The Journal of Trauma Injury Infection and Critical Care, Jul 1, 2003
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > June ...
Management of newborn infants with esophageal atresia and tracheoesophageal fistula that require ... more Management of newborn infants with esophageal atresia and tracheoesophageal fistula that require mechanical ventilation is challenging. Without rapid control of the fistula, these patients develop profound respiratory failure and massive distention of the gastrointestinal tract. We present the case of a newborn who upon intubation exhibited respiratory failure and cardiovascular collapse, and in whom traditional intra-operative techniques to gain control of the tracheoesophageal fistula were unsuccessful. We describe a technique that temporarily occludes the gastroesophageal junction, and allows for stabilization of the neonate and definitive repair of the tracheoesophageal fistula.
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > June ...
l The response of the villus microcirculation to moderate hemorrhage was compared in adult and im... more l The response of the villus microcirculation to moderate hemorrhage was compared in adult and immature rats. As an estimate of villus blood flow, flux of red blood cells through the terminal arteriole loop at the villus tip was quantified in vivo using fluorescence epilumination videomicroscopy. Baseline red blood cell flux and mean arterial pressure (MAP) of immature rats (973 cells/s, 84 mm Hg) were significantly less -. than that of adults (1,435 ceiisis, 131 mm Hgj. Following hemorrhage of 30% of estimated blood volume, MAP of immature rats was still 24% less than that of adults; however, villus flux was not significantly different (578 cells/s immature, 640 cells/s adult; P = .63). Thus, as indicated by changes in villus flux, immature rats do not appear to be more susceptible to acute intestinal blood flow reduction induced by a single moderate hemorrhage. Immaturity of villus microvascular anatomy and of intestinal vasoregulatory mechanisms may account for the differential response.
Unplanned readmissions are costly to family satisfaction and negatively associated with quality o... more Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission. All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included. A retrospective cohort study using multivariable forward stepwise logistic regression determined factors associated with unplanned readmission within 30 days of discharge. Among 20,785 patients with an operation there were 26,978 encounters and 3,092 readmissions (11.5%). Thirteen of 33 candidate variables considered in the stepwise regression were significantly associated with readmission. Patients with an emergency department visit within 365 days of operation, American Society of Anesthesiologists class 4 or greater, Hispanic ethnicity and late-day or holiday/weekend discharges were more likely to have an unplanned readmission (odds ratio [OR] =...
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals,... more Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. A trichobezoar represents a mass of accumulated hair. Trichobezoars may present as an isolated gastric mass, as an extension into the small intestine, or as an independent fragmented mass in the small intestine. The presence of discrete coexisting gastric and ileal trichobezoars has been reported only rarely in the literature. This is a case report of a 9-year-old girl presenting with small-bowel obstruction secondary to synchronous trichobezoars in the stomach and ileum. The case highlights the role of imaging and importance of complete evaluation of the gastrointestinal tract at the time of surgical evacuation.
Analyses of volume-outcome relationships in adult surgery have found that hospital and physician ... more Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear. To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery. A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted. Sixty-three studies were reviewed. Significant heterog...
BACKGROUND: The aim of this study was to examine the implementation and sustainability of checkli... more BACKGROUND: The aim of this study was to examine the implementation and sustainability of checklist use among procedural-based specialties in a pediatric hospital and to survey perceptions of checklist efficacy among staff members and physicians.
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals,... more Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. A trichobezoar represents a mass of accumulated hair. Trichobezoars may present as an isolated gastric mass, as an extension into the small intestine, or as an independent fragmented mass in the small intestine. The presence of discrete coexisting gastric and ileal trichobezoars has been reported only rarely in the literature. This is a case report of a 9-year-old girl presenting with small-bowel obstruction secondary to synchronous trichobezoars in the stomach and ileum. The case highlights the role of imaging and importance of complete evaluation of the gastrointestinal tract at the time of surgical evacuation.
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals,... more Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. In adults, bezoars are most frequently encountered after a gastric operation, but in children, bezoars are associated with pica, mental retardation, and coexistent psychiatric pathologic disorders. We describe a 4-year-old girl with trichotillomania in whom a gastric trichobezoar resulted in failure to gain weight, iron deficiency anemia, and a painless epigastric mass. The causes of gastric bezoars are discussed, with emphasis on diagnostic considerations, treatment options, and preventive measures.
Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who pres... more Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who presented with signs and symptoms suggestive of an incarcerated inguinal hernia. Ultrasound examination demonstrated an aperistaltic multicystic inguinal mass of uncertain origin. The mass was resected, and the adjacent hernia was repaired. Histologic examination identified the mass as a mesothelial cyst. Mesothelial cysts are rare groin lesions in children that can masquerade as an incarcerated inguinal hernia in a child.
Intrathoracic gastric volvulus associated with neonatal paraesophageal hernia is very rare in the... more Intrathoracic gastric volvulus associated with neonatal paraesophageal hernia is very rare in the newborn period. We report a case of a 3-week-old term infant who presented to the hospital with a history of non-bilious vomiting. Workup for hypertrophic pyloric stenosis eventually revealed the presence of a congenital hiatal hernia and intrathoracic gastric volvulus requiring urgent surgical management. The infant underwent successful laparoscopic repair. We discuss the diagnosis and management of this extremely rare surgical cause of neonatal nonbilious emesis.
Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication ... more Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein. The fistula was surgically repaired. This case report describes the clinical imaging and treatment options for infants with iatrogenic AVF.
The Journal of Trauma Injury Infection and Critical Care, Jul 1, 2003
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > June ...
Management of newborn infants with esophageal atresia and tracheoesophageal fistula that require ... more Management of newborn infants with esophageal atresia and tracheoesophageal fistula that require mechanical ventilation is challenging. Without rapid control of the fistula, these patients develop profound respiratory failure and massive distention of the gastrointestinal tract. We present the case of a newborn who upon intubation exhibited respiratory failure and cardiovascular collapse, and in whom traditional intra-operative techniques to gain control of the tracheoesophageal fistula were unsuccessful. We describe a technique that temporarily occludes the gastroesophageal junction, and allows for stabilization of the neonate and definitive repair of the tracheoesophageal fistula.
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > June ...
l The response of the villus microcirculation to moderate hemorrhage was compared in adult and im... more l The response of the villus microcirculation to moderate hemorrhage was compared in adult and immature rats. As an estimate of villus blood flow, flux of red blood cells through the terminal arteriole loop at the villus tip was quantified in vivo using fluorescence epilumination videomicroscopy. Baseline red blood cell flux and mean arterial pressure (MAP) of immature rats (973 cells/s, 84 mm Hg) were significantly less -. than that of adults (1,435 ceiisis, 131 mm Hgj. Following hemorrhage of 30% of estimated blood volume, MAP of immature rats was still 24% less than that of adults; however, villus flux was not significantly different (578 cells/s immature, 640 cells/s adult; P = .63). Thus, as indicated by changes in villus flux, immature rats do not appear to be more susceptible to acute intestinal blood flow reduction induced by a single moderate hemorrhage. Immaturity of villus microvascular anatomy and of intestinal vasoregulatory mechanisms may account for the differential response.
Unplanned readmissions are costly to family satisfaction and negatively associated with quality o... more Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission. All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included. A retrospective cohort study using multivariable forward stepwise logistic regression determined factors associated with unplanned readmission within 30 days of discharge. Among 20,785 patients with an operation there were 26,978 encounters and 3,092 readmissions (11.5%). Thirteen of 33 candidate variables considered in the stepwise regression were significantly associated with readmission. Patients with an emergency department visit within 365 days of operation, American Society of Anesthesiologists class 4 or greater, Hispanic ethnicity and late-day or holiday/weekend discharges were more likely to have an unplanned readmission (odds ratio [OR] =...
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals,... more Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. A trichobezoar represents a mass of accumulated hair. Trichobezoars may present as an isolated gastric mass, as an extension into the small intestine, or as an independent fragmented mass in the small intestine. The presence of discrete coexisting gastric and ileal trichobezoars has been reported only rarely in the literature. This is a case report of a 9-year-old girl presenting with small-bowel obstruction secondary to synchronous trichobezoars in the stomach and ileum. The case highlights the role of imaging and importance of complete evaluation of the gastrointestinal tract at the time of surgical evacuation.
Analyses of volume-outcome relationships in adult surgery have found that hospital and physician ... more Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear. To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery. A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted. Sixty-three studies were reviewed. Significant heterog...
BACKGROUND: The aim of this study was to examine the implementation and sustainability of checkli... more BACKGROUND: The aim of this study was to examine the implementation and sustainability of checklist use among procedural-based specialties in a pediatric hospital and to survey perceptions of checklist efficacy among staff members and physicians.
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals,... more Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. A trichobezoar represents a mass of accumulated hair. Trichobezoars may present as an isolated gastric mass, as an extension into the small intestine, or as an independent fragmented mass in the small intestine. The presence of discrete coexisting gastric and ileal trichobezoars has been reported only rarely in the literature. This is a case report of a 9-year-old girl presenting with small-bowel obstruction secondary to synchronous trichobezoars in the stomach and ileum. The case highlights the role of imaging and importance of complete evaluation of the gastrointestinal tract at the time of surgical evacuation.
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals,... more Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. In adults, bezoars are most frequently encountered after a gastric operation, but in children, bezoars are associated with pica, mental retardation, and coexistent psychiatric pathologic disorders. We describe a 4-year-old girl with trichotillomania in whom a gastric trichobezoar resulted in failure to gain weight, iron deficiency anemia, and a painless epigastric mass. The causes of gastric bezoars are discussed, with emphasis on diagnostic considerations, treatment options, and preventive measures.
Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who pres... more Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who presented with signs and symptoms suggestive of an incarcerated inguinal hernia. Ultrasound examination demonstrated an aperistaltic multicystic inguinal mass of uncertain origin. The mass was resected, and the adjacent hernia was repaired. Histologic examination identified the mass as a mesothelial cyst. Mesothelial cysts are rare groin lesions in children that can masquerade as an incarcerated inguinal hernia in a child.
Intrathoracic gastric volvulus associated with neonatal paraesophageal hernia is very rare in the... more Intrathoracic gastric volvulus associated with neonatal paraesophageal hernia is very rare in the newborn period. We report a case of a 3-week-old term infant who presented to the hospital with a history of non-bilious vomiting. Workup for hypertrophic pyloric stenosis eventually revealed the presence of a congenital hiatal hernia and intrathoracic gastric volvulus requiring urgent surgical management. The infant underwent successful laparoscopic repair. We discuss the diagnosis and management of this extremely rare surgical cause of neonatal nonbilious emesis.
Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication ... more Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein. The fistula was surgically repaired. This case report describes the clinical imaging and treatment options for infants with iatrogenic AVF.
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