RESUMEN
BACKGROUND: Malrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile-stained vomiting. This leads some clinicians to 'watch and wait'. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations. AIM: To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care. METHODS: Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children's hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death. RESULTS: There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation. CONCLUSION: Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for 'watch and wait' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.
Asunto(s)
Vólvulo Intestinal , Humanos , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/cirugía , Estudios Retrospectivos , Lactante , Femenino , Masculino , Recién Nacido , Preescolar , Factores de Tiempo , Niño , Tiempo de Internación/estadística & datos numéricos , Estudios de Cohortes , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/diagnóstico , QueenslandRESUMEN
AIM: Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland. METHODS: Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed. RESULTS: Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis. CONCLUSION: High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.
Asunto(s)
Atresia Esofágica , Fístula Traqueoesofágica , Niño , Preescolar , Atresia Esofágica/cirugía , Femenino , Humanos , Queensland/epidemiología , Estudios Retrospectivos , Tráquea , Fístula Traqueoesofágica/epidemiología , Fístula Traqueoesofágica/cirugíaRESUMEN
Hepatoblastoma is very uncommon in children, and intracardiac extension is rare. The SIOPEL-4 regime for metastatic hepatoblastoma has extended the surgical options with good results. We successfully treated a boy aged 2 years and 9 months with hepatoblastoma, using a multidisciplinary surgical strategy involving an extended left hepatectomy, left adrenalectomy, biopsy of the paraaortic and coeliac lymph nodes, and resection of the inferior vena caval-right atrial extension of the hepatoblastoma, under cardiopulmonary bypass and deep hypothermia.
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Atrios Cardíacos/cirugía , Hepatectomía , Hepatoblastoma/cirugía , Neoplasias Hepáticas/cirugía , Vena Cava Inferior/cirugía , Adrenalectomía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Puente Cardiopulmonar , Quimioterapia Adyuvante , Preescolar , Atrios Cardíacos/patología , Hepatoblastoma/secundario , Humanos , Hipotermia Inducida , Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética , Masculino , Terapia Neoadyuvante , Invasividad Neoplásica , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vena Cava Inferior/patologíaRESUMEN
Disc battery ingestion in children is becoming increasingly common with the proliferation of small battery-powered electronic devices. In the case of esophageal impaction, the likelihood and severity of complications are proportionate to the time between ingestion and removal. Tracheo-esophageal fistulae (TOF) are a recognized complication and can be life-threatening. We describe an interesting case of disc battery ingestion with delayed recognition of a TOF. We document the tracheal mucosal healing process of a large airway defect and describe the role of bronchoscopy in guiding the timing of surgical intervention. This case highlights the important role of early bronchoscopic assessment in management of these patients.
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Broncoscopía , Suministros de Energía Eléctrica , Cuerpos Extraños/diagnóstico , Aspiración Respiratoria/diagnóstico , Fístula Traqueoesofágica/diagnóstico , Diagnóstico Precoz , Esofagostomía , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Gastrostomía , Humanos , Lactante , Masculino , Aspiración Respiratoria/complicaciones , Aspiración Respiratoria/cirugía , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/cirugíaRESUMEN
BACKGROUND: A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. METHODS: Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected. RESULTS: Eighty-eight patients with gastroschisis were managed over an 11 year period. Forty-four of these patients received SWR, with 2 deaths in the neonatal period. In the 42 survivors, 35 patients were reviewed at a median age of 7 years and 10 months (range, 6-134 months; interquartile range, 37-124 months). One patient experienced failure to thrive and developmental delay, and later died of a medical complication. Thirty-two patients (91.4%) developed an umbilical hernia, only 2 of whom required umbilical herniotomy. Four patients (11.4%) developed small bowel obstruction, all within the first year. CONCLUSION: Most patients with SWR exhibited normal growth with minimal bowel complications. Despite the high incidence of umbilical hernia, the majority resolved spontaneously and did not require subsequent herniotomy.
Asunto(s)
Técnicas de Cierre de Herida Abdominal , Gastrosquisis/cirugía , Cuidado Intensivo Neonatal/métodos , Sistemas de Atención de Punto , Técnicas de Cierre de Herida Abdominal/instrumentación , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/etiología , Insuficiencia de Crecimiento/epidemiología , Insuficiencia de Crecimiento/etiología , Femenino , Estudios de Seguimiento , Hernia Umbilical/epidemiología , Hernia Umbilical/etiología , Hernia Umbilical/cirugía , Herniorrafia , Humanos , Incidencia , Recién Nacido , Enfermedades del Prematuro/cirugía , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Hipertensión Intraabdominal/prevención & control , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Sepsis/epidemiología , Sepsis/etiología , Centros de Atención Terciaria/estadística & datos numéricos , Resultado del TratamientoAsunto(s)
Antineoplásicos/uso terapéutico , Seudoobstrucción Colónica/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Antineoplásicos/efectos adversos , Niño , Estreñimiento/complicaciones , Estreñimiento/tratamiento farmacológico , Estreñimiento/etiología , Femenino , Humanos , Masculino , Neostigmina/uso terapéutico , Parasimpaticomiméticos/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológicoRESUMEN
Management of pediatric malignancy can result in disruption of the integrity of the gastrointestinal mucosa through a variety of mechanisms. We describe a pediatric oncology patient who developed a tracheoesophageal fistula as a complication of treatment for acute lymphoblastic leukemia.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Fístula Traqueoesofágica/inducido químicamente , Humanos , Lactante , Masculino , Tomografía Computarizada por Rayos X , Fístula Traqueoesofágica/diagnóstico por imagen , Fístula Traqueoesofágica/terapia , Resultado del TratamientoAsunto(s)
Quemaduras/etiología , Protección a la Infancia , Alimentos/clasificación , Calor/efectos adversos , Seguridad , Adolescente , Quemaduras/epidemiología , Quemaduras/prevención & control , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Factores de Riesgo , Turquía/epidemiologíaRESUMEN
BACKGROUND/PURPOSE: Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evaluate the results of EGD in our institution and compare them with a neurologically matched group of children who had Nissen fundoplication. METHODS: Twenty consecutive patients who had EGD were retrospectively evaluated and the results were compared with a neurologically matched group of 20 consecutive patients who had Nissen fundoplication. RESULTS: Twenty patients had EGD, 17 as a primary procedure. There was no operative mortality but 5 have died of other causes. Resolution of reflux-associated symptoms occurred in all patients. Of the 15 survivors, 5 remain on antireflux medication. Twenty patients had fundoplication. There was no operative mortality, but 8 patients have died of other causes. Failure occurred in 5 patients necessitating further surgery. Of the 10 unreoperated survivors, 6 remain on antireflux medication. CONCLUSIONS: Esophagogastric dissociation is an effective antireflux procedure when compared with fundoplication. It has a lower failure rate. We recommend EGD as a primary procedure in selected children with severe neurological impairment.
Asunto(s)
Esófago/cirugía , Fundoplicación , Reflujo Gastroesofágico/cirugía , Adolescente , Niño , Preescolar , Femenino , Reflujo Gastroesofágico/etiología , Gastrostomía , Humanos , Lactante , Masculino , Enfermedades del Sistema Nervioso/complicaciones , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The Nuss procedure is a new minimally invasive repair for pectus excavatum that was first published in 1998. Modifications in technique are constantly evolving to minimize complications, especially bar displacement, which are higher in adolescents and adults. The present study reviews our early experience with this procedure in a much older group of children than previously reported and suggests an alternative method of avoiding bar displacement. METHODS: Retrospective chart review was carried out on 78 consecutive patients who underwent the Nuss procedure between December 1999 and January 2004. All patients underwent a uniform technique using bilateral lateral stabilisers and thoracoscopy was not used. Operative details, subjective cosmetic results and complication rates were assessed. RESULTS: The mean age was 15.4 +/- 3.2 years. Single bars were used in 95%, double bars in 5%. The defect was asymmetrical in 26%. The defect was mild in 7%, moderate in 59% and severe in 34%. The median length of stay was 6.0 days (range 4-11). Total operating time was 58 min (range 35-95). Patient controlled analgesia (morphine) for pain relief was used for 105 h (range 61-169) or 4.4 days; the epidural infusion was stopped 1 day earlier. Cosmetic results were excellent in 80.3%. There was residual asymmetry in 75% of the asymmetrical defects although all were improved. Complications included eight (10%) reoperations for bar displacement. This was related to the learning curve as seven of these occurred in the first 2 years of the series. Removal of the bar has been accomplished in 31 (40%) patients. This was elective in all but four patients (three early removals for pain and one for infection). CONCLUSIONS: The Nuss procedure gives good results even in teenagers. Modification of technique and increased experience has reduced complications. The use of bilateral lateral stabilisers without additional wire fixation is an alternative method to avoid bar displacement.
Asunto(s)
Tórax en Embudo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adolescente , Adulto , Niño , Competencia Clínica , Femenino , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Early to mid-term fetuses heal cutaneous incisional wounds without scars; however, fetal response to burn injury has not been ascertained. We present a fetal model of thermal injury and subsequent analysis of fetal and lamb response to burn injury. A reproducible deep dermal burn injury was created in the fetus by application of water at 66 degrees C for 7 seconds, and at 82 degrees C for 10 seconds to the lamb. Macroscopically, the area of fetal scald was undetectable from day 7 post injury, while all lamb scalds were readily identified and eventually healed with scarring. Using a five-point histopathology scoring system for alteration in tissue morphology, differences were detected between control and scalded skin at all stages in lamb postburn, but no difference was detected in the fetal model after day 7. There were also large differences in content of alpha-smooth muscle actin and transforming growth factor-beta1 between control and scalded lamb and these differences were statistically significant at day 14 (P < 0.01). This novel model of fetal and lamb response to deep dermal injury indicates that the fetus heals a deep burn injury in a scarless fashion. Further elucidation of this specific fetal process of burn injury repair may lead to improved outcome for patients with burn injury.
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Quemaduras/fisiopatología , Cicatriz/fisiopatología , Dermis/fisiopatología , Cicatrización de Heridas/fisiología , Actinas/biosíntesis , Animales , Quemaduras/metabolismo , Dermis/lesiones , Feto , Modelos Animales , Ovinos , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta1RESUMEN
Even eight hours after a campfire has been extinguished with sand, it retains sufficient heat to cause a full-thickness burn with contact of one second. Because extinguishing with sand disguises the danger, this is a particular hazard for children. The only safe way to extinguish a campfire is with water.
Asunto(s)
Quemaduras/prevención & control , Sistemas de Extinción de Incendios , Incendios , Niño , Preescolar , Humanos , Dióxido de Silicio , AguaRESUMEN
OBJECTIVES: To document and describe the effects of woodstove burns in children. To identify how these accidents occur so that a prevention strategy can be devised. DESIGN, PATIENTS AND SETTING: Retrospective departmental database and case note review of all children with woodstove burns seen at the Burns Unit of a Tertiary Referral Children's Hospital between January 1997 and September 2001. MAIN OUTCOME MEASURES: Number and ages of children burned; circumstances of the accidents; injuries sustained; treatment required and long-term sequelae. RESULTS: Eleven children, median age 1.0 year, sustained burns, usually to the hands, of varying thickness. Two children required skin grafting and five required scar therapy. Seven children intentionally placed their hands onto the outside of the stove. In all children, burns occurred despite adult supervision. CONCLUSIONS: Woodstoves are a cause of burns in children. These injuries are associated with significant morbidity and financial costs. Through public education, woodstove burns can easily be prevented utilising simple safety measures.
Asunto(s)
Prevención de Accidentes , Accidentes/estadística & datos numéricos , Quemaduras/epidemiología , Quemaduras/etiología , Pediatría/estadística & datos numéricos , Distribución por Edad , Australia/epidemiología , Unidades de Quemados/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Riesgo , Índices de Gravedad del TraumaRESUMEN
OBJECTIVES: To document and describe the effects of campfire burns on children. To identify the sources of danger contributing to such injuries, so that a prevention strategy can be devised. DESIGN, PATIENTS AND SETTING: Departmental database and case note review of all children with campfire burns seen at the Burns Unit of a tertiary referral children's hospital between January 1999 and June 2001. MAIN OUTCOME MEASURES: Number and ages of children burned; risk factors contributing to the accidents; injuries sustained; treatment required and long-term sequelae. RESULTS: Thirty-three children, median age 2.5 years, sustained burns, usually to the hands and feet, with eight requiring surgery and the majority requiring some form of scar therapy. Seventy-four percent of the children were burned by hot ashes and coals, usually from the previous night's fire, rather than by open flames. CONCLUSIONS: Campfires cause serious injuries to children. In particular, hot ashes and coals from inadequately extinguished campfires pose the greatest danger. Increasing the awareness of this easily preventable problem amongst campers is intended through a public education campaign.
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Quemaduras/epidemiología , Recreación , Accidentes , Australia/epidemiología , Niño , Preescolar , Traumatismos de los Pies/epidemiología , Traumatismos de la Mano/epidemiología , Humanos , Lactante , Factores de RiesgoRESUMEN
Riding waves on a bodyboard (boogie board) at the beach is popular with children. Three teenagers who sustained blunt abdominal trauma during bodyboarding are described. Two suffered lacerated livers, one a lacerated spleen. Serious blunt abdominal injuries from bodyboarding mishaps have not previously been reported. The usual method of riding a bodyboard may place the rider at risk of abdominal trauma.