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  • 1
    Electronic Resource
    Electronic Resource
    Pneumatic reduction: Advantages, risks and indications (1990)
    Springer
    Pediatric radiology 20 (1990), S. 475-477 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion It is easy to say that a “new” controversial technique is either perfect or useless. Invariably the truth lies somewhere in between. Overall, we strongly believe the air enema technique to be quicker, safer and more effective than liquid enemas in our hands using the guidelines outlined above. However, which ever technique is used, the radiologist involved should take into account the clinical circumstances of each patient. Safety has to be of prime concern in this as in any technique, and we believe that these guidelines are a safe starting point for further evaluation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02075214
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  • 2
    Electronic Resource
    Electronic Resource
    Partially reduced intussusception: When are repeated delayed reduction attempts appropriate? (1995)
    Springer
    Pediatric radiology 25 (1995), S. 104-107 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The imaging techniques for diagnosis and monitoring of reduction of intussusception by fluoroscopy and ultrasound continue to evolve. The common goal of all protocols is to reduce the intussusception by enema in as many patients as possible and avoid laparotomy with its potential morbidity. We report two infants in whom the initial attempt at reduction by air enema only achieved partial reduction, from the descending colon to the transverse colon in one, and from the splenic flexure to the caecum in the other. Both patients became asymptomatic and clinically stable. In light of the clinical stability, and in consultation with the surgeons, laparotomy was deferred. Sonography was used to confirm the persistence of the intussusception before repeat air enema several hours later. Following three further air enemas in each child, the intussusceptions were successfully reduced after 20 h and 24 h respectively. Both patients remained asymptomatic and did not require surgery. In infants with partially reduced intussusception we suggest that if the patient becomes asymptomatic and stable, surgery can be safely delayed to permit further attempts at enema reduction. Sonography has a valuable role in determining the persistence of the intussusception prior to repeat enema. Close cooperation with the surgeon and careful clinical monitoring of the patient are essential requirements for this proposal.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02010317
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  • 3
    Electronic Resource
    Electronic Resource
    Traumatic diaphragmatic injuries in infants and children: imaging findings (2000)
    Springer
    Pediatric radiology 30 (2000), S. 471-479 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives. Traumatic diaphragmatic injuries (DI) in infants and children are uncommon and are often associated with multiple severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. We present the imaging findings in a relatively large population of children who experienced this rare injury.¶Methods. Medical records of all patients admitted to our Trauma Service from 1977 to 1998 with DI were retrospectively reviewed recording imaging, clinical and surgical or autopsy findings.¶Results. Of sixteen patients with DI (7 females, 9 males; age 3 weeks to 15 years), 14 suffered from blunt trauma secondary to high-energy impact, and 2 from penetrating injuries. Unilateral DI occurred equally on each side, with one bilateral injury. Associated injuries, present in 81 %, included severe head injuries, visceral, mesenteric and vascular injuries and multiple fractures. Six patients died from multiple organ failure (3), head injury (2), and shock (1). Findings in the initial chest X-ray suggested the diagnosis in 13 (81 %) of 16 injuries, and CT demonstrated irregularity and thickening of the diaphragm in 4 out of 7.¶Conclusions. Plain film findings suggested the diagnosis in most; CT and MR were useful adjuncts. High index of suspicion and awareness of the mechanism of injury can lead to prompt diagnosis, early repair, and decreased morbidity and mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002470000242
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  • 4
    Electronic Resource
    Electronic Resource
    Intussusception in the 1990s: has 25 years made a difference? (1997)
    Springer
    Pediatric surgery international 12 (1997), S. 374-376 
    Details
    ISSN: 1437-9813
    Keywords: Intussusception ; Air enema ; Hydrostatic reduction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the current management of the infant and child with intussusception, the medical records of 188 consecutive intussusception patients over 5 years (1985–1990) were reviewed and compared to our series from 25 years ago (1959–1968). The peak months changed from May and June to January and July. Duration of symptoms and signs prior to diagnosis increased by one-third to 35 h with, however, a decrease in the incidence of pain, vomiting, abdominal mass, and rectal blood. Air was the only contrast used for the hydrostatic enema in the present series and was tried in every case with 81% success; this is a major improvement from 45% in the old series. There were three perforations (1.4%) with air-enema attempts compared with 1 (0.2%) 25 years ago. Recently only 19% of patients required operation but 30% needed resection; 55% of the patients in the older series required operation and 20% needed resection. Ten percent of intussusceptions continue to be found spontaneously reduced at operation. There were many less pathologic lead points in the newer series. The recurrences increased from 4% to 7%, but their reduction rate also increased from 31% with barium to 100% with air. There were no deaths in the last 25 years.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01076943
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  • 5
    Electronic Resource
    Electronic Resource
    Imperforate anus (anal agenesis) with rectal and sigmoid atresias in a newborn (1997)
    Springer
    Pediatric surgery international 12 (1997), S. 449-451 
    Details
    ISSN: 1437-9813
    Keywords: Key words Imperforate anus ; Anal agenesis ; Rectal atresia ; Colon (sigmoid) atresia ; Pena procedure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A male baby was born to a healthy mother after an uncomplicated 39-week pregnancy. He had finger and toe syndactyly, right hemidiaphragm eventration, and a high imperforate anus (anal agenesis). The kidneys and chromosomes were normal. A right transverse colostomy was done and 5 months later he underwent a posterior sagittal anorectoplasty (Pena procedure). An intermediate imperforate anus with no urethral fistula and a rectal atresia 2 cm proximal to the distal rectal pouch were found; the distal rectal pouch was resected and the standard Pena procedure completed. Dilatations were initiated 2 weeks postoperatively and continued until the colostomy was closed. Prior to closure of the colostomy, a distal colon loopogram demonstrated an obstruction in the sigmoid; constrast introduced via the rectum outlined the same obstruction separated by 2 cm. A low sigmoid atresia was then repaired. Three weeks later, a contrast loopogram showed a narrow but intact rectosigmoid anastomois, and the colostomy was closed. The anorectal dilatations were discontinued and he remains well at 7 years of age.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050178
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  • 6
    Electronic Resource
    Electronic Resource
    Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile? (1999)
    Springer
    Pediatric surgery international 15 (1999), S. 214-216 
    Details
    ISSN: 1437-9813
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pneumatic reduction of idiopathic intussusception is successful in about 80% of cases, while 60% of the failures are reduced at surgery without resection. To determine whether delayed, repeated attempts at enema reduction of failures would reduce the need for operation in selected cases, over a 2-year period (1994–1996 inclusive), 17 infants with idiopathic intussusception underwent delayed repeat enemas 2–19 h following the first failed attempt at reduction. Clinical parameters and radiologic findings were evaluated with respect to outcome. Ten intussusceptions were successfully reduced after the second attempt in 9 and after the fourth attempt in 1. Seven children underwent a laparotomy, 5 because of failure of progressive reduction at air enema (AE). Two were taken to surgery early in the series, 1 because of perforation during a second attempt and 1 while awaiting a third reduction attempt. The 10 successful reductions all showed progressive movement of the intussusceptum on each AE; the 2 who perforated failed to show progressive reduction on their second AE. Because of these cases, the remaining 5 were referred to surgery because of failure of progressive reduction of the intussusceptum on the second attempt. At laparotomy, of the 7 unsuccessful reductions, 4 required resection and 3 had difficult manual reduction. The presence of vomiting, a mass, and/or bloody stools were not predictors of outcome. Failures had higher body temperatures (38.1 ± 0.3 vs 37.4 ± 0.1 °C, P = 0.07), heart rates (153.7 ± 8 vs 136.9 ± 2.1 min, P = 0.03), and longer duration of symptoms (36.8 ± 4 vs 21.3 ± 3.6 h; P = 0.01) than successes. Delayed repeat AEs may be safe and effective in selected cases of idiopathic intussusception, but should be considered only if significant movement of the intussusceptum is noted at each attempt. The ideal time for repeat AE reduction prior to surgery is not established, but 2–4 h appears appropriate. Pyrexia, tachycardia, and duration of symptoms greater than 36 h are relative contraindications to this course of management.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050558
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  • 7
    Electronic Resource
    Electronic Resource
    Imperforate anus (anal agenesis) with rectal and sigmoid atresias in a newborn (1997)
    Springer
    Pediatric surgery international 12 (1997), S. 449-451 
    Details
    ISSN: 1437-9813
    Keywords: Imperforate anus ; Anal agenesis ; Rectal atresia ; Colon (sigmoid) atresia ; Pena procedure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A male baby was born to a healthy mother after an uncomplicated 39-week pregnancy. He had finger and toe syndactyly, right hemidiaphragm eventration, and a high imperforate anus (anal agenesis). The kidneys and chromosomes were normal. A right transverse colostomy was done and 5 months later he underwent a posterior sagittal anorectoplasty (Pena procedure). An intermediate imperforate anus with no urethral fistula and a rectal atresia 2 cm proximal to the distal rectal pouch were found; the distal rectal pouch was resected and the standard Pena procedure completed. Dilatations were initiated 2 weeks postoperatively and continued until the colostomy was closed. Prior to closure of the colostomy, a distal colon loopogram demonstrated an obstruction in the sigmoid; constrast introduced via the rectum outlined the same obstruction separated by 2 cm. A low sigmoid atresia was then repaired. Three weeks later, a contrast loopogram showed a narrow but intact rectosigmoid anastomois, and the colostomy was closed. The anorectal dilatations were discontinued and he remains well at 7 years of age.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01076966
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  • 8
    Electronic Resource
    Electronic Resource
    Laparotomy or drain for perforated necrotizing enterocolitis: who gets what and why? (1997)
    Springer
    Pediatric surgery international 12 (1997), S. 137-139 
    Details
    ISSN: 1437-9813
    Keywords: Necrotizing enterocolitis Neonatal perforation ; Peritoneal drain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between 1974 and 1988, 86 newborns with perforated necrotizing enterocolitis (NEC) were treated by either laparotomy (usually involving a bowel resection and a temporary stoma) or a peritoneal drain under local anesthesia. The survival of babies in the laparotomy group was 57% versus 59% in the drained group. However, for neonates less than 1,000 g survival in the drained group was 69% compared to 22% for the laparotomy group (P 〈.01). As the weight of the babies increased over 1,000 g, the survival in the laparotomy group increased to 67%. There was no significant increase in survival in infants over 1,500 g. The highest neonatal mortality risk is generally found among babies weighing less than 1,000 g at birth with a gestational age of less than 30 weeks. This risk increases even more when perforated NEC is added to the prematurity. With the use of peritoneal drainage, survival in this group can approach that of larger neonates.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01349981
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  • 9
    Electronic Resource
    Electronic Resource
    Pediatric pheochromocytoma A 36-year review (1997)
    Springer
    Pediatric surgery international 12 (1997), S. 595-598 
    Details
    ISSN: 1437-9813
    Keywords: Key word Pheochromocytoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fourteen children (10 boys and 4 girls, aged 8 to 17 years) had 20 pheochromocytomas treated over a 36-year period from 1959 to 1995 inclusive. Nine patients had 11 tumors before 1980; 5 children had 9 tumors up to 1987. There were no new children with pheochromocytomas at our hospital from 1988 to 1995. Hypertension, sweating, headache, and visual blurring were the most common symptoms and signs (average 5 months). The most reliable biochemical investigations were the urinary catecholamines and norepinephrine. Before 1980, intravenous pyelography and angiography were most successful in localizing the tumor, but since then ultrasonography and computerized tomography have been the radiological investigations of choice. Early involvement of the anesthesiologist in the preoperative control of the hypertension is essential; blood pressure (BP) control was achieved with phenoxybenzamine. The main anesthetic drugs used were: sodium thiopental, fentanyl, methoxyflurane, isoflurane, nitrous oxide, and metocurine. Sixteen tumors were adrenal and 4 were extra-adrenal (1 intrathoracic and 1 extradural). All except 2 tumors were completely resected; they ranged in size from 1.3 to 14 cm. Ligation of the tumor's venous drainage was usually associated with a sudden, temporary fall in systemic BP. There were 2 children with malignant tumors. Four patients had five recurrences (second pheochromocytoma) within 6 years, and all were heralded by a return of their original symptoms and signs. One girl was left with no adrenal tissue. The only complication was in a boy with a large, partly-resected malignant right adrenal tumor who had a subphrenic abscess drained and was left with a temporary bile fistula, cirrhosis, and chronic pain. All children were normotensive when discharged from hospital and remain alive and well with a follow-up of 7 to 36 years. There were no deaths. Long-term follow-up is essential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01371907
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  • 10
    Electronic Resource
    Electronic Resource
    To tube or not to tube: do infants and children need post-laparotomy gastric decompression? (1998)
    Springer
    Pediatric surgery international 13 (1998), S. 411-413 
    Details
    ISSN: 1437-9813
    Keywords: Key words Nasogastric decompression ; Pediatrics ; Post-laparotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this study was to evaluate the role of nasogastric (NG) decompression after laparotomy in pediatric surgical practice: 94 children who underwent abdominal surgery by a single surgeon were consecutively prospectively managed without postoperative NG tubes. Patients with either bowel obstruction or intra-abdominal infection were excluded from the study. These children were compared with 94 retrospective, matched controls who were routinely managed with postoperative NG decompression by the same surgeon. Data were analyzed with regard to patient, operative, and outcome variables. There was no difference in gender, age (3.8 ± 0.5 vs 3.5 ± 0.4 years, P 〉 0.7), or postoperative complications (P 〉 0.8) between the two groups. However, there was a higher incidence of postoperative vomiting (22% vs 11%, P 〉 0.05) in the children who did not have postoperative NG decompression. Nevertheless, a significant decrease in time to first feed, first stool, and discharge was noted in the group of patients managed without NG tubes (P 〈 0.05). NG decompression thus need not be routinely used in the pediatric patient undergoing abdominal surgery, as there is no difference in postoperative complications and the hospital stay is shortened.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050351
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