Pediatric surgery international
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Pediatr. Surg. Int. · Jul 2004
Review Case ReportsSevere esophageal damage due to button battery ingestion: can it be prevented?
Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. Medline was used to search the English medical literature, combining "button battery" and "esophageal burn" as keywords. ⋯ These data suggest that manufacturers should replace large batteries with smaller ones and thus eliminate most of the complications. When the battery remains in the esophagus, endoscopic examination and removal done urgently will allow assessment of the esophageal damage, and treatment can be tailored accordingly. There is a need for more public education about the dangers of battery ingestion; this information should be included as part of the routine guidelines for childproofing the home.
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Pediatr. Surg. Int. · Nov 2003
Review Historical ArticleConservative management of splenic trauma: history and current trends.
Evolution of the present-day policy of conservative management of ruptured spleen has been hailed as one of the most notable advances in pediatric surgery. Until 1971, routine splenectomy used to be the sacrosanct treatment for splenic trauma. It was universally believed that non-operative management carried a high mortality of 90 to 100%. ⋯ By 1979, numerous authors had reported the safety of non-operative management in hundreds of children all over the world. Currently, the policy of routine splenectomy has been universally abandoned; and the reported salvage rate of ruptured spleen is more than 90%. This paper traces the historical perspectives in the management of injured spleen from the times of Aristotle to the present day.
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Pediatr. Surg. Int. · Sep 2003
ReviewThe epidemiology of neonatal tumours. Report of an international working group.
Neonatal tumours occur every 12,500-27,500 live births and comprise 2% of childhood malignancies, but there is little clarity as to their real prevalence, sites of origin and pathological nature as reported series vary. As an entity, neonatal tumours provide a unique window of opportunity to study tumours in which minimal environmental interference has occurred. The majority of tumours present with a mass at birth (e.g., teratomas, neuroblastomas, mesoblastic nephroma, fibromatosis), which are not infrequently identified on antenatal ultrasound. ⋯ Certain constitutional chromosome anomalies, however, specifically favour tumours occurring in the foetal and neonatal period. In support of this hypothesis, certain cytogenetic anomalies appear to be specific to neonates, and a number of examples are explored. Other environmental associations include ionizing radiation, drugs taken during pregnancy, infections, tumours in the mother and environmental exposure.
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Patients with severe burn injury are a challenge for the pediatric anesthesiologist. Today with adequate care many children survive their trauma and have a good chance for complete functional and psychological rehabilitation. The anesthesiologist has to provide excellent care even for patients in suboptimal or unstable condition to enable wound debridement and grafting, because only rapid skin closure will stabilize the patient. Adequate pain treatment during all phases of burn treatment is mandatory.
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Active basic-science investigations and directed clinical research have resulted in effective therapies for improving the outcomes of burned children. Major areas of inquiry have been in resuscitation, hypermetabolism, wound coverage, and inhalation injury, all of which have yielded fruitful results. Probably the most important advance has been the widespread use of early excision and grafting, which has changed the pathophysiology of burn injury. Further advances in the fields of metabolism, wound healing, and respiratory medicine may improve results even further, particularily in functional and cosmetic outcomes.