Subject(s)
Accidental Falls/prevention & control , Geriatric Assessment/methods , Urinary Tract Infections/diagnosis , Accidental Falls/statistics & numerical data , Aged , Aged, 80 and over , Carboxylic Ester Hydrolases/urine , Case-Control Studies , Female , Humans , Logistic Models , Male , Nitrates/urine , Pyuria/urine , Retrospective Studies , Urinary Tract Infections/complicationsABSTRACT
Although it rarely occurs in children, acute arterial thromboembolism can cause significant morbidity and mortality. Rapid diagnosis and prompt treatment can increase the chances of survival with a functional limb. We describe the case of a 10-year-old boy with acute bilateral lower extremity ischemia due to arterial thromboemboli originating from a rare cancer. We discuss diagnosis of and treatment strategies for acute arterial thromboembolism in the pediatric population, as well as the rare cancer the patient was diagnosed with.
Subject(s)
Carcinoma/diagnosis , Iliac Artery , Nuclear Proteins/genetics , Oncogene Proteins/genetics , Peripheral Vascular Diseases/etiology , Popliteal Artery , Thoracic Neoplasms/diagnosis , Thromboembolism/etiology , Acute Disease , Carcinoma/complications , Carcinoma/genetics , Child , Fatal Outcome , Genetic Markers , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/pathology , Male , Neoplasm Proteins , Peripheral Vascular Diseases/diagnosis , Popliteal Artery/diagnostic imaging , Popliteal Artery/pathology , Radiography , Thoracic Neoplasms/complications , Thoracic Neoplasms/genetics , Thromboembolism/diagnosisABSTRACT
We report here an interesting unique case of total loss of small bowel in the absence of associated malrotation or gastroschisis. Total loss of small bowel, acquired in utero in the absence of associated anomalies such as malrotation or gastroschisis, has not been previously reported. Several reports of congenital short bowel exist. However, this uncommon finding is typically associated with malrotation. Babies with this condition often present with functional intestinal obstruction. Several cases in which infarction of gastroschisis and autolysis of the bowel, followed by in utero resolution of the abdominal wall defect, have been reported as a cause of congenital absence of the small bowel. We present here the first report, to our knowledge, of an infant with total absence of the small bowel without gastroschisis or malrotation.
Subject(s)
Intestinal Atresia/diagnosis , Intestine, Small/abnormalities , Fatal Outcome , Female , Humans , Infant, Newborn , Infant, PrematureABSTRACT
BACKGROUND: Establishment of a pediatric burn center represents a major commitment of resources. The impact of a Pediatric Burn Unit on the finances of a children's hospital has never been reported and was the purpose of this study. METHODS: Burn registry data for patients discharged from our Pediatric Burn Unit from 2000 to 2002 were integrated with financial and administrative data. Reimbursement was determined by calculating expected payments for each patient. The relationship between percent total body surface area (TBSA) burned and profit/loss margin was evaluated using regression analysis. RESULTS: During the study period, 264 pediatric burn patients were admitted to our burn service. One hundred forty-three (54%) had less than 10% TBSA burned, and their average loss margin was -179.03 dollars per patient. The 121 patients (46%) who had greater than 10% TBSA burned had an average profit margin of +349.68 dollars per patient (P =.22, SE+ 605.03) Patients treated operatively (49; 18%) had a profit margin of +2237.77 dollars per patient, whereas patients treated nonoperatively (215; 81%) had a profit margin of -432.30 dollars per patient (P =.0007, SE +249.65) The overall profit margin was +63.88 dollars per patient. CONCLUSIONS: Our pediatric burn service covered all hospital fixed costs and made a small profit. Pediatric burn care can be a profit center for children's hospitals. Investment in a Pediatric Burn Program provides adequate financial return for the hospital.
Subject(s)
Burn Units/economics , Hospital Costs , Hospitals, Pediatric/economics , Hospitals, Proprietary/economics , Burns/economics , Burns/epidemiology , Burns/surgery , Burns/therapy , Child , Hospital Bed Capacity , Humans , Insurance, Health, Reimbursement/economics , Managed Care Programs/economics , Medicaid/economics , Ohio , Regression Analysis , Severity of Illness IndexABSTRACT
Recent studies confirm that thromboembolic complications in burn patients are higher than previously reported. Swelling, pain, and erythema are not useful indicators of deep venous thrombosis (DVT) in burned extremities. We propose that D-dimer levels may be useful in determining which patients would benefit from further screening for DVT. Thirty adult hospitalized burn patients were screened for DVT with duplex ultrasound on admission and then weekly until discharge. D-dimer levels were measured at the same intervals. Seven patients developed 11 cases of DVT. The mean time to DVT diagnosis was 6.7 days. D-dimer levels were elevated in 86% of DVT patients at week 1, with a negative predictive value of 94%. The evaluation of elevated D-dimer levels at week 1 may be a useful screening tool for detecting DVT in the burn population.
