Journal of pediatric surgery
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The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus. ⋯ The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.
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Accidental ingestion of caustic substances may cause serious problems in children. Approximately 20% of caustic ingestions result in esophageal stricture formation, resulting from excessive collagen synthesis to the extracellular matrix by fibroblasts. Recent studies showed that a single application of 5-fluorouracil (5-FU) is a very effective inhibitor of fibroblast proliferation and differentiation for prolonged periods. Using an experimental model, we investigated the efficacy of single-dose 5-FU on stricture formation after caustic esophageal burn. ⋯ A single intraperitoneal dose of 5-FU had a preventive effect on stricture formation after caustic esophageal burn. This observation suggests that 5-FU may prevent this undesirable complication in the clinical setting. Clinical studies are now required to verify this form of treatment. Local intraesophageal application of 5-FU immediately after the burn injury was not effective. Further investigations are required to determine the appropriate timing of application of 5-FU at the local site of injury.
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In children, mild traumatic brain injuries (TBI) account for 70% to 90% of head injuries. Without clear guidelines, many of these children may be exposed to excess radiation owing to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in reducing hospital charges and repeated imaging of pediatric patients. ⋯ Implementation of a simple guideline for the care of children with mild TBI can have significant impact on charges and length of stay while simultaneously reducing radiation exposure. Widespread implementation of such guidelines will improve efficiency without sacrificing quality of care in the management of mild TBI in the pediatric population.
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Case Reports
Successful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins.
Pygopagus conjoined twins are very rare, and half of all pygopagus twins have other anomalies. This report describes the successful surgical separation of pygopagus twins who had a conjoined thecal sac and an epidermal cyst. Meticulous preoperative planning, development of a model simulator, multispecialty teamwork, and a staged surgery contributed to a successful outcome.
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Wound care for partial-thickness burns should alleviate pain, decrease hospital length of stay, and be readily applied to a variety of wounds. The effectiveness of Biobrane (UDL Laboratories, Rockford, IL) is compared with that of Beta Glucan Collagen (BGC; Brennan Medical, St. Paul, MN) in a retrospective cohort study. ⋯ Partial-thickness burn care consists of early debridement and application of a burn wound dressing. Biobrane dressings result in faster healing compared with BGC and may decrease hospital length of stay for patients requiring inpatient admission.