The 'classic' picture of intussusception might frequently not be present in children with intussusception. Reliance on 'classic' features alone might delay diagnosis. Delayed diagnosis is associated with poorer patient outcomes. Air enema has a high success rate for reduction of intussusception.
Increased awareness of idiopathic hypertrophic pyloric stenosis (IHPS) and readily available ultrasonographic diagnosis might mean that 'classic' presentations are becoming less common. We sought to describe the epidemiology, clinical features and outcomes of children with IHPS in the modern era. A retrospective case review of all cases of IHPS presenting to a single tertiary paediatric hospital over an 11 year period was conducted. Inclusion criteria were met by 329 children with confirmed IHPS. Eighty-four per cent of patients were male and 19% were born premature. Premature infants tended to present later, reflecting postmenstrual age. The median age at presentation was 5 weeks (range 0-31) with median symptom duration of 7 days (range 1-95). At least one classic symptom or sign was present in 87% of infants but only 14% had the classic triad (projectile vomiting, palpable olive and visible peristalsis). Elevated bicarbonate was present in 61% of blood samples, whereas hypochloraemia was found in only 29%. Ultrasound confirmed the diagnosis in 89%. Surgical techniques were similar in outcome, except that incomplete pyloromyotomy was more common with the laparoscopic compared with periumbilical approach (6% vs 1%, P= 0.023). IHPS occurs more frequently in male and ex-premature infants. It commonly presents without the full spectrum of 'classic' symptoms and signs. Given the availability of ultrasound diagnosis, IHPS should be considered in all babies with any one of the classic findings.
End-stage renal failure is most commonly caused by the obesity-related diseases, diabetes mellitus and essential hypertension, and is best treated with renal transplantation. Obesity may contribute to poor patient and graft survival, and is an exclusion criterion in some renal transplant programs. Diet and exercise programs have not proven to be effective for weight loss before transplantation, and bariatric surgery in any form has not been used in this setting before. We report three morbidly obese patients who underwent laparoscopic adjustable gastric banding to meet the criteria for renal transplantation and subsequently were successfully transplanted.
INTRODUCTION: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of nonbilious vomiting in infants. The “classic” presentation is one of a firstborn boy who is aged 2 to 8 weeks and has projectile vomiting; palpable olive, visible peristalsis; and hypochloremic metabolic alkalosis. With increased awareness of the condition and readily available ultrasonographic diagnosis, classic presentations may be becoming less common. OBJECTIVE: We sought to describe the epidemiology, clinical features, and outcomes of children with IHPS at our institution. METHODS: We conducted a retrospective case review of all cases of IHPS that presented to our tertiary pediatric hospital in an 11-year period. RESULTS: The inclusion criteria were met by 330 children with confirmed IHPS. A total of 84% of patients were male, and 19% were born preterm. Preterm infants tend to present later, reflecting postmenstrual age. The median age at presentation was 36 days (range: 7–218 days) with mean symptom duration of 11 days (range: 1–95 days). Whereas 87% of patients had at least 1 classic finding on history or examination, only 14% had the classic triad. Elevated bicarbonate was present in 61% of blood samples, whereas hypochloremia was found in only 29%. Ultrasound confirmed the diagnosis in 89%. Surgical techniques were similar in outcome, except that incomplete pyloromyotomy was more common with the laparoscopic approach compared with the periumbilical approach (6% vs 1%). CONCLUSIONS: IHPS occurs more frequently in boys and infants who were born preterm. It commonly presents without the full spectrum of classic findings. Given the availability of ultrasound diagnosis, IHPS should be considered in infants with any 1 of these findings.
Many emergency medicine practitioners who regularly see children and adolescents will identify with the potential difficulties associated with management of their mental health and behavioural problems.e mm_1316 358The Royal College of Psychiatrists (UK) have developed this well-written handbook in an attempt to provide emergency medicine practitioners with some of the skills and knowledge required to manage these children effectively.The first six of the thirteen chapters are particularly relevant to Australasian practice. The introductory chapters provide an excellent summary of the child and adolescent considerations associated with the assessment and management of mental health presentations in the emergency department environment.The following three chapters provide short summaries of each mental health and behavioural condition and presentation, utilizing practical lists and tables to great effect. Included within these chapters is a common-sense approach to the patient with an autisticspectrum disorder; the adolescent with self-harm; the management of medication side effects; and the management of violent behaviour. All are of particular interest.The second half of the book discusses issues more specific to the UK practitioner. There is a review of the UK Mental Health and Child Protection system and also a discussion of the framework of the pertinent local legislation.The Australasian emergency medicine practitioner will find much that is useful to in this book, which provides a common-sense approach to assessment and management of these often-difficult cases.
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