Aim: There has been a recent shift in the management of paediatric splenic trauma, from surgical management to that of a more conservative nature. This audit aimed to determine the current rates of splenectomy in a paediatric population following a traumatic injury. Methods: Retrospective review of all cases of splenic injury presenting to Starship Children's Hospital over the 31 months from 1 December 2005 to 30 June 2008. Results: Over the above-mentioned time period, there were a total of 36 patients between the ages of 0 and 14 with a coded diagnosis of Splenic Injury. Only one splenectomy was carried out at our institution and all other cases of splenic injury secondary to trauma were managed conservatively, giving an overall rate of splenectomy of 2.8%. The median age at presentation was 8.5 years, the most common mechanism of injury was sporting accidents, the median haemoglobin at admission was 123 g/l and the median lowest haemoglobin during admission was 112. 8 g/l out of the 36 patients were transfused with red blood cells. No patients received an ultrasound scan only, 30 patients received a CT scan only and 6 patients underwent both. The median length of stay in hospital was 5 days.Conclusions: Splenic trauma in the paediatric population is a relatively common occurrence. This audit shows the trend towards conservative management in recent years. Surgery can be safely avoided in the majority of children suffering a splenic injury, and need only be performed in multi-trauma patients with multiple sources of bleeding.Background: Motor vehicle collisions comprise a significant proportion of the injury burden in children. Extensive studies have shown that inappropriate use of child restraint systems (CRS) contributes to increased risk of injury and death. However, Australian legislation regarding CRS use is incomplete and inconsistent, and there is evidence to suggest that parents remain uninformed regarding appropriate CRS. Objective: To review the use, and carers' knowledge of CRS in children attending The Royal Children's Hospital Melbourne. Method: A cross-sectional prospective survey was given to parents whose children were visiting the outpatient or emergency departments. Results: 213 surveys including 299 children were completed. 82% of children had been correctly restrained on the day of attendance, but 13% had been placed in a CRS inappropriate to their weight. Within specific age groups, up to 24% of children had been placed in a CRS designed for heavier children, including 14% of infants weighing <8 kg. 37 patients (12%) were travelling as front seat passengers, with 11% of these weighing less than the recommended <26 kg. While 38% of carers had received a Victorian Roads Corporation booklet on appropriate CRS use, comparison with the other survey respondents did not show a difference in CRS knowledge or practice. Conclusion: Although most children are appropriately restrained, a significant proportion are not. A lack of parental knowledge regarding CRS is evident. Based on these findings, we b...
Aim: There has been a recent shift in the management of paediatric splenic trauma, from surgical management to that of a more conservative nature. This audit aimed to determine the current rates of splenectomy in a paediatric population following a traumatic injury. Methods: Retrospective review of all cases of splenic injury presenting to Starship Children's Hospital over the 31 months from 1 December 2005 to 30 June 2008. Results: Over the above-mentioned time period, there were a total of 36 patients between the ages of 0 and 14 with a coded diagnosis of Splenic Injury. Only one splenectomy was carried out at our institution and all other cases of splenic injury secondary to trauma were managed conservatively, giving an overall rate of splenectomy of 2.8%. The median age at presentation was 8.5 years, the most common mechanism of injury was sporting accidents, the median haemoglobin at admission was 123 g/l and the median lowest haemoglobin during admission was 112. 8 g/l out of the 36 patients were transfused with red blood cells. No patients received an ultrasound scan only, 30 patients received a CT scan only and 6 patients underwent both. The median length of stay in hospital was 5 days.Conclusions: Splenic trauma in the paediatric population is a relatively common occurrence. This audit shows the trend towards conservative management in recent years. Surgery can be safely avoided in the majority of children suffering a splenic injury, and need only be performed in multi-trauma patients with multiple sources of bleeding.Background: Motor vehicle collisions comprise a significant proportion of the injury burden in children. Extensive studies have shown that inappropriate use of child restraint systems (CRS) contributes to increased risk of injury and death. However, Australian legislation regarding CRS use is incomplete and inconsistent, and there is evidence to suggest that parents remain uninformed regarding appropriate CRS. Objective: To review the use, and carers' knowledge of CRS in children attending The Royal Children's Hospital Melbourne. Method: A cross-sectional prospective survey was given to parents whose children were visiting the outpatient or emergency departments. Results: 213 surveys including 299 children were completed. 82% of children had been correctly restrained on the day of attendance, but 13% had been placed in a CRS inappropriate to their weight. Within specific age groups, up to 24% of children had been placed in a CRS designed for heavier children, including 14% of infants weighing <8 kg. 37 patients (12%) were travelling as front seat passengers, with 11% of these weighing less than the recommended <26 kg. While 38% of carers had received a Victorian Roads Corporation booklet on appropriate CRS use, comparison with the other survey respondents did not show a difference in CRS knowledge or practice. Conclusion: Although most children are appropriately restrained, a significant proportion are not. A lack of parental knowledge regarding CRS is evident. Based on these findings, we b...
e12068 Background: Randomized trials in Stage 0-II breast cancer have proven that APBI given via HDR implant in 5 days is equivalent to whole breast External Radiation Therapy (XRT) given in 5-6 weeks in regard to breast tumor local recurrence (LR). However, complications have been significant. Recently APBI using non-invasive IMRT given in 5 fractions has been shown in another randomized trial to be equivalent to XRT in 6 weeks, with respect to LR. IMRT was superior in regard to acute effects, late effects, and cosmesis. In the randomized clinical trial of APBI IMRT, the Clinical Target Volume (CTV) was defined by the injection of individual fiducial markers bordering the surgical cavity. At our institution, we have used the Biozorb fiducial system to localize the CTV for IMRT. We sought to confirm the APBI IMRT results with this simpler less labor intensive fiducial placement system. Methods: Between 2017 and 2019, 57 patients have undergone IMRT targeted to a Biozorb defined CTV with the walls of the surgical cavity sewn to the Biozorb device. Eligible patients were older than age 40, had tumor sizes ≤ 3 cm, negative surgical margins, and negative sentinel node dissections. IMRT dose was 30 Gy given in 5 fractions. Dose Constraints were as follows : V-30 Gy < 105%, Ipsilateral Breast V-15 Gy < 50%, Ipsilateral Lung V-10 Gy < 20%, Contralateral Lung V-5 Gy < 10%, Heart V-3 Gy < 20%, Contralateral Breast Dmax < 2 Gy and Skin Dmax < 27 Gy. The Planning Target Volume (PTV) ranged from 27 to 355 cc with a median of 80 cc. PTV = CTV + 1-2 cm. Results: Follow-up ranged from 1-14 months with a median of 7 months. LR has been 0% (0/57). There were no skin reactions. One patient developed pain around the Biozorb site. This resolved within 2 days on a short course of steroids. Cosmetic results as rated by the Surgeon, Radiation Oncologist, and Nurse, were rated excellent in 100% (57/57) of cases. Conclusions: Non-invasive APBI with IMRT targeted to Biozorb has resulted in LR, complications, and cosmetic results which compare favorably to invasive APBI given with HDR implant. At last follow-up, there have been no LR, skin reactions, or complications. Cosmesis has been excellent in 100% of patients.
e12596 Background: Randomized trials in stage 0-II breast cancer have proven that APBI given via HDR implant in 5 days is equivalent to whole breast External Radiation Therapy (XRT) given in 5-6 weeks in regard to breast tumor local recurrence (LR). However, complications have been significant. Recently APBI using non-invasive IMRT given in 5 fractions has been shown in another randomized trial to be equivalent to XRT in 6 weeks, with respect to LR. IMRT was superior in regard to acute effects, late effects, and cosmesis. In the randomized clinical trial of APBI IMRT, the Clinical Target Volume (CTV) was defined by the injection of individual fiducial markers bordering the surgical cavity. At our institution, we have used the Biozorb fiducial system to localize the CTV for IMRT. We sought to confirm the APBI IMRT results with this simpler less labor intensive fiducial placement system. Methods: Between 2017 and 2020, 135 patients have undergone SBRT targeted to a Biozorb defined CTV with the walls of the surgical cavity sewn to the Biozorb device. Eligible patients were older than age 40, had tumor sizes < 3 cm, negative surgical margins, and negative sentinel node dissections. SBRT dose was 30 Gy given in 5 fractions. Dose Constraints were as follows: V-30 Gy < 105%, Ipsilateral Breast V-15 Gy < 50%, Ipsilateral Lung V-10 Gy < 20%, Contralateral Lung V-5 Gy < 10%, Heart V-3 Gy < 20%, Contralateral Breast Dmax < 2 Gy and Skin Dmax < 27 Gy. The Planning Target Volume (PTV) ranged from 27 to 355 cc with a median of 80 cc. PTV = CTV + 1-2 cm. Results: Follow-up ranged from 1-26 months with a median of 12 months. LR has been 0% (0/135). There have been no skin reactions or seromas. Infection has occurred in one patient (0.7%). Three (2.2%) patients developed pain around the Biozorb site. This resolved within 2 days on a short course of steroids in all cases. Cosmetic results as rated by the Surgeon, Radiation Oncologist, and Nurse, were rated excellent in 98.5% (133/135) of cases. Conclusions: Non-invasive APBI with SBRT given qd over 5 days targeted to Biozorb has resulted in LR, complications, and cosmetic results which compare favorably to invasive APBI given bid with HDR implant. At last follow-up, there have been no LR, skin reactions, or significant complications. Cosmesis has been excellent in 98.5% of patients.
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