Procedural pain in a paediatric surgical emergency unit

Pain induced by various types of procedures was assessed in the Paediatric Surgical Emergency Department at St Göran's Children's Hospital in Stockholm. Assessments of pain were obtained from the nurse, the parent, and children over 10 years of age by means of a visual analogue scale. In children aged 3–9 years, the Smiley Five-Face Scale was used. The nurse and the parent also answered questionnaires about analgesic medication, the child's behaviour, and the parent's overall opinion of the pain management, etc. Irrigation of the glans penis because of balanitis, treatment of fractures and paronychia were considered to be the most painful procedures. Forty-four per cent of the children cried during the procedure and 16% fought against being restrained. In 24% of the cases, the child was judged to be in a state of "panic". In conclusion, we believe that the pain induced by procedures in the emergency rooms is unacceptably high. Children estimate higher pain scores than parents and nurses do. There was a poor correlation between the parent's and child's estimates of pain. Parents are not well informed about the possibilities for pain treatment. Infants and children attending emergency rooms must also benefit from recent advances in the treatment of pain.     

An audit of postoperative sepsis in a neonatal surgical unit

An audit of 143 consecutive neonatal surgical operations performed in one neonatal surgical unit is reported. Wound infections developed in 13 patients (9.1%) and bacteraemia in 9 (6.3%). Three groups at increased risk were identified: small-for-dates infants subjected to major surgery, infants subjected to invasive monitoring, and infants over 1 week of age with Staphylococcus aureus as a skin commensal. Infections were significantly less frequent in potentially contaminated wounds if antibiotic prophylaxis had been used (7.6% compared to 26.7%: P <0.05).     

Ultrasound and the diagnosis of renal and ureteral calculi

We retrospectively compared ultrasound examination with plain film radiography of the abdomen (KUB) in the diagnosis of renal and ureteral calculi in 13 patients. Overall, ultrasound was more sensitive than KUB (84% versus 54%) in detecting calculi. However, KUB was superior for the diagnosis of ureteral stones. No calculi were detected by intravenous urography that were not first seen on either ultrasound or KUB. Our experience suggests that the combination of ultrasound and KUB is less invasive and more sensitive than intravenous urography for the diagnosis of calculi in patients with symptoms and signs suggestive of stone disease or who are at high risk for stone formation.     

Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients.     

Evidence-based surgery: interventions in a regional paediatric surgical unit

OBJECTIVES: To determine the proportion of paediatric surgical interventions that are evidence-based and to identify areas where randomised controlled trials (RCTs) or further research are required. DESIGN: Prospective review of paediatric general surgical inpatients. SETTING: A regional paediatric surgical unit. SUBJECTS: All consecutive paediatric general surgical patients admitted in November, 1995. MAIN OUTCOME MEASURES: Each patient on whom a diagnosis had been made was allocated a primary diagnosis and primary intervention (n = 281). On the basis of expert knowledge, Plusnet Medline, and ISI Science Citation database searches, each intervention was categorised according to the level of supporting evidence: category 1, intervention based on RCT evidence; category 2, intervention with convincing non-experimental evidence such that an RCT would be unethical and unjustified; category 3, intervention without substantial supportive evidence. RESULTS: Of 281 patient interventions, 31 (11%) were based on controlled trials and 185 (66%) on convincing non-experimental evidence. Only 23% of interventions were category 3. CONCLUSIONS: In common with other medical specialties, the majority of paediatric surgical interventions are based on sound evidence. However, only 11% of interventions are based on RCT data, perhaps reflecting the nature of surgical practice. Further RCTs or research is indicated in a proportion of category 3 interventions.     

Varied types of urinary calculi in a patient with cystinosis without renal tubular acidosis

Renal calculi have rarely been cited as a major manifestation of cystinosis. We report a case history of a child with multiple urate calculi and a calcium oxalate stone resulting from proximal tubular dysfunction that was not associated with bicarbonate wastage.     

Dissolution of bilateral staghorn cystine renal calculi.

Bilateral staghorn renal calculi in a 7-year-old girl with cystinuria were dissolved over a period of 6 months, using a high fluid intake, urinary alkalinisation, and D-penicillamine. Even in children with extensive cystine urolithiasis, medical management may avert the need for surgery.     

经皮肾穿刺微造瘘取石术治疗儿童肾结石

目的探讨经皮肾穿刺微造瘘取石术（mini—PCNL）治疗儿童肾结石的手术技巧及临床应用价值。方法回顾性分析总结35例儿童肾结石患儿采用mini—PCNL术治疗的临床资料。结果22例I期取净结石，12例经二次取石，9例取净，另有1例经三次取石仍未取净。4例有残石者术后配合ESWL治疗，2例排净。随访2～32个月，患儿肾积水明显好转，结石无复发，7例肾盏颈部扩张者狭窄消失。1例有少许残石患儿结石体积有增大。结论mini—PCNL治疗儿童肾结石创伤小，安全、有效。结合术后ESWL治疗可以代替开放手术而成为儿童肾复杂结石、鹿角形结石以及合并肾内狭窄的首选治疗方法。     

Use of intraoperative lateral pelvic X-ray to localize and ensure coccyx removal during sacrococcygeal teratoma resection

En bloc removal of the coccyx during sacrococcygeal teratoma resection is necessary to decrease the risk of recurrence. However, variable anatomy often makes the border between the coccyx and sacrum difficult to identify. We describe the use of intraoperative lateral pelvic X-ray to localize this border and ensure complete coccygectomy.     

The use of the Statscan digital X-ray unit in paediatric polytrauma

We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided.     

Two cases of Ralstonia pickettii bacteremias in a pediatric oncology unit requiring removal of the Port-A-Caths

Ralstonia pickettii is an aerobic, gram-negative bacterium causing bacteremia following the use of contaminated saline vials, respiratory therapy solutions, skin disinfectants, blood culture mediums, and water supplies. It is rarely associated with human infections. The authors report two cases of R. pickettii bacteremia in patients with Port-A-Caths that could be treated only by removal of the ports.     

Use of echocardiography in the neonatal intensive care unit

The role of echocardiography in the neonatal intensive care unit (NICU) has rapidly evolved over the last two decades and there are now guidelines to direct Neonatologist Performed Echocardiography (NPE). Expert consensus statements have provided a framework for echocardiography training, scope of practice, and clinical governance structure for neonatologists. Now NPE is routinely being used a standard of care in the NICUs across the world. It is referred to as NPE, targeted neonatal echocardiography, point of care echocardiography or functional echocardiography, depending upon the country's guidelines. The terms are used somewhat interchangeably, but functional echocardiography is aimed less at the identification of structural abnormalities and more at determining cardiac function. Clinical examination and the existing tools for the haemodynamic monitoring in the neonatal intensive care lack sensitivity and specificity, and they are indirect parameters of cardiovascular well-being. Functional echocardiography provides direct assessment of haemodynamics at bedside. It is now widely regarded as a useful extension to the clinical examination and other monitoring tools in the critically ill infant. This review article provides an overview of the five most common applications of NPE in the neonatal intensive care unit; diagnosis and haemodynamic evaluation of PDA, diagnosis and evaluation of pulmonary hypertension, diagnosis of pericardial effusion and guide pericardiocentesis, assessment of cardiac functions and fluid volume status (pre-load). It describes how PE can be used by the healthcare professionals to optimize care for sick neonates with haemodynamic instability.     

微创经皮肾穿刺取石治疗儿童复杂肾结石

目的 探讨微创经皮肾穿刺取石治疗儿童复杂肾结石的疗效和安全性.方法 回顾性分析我院收治儿童复杂肾结石33例,男21例,女12例,年龄5～14岁,平均8.5岁.结石位于右侧16例,左侧13例,双侧4例.结石单发11例,多发19例,铸形结石3例,结石大小2.1 cm×3.2 cm-3.7 cmx6.7 cm.均采用B超定位经皮肾气压道碎石系统治疗,并观察结石清除情况.结果 本组33例均经一次穿刺即成功建立通道,其中4例行两通道碎石,4例同时行双侧碎石.31例I期行经皮肾微创造瘘术(MPCNL),2例Ⅱ期.手术时间80～130 min,平均92 min,术中出血30-80 ml,平均(61.5±12.3)ml,均无输血.1例有较大结石残留辅以体外震波碎石治疗.Ⅰ期结石清除率90.9%(30/33),Ⅱ期碎石后总清除率为96.9%(32/33).无气胸、腹腔脏器损伤、大出血等严重并发症.术后发热4例.术后24 h血红蛋白及血肌酐值与术前相比差异无统计学意义.术后住院时间4～8 d,平均5.4 d.术后随访3～18个月,平均9个月,结石无复发.结论 微创经皮肾取石治疗儿童复杂肾结石安全可行,疗效确切,具有创伤小、恢复快等优点,可成为本病首选治疗.     

学龄儿童肾结石经皮肾取石术疗效评估

目的 评价经皮肾取石术(PCNL)治疗学龄儿童肾结石的疗效与安全性.方法 2006年8月至2011年8月对25例7～12岁学龄儿童肾结石患者接受经皮肾取石术治疗.X线定位穿刺,建立16F经皮肾通道,8/9.8F输尿管镜下碎石取石.结果 平均手术时间74 min.20例肾结石患儿I期PCNL取出结石,2例患儿接受Ⅱ期pCNL治疗并取净结石,结石清除率88％(22/25).无严重并发症发生.结论 对有手术指征的学龄儿童肾结石,采用经皮肾取石术治疗是安全有效的.