Harefuah
-
Review Case Reports
[Epidural analgesia for postoperative pain in infants and children].
Until recently it was thought that children do not suffer as much from postoperative pain as adults. Coupled with the fear of administering systemic opiates to young children, this meant that babies were often left "to cry it out." Lately it has been acknowledged that children and even babies not only feel pain, but similar to adults, suffer from the physiologic consequences of the untreated stress response. It has also been shown that preventing this response improves the postoperative period in babies after undergoing cardiac surgery. ⋯ We use epidural analgesia in children who undergo major thoracic, abdominal, pelvic and major lower limb surgery, and are expected to suffer significant postoperative pain for more than 24 hours. We have not encountered any major complications or inadvertent dural punctures. We judiciously monitor these children, especially their respiratory function, as long as they receive epidural narcotics.
-
Trauma remains the leading cause of death in the pediatric age group, despite recent advances in prevention and treatment. We retrospectively analyzed 130 cases of multiple trauma among 725 pediatric patients with injuries treated here during 1988-1989. Road accidents and falls from heights were the most common causes of injury. ⋯ There was no mortality in those with PTS more than 7 or ISS less than 25. Thus, the prehospital care of pediatric patients with head injury is associated with high mortality. Absence of mortality in patients with PTS of more than 7 emphasizes the importance of designated trauma centers for these patients.
-
Strongyloides stercoralis (SS) is an intestinal nematode which infects a large proportion of tropical and subtropical populations. The endemic areas are southeast Asia, South America and sub-Saharan Africa. Infection is acquired when the worms penetrate the skin, pass via the blood stream to the lungs, ascend the respiratory tract, are swallowed and grow into adult worms in the mucosa of the small intestine. ⋯ Diagnosis was made from stool and bronchial smears. Treatment with thiabendazole was started early and within a week there was complete cure. This is the fourth reported case of SS hyperinfection treated in Israel.
-
We review the outcome of guided, percutaneous, catheter drainage of pleural collections in 102 patients over a 2-year period. In 87% diagnostic aspiration of small or loculated collections was performed. Drainage of malignant and nonmalignant effusions in high-risk patients, or after failure of drainage without imaging guidance, was performed in 13%. ⋯ If the collection was a small pneumothorax in a single patient. If the collections were large and easy to aspirate, we marked the best location for aspiration on the skin and sent the patient back to the ward for aspiration. We conclude that the use of sonography increases the proportion of successful drainage of small pleural collections and results in few complications.