Seminars in pediatric surgery
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The response to trauma begins in the immune system at the moment of injury. The loci are the wound, with activation of macrophages and production of proinflammatory mediators, and the microcirculation with activation of endothelial cells, blood elements, and a capillary leak. These processes are potentiated by ischemia and impaired oxygen delivery and by the presence of necrotic tissue, each exacerbating the inflammatory response. ⋯ An important part of these expanding concepts is the notion that all noxious stimuli activate the cytokine system as a final common pathway. Sepsis, hemorrhage, ischemia, ischemia-reperfusion, and soft tissue trauma all share an ability to activate macrophages and produce proinflammatory cytokines that may initiate the SIRS. Second-message compounds and effector molecules mediate the observed clinical phenomena.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thoracic injury is the second leading cause of death in pediatric trauma, second only to head injury in lethal potential. With the exception of lung contusion, serious injuries to vital thoracic structures are associated with mortality rates in excess of 50%. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Facility with management of thoracic injuries is therefore vital to optimal outcome in childhood trauma.
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Semin. Pediatr. Surg. · Feb 1995
ReviewMethods of assessing motility of the digestive system in children.
The study of gastrointestinal motility in children has evolved during the past 25 years. Miniaturization of tools for collecting data has created opportunities to study the maturation of gastrointestinal motility patterns in infants and complaints of abdominal pain, nausea, diarrhea, constipation and distention in children. Available methods, indications for testing, and data evaluation of pediatric esophageal, gastrointestinal, and colonic motility and manometric tests are discussed.
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Large mediastinal massess can cause compression of surrounding mediastinal structures. Patients may have symptoms of airway obstruction or cardiovascular compromise. The additive effects of anesthetics, paralysis, and positioning during biopsy can lead to acute airway obstruction and death. ⋯ When general anesthesia is necessary, specific measures should be taken to avoid disaster or immediately alleviate obstruction should it occur. Some patients at greatest risk will require pretreatment of the mass before tissue diagnosis. This article reviews these issues and provides a useful algorithm for managing patients with mediastinal masses.
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The ability to perform laparoscopic procedures in children is due to the remarkable advances in endoscopic technology and laparoscopic equipment. Although laparoscopy was first reported in 1901, poor exposure and inadequate visualization hampered advances in this area until fiberoptic technology was developed in the 1960s. ⋯ This article discusses the operative technique for creation of the pneumoperitoneum and the equipment necessary for the procedures, and reviews the complications from diagnostic laparoscopy. Further advances in technology surely will allow more procedures to be performed endoscopically.