Long-term outcome of JJ stent insertion for primary obstructive megaureter in children.

Background/aim: Endoscopic stenting is an accepted treatment option for children with symptomatic or progressive primary obstructive megaureter (PROM). Here, long-term outcomes with endoscopic stenting are reviewed.

Methods: Patients with PROM treated surgically over a 12-year period were identified using a prospectively maintained departmental database.

Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation.

Introduction: Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests.

Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study.

Objective: The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort.

Methods: We performed a prospective observational study of patients aged <18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs.

Comparing the usability of paediatric weight estimation methods: a simulation study.

Objective: Estimating weight is essential in order to prepare appropriate sized equipment and doses of resuscitation drugs in cases where children are critically ill or injured. Many methods exist with varying degrees of complexity and accuracy. The most recent version of the Advanced Paediatric Life Support (APLS) course has changed their teaching from an age-based calculation method to the use of a reference table.

Exploring the acceptability of using low-friction bedding for patients with burns: Qualitative results from the SILKIE study.

Background: Skin grafts following deep burns are needed to ensure healing. Grafts that fail and require re-grafting cause significant distress to patients and additional costs for the NHS. Shearing, which leads to graft loss, may be reduced through the use of low-friction bedding.

Anterior deflected urinary stream.

We present a case of anterior deflected urinary stream (ADUS) secondary to meatal shelf with no dysfunctional voiding symptoms (DV). The video illustrates the presentation, operative management and literature review. Meatal deformity in girls has been described in association with DV.

Drug safety in paediatric anaesthesia.

Life-threatening drug errors are more common in children than in adults. This is likely to be because of their variations in age and weight, combined with the occasional exposure of most anaesthetists to paediatric patients. Drug administration in anaesthesia is mostly undertaken by a single operator and thus represents a potentially greater risk compared with other areas of medicine.

Allogeneic stem cell transplantation for refractory acute myeloid leukemia in pediatric patients: the UK experience.

We report outcomes for 44 children who underwent stem cell transplantation (SCT) for refractory AML in the UK between 2000 and 2012. Median age at SCT was 11.5 years.

The development of worry throughout childhood: Avon Longitudinal Study of Parents and Children data.

Objectives: Anxiety is a normal part of childhood and adolescence; however, longitudinal research investigating the development of worrisome thoughts throughout childhood is lacking. This study investigated mothers' perspectives on their child's normal development of worry as the cognitive component of anxiety and its impact on child functioning in a longitudinal population-based cohort.

Methods: The data for this study were extracted from the Avon Longitudinal Study of Parents and Children.

Whither dexmedetomidine?

Dexmedetomidine has established a firm position in the armamentarium of anesthesia pharmacology. However, it is still a relatively new drug and its application is based on early evidence that is intriguing but far from conclusive. Based on experience with previous cure-alls, anesthesia clinicians and researchers must insist on more information and formulate appropriate science that will allow us to truly understand the role of this dexmedetomidine in our specialty—as wonder drug or also-ran.

Anxiety at 13 and its effect on pain, pain-related anxiety, and pain-related disability at 17: An ALSPAC cohort longitudinal analysis.

The aim of the present study was to investigate the influence of anxiety at 13 years of age on the presence of chronic pain, pain-related anxiety, and pain-related disability at 17 years of age in a large longitudinal cohort. We hypothesized that mother-reported anxiety at 13 would be associated with the presence of chronic pain at 17 and an increase in pain-related anxiety using all available data from the longitudinal cohort. Further, we hypothesized that anxiety at 13 would predict pain-related disability in adolescents who reported chronic pain at 17 years of age.

How dangerous a toy can be? The magnetic effect.

During the last decade, there has been a significant increase in the number of magnetic toys available for children. Two or more magnets separate from each other along the gastrointestinal course can attract each other across bowel walls, resulting in pressure necrosis, bowel perforations and fistulas formation. This has led to an increasing number of case reports describing serious complications from ingesting more than one magnet.

Systematic review and meta-analysis of the effect of intraoperative α₂-adrenergic agonists on postoperative behaviour in children.

Undergoing general anaesthesia is distressing for children, with up to two-thirds demonstrating abnormal behaviours after their procedure, such as emergence delirium (ED) and post-hospitalization behaviour change. The aim of this systematic review was to determine the effect of intraoperative i.v.

Limitations and vulnerabilities of the neonatal cardiovascular system: considerations for anesthetic management.

Development of the cardiovascular system through the last trimester of pregnancy and the subsequent neonatal period is profound. Morphological changes within the myocardium make the heart vulnerable to challenges such as fluid shifts and anesthetic drugs. The sensitivity of the myocardium to metabolic challenges and potential harm of drugs needed to maintain adequate blood pressure and cardiac output are highlighted.

Ductal ligation in the very low-birth weight infant: simple anesthesia or extreme art?

Management of the very low-birth weight infant in the neonatal intensive care unit (NICU) is geared to provide optimal outcome not only in term of survival but increasingly with a goal of limitation of long-term neurological and pulmonary morbidities. Careful follow-up studies have demonstrated that relatively small variations in oxygenation and gas exchange, ventilator management, and other management modalities can have long-term consequences. Within this context, there are good data that closure of a clinically significant patent ductus arteriosus has outcome benefit, but little data on the idealized anesthetic to manage such fragile patients.

Red cell exchange transfusion as a rescue therapy for tacrolimus toxicity in a paediatric renal transplant.

Tacrolimus is a widely used macrolide immunosuppressant that has a narrow therapeutic index and potential side effects including neurotoxicity. A 20-month-old boy with kidney disease secondary to prune belly syndrome variant, managed on peritoneal dialysis, received a deceased donor transplant. Standard immunosuppression was used.

Microsimulation and clinical outcomes analysis support a lower age threshold for use of biological valves.

Objective: To characterise contemporary results of aortic valve replacement in relation to type of prosthesis and subsequent competing hazards.

Methods: 5470 procedures in 5433 consecutive patients with aortic valve replacement ± coronary artery bypass grafting (CABG) were studied. Microsimulation of survival and valve-related outcomes was performed based on meta-analysis and patient data inputs, with separate models for age, gender and CABG.

Management of chronic myeloid leukaemia in relapse following donor lymphocyte infusion induced remission: a retrospective study of the Clinical Trials Committee of the British Society of Blood & Marrow Transplantation (BSBMT).

Donor lymphocyte infusion (DLI) can restore remission in a high percentage of patients with chronic myeloid leukaemia (CML) who relapse after allogeneic stem cell transplant (SCT). Subsequent relapses after a DLI-induced remission do occur and the optimal management of these patients is not defined. A retrospective study of the practice of UK transplant centres was conducted.

Granulocyte transfusions in the G-CSF era. Where do we stand?

The efficacy of granulocytes transfusions (GTX) in either the prevention or treatment of neutropenic sepsis has been a controversial issue. Early studies employing steroid mobilised GTX showed variable, dose-dependent results and significant pulmonary toxicity was reported. With the introduction of the recombinant myeloid growth factor, granulocyte-colony stimulating factor (G-CSF), the quantity of granulocytes that could be harvested was substantially increased leading to renewed interest in the clinical application of GTX.