Accurate knowledge of surface anatomy is fundamental to safe clinical practice. A paucity of evidence in the literature regarding thoracic surface anatomy in children was identified. The associations between surface landmarks and internal structures were meticulously analyzed by reviewing high quality computed tomography (CT) images of 77 children aged from four days to 12 years. The results confirmed that the sternal angle is an accurate surface landmark for the azygos-superior vena cava junction in a plane through to the level of upper T4 from birth to age four, and to lower T4 in older children. The concavity of the aortic arch was slightly below this plane and the tracheal and pulmonary artery bifurcations were even lower. The cardiac apex was typically at the 5 intercostal space (ICS) from birth to age four, at the 4 ICS and 5 rib in 4-12 year olds, and close to the midclavicular line at all ages. The lower border of the diaphragm was at the level of the 6 or 7 rib at the midclavicular line, the 7 ICS and 8 rib at the midaxillary line, and the 11 thoracic vertebra posteriorly. The domes of the diaphragm were generally flatter and lower in children, typically only one rib level higher than its anterior level at the midclavicular line. Diaphragm apertures were most commonly around the level of T9, T10, and T11 for the IVC, esophagus and aorta, respectively. This is the first study to provide an evidence-base for thoracic surface anatomy in children. Clin. Anat. 30:788-794, 2017. © 2017Wiley Periodicals, Inc.

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This article describes a notable case of Haemophilus influenzae serotype a (Hia) septic arthritis in an immunized central Australian indigenous child. Since the widespread immunization for H. influenzae serotype b (Hib) in many indigenous peoples worldwide, there has been an increase in reported cases of Hia, postulating that this serotype is taking over the niche that Hib once occupied in indigenous populations.

This case report describes a case of Strongyloides 'Larva currens' following high dose dexamethasone for upper airway burns following a fat fire. The patient who was originally from Samoa had been living in New Zealand for over 30 years. This case report reviews the literature surrounding Strongyloides hyperinfection and strongyloides in Samoa.

Background Severe liver trauma can cause major haemorrhage and death. Haemostatic resuscitation principles are associated with improved survival in trauma patients with major haemorrhage. We hypothesised death from liver haemorrhage decreased in parallel with the introduction of haemostatic resuscitation. Aim To establish the incidence of haemorrhagic death in patients with severe liver trauma and review how outcomes in two time periods associate with changes in resuscitation practice. Methods A retrospective review of all adult patients admitted to Auckland City Hospital with liver trauma was undertaken for a 14‐year period. Resuscitation fluid for patients with grade V liver trauma or death from liver haemorrhage was compared between the first and second half of the study (2006–2013 vs. 2013–2020). Results Four hundred and fifty patients were admitted with liver trauma during the 14‐year period. Mortality from haemorrhage in patients with severe liver trauma (grade IV and V) decreased between the first and second half of the study (p = 0.009). Pre‐hospital and emergency department crystalloid fluid use decreased (p = 0.002). Fresh frozen plasma in ED (p = 0.076) and total cryoprecipitate use (p = 0.072) increased. Tranexamic acid use increased (p = 0.002). Use of colloid fluid was abandoned (p = 0.013). There was no significant difference in pre‐hospital time or time from hospital arrival until haemorrhage control laparotomy. Conclusion Death from liver haemorrhage decreased in association with the introduction of haemostatic resuscitation while the incidence, severity and surgical management of liver trauma was comparable.

Cecal varices are a rare cause of gastrointestinal bleeding in patients with cirrhosis. We describe a 29‐year‐old man with decompensated alcoholic cirrhosis who developed gastrointestinal bleeding in the hospital. A computed tomography mesenteric angiogram showed bleeding cecal varices, which were successfully treated by glue injection therapy at colonoscopy. The procedure appeared to be complicated by bacteremia due to Escherichia coli.

Background:Pancreatic and duodenal injuries are uncommon due to a relative protection by their posterior anatomical position and have an incidence of less than 1% of all hospital admissions for trauma. Auckland City Hospital (ACH) is a tertiary referral hospital in New Zealand with Trauma and Hepatopancreatobiliary units and admits approximately 384 patients with major trauma per year, predominantly from blunt mechanisms. This study is used to assess the incidence, diagnosis and clinical management of pancreatic and duodenal injuries in trauma patients at a single trauma centre. Method:A retrospective study was undertaken using data from a prospectively collected trauma registry. Inpatient notes including all patients admitted from 2007 to 2020 were reviewed. Pancreatic and duodenal injuries were graded using the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) grading system. Investigations including radiology and biochemistry and clinical management were noted.Results:A total of 45 trauma patients admitted to Auckland City Hospital had sustained pancreatic or duodenal injuries, during a period in which approximately 380 patients per year were admitted with major trauma. Six patients had combined pancreaticoduodenal injuries, 16 had duodenal and 23 had pancreatic injuries. Grade I organ injuries were the most common in pancreatic (19/29) and duodenal injuries (9/22). The majority of patients underwent laparotomy (33/45) for associated haemodynamic instability. All organ specific indications for surgery occurred in Grade II and higher injuries. 10/45 patients were managed non-operatively, of which the majority had Grade I or II organ injuries (9/45). 3/45 patients died.Conclusion:The incidence of pancreaticoduodenal injuries is rare (45 patients in 13 years) and in keeping with trauma literature. In our series, haemodynamically stable patients with Grade I - II pancreatic and Grade I - II (non-laceration type) duodenal injuries did not require operative management. Endoscopic pancreatic stenting may facilitate selective non-operative management in some patients with pancreatic duct injury or complications.

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