RESUMO
INTRODUCTION: As part of the primary investigation, polytrauma patients arriving at our emergency department are examined in accordance with the Advanced Trauma Life Support (ATLS) rules, using the new Lodox Statscan (LS) digital low-radiation imaging device. The aim of this study was to establish whether entrance and effective radiation doses using LS in children were comparable to those of paediatric Computed Radiography (CR) and to evaluate the duration of scanning for both techniques in young polytrauma patients. METHODS: 19 consecutive polytrauma patients aged <16 years who had LS imaging were included in this prospective analysis. For a comparison of our results, we put together an age-, size-, injury type- and ISS-matched group of young patients screened using paediatric Conventional Radiology (CR). Entrance, effective doses and mean duration of diagnostic imaging were recorded for both groups. RESULTS: Effective and entrance doses were higher in the LS group compared to the paediatric CR group (p<0.001). This might be partly due to the higher radiation dose necessary for lateral LS spine imaging, and also because with conventional radiography, only selected parts of the spine are imaged compared to the standard full spinal view with LS. Diagnostic imaging with LS required less time than paediatric CR (p=0.117). CONCLUSION: LS scanning will probably be a useful diagnostic tool for a range of paediatric clinical indications in the future. But only the future will show whether LS will survive in the face of low-dose radiation CT scanners and magnetic resonance imaging devices that may eventually completely replace conventional radiography.
Assuntos
Ferimentos e Lesões/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Programas de Rastreamento , Estudos Prospectivos , Doses de Radiação , Radiografia , Fatores de Tempo , Imagem Corporal TotalRESUMO
Spontaneous pneumothorax in children is an emergency. A rapid and structured treatment is necessary. Indicating clinical signs are dyspnoea with unilateral reduced breath sounds and hypersonic percussion note. Chest x-ray confirms diagnosis. CT scan shows detailed information's of pathological changes in lung tissue and offers important considerations for the therapy. Today video assisted thoracoscopic surgery (VATS) takes a central role in the treatment of spontaneous pneumothorax. Thoracoscopy completes diagnosis detecting the pathologies, which were missed in imaging procedures. Definitive surgical treatment is performed simultaneously in the same anaesthesia.
Assuntos
Pneumotórax/etiologia , Cirurgia Torácica Vídeoassistida , Asma/complicações , Tubos Torácicos , Criança , Dispneia/etiologia , Humanos , Masculino , Pneumonectomia , Pneumotórax/diagnóstico , Pneumotórax/cirurgia , Fatores de Risco , Grampeadores Cirúrgicos , Tomografia Computadorizada por Raios XRESUMO
The case of a 20 month-old girl that was admitted to the emergency ward because of worsening of her general condition in the setting of acute non-bloody gastroenteritis is reported. The clinical examination revealed signs of severe dehydration and a prominent tender abdomen. Laboratory evaluation showed leucocytosis, elevated C-reactive protein and severe hypochromic microcytic anemia. Abdominal X-ray revealed diffuse meteorism. The child underwent laparascopic evaluation. A perforated Meckel's diverticulum was found. Perforation and anemia due to occult bleeding are unusual presentations of Meckel's diverticulum. The differential diagnosis of children presenting with an acute abdomen with special focus on Meckel's diverticulum is discussed.
Assuntos
Abdome Agudo/etiologia , Anemia Ferropriva/etiologia , Coristoma/diagnóstico , Mucosa Gástrica , Doenças do Íleo/diagnóstico , Perfuração Intestinal/diagnóstico , Divertículo Ileal/diagnóstico , Coristoma/patologia , Coristoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Doenças do Íleo/patologia , Doenças do Íleo/cirurgia , Íleus/diagnóstico , Íleus/cirurgia , Lactente , Perfuração Intestinal/patologia , Perfuração Intestinal/cirurgia , Divertículo Ileal/patologia , Divertículo Ileal/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , ReoperaçãoRESUMO
PURPOSE: The use of mini-laparoscopy scissors to remove a central venous catheter inadvertently fixed to the wall of the brachiocephalic vein is described. PATIENT AND METHODS: During a rethoracotomy in a 15-year-old female patient, a central venous catheter preoperatively introduced in the left subclavian vein was inadvertently trapped by a suture and fixed to the wall of the left brachiocephalic vein. The foreign body was removed by use of a transjugularly introduced venous sheath, a catheter wire snare, and mini-laparoscopy scissors. RESULTS: The fixed catheter was freed from the wall of the vein under fluoroscopic control with the help of a mini-laparoscopy scissors. Since the intravasal end of the catheter had already been grasped during mobilization with the wire snare it could be completely removed subsequently without any problem. CONCLUSIONS: The percutaneous, intravascular use of mini-laparoscopy instruments may be considered for foreign body removal in special cases.
Assuntos
Veias Braquiocefálicas , Cateterismo Venoso Central/instrumentação , Laparoscópios , Microcirurgia/instrumentação , Instrumentos Cirúrgicos , Adolescente , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Desenho de Equipamento , Falha de Equipamento , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos , Radiografia , SuturasRESUMO
Between 1991 and 1993, 106 newly diagnosed cases of Hirschsprung's disease (HD) were prospectively analyzed for the association of HD and intestinal neuronal dysplasia (IND) at ten pediatric surgical departments in central Europe. Hirschsprung-associated IND (HaIND) was found in 40% of cases. IND was disseminated in one-third and localized in two-thirds of the patients. Initial clinical symptoms were related to the length of the aganglionic segment, but not to the presence of HaIND. An enterostomy performed in 72 cases (67.9%) was located in a segment of pathologically innervated bowel in 50% of all cases, but in 72% of cases of HaIND. The proximal margin of the resected bowel showed pathological innervation in 44% of cases. Supplemental biopsies from the intestine (apart from diagnostic suction biopsies and biopsies at the enterostomy site) led to the first identification or definition of length of associated IND in 17.9% of cases. Postoperatively, the presence of long-segment aganglionosis or associated IND implied a delay in the restoration or normal defecation. Persistent constipation was found in 40% of patients with associated disseminated IND at follow-up at 6 months, compared to 20.6% in patients with isolated HD. These children needed secondary interventions more often than patients with associated localized IND or isolated HD. HaIND thus has clinical implications for the postoperative course if IND is disseminated.
Assuntos
Doença de Hirschsprung/epidemiologia , Doença de Hirschsprung/cirurgia , Intestinos/inervação , Criança , Comorbidade , Enterostomia , Humanos , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
BACKGROUND AND OBJECTIVE: Hemangiomas have a typical clinical course and may lead to life-threatening obstruction if the central respiratory tract is involved. STUDY DESIGN/PATIENTS AND METHODS: This was observed in 32 children over a period of 20 years. The radiation parameters and application procedure of Neodymium:Yttrium-Aluminum-Garnet-laser (Nd:YAG-laser) therapy were adjusted for the degree of obstruction and the type of disease. RESULTS: The success rate was 93.8%, of which a maximum of one application was sufficient in 24 children (75.0%). Subglottic cicatricial stenosis was considered a laser-related complication. CONCLUSION: Nd:YAG-laser treatment is a safe and effective therapeutic measure for eliminating respiratory tract obstruction caused by hemangiomas.
Assuntos
Hemangioma Capilar/cirurgia , Hemangioma Cavernoso/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Neoplasias da Traqueia/cirurgia , Broncoscopia , Feminino , Seguimentos , Hemangioma Capilar/classificação , Hemangioma Cavernoso/classificação , Humanos , Lactente , Recém-Nascido , Neoplasias Laríngeas/classificação , Laringoscopia , Terapia a Laser/instrumentação , Terapia a Laser/estatística & dados numéricos , Masculino , Neoplasias da Traqueia/classificação , Resultado do TratamentoRESUMO
PURPOSE: To investigate the use of magnetic resonance (MR) imaging to guide interstitial laser therapy of deep hemangiomas and vascular malformations in children. MATERIALS AND METHODS: Sixteen children aged 3 months to 16 years with symptomatic vascular lesions underwent percutaneous laser treatment. MR imaging guidance of the laser applicator and online thermomonitoring with MR imaging were performed with a 0.2-T open MR system. Follow-up studies were performed 2 days and 6 weeks after thermotherapy. RESULTS: Interactive positioning of the laser applicator was possible in all patients. Online thermomonitoring was possible in 122 of 137 therapy spots (89%). There was a good correlation between volumes of coagulated tissue on intraprocedural T1-weighted images and volumes of coagulated tissue on follow-up T2-weighted images. At 6-week follow-up, MR imaging demonstrated a reduction in lesion size in 10 patients (mean reduction, 72%) and an increase in lesion size in two patients (mean increase, 134%). Clinical symptoms improved in 14 of 16 patients (88%). CONCLUSION: MR imaging-guided laser therapy appears to be a safe and potentially effective minimally invasive treatment for selected children with vascular lesions.
Assuntos
Malformações Arteriovenosas/terapia , Hemangioma/terapia , Hipertermia Induzida/instrumentação , Imageamento por Ressonância Magnética/instrumentação , Adolescente , Malformações Arteriovenosas/diagnóstico , Criança , Pré-Escolar , Terapia Combinada , Feminino , Hemangioma/diagnóstico , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Lactente , Masculino , Sistemas On-Line , Resultado do TratamentoRESUMO
Retroperitoneal lymphangiomas are rare congenital vascular malformations. They cannot always be completely excised and are associated with high recurrence, complication and morbidity rates. We therefore utilize an alternative treatment concept in some cases. We excise the cystic types laparoscopically with a Nd: YAG laser (wavelength 1064 nm). Residual tissues are percutaneously managed by interstitial laser therapy under MRI monitoring. The high soft-tissue contrast of the MRI enables exact positioning of the laser fiber. The examination is thermosensitive and provides online and noninvasive demonstration of the interstitial tissue coagulation. We have treated four infants laparoscopically and three other children percutaneously.
Assuntos
Laparoscopia , Terapia a Laser , Linfangioma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Linfangioma/patologia , Imageamento por Ressonância Magnética , Masculino , Invasividade Neoplásica , Prognóstico , Neoplasias Retroperitoneais/patologiaRESUMO
BACKGROUND AND OBJECTIVE: Interstitial laser therapy (ILT) is a minimally invasive treatment method for congenital vascular malformations (CVM). This study was intended to show whether or not open magnetic resonance imaging (MRI) offers a means of on-line thermometry and procedure control. STUDY DESIGN/PATIENTS AND METHODS: ILT using a bare fiber and an Nd:YAG laser was applied in 20 children with CVM under open MR control. RESULTS: With the open MR systems, needle placement and advancement was excellent in all cases. On-line thermometry was possible in 90% of the therapy spots. The 6 week MR follow-up revealed a 76% reduction in tumor size in 14 patients. Clinical symptoms improved in 85% of the patients. CONCLUSION: MR-guided ILT could become a safe method to treat selected types or selected regions of CVM.
Assuntos
Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/cirurgia , Terapia a Laser , Angiografia por Ressonância Magnética , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Angiografia por Ressonância Magnética/métodos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Resultado do TratamentoRESUMO
UNLABELLED: Duodenal gastrinomas in childhood are extremely rare and often missed at first medical consultation. We report on a 7-year-old child with sporadic gastrinoma of primary localisation in the distal duodenum. Small metastases in the liver and regional nodes were detected pre-operatively by somatostatin receptor scintigraphy (SRS) but not by other conventional imaging procedures. Diagnostic procedures include pre-operative SRS, endoscopic ultrasound and intra-operative endoscopic transillumination. CONCLUSION: Gastrinomas are rare abdominal tumours in childhood. Pre-operative tumour-specific diagnosis is possible by 111indium pentreotide SRS.
Assuntos
Neoplasias Duodenais/diagnóstico por imagem , Gastrinoma/diagnóstico por imagem , Radioisótopos de Índio , Somatostatina/análogos & derivados , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Biomarcadores Tumorais , Criança , Neoplasias Duodenais/fisiopatologia , Neoplasias Duodenais/terapia , Feminino , Gastrinoma/fisiopatologia , Gastrinoma/terapia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Metástase Linfática/diagnóstico por imagem , Receptores de Somatostatina/análise , Sensibilidade e EspecificidadeAssuntos
Endoscópios , Terapia a Laser/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Doenças Torácicas/cirurgia , Neoplasias Torácicas/cirurgia , Toracoscópios , Criança , Pré-Escolar , Desenho de Equipamento , Hemostasia Cirúrgica/instrumentação , Humanos , Lactente , Recém-Nascido , Doenças Torácicas/congênito , Neoplasias Torácicas/congênitoRESUMO
Ultrasound-guided, laser-induced thermocoagulation with Nd:YAG laser (1064 nm) was performed in a child with metastatic gastrinoma disease. The emitted laser energy to coagulate a radius of 15-20 mm of metastatic liver tissue was 4 W with a duration time of 300 s. Marked reduction of gastrin was observed after interstitial laser hyperthermia.
Assuntos
Neoplasias Duodenais/terapia , Gastrinoma/secundário , Hipertermia Induzida/instrumentação , Neoplasias Hepáticas/secundário , Biomarcadores Tumorais/sangue , Criança , Cromogranina A , Cromograninas/sangue , Terapia Combinada , Neoplasias Duodenais/patologia , Gastrinoma/patologia , Gastrinoma/terapia , Gastrinas/sangue , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Metástase Linfática , Equipe de Assistência ao PacienteRESUMO
In neonates a new fixation of the trocars must be found since the umbilical ring is large and distensible and the abdominal wall is very thin. The pressure-controlled pneumoperitoneum is maintained by using a special "surgiflator" system which prevents high pressure peaks in the small abdominal cavity of neonates. By using a Nd:YAG laser for transection during coagulation an additional trocar can be dispensed with.
Assuntos
Endoscópios , Laparoscópios , Toracoscópios , Desenho de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/patologia , Doenças do Prematuro/cirurgia , Terapia a Laser/instrumentação , Masculino , Pneumoperitônio Artificial/instrumentação , Instrumentos CirúrgicosRESUMO
Duodenal duplications are rare. Modern imaging procedures demonstrate the relation of the duplication to the duodenum and the adjacent organs. Thus the surgical procedure can be selected preoperatively. Endoscopic ultrasound is an excellent technique for visualizing a duodenal duplication. A cystic duodenal duplication measuring 6 cm in diameter was resected in a 13-year-old boy.