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Factors related to the presence of head injury in bicycle-related pediatric trauma deaths
INTERNATIONAL
448
Results of Surgical Treatment of Cryptorchidism .. .. .. .. ... . .. .. ... .. .. ... .. .. .. .. .. ... .. .. .. .. .. ... .. .. .. ... .. . Peno-Scrotal Transposition .. .. ... .. .. .. ... .. . .. ... .. .. .. ... . Treatment of Micropenis With Testosterone ... .. . Neonatal Management of Female Intersex by Clitoroplasty . .. ... .. . .. ... .. .. .. .. ... .. .. .. ... .. .. .. .. ... . ... .. .. . Glanuloplasty and In Situ Tubularization of Urethral Plate in Repair of Hypospadias .. .. .. . ... .. .. . Radical Mobilization of Soft Tissues in Repair of Vesical Exstrophy . .. .. .. ... .. .. .. .. ... .. .. .. .. ... . ... .. .. . Maximum and Average Urine Flow Rates in Normal Children . .. .. ... . ... .. .. .. .. .. ... .. .. .. ... .. .. .. .. ... . . Pelvic Floor Exercises for Treatment of Dysfunctional Voiding in Children . .. .. .. ... .. .. .. .. ... .. .. .. ... . . Augmentation Cystoplasty in Boys With Posterior Urethral Valves .. .. .. .. ... .. .. .. ... .. .. .. .. .. ... .. .. ... . . Posterior Urethral Valves, Pressure Pop-Offs, and Bladder Function .. .. ... . .. .. ... .. .. ... .. .. .. .. .. ... .. .. Perinatal Renal Changes Associated With Vesico-Ureteral Reflux . ... .. .. .. ... .. .. .. ... .. .. .. .. ... .. . . Long-Term Urologic Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic Therapy .. .. .. .. .. ... .. .. .. ... .. . ... .. .. .. ... .. .. .. .. ... .. .. .. .. Urinary Diversion in Bladder Exstrophy and Incontinent Epispadias .. ... . .. ... .. .. ... .. .. .. .. .. ... .. .. .. Favorable Long-Term Outcome in Patients With Posterior Urethral Valves Treated With Renal Transplantation .. .. ... .. .. .. .. ... . ... .. .. .. .. ... .. .. .. ... . Advances in Urologic Laparoscopy . .. .. .. .. ... .. .. .. ... .
454 454 454 454 455
GENERAL Pediatric cal Point
Day-Care of View.
diseases, the patient’s age, previous vaccinations, and social conditions limit the feasibility of day-care surgery. Premature infants under the age of 1 year should not be treated on an outpatient basis because of the higher incidence of early postoperative complications. Above all, anesthesia problems play an important role in day-care surgical patients. Fortunately, most of the complications are minor. During a 14-year period, 2,179 children were treated in the authors’ department on an outpatient basis. The overall complication rate was 1.7%. Day-care surgery can be regarded as standard treatment for most of the routine surgical procedures in children.-G.H. willital
455 455 455 455 455 455
455 456
456 456
Neoplasms
Effect of Neoadjuvant Chemotherapy in Surgery for Wilms’ Tumor . .. .. ... .. .. ... .. .. .. .. .. ... .. .. .. .. .. ... .. .. . Classification of Rhabdomyosarcomas and Related Sarcomas . .. .. .. .. ... .. .. .. .. ... .. .. .. ... . .. ... .. .. .. ... .. . Characteristics of Thyroid Tumors in Children Exposed to Radiation as Result of the Chernobyl Disaster ... . ... .. ... .. .. .. ... .. .. .. .. . ... .. ... .. .. .. ... .. .. . Diagnostic Pitfalls and Therapeutic Problems in Liver Tumors of Neonates and Very Young Infants ,............................................................... Outcome of Solid Tumors Occurring in the Neonatal Period .. .. ... . .. .. ... .. .. .. ... .. .. .. .. ... .. .. .. .. .. .. ... .. .. . Childhood Cancers in Zambia Before and After the HIV Epidemic . .. .. .. ... .. .. .. .. ... .. .. .. ... .. .. .. .. ... . ...
ABSTRACTS
456
The Need for a Universal Illness to Allow Accurate ment in Neonatal Surgical
Method Analysis Cases.
of Quantifying Severity of of the Results of TreatM.R.Q. Davies. Pediatr Surg
Int 10:305-308, (July), 1995. It is necessary for all surgeons to have an idea of the outcome of their therapy in relation to the overall status of the patient. This is important to evaluate what factors affect the success or failure of therapy and also to determine the contribution made by intensivists and other specialists toward the care of the patient. This study uses a neonatal therapeutic intervention scoring system (NISS) (modified from that used in adults) on two groups of neonates to assess the usefulness of such a severity of illness score (SOI). Group A neonates had necrotizing enterocolitis (NEC). Those with a predicted mortality rate of 5% (score of < 19) had no mortality; among those with a predicted mortality of 20% (score of 20 to 29) the mortality rate was 22%, and those whose predicted mortality rate was 30% (score of >30) had an actual mortality rate of 37%. Group B consisted of 50 cases of esophageal atresia. The time spent in the intensive care unit (ICU) among this group has been correlated with the NTISS score. Here again, the authors show a good correlation between the score and the time spent in the neonatal KU. This study shows that available neonatal scoring systems may be used, which are appropriate for neonates with a primary medical problem or a primary surgical condition. Modifications and further studies will be needed to obtain a scoring system that is universally applicable and acceptable.-P. Pun’ Factors Related
Related Pediatric
to the Trauma
Presence Deaths.
of Head Injury G. Li, S.P. Baker,
in BicycleC. Fowler, et
al. J Trauma 38:871-875, (June), 1995.
456
456
457 457 457
The authors studied the presence and outcome of bicycle-related head injuries in 2,333 patients enrolled in the National Pediatric Trauma Registry. More than half (54%) of the children with bicycle-related injuries sustained head injury, predominantly skull fractures and concussions. Children who sustained head injury were more likely to have had a preexisting neurological disorder, less likely to have worn a helmet, and more likely to have been injured on a road. Patients with head injury were four times as likely to be treated in intensive care units and were almost twice as likely to have complications as were those with no head injury. The authors urge that special attention be paid to these high-risk groups when bicycle safety programs are implemented.-sreven Siylianos
CONSIDERATIONS
Surgery-Limits G. Steinay
and Risks From the CliniK.P. Riesener, S. We&s, et al.
Chirurgie 66:291-296, (April), 1995. Day-care surgery in childhood has to meet the same safety criteria as inpatient care. Thus, a knowledge of the risks and limits is mandatory. The kind of operation, its duration, concomitant
Epidemiology lation-Based
of Rural Traumatic Death in Children: Study. D.W. Vane and S.R. Shackford.
A Popu-
J Trauma
38:867-870, (June), 1995. The authors reviewed all pediatric trauma deaths that occurred in Vermont over a 6-year period. Only 13% of the deaths occurred in a hospital setting. Surprisingly, 87% of children who died never reached a hospital and were identified by population-based rather
448
Results of Surgical Treatment of Cryptorchidism .. .. .. .. ... . .. .. ... .. .. ... .. .. .. .. .. ... .. .. .. .. .. ... .. .. .. ... .. . Peno-Scrotal Transposition .. .. ... .. .. .. ... .. . .. ... .. .. .. ... . Treatment of Micropenis With Testosterone ... .. . Neonatal Management of Female Intersex by Clitoroplasty . .. ... .. . .. ... .. .. .. .. ... .. .. .. ... .. .. .. .. ... . ... .. .. . Glanuloplasty and In Situ Tubularization of Urethral Plate in Repair of Hypospadias .. .. .. . ... .. .. . Radical Mobilization of Soft Tissues in Repair of Vesical Exstrophy . .. .. .. ... .. .. .. .. ... .. .. .. .. ... . ... .. .. . Maximum and Average Urine Flow Rates in Normal Children . .. .. ... . ... .. .. .. .. .. ... .. .. .. ... .. .. .. .. ... . . Pelvic Floor Exercises for Treatment of Dysfunctional Voiding in Children . .. .. .. ... .. .. .. .. ... .. .. .. ... . . Augmentation Cystoplasty in Boys With Posterior Urethral Valves .. .. .. .. ... .. .. .. ... .. .. .. .. .. ... .. .. ... . . Posterior Urethral Valves, Pressure Pop-Offs, and Bladder Function .. .. ... . .. .. ... .. .. ... .. .. .. .. .. ... .. .. Perinatal Renal Changes Associated With Vesico-Ureteral Reflux . ... .. .. .. ... .. .. .. ... .. .. .. .. ... .. . . Long-Term Urologic Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic Therapy .. .. .. .. .. ... .. .. .. ... .. . ... .. .. .. ... .. .. .. .. ... .. .. .. .. Urinary Diversion in Bladder Exstrophy and Incontinent Epispadias .. ... . .. ... .. .. ... .. .. .. .. .. ... .. .. .. Favorable Long-Term Outcome in Patients With Posterior Urethral Valves Treated With Renal Transplantation .. .. ... .. .. .. .. ... . ... .. .. .. .. ... .. .. .. ... . Advances in Urologic Laparoscopy . .. .. .. .. ... .. .. .. ... .
454 454 454 454 455
GENERAL Pediatric cal Point
Day-Care of View.
diseases, the patient’s age, previous vaccinations, and social conditions limit the feasibility of day-care surgery. Premature infants under the age of 1 year should not be treated on an outpatient basis because of the higher incidence of early postoperative complications. Above all, anesthesia problems play an important role in day-care surgical patients. Fortunately, most of the complications are minor. During a 14-year period, 2,179 children were treated in the authors’ department on an outpatient basis. The overall complication rate was 1.7%. Day-care surgery can be regarded as standard treatment for most of the routine surgical procedures in children.-G.H. willital
455 455 455 455 455 455
455 456
456 456
Neoplasms
Effect of Neoadjuvant Chemotherapy in Surgery for Wilms’ Tumor . .. .. ... .. .. ... .. .. .. .. .. ... .. .. .. .. .. ... .. .. . Classification of Rhabdomyosarcomas and Related Sarcomas . .. .. .. .. ... .. .. .. .. ... .. .. .. ... . .. ... .. .. .. ... .. . Characteristics of Thyroid Tumors in Children Exposed to Radiation as Result of the Chernobyl Disaster ... . ... .. ... .. .. .. ... .. .. .. .. . ... .. ... .. .. .. ... .. .. . Diagnostic Pitfalls and Therapeutic Problems in Liver Tumors of Neonates and Very Young Infants ,............................................................... Outcome of Solid Tumors Occurring in the Neonatal Period .. .. ... . .. .. ... .. .. .. ... .. .. .. .. ... .. .. .. .. .. .. ... .. .. . Childhood Cancers in Zambia Before and After the HIV Epidemic . .. .. .. ... .. .. .. .. ... .. .. .. ... .. .. .. .. ... . ...
ABSTRACTS
456
The Need for a Universal Illness to Allow Accurate ment in Neonatal Surgical
Method Analysis Cases.
of Quantifying Severity of of the Results of TreatM.R.Q. Davies. Pediatr Surg
Int 10:305-308, (July), 1995. It is necessary for all surgeons to have an idea of the outcome of their therapy in relation to the overall status of the patient. This is important to evaluate what factors affect the success or failure of therapy and also to determine the contribution made by intensivists and other specialists toward the care of the patient. This study uses a neonatal therapeutic intervention scoring system (NISS) (modified from that used in adults) on two groups of neonates to assess the usefulness of such a severity of illness score (SOI). Group A neonates had necrotizing enterocolitis (NEC). Those with a predicted mortality rate of 5% (score of < 19) had no mortality; among those with a predicted mortality of 20% (score of 20 to 29) the mortality rate was 22%, and those whose predicted mortality rate was 30% (score of >30) had an actual mortality rate of 37%. Group B consisted of 50 cases of esophageal atresia. The time spent in the intensive care unit (ICU) among this group has been correlated with the NTISS score. Here again, the authors show a good correlation between the score and the time spent in the neonatal KU. This study shows that available neonatal scoring systems may be used, which are appropriate for neonates with a primary medical problem or a primary surgical condition. Modifications and further studies will be needed to obtain a scoring system that is universally applicable and acceptable.-P. Pun’ Factors Related
Related Pediatric
to the Trauma
Presence Deaths.
of Head Injury G. Li, S.P. Baker,
in BicycleC. Fowler, et
al. J Trauma 38:871-875, (June), 1995.
456
456
457 457 457
The authors studied the presence and outcome of bicycle-related head injuries in 2,333 patients enrolled in the National Pediatric Trauma Registry. More than half (54%) of the children with bicycle-related injuries sustained head injury, predominantly skull fractures and concussions. Children who sustained head injury were more likely to have had a preexisting neurological disorder, less likely to have worn a helmet, and more likely to have been injured on a road. Patients with head injury were four times as likely to be treated in intensive care units and were almost twice as likely to have complications as were those with no head injury. The authors urge that special attention be paid to these high-risk groups when bicycle safety programs are implemented.-sreven Siylianos
CONSIDERATIONS
Surgery-Limits G. Steinay
and Risks From the CliniK.P. Riesener, S. We&s, et al.
Chirurgie 66:291-296, (April), 1995. Day-care surgery in childhood has to meet the same safety criteria as inpatient care. Thus, a knowledge of the risks and limits is mandatory. The kind of operation, its duration, concomitant
Epidemiology lation-Based
of Rural Traumatic Death in Children: Study. D.W. Vane and S.R. Shackford.
A Popu-
J Trauma
38:867-870, (June), 1995. The authors reviewed all pediatric trauma deaths that occurred in Vermont over a 6-year period. Only 13% of the deaths occurred in a hospital setting. Surprisingly, 87% of children who died never reached a hospital and were identified by population-based rather