Introduction. Acute appendicitis is the most common surgical emergency in the pediatric population. The peak incidence occurs in the first decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but in very young children this standardized operation is not always easy to perform. Material and Methods. From January 2009 to December 2015 we operated on 525 acute appendicitis, with 120 patients less than 5 years of age. Results. 90 children had a complicated appendicitis (localized or diffuse peritonitis): 43 (48%) were operated on by open approach and 47 (52%) by laparoscopy. The overall incidence of postoperative complications was greater in the open appendectomy group (63% versus 26%) and all severe complications requiring reintervention (6% of cases: 3 postoperative abscesses resolved with ultrasound guided percutaneous abscess drainage; 1 tubal surgery for salpingitis; 1 adhesion-related ileus requiring relaparotomy) were mostly associated with open surgery. Conclusions. Laparoscopic surgery resulted as the best approach for treating complicated appendicitis also in younger children, with minor and less severe postoperative complications compared to open surgery.
Background/Introduction:The World Health Organization (WHO) declared climate change a defining issue in the 21st century with more intense heatwaves, higher risks of flooding and damaging storms, and a changing pattern of emerging infectious diseases. In this scenario, the response of Emergency Medical Teams (EMTs) to disasters represents a fundamental resource.Objectives:To expand EMT2-ITA-Regione Piemonte operational independence and to minimize its environmental footprint.Method/Description:A multiphasic and prospective project is planned in order to:(1) Reduce water consumption: use of a sterilizer designed with a set of high-efficiency heat exchangers enabling a substantial saving in water consumption by the vacuum pump and a significant reduction of total water usage through a recirculation system.(2) Reduce demand for diesel: photovoltaic (PV) system to integrate the current energy production system based on diesel generators.(3) Reduce paper consumption: use of sterilization management and traceability system and computerized medical record in order to be paperless.(4) Improve staff awareness and education on greening practices: educational program for the staff focused on waste segregation/management and energy and water saving both in the hospital and in the Base of Operation (BoO).Results/Outcomes:EMT2-ITA-Regione Piemonte aims to reduce energy and water consumption by 30% and to become paperless.Conclusion:Advances in greening initiatives offer to EMT2-ITA-Regione Piemonte the potential to improve its disaster medical response capabilities and to reduce its ecological footprint.
Introduction:A disaster involving significant casualties in a populated area demands the rapid development of a field hospital with personnel specialized in Disaster Medicine. In this scenario, the clinical response of Emergency Medical Teams should be guided by the knowledge of how the medical needs of the population change after the disaster itself. In order to reduce the loss of life and prevent long-term disability, it is essential to have the right tools to treat critical patients. In fact, disasters cause a variety of conditions ranging from minor to life-threatening injuries requiring admission to Intensive Care Unit (ICU).Method:A systematic review was carried out and electronic healthcare databases were searched using terms such as “Disaster” or “Flood” or “Storm” or “Earthquake” or “Mass Casualty Incidents” and “Intensive Care Unit” or “Intensive Care” or “Health Impact”. Articles that met the search criteria, published in the last 15 years in the English language, were analyzed and summarized. The objective of the review was to identify the main health problems following disasters and, in particular, the diseases that may require intensive care in order to assess the need to include ICU in the minimum technical standard for Emergency Medical Teams type 2.Results:The review included 12 studies identified as relevant and significant for our purpose. Health problems were sorted for disaster type and severity of the injury. The review demonstrates that health problems after a disaster are different depending on disaster type, but in all the scenarios there are diseases that potentially may require timely intensive care.Conclusion:The presence of an ICU within an Emergency Medical Team type 2 (according to WHO EMT classification) is an essential part of disaster management plans as ICU plays an irreplaceable role in saving lives and in reducing the health impact of a disaster.
Extremely low birthweight neonates often require total parenteral nutrition by central venous catheterization.The technique of choice is the percutaneous cannulation via the basilica or cephalic vein; in particular cases, these peculiar patients need a cut down catheterization. This paper describes some unusual complications of this surgical approach.
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