The U.S. military wartime pediatric trauma mission: how surgeons and pediatricians are adapting the system to address the need.

Purpose: Over 3,500 infants and children, many critically ill and injured, have been admitted to military combat support hospitals (CSH) in Afghanistan and Iraq, which are not doctrinally staffed or equipped to provide their care. This report details how the military medical system is adapting to create a data driven and comprehensive response to optimize the medical and surgical pediatric care being provided.

Methods: Information from multiple sources was used over time to craft the military medical response to the pediatric wartime mission.

Etiology and retrieval of retained central venous catheter fragments within the heart and great vessels of infants and children.

Background: The use of centrally positioned venous catheters plays an indispensable role in the care of infants and children.

Methods: Since 1992 the authors have seen nine patients who experienced fragmentation and migration of catheter fragments into the central circulation. The patients ranged in age from 6 days to 15 years.

Failure of pre-natal ultrasonography to prevent urinary infection associated with underlying urological abnormalities.

Objectives: To analyse the reasons underlying the failure of routine pre-natal ultrasonography to prevent the subsequent development of urinary tract infection (UTI) in children with predisposing urological abnormalities.

Patients And Methods: This retrospective study comprised 39 children (22 females and 17 males) who had at least one documented UTI, the presence of an anatomical anomaly of the urinary tract recognized as predisposing to UTI and had undergone ultrasonography of the urinary tract undertaken in fetal life as part of routine maternal ante-natal ultrasonography. Four categories of patients were defined: Group A, those with normal findings on pre-natal ultrasonography and no urological abnormality detected; Group B, those with a urological abnormality detected but where there was a subsequent failure of communication among clinicians; Group C, those with a urological abnormality but who received inappropriate or sub-optimal post-natal management and; Group D, those with a urological abnormality but who had a UTI despite appropriate post-natal management.

Laparoscopic exploration of the contralateral groin in children: an improved technique.

Repair of inguinal hernias are among the most frequently performed operative procedures in children. Bilateral inguinal hernias (BIH) are common, especially in patients under the age of 2 years, and present both synchronously and metachronously. Most pediatric surgeons perform open exploration of the contralateral groin in infants and young children with symptomatic unilateral inguinal hernias to avoid missing the potential metachronous presentation of BIH.

Primary laparoscopic pull-through for Hirschsprung's disease in infants and children.

Between November 1993 and September 1994, 12 primary laparoscopic colon pull-through procedures were performed in infants and children. The patients' ages ranged from 3 days to 6 years. The primary diagnosis in all 12 patients was Hirschsprung's disease.

Emergency reduction of paraphimosis.

Paraphimosis in uncircumcised or incompletely circumcised children is a serious and painful condition requiring prompt reduction to prevent possible necrosis of the glans or urinary obstruction. Techniques described to reduce oedema distal to the constricting ring include application of ice packs, compressive elastic bandages, and making a dorsal slit which necessitates later circumcision. We have used a simple "puncture" technique to treat successfully an uncircumcised 12-year-old boy with severe paraphimosis.

The United States Army Special Forces--Walter Reed Army Institute of Research Field Epidemiological Survey Team (Airborne), 1965-1968.

In 1965, an innovative concept in field medicine was launched in the form of a team of highly-trained, multi-disciplined AM-EDD specialists who were assigned to the Walter Reed Army Institute of Research and attached to the 5th Special Forces Group (Abn) while in Vietnam. Officially designated the U.S.

The effect of betamethasone on neonatal neutrophil chemotaxis.

Antenatal maternal glucocorticoid administration has been widely used to accelerate fetal lung maturation. Glucocorticoids have also been used postnatally in selected neonates as antiinflammatory agents. Numerous studies have shown that glucocorticoids inhibit multiple components of the immune system including neutrophil (PMN) function in children and adults.

The fetal biophysical profile in patients with premature rupture of the membranes--an early predictor of fetal infection.

A modified fetal biophysical profile (nonstress test, fetal movements, fetal breathing movements, fetal tone, amniotic fluid volume, and placental grading) was serially assessed in 73 patients who presented with premature rupture of the membranes and were not in labor. The last study before delivery was compared with the outcome of pregnancy. The relationships between individual variables and combinations of variables (biophysical scoring) and the outcome of pregnancy--as reflected by the development of chorioamnionitis and/or neonatal sepsis--were determined.

Delayed pancreatic pseudocyst formations. Long-term complication of L-asparaginase treatment.

L-asparaginase-induced pancreatitis has been reported during or closely following administration of the drug. Three cases of pseudocyst of the pancreas in two women and one man have previously been reported with the use of intravenous L-asparaginase. An adolescent male developed acute pancreatitis and pseudocyst of the pancreas 16 weeks after cessation of intramuscular L-asparaginase.

Effect of various corticosteroids upon the phagocytic bactericidal activity of neutrophils.

Corticosteroid compounds are used broadly in surgical practice, although mechanisms remain unclarified and efficacy in some situations remains unproved. A recognized adverse effect of steroids in all doses is the potentiation of infection. Specific derivatives of the glucocorticoids appear to have varying degrees of effectiveness in the enhancement of bacterial infection.