Objective. The authors compared a 1-time application of bovine collagen and human amniotic membrane (HAM) to treat children with superficial second-degree burns. Materials and Methods. A prospective, blinded, internally randomized trial of 43 children was conducted. Fresh HAM (prepared in-house at the Christian Medical College, Vellore) and bovine collagen were applied to different halves of each wound and dried naturally to form a hard, shell-like, so-called exoskeleton. The shell was shed as epithelialization occurred beneath it. Clinical examination and serial photographs were used to track progress until the wound healed completely, as well as at 3 and 6 months after the burn injury. Two burns surgeons blinded to the material used evaluated the resulting scars using the Vancouver Scar Scale. Results. The 43 children presented 3 hours after burn injury on average. A 1-time application was successful in 40 children (93%). After the dressing dried, all parents reported that their child was pain free and the exoskeleton could be handled over the burned area. A total of 16 children (37%) with a low-grade fever at the time of application were treated with simple antipyretic agents. Eight children reported itching at the dressing site. The dressing did not take or was removed in 3 children (7%). Minor serous collections occurred in 8 children who subsequently underwent aspiration. The median time to healing was 10 days in both study arms, with no significant difference in scarring between the 2 materials. Children with earlier shedding of the shell had significantly better scar quality (P <.001). Conclusions. Collagen and HAM are safe and provide a one-time ambulatory option for burn dressing with comparable time to healing and scarring. Earlier shedding of the dressing is predictive of better scar quality. Because HAM is inexpensive and simple to prepare and store, it is an excellent choice for use in economically disadvantaged areas where collagen may be unavailable.
Inflammatory myofibroblastic tumor (IMT) is a rare, low grade malignant lesion which can occur anywhere in the body. In children it is usually found in the visceral soft tissues with a potential for local invasion and recurrence, and rarely distant metastasis. We report the diagnostic dilemma faced in the management of a 12-year old girl who presented with obstructive jaundice with a mass lesion at the distal end of the common bile duct. She underwent a tumor resection with a bilio-enteric bypass followed by a course of oral steroids and celecoxib.
Female hypospadias is a rare anomaly of the female urethra where it opens on the anterior vaginal wall anywhere between the introitus and the fornix. It is often associated with other genitourinary anomalies such as Cloacal malformation, female pseudohermaphroditism, nonneurogenic neurogenic bladder and urethral duplication. Idiopathic female pseudohermaphroditism is extremely rare, and most cases occur secondary to adrenogenital syndrome or maternal androgen exposure. We report a unique case of a 1-year and 4-month-old girl who presented with ambiguous genitalia and renal failure secondary to a non-neurogenic neurogenic bladder. On further evaluation, she was found to have urethral duplication with a hypospadiac female urethra. She initially underwent a vesicostomy and was further planned to undergo an appendicular Mitrofanoff at an older age. The mainstay of treatment in these cases includes relief of bladder outlet obstruction and recovery of renal function by adequate urinary drainage. Clitoral reduction, if cosmetically warranted, may be planned at puberty.
Gastrocolic fistulas in children are most commonly seen after placement of a percutaneous endoscopic gastrostomy. We present a 14-year-old girl who developed a gastrocolic fistula following accidental corrosive acid ingestion. On evaluation of her symptoms, a barium swallow identified the gastrocolic fistula. It healed spontaneously in 3 months. This was both unexpected and remarkable. To the best of our knowledge this is the first case of a gastrocolic fistula occurring following corrosive ingestion.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.