Transport of unstable respiratory failure patients on extracorporeal life support

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31292/1/0000198.pd

Resolution of splenic injury after nonoperative management

Numerous studies have demonstrated success with nonoperative management of splenic injuries in pediatric patients. However, the resolution of the splenic injury has not been previously evaluated. The records of 50 pediatric patients with splenic injuries from blunt trauma treated nonoperatively between 1984 to 1992 were reviewed retrospectively. Abdominal computed tomography (CT) was performed at the time of injury and 6 weeks postinjury in 25 patients. These scans were reviewed and categorized by a modification of a previously reported grading system for parenchymal injury. All patients had healing of the splenic injuries, with complete resolution of the healing process observed at 6 weeks postinjury in 44%. Even those with shattered spleens (n = 6) had consistent improvement in splenic architecture, with resolution of fractures and/or contusions and return of splenic perfusion. Ten (77%) of 13 grade 1 and 2 injuries were completely resolved by the 6-week follow-up examination, whereas only one (8%) of 12 grade 3 to 5 injuries showed radiological resolution of splenic injuries. None of the 25 follow-up CT scans affected clinical decision-making or led to a deviation from the established protocol, which included a 3-month period of reduced activity. All 50 patients did well, without evidence of morbidity, mortality, or complications after return to full activity 3 months postinjury. These CT scan results and clinical data show (1) radiological resolution of splenic injury, with return toward a normal appearance by 6 weeks postinjury, (2) uniform success of nonoperative management of splenic injury in children, (3) that follow-up CT scans may be used to indicate earlier return to full activity in most cases of grade 1 and 2 splenic injuries, but otherwise they do not appear to contribute to the clinical management of the child after nonoperative treatment of splenic trauma.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31314/1/0000223.pd

Radical approach to traumatic tracheoesophageal fistula: Use of a biliary stent for esophageal repair in an infant

Background: The incidence of button battery ingestion has increased over time along with its most alarming complications including tracheoesophageal fistula. Historically this issue has been treated with sternotomy and closure of the fistula. However, morbidity and mortality of this invasive approach can be improved upon. Methods: This is an expert report from a tertiary care center, utilizing an adult biliary stent for closure of a giant 2 cm traumatic TEF secondary to a button battery ingestion in a 9 month old. Results: The patient's fistula healed with this radical approach and demonstrated a full return to swallowing, without invasive operative interventions. Conclusion: We present a radical approach with successful treatment of a TEF. This is the first study of its kind to utilize adult biliary stents for closure of a traumatic TEF in an infant. Level of evidence: V