ABSTRACT
Unlike many medical problems which allow us the luxury of casual contemplation or a diligent search for relevant references for assistance, the care of children suffering major trauma does neither. Our only proper response to these young patients is a rapid assessment and treatment, often performed simultaneously, if we are to preserve life and limb. The anxiety this challenge presents us cannot be minimized: the almost unbelievably thin margin for error in injured youngsters, their small total blood volume, the variation in blood pressure, other vital signs and drug dosages with age, and the family's justifiable hope for a complete recovery all account, in part, for this anxiety. It is, however, precisely for these reasons that our preparation and knowledge is critical if the disability and mortality too often associated with childhood trauma are to be circumvented. Neither the price of failure nor the rewards of success can be measured--they're both too high.
Subject(s)
Intensive Care Units, Pediatric , Multiple Trauma/therapy , Child , HumansABSTRACT
A multidisciplinary approach is necessary in addressing the needs of a patient with end-stage liver disease. The development of the liver transplant program at MHI was a natural extension of the transplant and critical care programs already in place. The case report described exemplifies that valuable input from ancillary support groups is necessary for a successful liver transplant program. Experience gained in the area of liver transplantation not only benefits liver transplant patients but also extends to other areas of clinical medicine. One year ago, an Indiana resident had to travel out of state to receive this specialized form of care. Today this is no longer the case.
Subject(s)
Liver Transplantation , Humans , Indiana , Infant, Newborn , Liver Diseases/surgery , Male , Patient Care Team , Transplantation, HomologousSubject(s)
Abdominal Injuries/therapy , Abdominal Injuries/diagnosis , Abdominal Injuries/etiology , Child , HumansSubject(s)
Infant, Newborn, Diseases/surgery , Meconium , Peritonitis/surgery , Abscess/drug therapy , Animals , Calcinosis/diagnosis , Cystic Fibrosis/diagnosis , Female , Humans , Infant, Newborn , Infant, Newborn, Diseases/diagnostic imaging , Infant, Newborn, Diseases/pathology , Male , Meconium/microbiology , Peritoneal Diseases/drug therapy , Peritonitis/diagnostic imaging , Peritonitis/pathology , Radiography , RatsABSTRACT
Sixteen of 116 infants (14 percent) with Hirschsprung's disease had total colonic aganglionosis. Treatment was delayed in 6 of 16 patients because the condition was not recognized. Diagnosis was eventually achieved by rectal biopsy and the extent of aganglionosis was documented after multiple intestinal biopsies. All patients were initially managed by diverting enterostomy. Ileoanal pull-through operation was performed in nine patients at 12 to 24 months of age with no operative mortality. The overall mortality rate was 25 percent, including the deaths of two infants with diagnostic delay. Survivors had normal growth and satisfactory bowel function, Hirschsprung's disease should be suspected and rectal biopsy performed in infants with persistent or intermittent abdominal distention and constipation. Instances of total colonic aganglionosis can be documented by appropriate biopsies at the time of laparotomy. The modified Duhamel operation is an acceptable procedure for this condition. A ganglionic antimesenteric patch enteroplasty may prove a useful adjunct in infants with extensive aganglionosis involving the proximal small bowel.
