Intravenous vasoactive intestinal polypeptide lowers pulmonary-to-systemic vascular resistance ratio in a neonatal piglet model of pulmonary arterial hypertension.

Background: Several studies of vasoactive intestinal polypeptide (VIP) demonstrated its potent vasodilative effects on pulmonary and systemic circulation. However, no hemodynamic studies were performed to depict the effects of VIP in an in vivo model of pulmonary arterial hypertension (PAH), thereby limiting a complete understanding of the overall hemodynamic effects of VIP in PAH.

Methods And Results: The pulmonary and systemic hemodynamic effects of intravenous infusion of 100 ng/kg per minute of VIP in control and pulmonary hypertensive piglets at 6 to 8 weeks of age were assessed.

Intraabdominal pulmonary sequestration. A case series and review of the literature.

Pulmonary sequestrations are infrequent congenital malformations, and very rarely they are located below the diaphragm, particularly in the left suprarenal area. Prenatal detection is available. Differential diagnosis includes lesions such as enteric duplication cysts and neuroblastomas.

An unusual late complication of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) now is managed frequently successfully without surgical intervention. NEC may result in strictures, which present after the acute inflammatory process has resolved. Strictures usually present as obstruction in the first year or two of life.

Thoracic injuries in children.

The successful management of pediatric thoracic injuries includes immediate and careful evaluation of the injury type and severity. Early treatment can be conservative in nature or require surgical management. Prompt intervention can reduce morbidity and mortality rates, associated complications, and ensure optimal outcomes.

The New Injury Severity Score and the evaluation of pediatric trauma.

Background: To compare the effectiveness of the Injury Severity Score (ISS) and New Injury Severity Score (NISS) in predicting mortality in pediatric trauma patients.

Methods: NISS, the sum of the squares of a patient's three highest Abbreviated Injury Scale scores (regardless of body region), were calculated for 9,151 patients treated at four regional pediatric trauma centers and compared with previously calculated ISS values. The power of the two scoring systems to predict mortality was gauged through comparison of misclassification rates, receiver operating characteristic curves, and Hosmer-Lemeshow goodness-of-fit statistics.

Effect of cross-sectional imaging on negative appendectomy and perforation rates in children.

Purpose: To compare negative appendectomy and perforation rates in children who underwent ultrasonography (US), computed tomography (CT), or no imaging before urgent appendectomy.

Materials And Methods: All children who underwent urgent appendectomy during a 4(1/2)-year period were identified in a surgical billing database. Pathology reports were coded as negative or as showing acute inflammation or perforation.

Effects of pediatric head trauma for children, parents, and families.

Severe pediatric head injury has negative consequences for children of all ages. Even mild and moderate head injury results in residual impairment for school-age children and adolescents. Data are needed on the effects of these less severe insults, especially for preschoolers.

Acute hemoperitoneum in children: prevalence of low-attenuation fluid.

Background: Recent evidence indicates that acute hemoperitoneum may have lower than expected attenuation values at CT.

Objective: To characterize the attenuation of acute hemoperitoneum at CT in children following blunt abdominal trauma and to assess the prevalence of low-attenuation fluid.

Materials And Methods: The CT scans of 19 consecutive children with isolated hepatic or splenic injury and associated peritoneal fluid were retrospectively analyzed.

Preventing bicycle-related head trauma in children.

Although the majority of bicycle-related injuries and deaths could be prevented by the use of bicycle helmets, rates of helmet use in the United States remain well below Healthy People 2000's goal of 50% usage. Educational efforts to improve usage rates often fail to produce significant changes, in part because a child's understanding of risk plays only a small role in his or her decision to wear a helmet. To address the need for more effective injury prevention techniques, the authors propose a modification of the Health Belief Model, which is used by injury control experts to explain the various cognitive, social, and environmental factors that influence preventative health behavior.

Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness of sonography versus CT.

Objective: The purpose of this study was to compare the diagnostic accuracy of graded compression sonography with that of helical CT for the diagnosis of appendicitis in a pediatric and young adult population.

Subjects And Methods: Between June 1996 and April 1999, 386 pediatric and young adult patients with suspected appendicitis were examined using sonography, CT, or both: 233 underwent sonography only, 71 underwent CT only, and 82 underwent sonography and CT. All sonograms and CT scans were prospectively interpreted as showing positive or negative findings for appendicitis by one of six pediatric radiologists.

Evaluation of suspected appendicitis in children and young adults: helical CT.

Purpose: To evaluate the accuracy of helical computed tomography (CT) for the diagnosis of appendicitis in children and to assess the utility of CT in establishing alternative diagnoses.

Materials And Methods: The medical records of 154 children (median age, 12 years; age range, 1-20 years) who were suspected to have appendicitis and who underwent CT were reviewed. The gastrointestinal tract was opacified in 151 of 154 patients: Only orally administered contrast material was used in 126 patients; only rectally administered contrast material, in 21 patients; and both oral and rectal contrast material, in four patients.

Pediatric perineal impalement injuries.

Pediatric perineal impalement injuries are relatively uncommon. There may be difficulty in recognizing or properly treating such injuries, because their severity may not be reflected accurately by the external appearance of the perineum. The authors describe 3 case reports of patients with perineal impalement injuries and their management.

Pediatric airbag injuries: the Ohio experience.

Background/purpose: We sought to determine if properly restrained children, less than 13 years of age, placed in the front passenger seat are at greater risk for trauma from airbag deployment than unrestrained children.

Methods: The charts of children treated at any of 3 regional pediatric trauma centers in Ohio were reviewed for airbag injuries sustained in motor vehicle crashes between January 1995 and September 1998. Injury Severity Scores (ISS) were compared with Mann-Whitney Rank Sum Test and outcome data with Fisher's Exact Tests.

Selective management of pediatric pancreatic injuries.

Background: Despite trauma being the most common cause of pediatric pancreatitis, the diagnosis and management is often difficult.

Methods: The hospital course, diagnostic and surgical procedures, and complications for all children with traumatic pancreatitis evaluated at a Regional Level I Trauma Center were reviewed retrospectively.

Results: Twelve of 3,500 children (0.

Pediatric hepatic trauma: does clinical course support intensive care unit stay?

Purpose: The objective of this study is to determine if grade of liver injury predicts outcome after blunt hepatic trauma in children and to initiate analysis of current management practices to optimize resource utilization without compromising patient care.

Methods: A retrospective review of 36 children who had blunt hepatic trauma treated at a pediatric trauma center from 1989 to present was performed. Hepatic injuries graded (AAST Organ Injury Scaling) ranged from grade I to IV.

Nitric oxide synthesis inhibition: the effect on rabbit pyloric muscle.

The relaxation mechanism of the pyloric smooth muscle is largely dependent on a nonadrenergic noncholinergic (NANC) inhibitory innervation mediated in part by nitric oxide (NO). The aim of the present study was to investigate the effect of NO antagonists on the contractility of the pyloric smooth muscle. In the clinical trial, 10 anesthetized experimental rabbits were infused intraarterially with the NO synthesis inhibitor N-nitro-L-arginine (L-NNA), at a concentration of 10(-4) mol/L; 10 controls received normal saline intraarterially.

Vasoactive intestinal polypeptide causes relaxation of the pyloric sphincter in the rabbit.

Vasoactive intestinal peptide (VIP), which causes relaxation of gastrointestinal smooth muscle, has been found in high concentrations in the pylorus in many animal species, suggesting a prominent role for VIP in the control of pyloric sphincter function. We infused VIP into the gastric artery of 6 rabbits at rates from 12 to 1,200 ng/min and measured the intensity, duration, and frequency of spontaneous pyloric contractions with an intraluminal balloon and electromyography. VIP produced a dose-dependent reduction in the intensity (55% +/- 15% of baseline, P < .

The accuracy of antenatal ultrasonography in identifying renal abnormalities.

Objective: To determine the accuracy of measuring antenatal renal pelvic diameter for prediction of renal abnormalities.

Research Design: Prospective evaluation of all pregnant women undergoing ultrasonography.

Setting: A teaching hospital providing primary and referral maternity care.

Incidence of thrombosis during central venous catheterization of newborns: a prospective study.

Forty-two newborns were studied prospectively to determine the incidence of thrombosis due to central venous catheterization. Following Broviac catheter placement, the catheter tip, distal superior vena cava, and right atrium were evaluated by weekly two-dimensional echocardiograms. The presence of thrombosis was examined in relation to birth weight, gestational age, age and weight at the time of catheter placement, antithrombin III levels, and platelet counts.

Indium 111 oxine-labeled leukocytes for early diagnosis of ischemic enterocolitis.

The feasibility of the use of indium 111 oxine-labeled autologous leukocytes for the diagnosis of ischemic enterocolitis in vivo was examined in an experimental model of ischemia in dogs. A 30-cm segment of small intestine was devascularized by ligating the arteries and veins from the last arcade in 7 dogs. A sham operation was performed in 3 control dogs.

[The early diagnosis of intestinal ischemia by gammagraphic study].

Intestinal wall necrosis without perforation was produced in six dogs. Another group of three dogs served as a control. The histologic findings, the degree of ischemia and scintigraphic images obtained after the infusions of autologous white blood cells labelled with indium-111 oxine were correlated.

Pediatric blunt liver injury: establishment of criteria for appropriate management.

There is no consensus regarding the most appropriate management of pediatric blunt liver injury. This study addresses this issue by reviewing our experience with blunt liver trauma in relationship to the grade of injury. Forty-one pediatric patients with blunt abdominal trauma and documented liver injury were managed from 1979 to 1989.

Plasma vasoactive intestinal polypeptide in the newborn infant.

Vasoactive intestinal polypeptide (VIP) has been suggested as a possible contributor to the development of gastrointestinal problems. VIP is produced by nerve endings in the intestinal tract and appears to have marked effects on gut motility and its blood flow. Since necrotizing enterocolitis and feeding intolerance are common problems in the newborn, we examined the plasma VIP responses to feeding in healthy preterm and term newborn infants.

The spectrum of cholelithiasis in the first year of life.

Cholelithiasis is being diagnosed with increased frequency in the very young. We encountered 12 patients over a 5-year period in whom cholelithiasis was diagnosed prior to age 1 year. The earliest diagnosis was made in utero during the seventh gestational month.