgent intervention for OT, with liberal use of diagnostic laparoscopy and without reliance on a definitive diagnosis by imaging, should be considered in girls with lower abdominal pain.
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This study sought to summarize the experience of diagnosis and treatment of tracheobronchial foreign bodies in children to effectively reduce complications and mortality. ⋯ Timely accurate diagnosis and treatment of tracheobronchial foreign bodies in children can avoid delay in treatment and effectively reduce complications and mortality.