Laparoscopic-assisted resection of Meckel's diverticulum in children.

BACKGROUND AND OBJECTIVES: Meckel's diverticulum (MD) presents unique challenges for a pediatric surgeon, as it is prone to varied complications. This case series highlights the diverse presentations and laparoscopic management of MD in children. METHODS: We performed a retrospective analysis of consecutive cases of laparoscopic-assisted transumbilical Meckel's diverticulectomy (LATUM) performed by the same surgeon for incidental as well as diverse Meckel's diverticular complications over 20 months. RESULTS: Eight patients (5 males and 3 females) aged 3 years to 13 years (median, 12) underwent LATUM. Three patients had painless per-rectal bleeding and 1 presented with intestinal obstruction due to a mesodiverticular band and intestinal ischemia. Two patients had features masquerading as appendicitis; one had perforated MD with secondary inflammation of the appendix, and the other had a torsed, gangrenous MD. In 2 patients, incidental MD with a narrow base was noted at appendicectomy for appendicitis. All patients underwent successful LATUM along with appendicectomy in 4 patients. The operative duration was 72 minutes to 165 minutes (mean, 112.1+/-30.6). There were no operative complications, and no conversion to open surgery was required. The hospital stay was 4 days to 7 days (mean, 4.7+/-1.2). The patient with mesodiverticular band intestinal obstruction presented with adhesive intestinal obstruction 2 weeks after the surgery. Laparoscopic-assisted minilaparotomy was done to release the pelvic adhesions. There were no other complications during the follow-up (median, 11 months). CONCLUSIONS: LATUM is a simple, safe, and effective procedure with a better cosmetic outcome that can be performed for diverse manifestations of MD. The technique also allows palpation of the MD and avoids use of expensive staplers.     

Treatment methodology Guiding of behaviour through redirection in brain injury rehabilitation

Confusion, agitation, and non-compliance are some of the most common behaviours exhibited by individualswith brain injury. The presence of these behaviours affects their daily functioning and social interactions with others. Management of these behaviours ranges from prevention and total ignoring to restraint, with the strategy of redirection cited most often in the literature. However, few guidelines exist on how to use redirection to manage clients who exhibit confusion and agitation beyond the acute phase of rehabilitation. This paper describes some of the intervention strategies that use guidance and redirection for individuals with brain injury in post-acute rehabilitation. Case examples are used to illustrate the various interventions.     

Quantitation of uterine activity in 100 primiparous patients.

An on-line technique for quantitating uterine activity by measuring the total area under the intrauterine pressure curve was utilized during the labor of 100 primiparous patients. Uterine activity was measured in uterine activity units (1 UAU=1 Torr minute). UAU's were calculated for each patient in both cumulative and noncumulative fashions. The rate of uterine activity (UAU per unit of time) increased as labor progressed, yet the total UAU's expended at each centimeter of dilatation progressively decreased with advancing dilatation. Thus, the rate of cervical dilatation increased faster than could be accounted for by the increase in uterine activity. The implication being that the efficiency of uterine contractions increases with advancing labor. It no longer appears reasonable to refer to labor in terms of elapsed time. Information regarding the "pattern of cervical dilatation" and uterine activity appears to be much more meaningful to the evaluation of progress in labor. Quantitation of uterine activity may provide useful information for the ongoing management of labor. Quantitation of UA does provide a means of evaluating the effects of specific events such as medication, anesthesia, and manipulation on UA.     

Critical airway obstruction, superior vena cava syndrome, and spontaneous cardiac arrest in a child with acute leukemia

We report the unusual presentation of a previously healthy girl with sudden cardiopulmonary arrest caused by acute lymphoblastic leukemia and mediastinal involvement leading to acute tracheal and airway obstruction. Despite active resuscitation and mechanical ventilation, she developed severe cerebral edema as a result of cerebral asphyxia. She also had facial edema caused by superior vena cava obstruction, a high peripheral white cell count with blast differentials, and renal failure. Because of severe asphyxia leading to brain death and renal failure, chemotherapy was withheld. Her white cell count spontaneously reverted to reference range without chemotherapy. This report serves to alert clinicians of the oncological emergency of "superior mediastinal syndrome" causing airway and superior vena cava obstruction leading to death in this potentially curable disease.     

Cardiovascular profile after intravenous injection of Africanized bee venom in awake rats

The manifestations caused by Africanized bee stings depend on the sensitivity of the victim and the toxicity of the venom. Previous studies in our laboratory have demonstrated cardiac changes and acute tubular necrosis (ATN) in the kidney of rats inoculated with Africanized bee venom (ABV). The aim of the present study was to evaluate the changes in mean arterial pressure (MAP) and heart rate (HR) over a period of 24 h after intravenous injection of ABV in awake rats. A significant reduction in basal HR as well as in basal MAP occurred immediately after ABV injection in the experimental animals. HR was back to basal level 2 min after ABV injection and remained normal during the time course of the experiment, while MAP returned to basal level 10 min later and remained at this level for the next 5 h. However, MAP presented again a significant reduction by the 7th and 8th h and returned to the basal level by the 24th h. The fall in MAP may contribute to the pathogenesis of ATN observed. The fall in MAP probably is due to several factors, in addition to the cardiac changes already demonstrated, it is possible that the components of the venom themselves or even substances released in the organism play some role in vascular beds.