Recurrent rectal prolapse following primary surgical treatment.

Purpose: The management of recurrent rectal prolapse following initial surgical procedures remains unclear. We present a series of pediatric patients with rectal prolapse and describe their surgical management, and the subsequent care for those children developing recurrence.

Methods: The records of 29 pediatric patients with rectal prolapse refractory to conservative medical management who were managed with primary modified Thiersch procedures over a 14-year period were reviewed.

C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients.

Background: Appendectomy is the treatment of choice in acute appendicitis in children. Delayed diagnosis of acute appendicitis in children can lead to complications like perforation. Studies on the diagnostic value of WBC and CRP in establishing the diagnosis of appendicitis have contradictory results.

Laparoscopic vs open surgical approach for intussusception requiring operative intervention.

Purpose: Laparoscopy has recently been used to treat intussusception that cannot be reduced radiologically. The effectiveness and practical nature of this approach has been questioned.

Methods: This study retrospectively analyzed the authors' experience with this laparoscopic approach and compared this to the conventional open laparotomy procedure.

Outpatient adolescent surgical problems.

There are several conditions for which adolescents seek surgical opinion. Many of these necessitate the performance of an office procedure. This article gave perspective on those relatively common and superficial lesions in an office setting.

Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children.

Biliary dyskinesia is defined as symptomatic biliary colic without cholelithiasis, and is diagnosed during cholescintigraphy by assessing gallbladder emptying with cholecystokinin (CCK) stimulation. Unfortunately, gallbladder emptying is not routinely assessed during cholescintigraphy in pediatric patients. The purpose of this review is to assess the effectiveness of cholecystectomy in patients with chronic abdominal pain and delayed gallbladder emptying and to assess whether these findings correlate with the histologic evidence of chronic cholecystitis.

Severe esophageal damage due to button battery ingestion: can it be prevented?

Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. Medline was used to search the English medical literature, combining "button battery" and "esophageal burn" as keywords.

Specialty networking in pediatric surgery: a paradigm for the future of academic surgery.

Objective: To review retrospectively a 4-year experience with pediatric surgical networking at a major academic medical center in the Midwest.

Background: The growth of managed care in the United States during the past decade has had a major impact on the practice of medicine in general, but especially on academic medicine. In some academic medical centers, the loss of market share has not only affected clinical activity but has also compromised the educational and research missions of these institutions.

Chest wall deformities.

Children present with chest wall deformities to their pediatrician because of physiologic and psychologic causes. We have a 22-year experience in the operative management of more than 300 of these children. Initial evaluation should accurately categorize the deformity, determine the severity, assess for associated problems and refer the child at an appropriate time for further management.

Aggressive giant cell fibroblastoma with a balanced 17;22 translocation.

Cytogenetic analysis of an aggressive giant cell fibroblastoma in a 15-month-old male revealed the following balanced translocation: t(17;22)(q21.33;q13.1).

Nutritional management of dumping syndrome associated with antireflux surgery.

Eight children were identified as having dumping syndrome by a glucose tolerance test and evidence of rapid gastric emptying. All had undergone a fundoplication with concomitant feeding gastrostomy placement at 18.4 +/- 17.

Impact of nutritional rehabilitation on gastroesophageal reflux in neurologically impaired children.

The impact of nutritional rehabilitation on gastroesophageal reflux (GER) in 10 malnourished neurologically impaired children (NIC) was studied (mean age, 9.1 +/- 3.1 years).

Pectus excavatum: a 15-year perspective.

Pectus excavatum is relatively uncommon. Our experience with 177 children during a 15-year period produced changes in our surgical technique, which now includes a small transverse incision, minimal subcutaneous flap elevation, a muscle-relaxing incision over the fifth costal cartilage, complete resection of involved cartilage, use of Adkins' strut, suspension of sternum to strut, taut reefing of intercostal muscle, no tubes or drains, epidural analgesia, a patient-controlled analgesia device postoperatively, and eventual strut removal. Use of the evolved technique gives excellent cosmetic results, good functional results with minimal discomfort, and a shorter convalescent period.

Shotgun injuries in pediatric patients.

Firearms, particularly high-powered automatic weapons, injure progressively younger children in urban environments. At Arkansas Children's Hospital, 32 children have been admitted for gunshot wounds in 12 years. Air guns (3), handguns (19), and shotguns (10) caused the injuries.

A randomized clinical trial of ampicillin, gentamicin and clindamycin versus cefotaxime and clindamycin in children with ruptured appendicitis.

This prospective, randomized, double-blind study compares the efficacy, safety and cost-effectiveness of ampicillin, gentamicin and clindamycin (AGC) or cefotaxime and clindamycin (CC) for the treatment of children with complicated appendicitis. Ninety-seven children were randomized. Forty-seven were assigned to the AGC regimen and 50 received CC.

Abscess of the iliopsoas muscle diagnosed by magnetic resonance imaging and ultrasonography.

We have reported a case of abscess of the iliopsoas muscle, in which a limp and hip pain pointed toward pathology of the hip. The diagnosis in such cases may be difficult unless there is close attention to the clinical history and a good physical examination is obtained. One ultrasonographic examination of the hip in such a patient, subtle differences between the iliopsoas muscles should alert the radiologist to examine the psoas muscle.

Porcelain gallbladder in a child: a case report and review.

Calcification of the gallbladder wall (porcelain gallbladder; PGB) is a rare form of gallbladder disease not previously described in a child. A 10-year-old girl is presented with PGB that was discovered incidentally during intravenous urography. Computed tomography localized the calcification to the gallbladder wall.

Transthoracic fundoplication after previous abdominal surgery: an alternate approach.

Fundoplication for gastroesophageal reflux is a frequent procedure for pediatric surgeons. Reoperation in the abdominal cavity can be time-consuming and hazardous. Therefore, 33 patients (16 male and 17 female) with symptomatic gastroesophageal reflux after previous abdominal procedures had transthoracic fundoplications.

Pediatric pilonidal disease: a method of management.

Pilonidal disease is a common problem; its many management options are testimony to the difficulty in its eradication. Its etiology is distention of midline skin orifices with ingestion of hair shafts from hirsute buttocks. Thus, the disease does not usually appear until after puberty.

Sigmoid volvulus in childhood.

Although it is common in the adult population, sigmoid volvulus is unusual in childhood. We report the cases of four children treated for sigmoid volvulus, and we review an additional 44 cases. The mean age of occurrence was 8 years.

Management of empyema in children.

The antibiotic era has changed the incidence, causal factors, and gravity of empyema. Between 1977 and 1988, 27 children with empyema were surgically managed. Ten cases occurred after an operation (8 esophageal and 2 abdominal).