RESUMEN
BACKGROUND: We hypothesize that in testicular torsion, the duration of symptoms (DoS) better correlates with predicting testicular viability than minimizing the "time-to-treat" (TtT) after presentation to a medical facility. MATERIALS AND METHODS: Medical records of male pediatric patients treated for suspected diagnosis of testicular torsion in the emergency department (ED) from January 1, 2016, to December 31, 2018, were retrospectively evaluated. Forty-one patients met inclusion criteria. Statistical analysis compared testicular viability based on TtT, DoS, and site of initial presentation. RESULTS: Testicular salvage rates for patients presenting directly to our ED was 56.3% with an average TtT of 2.5 h versus 77.8% and 1.96 h, respectively, for transferred patients. Overall testicular survival was not statistically impacted by the difference in TtT. Comparing DoS, an 84% testicular salvage rate (DoS < 24 h) versus a 15.4% salvage rate (DoS > 24 h) was shown in patients presenting directly to our ED (P ≤ 0.0001). Within the total population (n = 41), a significant difference was also shown (P ≤ 0.0001) when comparing overall testicular salvage rates in patients presenting with <24 h versus >24 h total DoS (84% versus 25%). CONCLUSIONS: These data reveal that an alternative predictor of testicular salvage rates is a DoS < 24 h. This is a meaningful metric when providing accurate preoperating counseling to parents and may be a better focus of quality improvement efforts surrounding this topic.
Asunto(s)
Reglas de Decisión Clínica , Toma de Decisiones Clínicas/métodos , Diagnóstico Tardío , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/cirugía , Tiempo de Tratamiento , Supervivencia Tisular , Adolescente , Niño , Preescolar , Humanos , Lactante , Masculino , Orquiectomía , Pronóstico , Estudios Retrospectivos , Torsión del Cordón Espermático/patologíaAsunto(s)
Enfermedades Gastrointestinales/diagnóstico por imagen , Gastrosquisis/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Prenatal , Líquido Amniótico , Nutrición Enteral , Femenino , Enfermedades Gastrointestinales/etiología , Gastrosquisis/complicaciones , Gastrosquisis/cirugía , Humanos , Recién Nacido , Complicaciones Posoperatorias/etiología , Análisis de Regresión , Estudios RetrospectivosRESUMEN
Congenital bronchobiliary fistula (CBBF) is a rare anomaly. Twenty-three cases have been reported since the anomaly was first described in 1952. Most of these cases were diagnosed by bronchoscopy, cholangiography, or hepatobiliary nuclear imaging. Our case of a newborn with bilious emesis with CBBF was depicted by T1-weighted gradient-echo MRI sequences.
Asunto(s)
Fístula Biliar/congénito , Fístula Biliar/diagnóstico , Fístula Bronquial/congénito , Fístula Bronquial/diagnóstico , Imagen por Resonancia Magnética , Enfermedades de los Conductos Biliares/congénito , Enfermedades de los Conductos Biliares/diagnóstico , Enfermedades de los Conductos Biliares/cirugía , Fístula Biliar/cirugía , Enfermedades Bronquiales/congénito , Enfermedades Bronquiales/diagnóstico , Enfermedades Bronquiales/cirugía , Fístula Bronquial/cirugía , Terapia Combinada , Endoscopía del Sistema Digestivo/métodos , Estudios de Seguimiento , Humanos , Recién Nacido , Laparotomía/métodos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Toracotomía/métodos , Resultado del TratamientoRESUMEN
Children restrained with lap belts may sustain severe injuries. We investigated the frequency of each type of injury associated with seatbelt contusions. The medical records of all trauma patients with ICD-9 codes for abdominal wall contusions from January 1, 1999, to December 31, 2001, were reviewed. All patients with seatbelt contusions were included in the study. Age, seat position, weight, restraint-type, sex, and mechanism of injury were noted. There were 1447 admissions for trauma over the 3-year period. Forty-six patients (ages 4-13) had a seatbelt contusion. Thirty-three wore lap belts, and 13 wore lap and shoulder harnesses. Twenty-two children required abdominal exploration. Small bowel injuries were the most common intra-abdominal injuries. Facial injuries were the most common associated injuries. Forty-eight per cent of children with seatbelt contusions in our institution required surgery. The smaller patients tend to have higher frequency of abdominal injuries. The presence of seatbelt contusion indicates the possibility of severe internal injuries.