Gastroschisis: determinants of neonatal outcome.

This retrospective study elicits information regarding the dependence of neonatal outcome in gastroschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome.

Cardiac arrest outcomes at the Melbourne Cricket Ground and shrine of remembrance using a tiered response strategy-a forerunner to public access defibrillation.

The provision of medical, paramedical and first aid services at major public events is an important concern for pre-hospital emergency medical care providers. Patient outcomes of a cardiac arrest response strategy employed at the Melbourne Cricket Ground (MCG) and the Shrine of Remembrance by St John Ambulance Australia volunteers are reported. Twenty-eight consecutive events occurring between December 1989 and December 1997 have been analysed. Included are three cardiac arrests managed at ANZAC day parades utilising the same response strategy by the same unit. The incidence of cardiac arrest at the MCG was 1:500000 attendances. Of the 28 patients, 24 (86%) left the venue alive and 20 (71%) were discharged home from hospital. In all cases the initial rhythm was ventricular fibrillation (VF). All 26 patients (93%) who were defibrillated by St John teams had this intervention within 5 min from the documented time of collapse. One patient in VF spontaneously reverted during CPR. Of the eight fatalities, four died at the scene. At major public venues and events, a co-ordinated emergency life support provision strategy, tailor made for the venue, is necessary for the delivery of prompt CPR, timely defibrillation and advanced life support.

Does tea tree oil have a place in the topical treatment of burns?

Burnaid is a sorbalene-based cream containing 40 mg/g of tea tree oil and 1 mg/g of triclosan. This investigation was carried out to determine the effect of Burnaid, a commercial tea tree oil preparation, against Enterococcus faecalis (ATCC29212), Staphylococcus aureus (ATCC29213), Escherichia coli (ATCC25922), and Pseudomonas aeruginosa (ATCC27853), with the activity of the base product in the commercial preparation. The organisms were suspended in sterile saline (0.5 McFarland Standard) and inoculated onto horse blood agar (E. faecalis and S. aureus) or Mueller-Hinton agar (E. coli and P. aeruginosa). One hundred microliters of Burnaid unsterilized, Burnaid sterilized and the base product (Tinasolve) were placed in duplicate in wells cut into the agar plates. Sterility and inactivation cultures were also performed on the samples. None of the samples were found to be contaminated with bacteria prior to testing. Only S. aureus and E. coli showed zones of growth inhibition around the Burnaid and Tinasolve. Zones of growth inhibition (22 mm) were similar for the active product (Burnaid) and the base (Tinasolve). There was no activity against E. faecalis or P. aeruginosa. In view of our findings and literature indicating the cytotoxicity of tea tree oil against human fibroblasts and epithelial cells, it is recommended that this product should not be used on burn wounds.

Critical appraisal of surgical venous access in children.

Central venous catheters (CVC) have become an important adjunct to the overall management of paediatric patients, but their use is associated with frequent complications resulting in premature removal. This report evaluates the insertion techniques and complications of 295 consecutive surgically inserted CVC from 1987 to 1991 in a paediatric hospital. Fully implanted catheters had significantly less incidence of catheter-related problems necessitating removal (infection, dislodgment, leaking, blockage, or migration - 31%) compared to exteriorised catheters (58%). One-third of catheters were removed because of infection, one-third as they were no longer needed, and the remaining for multiple reasons. Infected (110+/-18 days), dislodged (18+/-4 days), or migrated (44+/-6 days) catheters were removed significantly earlier than those removed because they were no longer needed (195+/-24 days). Catheters became dislodged more frequently in the younger patients. Catheters with the tip in the subclavian vein (29%) migrated more frequently than those in the right atrium. There was a significantly increased incidence of infection in catheters inserted into the saphenous vein (43%) compared to those in the internal jugular vein (11%). Some episodes of catheter infection were managed with antibiotics, with short-term resolution of symptoms and signs. However, all 71 infected catheters ultimately required removal for further sepsis. Fully implanted catheters had 1.1 episodes of catheter-related sepsis per 1,000 catheter days compared to 3.7 for exteriorised catheters. The position of the catheter tip, vein used for insertion, training of young surgeons, and location of the subcutaneous tunnel need particular attention in order to reduce catheter complications.

Hereditary presacral teratoma.

A case of hereditary presacral teratoma involving father and daughter is described. The use of magnetic resonance imaging in the diagnosis of this condition is illustrated and a review of the literature of this unusual condition is presented.

Bicycle incidents in children--abdominal trauma and handlebars.

OBJECTIVES: To investigate the frequency and causes of bicycle related abdominal injuries in children and to examine the pattern of presentation. DESIGN: The study was a prospective study of bicycle related injury in children less than 15 years of age presenting to two paediatric hospitals (15 April-30 June 1992) and three general hospitals (1 August 1991-30 June 1992). RESULTS: In a series of 813 children, 41 sustained non-penetrating abdominal trauma due to a bicycle incident. In 21 cases, handlebar trauma was responsible. Ten of these children suffered life-threatening intra-abdominal injury. Handlebars with no plastic or foam covering of the metal ends were involved in all ten cases. In several of these cases, presentation to hospital was delayed and in others confirmation of the extent of injury took up to 48 hours. The length of hospital stay for those with significant intra-abdominal organ damage ranged from two to 156 days. CONCLUSIONS: Intra-abdominal trauma must be considered when dealing with children who are victims of bicycle trauma. Impact with handlebars may have occurred and some form of padded protection of handlebar ends is recommended unless their design can be suitably modified.

Metastasis of pineal germinoma via ventriculoperitoneal shunt.

The case of a 13 year old boy with pineal germinoma and subsequent metastasis 3 years later via ventriculoperitoneal shunt to the abdominal cavity is presented. The abdominal disease was managed with chemotherapy and subsequent surgical resection. He remains free of disease 2 years following the resection. The literature regarding this rare complication is reviewed.

Cutaneous button battery injury: a new paediatric hazard.

Button or disc batteries have become increasingly popular as the energy source for electronic devices such as cameras, calculators, computers, watches, hearing aids and children's toys. Button battery burns to the gastrointestinal tract, ear and nose have been reported in children from many centres. Cutaneous injury from these sources has not been similarly reported. We believe our case represents the first, reported to date, to have suffered this injury and highlights this further potential hazard of the small, benign-looking button batteries.

Segmental dilatation of the small bowel: report of three cases and literature review.

Segmental dilatation of the small bowel is a rare congenital abnormality that occurs mainly in children and produces significant nonspecific symptoms. The authors reviewed 33 cases reported in the literature and present three new cases in which the lesion was demonstrated on radiographs obtained before laparotomy. These cases showed the spectrum of symptoms and characteristic radiologic features of this condition in both plain abdominal radiographs and barium studies. Plain radiographs of the abdomen may show an isolated loop of bowel containing an air-fluid level. The characteristic finding in barium studies of the small bowel is a localized dilatation of the small bowel lumen with afferent and efferent loops. In the absence of a complication or coexistent cause of obstruction, the transit time of contrast medium through the small bowel is not delayed. The radiologic examination is useful in diagnosis, and the condition is cured with surgery.

Renal and urinary tract complications following the intravesical instillation of formalin.

The case is reported of a 10-yr-old girl who developed intractable hematuria from hemorrhagic cystitis following chemotherapy for a malignant lymphoma. Following the intravesical instillation of formalin, which controlled the hematuria, she developed oliguria attributable to ureteric stenosis and fibrotic contraction of the renal pelves. Bilateral nephrostomies were constructed, but recurrent pyelonephritis and further renal pelvic obstruction developed. A series of renal biopsies and ultimately bilateral nephrectomy revealed severe, chronic interstitial nephritis, massive renal interstitial accumulation of deposits probably containing Tamm-Horsfall protein and, in the left nephrectomy specimen, a florid interstitial chronic granulomatous inflammatory reaction. Although ureterohydronephrosis has been described by others as a complication of the intravesical instillation of formalin, fibrotic contraction of the upper urinary tract and the florid interstitial nephritis with granulomata as described herein have not previously been reported. It is proposed that vesicoureteric reflux of formalin, perhaps accompanied by intrarenal reflux, caused or contributed to these pathological changes.

Spontaneous neonatal renal vein thrombosis.

A case of spontaneous neonatal renal vein thrombosis is presented. A 1 week old, 36 week gestation, male child presented with gross haematuria and a large right flank mass. Investigations including intravenous pyelogram, ultrasound and venacavogram indicated the diagnosis. The child was clinically well, with normal renal and clotting function. No predisposing cause could be found. A conservative approach to treatment was undertaken in view of the normal renal function, and no evidence of consumptive coagulopathy or pulmonary emboli. The child remains well, but may require nephrectomy in the future.