The incidence of DVT in hospitalized children is increasing. Those presenting with DVT typically have prior DVT, thrombophilia, or lower extremity disease. Our study suggests that children admitted with severe medical conditions who require a prolonged intensive care unit stay in addition to central venous access (especially via the femoral vein) should be considered candidates for DVT prophylaxis. A clinical probability scoring system alone cannot stratify patients sufficiently to forgo prophylaxis in hopes of a rapid clinical diagnosis. Childhood-specific level 1 trials aimed at determining guidelines for DVT prophylaxis are urgently required.
We have developed a counter rotating cone extrusion device to produce the next generation of three-dimensional collagen scaffold for tissue engineering. The device can produce a continuously varying fibril angle from the lumen to the outside of a 5-mm-diameter collagen tube, similar to the pattern of heart muscle cells in the intact heart. Our scaffold is a novel, oriented, type I collagen, tubular scaffold. We selected collagen because we believe there are important signals from the collagen both geometrically and biochemically that elicit the in vivo -like phenotypic response from the cardiomyocytes. We have shown that cardiomyocytes can be cultured in these tubes and resemble an in vivo phenotype. This new model system will provide important information leading to the design and construction of a functional, biologically based assist device.
Numerous operations have been described to address the unilateral cleft lip deformity. One area that has not received significant attention is the deficient join between the nasal ala and the upper lip. Several surgeons have advocated detaching the ala and rotating it medially to restore the nasal sill and decrease the alar flare. Unfortunately, many children with clefts do not have enough available tissue to perform these maneuvers without compromising the nostril opening. In this article, the authors present a technique using composite earlobe grafts with sandwiched cartilage grafts to restore symmetry with the contralateral nostril. This technique has also been used in adult patients undergoing reconstruction because of cancer ablation or traumatic injuries. All patients received adjuvant hyperbaric oxygen therapy.
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