ABSTRACT
PURPOSE: To compare the outcomes of open (OPN) and prone retroperitoneoscopic partial nephrectomy (PRPN) in children. MATERIALS AND METHODS: The medical and radiological records of all children undergoing OPN and PRPN over a 6-year period (2002-2008) were reviewed. RESULTS: Thirty-nine (11 boys/28 girls) partial nephrectomies were performed in a single institution. There were 24 OPNs (15 upper, 9 lower) and 15 PRPNs (13 upper, 2 lower) with a median age at surgery of 2.3 years and 3.4 years, respectively. Median duration of surgery was 50 min (range 30-180) for the OPN and 150 min (range 70-205) for the PRPN (P < 0.001). Median postoperative hospital stay was 4 days (range 2-7) for the OPN and 2 days (range 1-5) for the PRPN (P < 0.001). One patient in the OPN underwent a total nephrectomy with a loss of the remaining moiety. In 20 (87%) patients of the OPN group an epidural infusion was administered and four required a morphine infusion, while only five patients in the PRPN group required a morphine infusion. CONCLUSIONS: Open partial nephrectomy had a significantly shorter operative time, but it was associated with a longer postoperative stay and higher analgesia requirements when compared to PRPN.
Subject(s)
Endoscopy , Nephrectomy/methods , Retroperitoneal Space/surgery , Analgesics, Opioid/administration & dosage , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , Length of Stay , Male , Morphine/administration & dosage , Nephrectomy/adverse effects , Postoperative Complications , Prone Position , Time Factors , Treatment OutcomeABSTRACT
A 2-year-old male presented to hospital with a 5-day history of vomiting and pyrexia. He was initially treated with non-steroidal medication as an anti-pyretic. Initial investigations demonstrated a raised urea and creatinine and he was treated with intravenous fluids. Within 24 h he became anuric with progressive renal insufficiency. Ultrasound scan demonstrated minimal bilateral hydronephrosis with debris in the lower pole calyces. The bladder was empty. Cystoscopy and retrograde contrast imaging revealed bilateral ureteric obstruction. Double J stents were inserted and his renal function returned to normal within 4 days. We believe the aetiology to be renal papillary necrosis and bilateral ureteric obstruction secondary to the administration of ibuprofen in association with dehydration.
Subject(s)
Kidney Papillary Necrosis/complications , Kidney Papillary Necrosis/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Dehydration/complications , Diagnosis, Differential , Humans , Ibuprofen/adverse effects , Infant , Kidney Papillary Necrosis/diagnosis , Male , Ureteral Obstruction/diagnosisABSTRACT
A 22-year-old man presented with a lower esophageal adenocarcinoma having been treated for a left-sided congenital diaphragmatic hernia (CDH) as a neonate. There is no known association or similar case reported in the literature. We review the known long-term sequelae of CDH, possible theories for the occurrence of adenocarcinoma, and its implications for follow-up of patients with CDH.
Subject(s)
Adenocarcinoma/etiology , Esophageal Neoplasms/etiology , Hernia, Diaphragmatic/complications , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Adult , Biopsy , Diagnosis, Differential , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Esophagoscopy , Humans , Male , Palliative Care , Tomography, X-Ray ComputedABSTRACT
Dealing with the diverse healthcare needs of people in prison can be a very challenging role for a nurse. This article explores the care management issues which arise when caring for prisoners within a general hospital theatre environment. It is based on the author's experience working as a nurse in the operating theatre and in the prison environment--a 'unique environment that presents unique challenges'.
