Neonatal nevus lipomatosus cutaneous superficialis managed by surgical resection alone.

Naevus Lipomatosus Cutaneous Superficialis(NLCS) is very rare in neonates and presents as part of broad spectrum of skin lesions. Clinical appearance alone can be deceptive. Prompt radiologic evaluation and surgical excision with visible clear margins should be first line of management followed by pathological confirmation to rule out any other sinister pathology.

Off-road vehicle trauma in children: a New South Wales perspective.

OBJECTIVE: There is paucity of data on off-road vehicle injuries in children in Australia. We performed a retrospective study from 1998 to 2003 to analyze the frequency and nature of injuries in children involved in off-road vehicle crashes in the state of New South Wales. METHODS: Medical records were identified from search of the trauma database and hospital medical records database for off-road (all-terrain) vehicles. RESULTS: A total of 271 children were identified, 86% of whom were boys. The mean age was 10 years (range, 2-16 years); and the mean length of stay, 5.8 (9) days (range, 1-40 days). The mean injury severity score was 6 (5.9). Most were drivers (85%). Injury mechanism was falls in 161; collision with stationary object, 54; moving object, 4; rollovers, 7; and others, 8. Eighty-four percent were on 2 wheelers, whereas 11% were quad bikes, and the rest were on tricycles or other vehicles. Distribution of the body region injured was head and neck in 66 patients; face, 51; chest, 25; abdomen, 36; pelvis, 5; spines, 14; upper limbs, 96; and lower limbs, 116. Only 55% were helmeted at the time of the incident. Sixty-five percent of these children required surgical treatment. Most were fractures (98) followed by soft tissue injuries (49). Seventeen had posthead injury sequelae requiring rehabilitation support, and 21 required multiple surgeries. There were 7 deaths during the study period in New South Wales. CONCLUSIONS: Off-road motor vehicle injuries are a significant problem in children. There are no legal safety regulations for use of these vehicles. With the increasing sales of these vehicles, the incidence of injury may rise. There seems a need for education and legislation in relation to the safety issues concerned with these vehicles.

Dominant dorsal duct syndrome: a rare cause of acute recurrent pancreatitis in children revisited.

Acute recurrent pancreatitis in children can be caused by anomalies of fusion of pancreatic ducts such as the dominant dorsal duct syndrome wherein a dominant dorsal pancreatic duct is associated with stenosis of the minor papilla. Clinical presentations and management of 2 patients are discussed. An infant presented with severe acute pancreatitis with pseudocyst formation due to an underlying ductal disruption. Surgical treatment was offered on account of failure of medical therapy and endoscopic stenting. A dominant dorsal duct with minor papilla stenosis was encountered. Sphincteroplasty of the minor papilla and lateral pancreaticojejunostomy were performed with good result. A 14-year-old boy with a type 1 choledochal cyst was troubled by recurrent acute pancreatitis. At operation, a dilated dorsal pancreatic duct opening into a stenosed minor papilla was found in addition to the choledochal cyst. Choledochal cyst excision, choledochoduodenostomy, and sphincteroplasty of the minor papilla stenosis were performed. Dominant dorsal duct syndrome is a rare cause of acute pancreatitis in children. A high index of suspicion is necessary to establish a precise diagnosis. Sphincteroplasty of the minor papilla may affect adequate pancreatic drainage and prevent recurrent pancreatitis.

Adhesion reformation after laparoscopic adhesiolysis: where, what type, and in whom they are most likely to recur.

STUDY OBJECTIVE: To assess if the severity or extent of adhesions, the organs involved, or presence of endometriosis predict recurrence or de novo adhesion formation. DESIGN: Comparison of adhesion scores at initial operative laparoscopy and at second-look laparoscopy using the revised American Fertility Society adhesion classification system (Canadian Task Force classification I). SETTING: A university-affiliated reproductive endocrinology and infertility center. PATIENTS: In all, 38 women with moderate to severe adhesions who underwent laparoscopic adhesiolysis and second-look laparoscopy. INTERVENTIONS: Adhesion scores were assessed at 6 sites in the peritoneal cavity before initial laparoscopic adhesiolysis and compared with adhesion scores at second-look laparoscopy. Adhesions were evaluated by extent, severity, organ involvement, and presence or absence of endometriosis to evaluate potential determinants of recurrence and de novo adhesion formation. All adhesions were totally removed at initial laparoscopy, all patients received 1000 mL of Ringer's lactate solution intraperitoneally at the end of procedures, and the same surgeon treated all patients. MEASUREMENTS AND MAIN RESULTS: Adhesion scores decreased in extent [23.3% (p = .005)] and severity [26.3% (p = .001)]. Dense adhesions decreased 31% (p < .000) and filmy adhesions decreased 35% (p = .048). Extent of adhesions assessed at less than one-third, one-third to two-thirds, and more than two-thirds decreased by 33% (p = .002), 42% (p = .000), and 31% (p < .000), respectively. Severity and extent of adhesions of abdominal wall decreased by 45% (p = .003) and 40% (p = .016); of bowel by 33% (p = .002) and 31% (p = .012); and of posterior cul-de-sac by 14% (p = .040) and 9.5% (p = .091), respectively. Severity and extent of adhesions involving both adnexa decreased by 12% to 15%, respectively, which was not statistically significant. Presence of endometriosis did not affect adhesion recurrence. De novo adhesions developed at 48 (21%) of 228 potential sites occurring in 22 of 38 patients, and were most frequent and severe on the adnexa and least on the abdominal wall. CONCLUSION: Both extent and severity of adhesions are significantly reduced by laparoscopic adhesiolysis. Initial extent and severity of adhesions did not predict recurrence; however, the involved organ did, being most frequent on the adnexa and least frequent on the abdominal wall and bowel.