Extracorporeal photopheresis in the treatment of persistent rejection in a pediatric lung transplant recipient.

Lung transplantation is an accepted therapy for children with end-stage lung disease. One-year lung transplant survival rates of 86% have been reported by the United Network for Organ Sharing. Allograft rejection is a common cause of death following transplantation. Extracorporeal photopheresis is a novel therapy used to treat solid-organ rejection; this therapy involves separating the leukocyte-rich fraction from whole blood, treating with psoralen and ultraviolet light A exposure. The objective of therapy is to reverse progressive and persistent rejection. Working collaboratively with an institution that offers extracorporeal photopheresis may provide an alternative or additional therapy in the management of ongoing rejection following solid-organ transplantation.

In their own words: the lived experience of pediatric liver transplantation.

Liver transplantation is the treatment of choice for children with end-stage liver disease. Few studies have examined the experience of transplantation from the child's perspective. Using a phenomenological approach establishes a safe environment for children to reflect on their lives as transplant recipients. The aim of this study was to uncover the experiences of pediatric liver transplant recipients from the period prior to transplantation, through surgery, and beyond. In-depth conversations with 9 pediatric recipients were carried out. Phenomenological methodology guided the data collection and analysis. The children faced many challenges, including surviving a life-threatening illness while accomplishing normal developmental tasks. The predominant theme was striving for normalcy in their lives.

Management of blunt abdominal trauma in children.

TOPIC: Over the last decade non-operative management of children with blunt abdominal trauma has been established as safe and efficacious. PURPOSE: This paper reviews the clinical management and resource utilization patterns in a pediatric trauma center in the mid-Atlantic region. It focuses on the following issues admission to the intensive care unit, safe interval for activity restriction, pre and post imaging with CT, rate of laparotomy and transfusion requirements of children with blunt abdominal trauma. Nursing care and medical management from the initial evaluation through discharge are discussed. SOURCES: Management of blunt abdominal injury in children was restructured using an algorithm suggested by the American Pediatric Surgical Association (APSA) trauma committee to coordinate care at a regional trauma center. CONCLUSIONS: Results indicated a decrease in LOS from 6 days to 4 days, and a 20% reduction in total costs.

The effect of dysfunctional voiding on the costs of treating vesicoureteral reflux: a computer model.

PURPOSE: We created a computer model for evaluating the effect of dysfunctional voiding on the costs of managing vesicoureteral reflux in children. MATERIALS AND METHODS: The literature on vesicoureteral reflux was reviewed to create a set of assumptions regarding the epidemiology, likelihood of resolution, need for operative intervention, risk of infection and appropriate regimen for nonoperative surveillance. Recent literature describing the effect of dysfunctional voiding on the clinical course of vesicoureteral reflux was included in the model to compare the costs of treating vesicoureteral reflux in children with and without dysfunctional voiding. A 5-year management period was considered. RESULTS: Dysfunctional voiding in children with vesicoureteral reflux increased the cost of treatment per patient by 51.2%. The cost per patient increased with increasing grade in those with and without dysfunctional voiding. The difference in costs in the 2 groups increased from 18.7% for grade 1 reflux to 62.1% for grade 5. Sensitivity analysis was performed, in which the risk of urinary tract infection, rate of surgical resolution, incidence of dysfunctional voiding and discount rate varied. The cost in children with dysfunctional voiding remained higher in all scenarios studied, showing the robustness of the model. CONCLUSIONS: Dysfunctional voiding substantially increases the costs of treating children with vesicoureteral reflux due to the higher rate of urinary tract infection in children with dysfunctional voiding. Methods that would decrease the rate of urinary tract infection in children with dysfunctional voiding and vesicoureteral reflux would lead to a significant saving of health care dollars.