Systematic review for paediatric metachronous contralateral inguinal hernia: a decreasing concern.

Purpose: Controversy still surrounds the treatment of the asymptomatic inguinal region in paediatric patients with a unilateral inguinal hernia. The concern is the development of a future metachronous contralateral inguinal hernia (MCIH) and therefore the need for a second operation. Our aim was to provide a current systematic review of the evidence for routine contralateral exploration, and identify potential at-risk groups.

A novel plain abdominal radiograph sign to diagnose malrotation with volvulus.

Malrotation with associated volvulus is a potentially lethal event for a neonate. The gold standard for diagnosis is an upper gastrointestinal contrast study. However this can delay the diagnosis and the timing of surgical intervention.

A rare case of 'blow-up' fracture of the orbit in a child.

We present a case of blow-out fracture of the superomedial orbital wall in a 6-year-old boy. The initial plain radiograph showed an intact orbital margin and opacification of the ethmoid sinus. A fine-cut CT scan of the facial bones revealed a complex fracture of the medial orbital wall extending into the orbital roof, with migration of fracture fragments into the anterior cranial fossa.

Exomphalos major: the Northern Ireland experience.

Purpose: In exomphalos major (EM), closure of the defect in the abdominal wall presents a challenge. The aim of this study is to evaluate a single centre experience of EM.

Materials: A 15-year retrospective case-note review; data presented as median (range).

A two-center experience with the exclusive use of laparoscopic transperitoneal nephrectomy for benign renal disease in children.

Background: This study aimed to evaluate a two-center experience with pediatric transperitoneal laparoscopic nephrectomy, specifically focusing on the outcome parameters of operative time, complication, analgesic requirement, and postoperative stay.

Methods: This ambispective study was conducted over a 4-year period between May 2001 and May 2005 in two tertiary pediatric surgical centers. Data were prospectively recorded from an in-house expanded medical audit system (EMAS) and a Microsoft Excel database.

Two dimensional ultrasound guidance in central venous catheter placement; a postal survey of the practice and opinions of consultant pediatric anesthetists in the United Kingdom.

Background: Recent guidelines from the UK National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheter (CVC) insertion in children. We conducted a survey of pediatric anesthetists to determine current practice and opinion on the appropriate use of ultrasound guidance.

Method: A confidential postal questionnaire was sent to all members of the Association of Paediatric Anaesthetists working in the UK.

Oral xanthines as maintenance treatment for asthma in children.

Background: Xanthines have been used in the treatment of asthma as a bronchodilator, though they may also have anti-inflammatory effects. The current role of xanthines in the long-term treatment of childhood asthma needs to be reassessed.

Objectives: To determine the efficacy of xanthines (e.

The Integrated Children's System: challenges of information sharing.

Information has to be shared within and between agencies if Every Child Matters (DH 2003a) is to bring real benefits to children in need and their families. The Integrated Children's System is a theoretical framework that offers a single approach to assessing, planning, intervention and reviewing based on an understanding of children's developmental needs in the context of their families and communities. It should not be seen as an IT project, but is closely linked to the electronic social care record and to NHS care record service developments.

The role of the nurse in paediatric asthma management.

In recent years the role that specialist nurses play in chronic disease management has broadened and they are now recognised as valuable members of the multi-disciplinary team, demonstrating that their skilled practice contributes to the quality of patient care. Nurses in primary and secondary care are working as autonomous practitioners managing their own caseload of asthmatic patients and taking a key role in facilitating ongoing treatment regimes. The development of advanced nursing roles has provided an opportunity to broaden many nursing skills producing highly competent paediatric respiratory nurses.

Management of thoracic empyema in childhood: does the pleural thickening matter?

Aims: To determine the clinical course and long term outcome of empyema treated without decortication.

Methods: Fourteen consecutive admissions to one hospital were studied; radiological resolution and lung function were subsequently followed. The children were aged 2-14 years.

Growing need.

THE INCIDENCE of paediatric respiratory disease has increased over recent years giving nurses an opportunity to grow with the specialty and become providers of high quality care. Respiratory disease can affect all ages but advances in neonatal intensive care have given rise to a group of children who have persistent respiratory disease into early life. Asthma incidence continues to rise, for example, and can affect children of any age with many attendant clinical and management problems.

How do we treat wheezing infants? Evidence or anecdote.

Consultant paediatricians were questioned about their management of wheezing disorders in infants. Salbutamol was the preferred bronchodilator for recurrent wheeze, whereas ipratropium was preferred in viral bronchiolitis. Doses of both medications varied widely.

Assessment of a low-cost home monitoring spirometer for children.

Electronic devices are now available to measure and store lung function parameters in the home. Before adopting a device for clinical or research use, it is important to validate it in the target patient group. The aim of this study was to assess a low-cost, portable, logging spirometer, the VM Plus (VM), against a standard laboratory Jaeger spirometer (JS) for use in children with respiratory disease.

The difficult paediatric airway: a new method of intubation using the laryngeal mask airway, Cook airway exchange catheter and tracheal intubation fibrescope.

We describe a new technique of intubation for use in difficult paediatric airway cases utilizing the laryngeal mask airway, a Cook Airway Exchange Catheter and a paediatric intubation fibrescope. This method has a number of potential advantages over previously described methods.

Comparison of resistance measured by the interrupter technique and by passive mechanics in sedated infants.

Airways resistance measured by the interrupter technique (Rint) requires little patient cooperation and has been successfully used in young children, but little studied in infants. The authors aimed to evaluate the measurement of Rint in infants, using a commercially available device (the MicroRint), by comparing it with an established technique to measure respiratory resistance: the single breath occlusion technique (SBT); and a measure of airflow obstruction during forced expiration. Infants <18 months old with a history of wheeze, sedated with triclofos for pulmonary function testing, had measurements taken and compared to Rint (using the MicroRint), respiratory system resistance (Rrs) by SBT, and to maximal flow at functional residual capacity (V'maxFRC).

Ectopic intrathoracic liver.

Accessory hepatic tissue, unlike accessory splenic and pancreatic tissue, is rare and has a limited and almost exclusively sub diaphragmatic distribution. Fewer than ten cases of intrathoracic ectopic liver have been reported so far in the literature. This paper reports a case that caused a diagnostic dilemma.

Persistent wheezing in infants with an atopic tendency responds to inhaled fluticasone.

Background: The role of inhaled corticosteroids for the treatment of wheeze in infancy remains unclear.

Aim: To investigate the effect of inhaled fluticasone on symptoms in a group of wheezy infants who had a high risk of progressing to childhood asthma.

Methods: A total of 52 infants, under 1 year of age, with a history of wheeze or cough and a history (personal or first degree relative) of atopy were prescribed either 150 microg fluticasone twice daily (group F) or placebo (group P), via metered dose inhaler, for 12 weeks following a two week run in period.

Congenital segmental dilatation of the duodenum--differential diagnosis for an antenatally-diagnosed intra-abdominal cyst.

We report the third case of segmental dilatation of the duodenum and the first to be diagnosed antenatally. The lesion presented as an intra-abdominal cyst on an antenatal scan at 17 weeks and was followed up with more specific investigations after birth. The final diagnosis was obtained only at laparotomy where the dilated segment was resected.

Management of acute childhood asthma: a prospective multicentre study.

Children with acute asthma account for a significant proportion of paediatric hospital admissions, and clear guidelines exist for their care. The aim of this study was to determine their management in the UK. Over 1 year (February 1995 to January 1996), children aged 1-14 yrs admitted with acute asthma were studied in both teaching and district general hospitals.