Journal of pediatric surgery
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Case Reports
Combined endovascular and surgical recanalization after central venous catheter-related obstructions.
Central venous occlusion in children is a challenging problem that can occur after a central venous catheter insertion. Long-term catheter-related complications include sepsis and venous thrombosis with consequent loss of central access. ⋯ The patients' survival was dependent on the restoration of central venous access until the planned intestinal transplantation could be performed. Retrograde recanalization of the superior vena cava was successfully achieved using a pathway created under general anesthesia from the femoral vein to, respectively, the right thyroid vein and the right subclavian vein.
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Comparative Study
Laser microdissection allows detection of abnormal gene expression in cystic adenomatoid malformation of the lung.
Congenital cystic adenomatoid malformation (CCAM) of the lung may result from a localized aberrant epithelial-mesenchymal interaction during lung development. We used laser microdissection (LMD) to isolate the epithelium and mesenchyme of CCAM, and studied candidate gene expression in these pure cell populations. ⋯ LMD may be used to overcome the limitations of tissue heterogeneity in the study of CCAM. Abnormal growth factor expression may play a role in the etiology of this lesion.
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Trauma resuscitations require a high level of team performance. This study evaluated the impact of a comprehensive effort to improve trauma care through multidisciplinary education and the use of simulation training to reinforce training and evaluate performance. ⋯ Training of a multidisciplinary team in the care of pediatric trauma patients can be enhanced and evaluated through the use of high-fidelity simulation. Improvements in team performance using innovative technology can translate into more efficient care with fewer errors.
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Case Reports
Partial laparoscopic splenectomy for splenic abscess because of Salmonella infection: a case report.
Splenic abscess as a presentation of a Salmonella infection is described in children and adults. A combination of antibiotics and splenectomy is the standard treatment. We report a 12-year-old girl admitted to the hospital with fever, abdominal pain, and anorexia. ⋯ Splenic abscess in children is a rare condition. Long-term antibiotic therapy is needed. Percutaneous drainage can be a temporary solution, but (partial) splenectomy is the final treatment in most cases.
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We report on 2 sisters presenting with acute torsion of a wandering spleen within a 3-year interval. The diagnosis was made preoperatively by computed tomography (CT) in both cases. A high index of suspicion because of our experience with the first patient, who underwent splenectomy, enabled a correct early diagnosis in the sibling. On urgent surgery, reversible ischemic changes were found, and detorsion and splenopexy resulted in preservation of the spleen.