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Renal artery occlusion in pediatric blunt abdominal trauma—decreasing the delay from injury to treatment
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These data demonstrate preferential oxidation of Ala during C and GLC stimulation in S livers. With PE, both sham and S livers use LAC as preferred fuel (confirmed by additional experiments with labeled LAC). Thus, hepatic substrate utilization is altered by the specific second messenger system activated during sepsis. Abnormal Aorta and Iliac Arteries in Children With Urogenital Abnormalities. E. H. Dykes, I. Oesch, P. G. Ran&y, W. H. Hendren, Hospital for Sick Children, London, England; Landeskrankenanstralten, Salzbutg, Austria; Children’s Hospital, Boston, MA.
The authors have encountered six children with various urogenital abnormalities who were found to have severe vascular malformations affecting the distal aorta and iliac arteries. In all cases the normal distal aorta and bifurcation were absent, and the “iliac” arteries were found to arise high and anteriorly from an aberrant tortuous vessel, which appeared to be related to the umbilicus. The “iliac” arteries themselves were tortuous and misplaced, running anteriorly over the bladder before diverging to become the single feeding vessels to the lower limbs. In all cases the arteries were not immediately recognizable as limb vessels and in one patient the artery was inadvertently divided during reconstruction. We hypothesize that this anomaly arises embryologically from a failure of involution of the anterior roots of the original umbilical arteries, an event that may occur at the same developmental time as the urogenital abnormality. The recognition of this anomaly has important surgical implications for those undertaking repair of similar urogenital malformations. Trauma Prevention: An Attempt at Behavior Modification. Jana Ganski, Edward J. Doolin, Southern New Jersey Regional Trauma Center, Robett Wood Johnson Medical School, Camden, NJ.
Pediatric trauma is the major cause of death in children, with motor vehicle accidents claiming the most lives. In 1989, the National Highway Traffic Administration (NTSA) reported more than 75% of child fatalities involved a victim who was unrestrained. At least 31 states have mandatory seatbelt laws. Even with child passenger safety laws, compliance is still inconsistent and bicycle helmet use is even less prevalent. Strategies to prevent these injuries and deaths among children should be assigned high priority. Methods to reduce accidental death and injury in children should center around education. Laws that require restraint have not been successful in achieving compliance. Technological advancements in automatic protection face political, social, and economic obstacles. Therefore, injuryprevention programs aimed at behavior modification that pursuade children to protect themselves and significant others are a logical option. Innovative, ongoing programs tend to improve public awareness. Our hope is with the next generation. The Traumasaur Injury Prevention Program (TIPP) was designed to be presented to children ages 3 to 10 years when a behavior change is most likely to occur. It uses a story format with illustrations to demonstrate the consequences of not taking safety precautions. The characters in the story are a family of dinosaurs who encounter situations familiar to children. The characters take advantage of the current popularity of the dinosaurs. This program attempts to significantly decrease the number of injuries and fatalities caused by motor vehicles in children ages 3 to 10 years. By providing continuous, appealing stories, we hope to increase awareness in children and their families. Because scare tactics and law enforcement are ineffective, positive reinforcement and education are the best alternative. A pleas-
ABSTRACTS
FROM POSTER SESSIONS
ant and ongoing experience may achieve success at achieving safety compliance. Renal Artery Occlusion in Pediatric Blunt Abdominal TraumaDecreasing the Delay From Injury to Treatment. Samuel D. Smith, Richard J. Jackson, Mary J. Gardner, Marc I. Rowe, Children’s Hospital of Pittsburgh, Pittsburgh, PA.
Delay in revascularization is the major factor in the low salvage rate of renal artery occlusion secondary to blunt trauma. A chart review was done to determine: (1) if contrast-enhanced computed tomography (CT) alone can be diagnostic and eliminate the need for intravenous pyelography (IVP) and arteriography (ART); (2) the time sequence from injury to revascularization; and (3) a more efficient strategy for management. From 1980 to 1989, 6 children (average age, 5.3 years) were treated for blunt renal artery injuries. All had hematuria. The severity of injury was indicated by associated injuries: liver laceration (2), splenic laceration (3), pancreatic transection (2), and pelvic fracture (1). The diagnosis of arterial occlusion was suggested by: the lack of renal contrast enhancement in 5 patients with CT and nonvisualization on IVP in 2 patients. ART was confirmatory in 3 patients. The diagnosis was suggested by IVP or CT within 5.1 hours of injury, but ART added an additional 2.3 hours to the diagnostic workup. Regardless of the method of diagnosis, the average time from injury to the onset of operative therapy was 8 hours. Compounding this problem was an additional 3.8-hour average delay in the operating room prior to revascularization. Five patients underwent revascularization; results-3 had minimal function and 2 no function by renal scan. The diagnosis of renal artery occlusion can be rapidly made by contrast-enhanced CT without IVP or ART. To further decrease delay from injury to revascularization the time periods from: (1) diagnosis to operating room, (2) operating room to induction of anesthesia, and (3) induction of anesthesia to revascularization (stop bleeding then revascularize) must be expedited. Use of lntraosseous Infusions in Pediatric Trauma Patients. J. Guy, K.J. Haley, S.J. Zuspan, Children’s Hospital, Columbus, OH.
Intraosseous infusions (IO) are frequently used for gaining rapid vascular access in critically ill children. The objective of this study was to describe one pediatric institution’s experience with the procedure of IO in young trauma victims. This study evaluated indications, insertion sites, complications, infused pharmacological agents, age, injury severity, and outcome. Fifteen patients received IO placement for cardiopulmonary arrest, 7 for hypovolemic shock, and 5 for neurological compromise. Patient ages ranged from 3 weeks to 10 years (mean, 2.9 years). Twenty-nine 10s were attempted in the tibia and 3 in the femur. Four of 32 attempts were unsuccessful. Of 32 attempts at IO placement (5 patients received multiple attempts), 15 were started in the prehospital setting and 16 in the emergency department. Multiple resuscitation medications as well as large colloid and crystalloid boluses were successfully infused. Seven of the 27 patients survived without observed IO-related complications. This study supports the use of IO infusion by prehospital as well as hospital personnel in the initial resuscitation of critically injured children. Treatment of Second-Degree Burns With Porcine Xenografts Versus Silver Sulfadiazine Cream: A Study of Pain and Wound Healing. C.J. Priebe, Jr, R. Friedman, G. Noble, G. Martucci, M. Driessnack, H.S. Soroftc Division of Pediatric Surgery, Department of Surgery, SUNY-Stony Brook, Stony Brook, NY.
These data demonstrate preferential oxidation of Ala during C and GLC stimulation in S livers. With PE, both sham and S livers use LAC as preferred fuel (confirmed by additional experiments with labeled LAC). Thus, hepatic substrate utilization is altered by the specific second messenger system activated during sepsis. Abnormal Aorta and Iliac Arteries in Children With Urogenital Abnormalities. E. H. Dykes, I. Oesch, P. G. Ran&y, W. H. Hendren, Hospital for Sick Children, London, England; Landeskrankenanstralten, Salzbutg, Austria; Children’s Hospital, Boston, MA.
The authors have encountered six children with various urogenital abnormalities who were found to have severe vascular malformations affecting the distal aorta and iliac arteries. In all cases the normal distal aorta and bifurcation were absent, and the “iliac” arteries were found to arise high and anteriorly from an aberrant tortuous vessel, which appeared to be related to the umbilicus. The “iliac” arteries themselves were tortuous and misplaced, running anteriorly over the bladder before diverging to become the single feeding vessels to the lower limbs. In all cases the arteries were not immediately recognizable as limb vessels and in one patient the artery was inadvertently divided during reconstruction. We hypothesize that this anomaly arises embryologically from a failure of involution of the anterior roots of the original umbilical arteries, an event that may occur at the same developmental time as the urogenital abnormality. The recognition of this anomaly has important surgical implications for those undertaking repair of similar urogenital malformations. Trauma Prevention: An Attempt at Behavior Modification. Jana Ganski, Edward J. Doolin, Southern New Jersey Regional Trauma Center, Robett Wood Johnson Medical School, Camden, NJ.
Pediatric trauma is the major cause of death in children, with motor vehicle accidents claiming the most lives. In 1989, the National Highway Traffic Administration (NTSA) reported more than 75% of child fatalities involved a victim who was unrestrained. At least 31 states have mandatory seatbelt laws. Even with child passenger safety laws, compliance is still inconsistent and bicycle helmet use is even less prevalent. Strategies to prevent these injuries and deaths among children should be assigned high priority. Methods to reduce accidental death and injury in children should center around education. Laws that require restraint have not been successful in achieving compliance. Technological advancements in automatic protection face political, social, and economic obstacles. Therefore, injuryprevention programs aimed at behavior modification that pursuade children to protect themselves and significant others are a logical option. Innovative, ongoing programs tend to improve public awareness. Our hope is with the next generation. The Traumasaur Injury Prevention Program (TIPP) was designed to be presented to children ages 3 to 10 years when a behavior change is most likely to occur. It uses a story format with illustrations to demonstrate the consequences of not taking safety precautions. The characters in the story are a family of dinosaurs who encounter situations familiar to children. The characters take advantage of the current popularity of the dinosaurs. This program attempts to significantly decrease the number of injuries and fatalities caused by motor vehicles in children ages 3 to 10 years. By providing continuous, appealing stories, we hope to increase awareness in children and their families. Because scare tactics and law enforcement are ineffective, positive reinforcement and education are the best alternative. A pleas-
ABSTRACTS
FROM POSTER SESSIONS
ant and ongoing experience may achieve success at achieving safety compliance. Renal Artery Occlusion in Pediatric Blunt Abdominal TraumaDecreasing the Delay From Injury to Treatment. Samuel D. Smith, Richard J. Jackson, Mary J. Gardner, Marc I. Rowe, Children’s Hospital of Pittsburgh, Pittsburgh, PA.
Delay in revascularization is the major factor in the low salvage rate of renal artery occlusion secondary to blunt trauma. A chart review was done to determine: (1) if contrast-enhanced computed tomography (CT) alone can be diagnostic and eliminate the need for intravenous pyelography (IVP) and arteriography (ART); (2) the time sequence from injury to revascularization; and (3) a more efficient strategy for management. From 1980 to 1989, 6 children (average age, 5.3 years) were treated for blunt renal artery injuries. All had hematuria. The severity of injury was indicated by associated injuries: liver laceration (2), splenic laceration (3), pancreatic transection (2), and pelvic fracture (1). The diagnosis of arterial occlusion was suggested by: the lack of renal contrast enhancement in 5 patients with CT and nonvisualization on IVP in 2 patients. ART was confirmatory in 3 patients. The diagnosis was suggested by IVP or CT within 5.1 hours of injury, but ART added an additional 2.3 hours to the diagnostic workup. Regardless of the method of diagnosis, the average time from injury to the onset of operative therapy was 8 hours. Compounding this problem was an additional 3.8-hour average delay in the operating room prior to revascularization. Five patients underwent revascularization; results-3 had minimal function and 2 no function by renal scan. The diagnosis of renal artery occlusion can be rapidly made by contrast-enhanced CT without IVP or ART. To further decrease delay from injury to revascularization the time periods from: (1) diagnosis to operating room, (2) operating room to induction of anesthesia, and (3) induction of anesthesia to revascularization (stop bleeding then revascularize) must be expedited. Use of lntraosseous Infusions in Pediatric Trauma Patients. J. Guy, K.J. Haley, S.J. Zuspan, Children’s Hospital, Columbus, OH.
Intraosseous infusions (IO) are frequently used for gaining rapid vascular access in critically ill children. The objective of this study was to describe one pediatric institution’s experience with the procedure of IO in young trauma victims. This study evaluated indications, insertion sites, complications, infused pharmacological agents, age, injury severity, and outcome. Fifteen patients received IO placement for cardiopulmonary arrest, 7 for hypovolemic shock, and 5 for neurological compromise. Patient ages ranged from 3 weeks to 10 years (mean, 2.9 years). Twenty-nine 10s were attempted in the tibia and 3 in the femur. Four of 32 attempts were unsuccessful. Of 32 attempts at IO placement (5 patients received multiple attempts), 15 were started in the prehospital setting and 16 in the emergency department. Multiple resuscitation medications as well as large colloid and crystalloid boluses were successfully infused. Seven of the 27 patients survived without observed IO-related complications. This study supports the use of IO infusion by prehospital as well as hospital personnel in the initial resuscitation of critically injured children. Treatment of Second-Degree Burns With Porcine Xenografts Versus Silver Sulfadiazine Cream: A Study of Pain and Wound Healing. C.J. Priebe, Jr, R. Friedman, G. Noble, G. Martucci, M. Driessnack, H.S. Soroftc Division of Pediatric Surgery, Department of Surgery, SUNY-Stony Brook, Stony Brook, NY.