Patients with pectus carinatum are at risk for a disturbed body image and reduced quality of life. Until recently, treatment required surgical reconstruction. A growing body of literature, however, now supports the use of orthotic bracing as a nonoperative alternative in select patients. This article reviews the current literature and describes the evaluation and management of children with pectus carinatum deformity.

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Background:Adult guidelines for the management of traumatic hemothorax are well established; however, there have been no similar studies conducted in the pediatric population. The purpose of our study was to assess the management and outcomes of children with traumatic hemothorax.Materials and Methods:Following Institutional Review Board approval, we conducted a retrospective cross-sectional study of all trauma patients diagnosed with a hemothorax at a Level-1 pediatric trauma center from 2007 to 2012.Results:Forty-six children with hemothorax were identified, 23 from blunt mechanism and 23 from penetrating mechanism. The majority of children injured by penetrating mechanisms were treated with tube thoracostomy while the majority of blunt injury patients were observed (91.3% vs. 30.4% tube thoracostomy, penetrating vs. blunt, P = 0.00002). Among patients suffering from blunt mechanism, children who were managed with chest tubes had a greater volume of hemothorax than those who were observed. All children who were observed underwent serial chest radiographs demonstrating no progression and required no delayed procedures. Children with a hemothorax identified only by computed tomography, after negative plain radiograph, did not require intervention. No child developed a delayed empyema or fibrothorax.Conclusion:The data suggest that a small-volume hemothorax resulting from blunt mechanism may be safely observed without mandatory tube thoracostomy and with overall low complication rates.

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Significance:The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the longterm effects of wound care pain in traumatic injuries-especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population. SCOPE AND SIGNIFICANCEAccording to the National Trauma Data Bank, 127,234 children were admitted to a hospital for trauma in 2012. 1 Trauma is well known to be the leading cause of morbidity and mortality in children. The number of soft tissue wounds in this population, though, is not well defined. Wounds result from blunt, penetrating, and thermal mechanisms and can pose management challenges. These management challenges include initial management of a complex wound; pain and sedation control for wound evaluation and care; ongoing delivery of wound care; and the psychological morbidity associated with traumatic wounds. TRANSLATIONAL RELEVANCEThe heightened awareness of medical cost and impact of hospitalization on the family of the injured child will drive the evolution of wound care to a more effective and efficient strategy. 2 With this strategy in mind, we have instituted a unique model at our institution for the delivery of pediatric wound care that is utilized in traumatic wounds. CLINICAL RELEVANCEBefore introducing this wound care model, we review in greater detail the types and current management of traumatic wounds with a focus on more complex injuries. We discuss the development of our novel approach to caring for these traumatic wounds. This model reduces the cost associated with the number of emergency department and operating room visits as well as the hospital length of stay for our pediatric patients....

endografts and longer and more radially supported balloon-expanded and self-expanding stent grafts has simplified these procedures. Moreover, increased familiarity with proper sizing, snorkel course and configuration, and factors for seal optimization has enhanced the appeal of this approach in many difficult clinical scenarios.

Neutral endopeptidase (NEP) is a key cell surface peptidase in the maintenance of airway homeostasis involving the development of pulmonary disorders. However, little information is available about the effect of respiratory particles on airway NEP. Cross‐shift spirometry and sputum NEP were measured on twelve normal subjects following acute diesel exhaust exposure. A significant increase in soluble NEP in sputum was observed with 31% average net increases when compared with pre‐exposure. Pearson's correlation analyses indicated that changes in sputum NEP activity were significantly associated with diesel exhaust particle (DEP) exposure. DEP exposure also induced a significant decline in forced expiratory volume in one second (FEV1, 4.03 ± 0.29 vs. 3.78 ± 0.29; p = 0.005 pre‐ vs. post exposure) and forced vital capacity (FVC, 5.16 ± 0.36 vs. 4.86 ± 0.39, p = 0.017), which were significantly associated with sputum NEP activity, not with DEP exposure. The changes in NEP activity may be an accurate endpoint for DEP exposure, be mechanistically linked to lung function, and indicate a greater susceptibility to the risk of pulmonary diseases.