Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica
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Tumors diagnosed during the first month of life are infrequent: 0.5 to 2% of all childhood neoplasms. This is an interesting group of tumors because their type, relative incidence, natural history and response to treatment differ from those seen in older children. ⋯ Diagnosis of congenital tumors is performed earlier in recent years due to the wide use of prenatal ultrasound. Their natural history is more benign than in other age groups, except for CNS tumors and very large or obstructing tumors. The histological patern is not determinant of the outcome. Complete surgical excision is the treatment of choice, most cases not need adjuvant chemotherapy. We ought to pass this message on to our colleagues in prenatal diagnosis, so parents get reliable information.
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Abdominal ultrasonographic study is a part of the acute abdominal pain diagnosis protocol in our hospital. As an internal quality assessment, we performed a six-month prospective study, including those patients who meet one of these requirements: 1st the reason for attendance being non-traumatic abdominal pain 2nd an abdominal ultrasonography achieved at the hospital. Collected data included: demographic characteristics, presenting sign and symptoms, test results, ultrasonography, final diagnosis and treatment. ⋯ Ultrasound examination, for acute appendicitis, had a sensitivity of 94.8%, specificity of 98.8%, positive predictive value of 97.3% and negative predictive value of 97.8%. Abdominal ultrasonography has showed usefulness for surgical pathology discrimination in acute abdominal pain. When ultrasonography is inconclusive, clinical follow-up and periodical ultrasonography results in a positive change in management and treatment.
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Epidemiological analysis of main factors affecting multiple trauma in children in our environment. ⋯ Traffic related injuries are the main cause of multiple trauma in children. The severity and high mortality of these injuries make imperative polytonal education systems and the use of restraining devices.
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Comparative Study
[Post-surgical paediatric pain: Nursing- PCA vs continuous I.V. infusion of tramadol ].
To evaluate the efficiency in the control of the post-surgical paediatric pain of the combination of a weak opioid [tramadol (T)] and an NSAID (paracetamol), comparing its administration through "Nursing-PCA" (NCA) techniques or through continuous i.v. infusion. ⋯ The combination of tramadol and paracetamol through "Nursing PCA" has turned out to be an efficient method in the treatment of the post-surgical pain in little children and those whose are in their lacteal period. It is a possible alternative of the continuous infusion of Morphine in these patients.
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Abdominal injuries are frequent in children, and the early assessment is the best guaranty for an accurate management. Although computed tomography (TAC) has been considered the diagnostic modality of choice for children with blunt abdominal trauma, is a costly radiological test that requires the patients be stable and sedated. The aim of this study is to evaluate the usefulness of abdominal ultrasonography, a quick, non-invasive technique, of low cost, and repeatable, during the initial assessment of these patients, arguing about the possibility of replace TAC in the detection of intra-abdominal posttraumatic injury. ⋯ The sensitivity, specificity, positive predictive value, and negative predictive value of the TAC were 92.85%, 100%, 100%, and 66% respectively. We conclude that TAC is the imaging modality of choice in children with severe abdominal trauma but ultrasonography is a reasonable technique to arouse diagnostic suspicion, that can avoid additional tomographic studies. Abdominal computed tomography must be reserved for the hemodynamically stable children with anormal ultrasonographic findings or with suspected injuries by a clinical evolution that gone unnoticed in the previous study.