Low morbidity profile of spleen mesh wrapping in children.

Purpose: Spleen mesh wrapping is a valuable and efficacious technique for treating severely traumatized spleens. We report the morbidity of the procedure and describe its management in children.

Methods: A retrospective survey of children admitted to the Hillel Yaffe Medical Center with a traumatized spleen was carried out.

Multimodality management in severe pediatric spleen trauma.

Background: Trauma is the leading cause of death in children. In abdominal lesions the spleen is the most commonly involved organ. During the last two decades much effort has focused on spleen tissue conservation.

Confirmation of the safety of central venous catheterisation in critically ill infants and children--the Baragwanath experience.

Objective: To evaluate, in critically ill children, the safety and effectiveness of routine central venous catheterisations (CVCs) performed by residents from all disciplines.

Design: Prospective audit of all CVCs over a 24-month period.

Setting: Multidisciplinary intensive care unit at Baragwanath Hospital, Soweto.

Emergency percutaneous balloon mitral valvotomy in a patient with septic shock.

We report an 18-year-old patient with severe mitral stenosis complicated by right lower lobe pneumonia, sepsis, and shock. Intractable low cardiac output led to an emergency percutaneous balloon mitral valvotomy in a patient, resulting in immediately improved hemodynamic parameters. We are unaware of another report of percutaneous balloon mitral valvotomy performed in a patient with sepsis and shock.

Comparison of central venous pressure measurements in the intrathoracic and the intra-abdominal vena cava in critically ill children.

A prospective study was conducted to compare simultaneous intrathoracic and intra-abdominal central venous pressures in 10 critically ill, ventilated paediatric intensive care patients. Central venous pressures were measured using the water column technique over a 6 h study period. There was excellent correlation between intrathoracic and intra-abdominal vena caval pressure measurements (r = 0.

Paediatric acute renal failure. A report on 2 cases successfully managed with continuous venovenous haemodiafiltration.

In critically ill patients continuous venovenous haemodiafiltration (CVVHD) is a method of renal replacement therapy gaining popularity. The advantage of CVVHD over intermittent haemodialysis and peritoneal dialysis lies in the accurate control of ultrafiltration and of solute clearance. Two paediatric patients with acute renal failure treated successfully with CVVHD are described.

Persistent bronchopleural fistula in a patient with adult respiratory distress syndrome. Treatment with pressure-controlled ventilation.

Bronchopleural fistula (BPF) continues to present a treatment problem in mechanically ventilated patients. We report a patient with a traumatic BPF, pneumonia, and adult respiratory distress syndrome (ARDS) who was successfully ventilated with pressure-controlled ventilation (PCV). This mode, by allowing the use of lower inspiratory airway pressures, may promote closure of the fistula.

Relationship between recurrent croup and airway hyperreactivity.

The relationship between recurrent croup and bronchial asthma was evaluated by measuring bronchial hyperreactivity (methacholine challenge), physiologic parameters of upper airway obstruction, and skin response to environmental allergens. Patients with recurrent croup (n = 10) had a significantly higher degree of airway hyperreactivity and atopy than healthy children (n = 15), but significantly less than the patients with bronchial asthma (n = 30). No physiologic signs of upper airway obstruction could be detected at rest or following methacholine.

Legg-Calve-Perthes disease following transient synovitis. How often?

Forty-one children with transient synovitis of the hip and 10 children with Legg-Calve-Perthes disease were followed. All 41 cases of transient synovitis had a benign outcome. In this series, nine of the 10 children with Legg-Calve-Perthes disease were diagnosed upon their first roentgenographic examination.