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关键词： Paediatric   ACL   Repair   Outcome  

摘要： Purpose Anterior cruciate ligament (ACL) surgery in the paediatric population has long been a challenge. Non-operative treatment will result in persistent instability which can lead to chondral and meniscal injuries. The results of primary open ACL repair are poor. Concerns of growth plate disturbance with transphyseal techniques and issues with relatively small-diameter grafts in Tanner 1 and 2 patients, which are inadequate, have contributed to these challenges. With advancing instrumentation, there is renewed interest in ACL repair. The minimally invasive approach of arthroscopic primary ACL repair retains the native ligament. The objective and subjective outcomes at 2 years are presented. Methods Paediatric patients, less than 16 years of age, presenting acutely with complete proximal ACL ruptures underwent direct arthroscopic ACL repair, reinforced by a temporary internal brace, which was subsequently removed after 3 months. Patient-reported outcome measures including the Lysholm, Tegner and KOOS scores were collected at 6 months, 1 year and 2 years post-operatively. Results Twenty patients (age 6-16) completed data at 2 years post-operatively. There were no failures, no complications and no growth disturbance out to 2 years. The 2-year postoperative outcomes;Lysholm 95 (90-100), Tegner 7 (6-10), KOOS-Child 96.5 (88.9-100) demonstrated statistically significant improvements following surgery (p < 0.001). Objective measurements with an accelerometer did not demonstrate any significant side-to-side difference. Conclusion ACL repair for proximal ACL tears in the paediatric population demonstrates the potential for excellent outcomes at short-term follow-up. This presents an attractive alternative to ACL reconstruction when an adequate ACL remnant permits direct repair. Our results demonstrate that paediatric ACL repair is safe and effective.

关键词： Appendicectomy   Hospital-volume   Paediatric surgery   Surgeon-volume  

摘要： Introduction Acute appendicitis is a common surgical emergency in children. The majority of appendicectomies in children are performed by general surgeons, rather than specialist paediatric surgeons. Aim To assess the impact of hospital specialization, hospital volume, and surgeon volume on outcomes for children undergoing appendicectomy in Ireland. Methods NQAIS (National Quality Assurance and Improvement System) data for all appendicectomies performed on children in Ireland between January 2014 and November 2017 was examined. Hospitals were categorized as specialist paediatric centres (SPCs), high-volume general (HVGHs), moderate-volume general (MVGHs), or low-volume general (LVGHs) by annual case volume. Similarly, surgeons were categorized as high-volume (HVSs), moderate-volume (MVSs), or low-volume (LVSs) by annual volume. Data relating to patient demographics, type of surgery (open/laparoscopic/laparoscopic converted to open), length of stay (LOS), mortality, admission to critical care, and readmission rates were collected and analysed. Results About 9593 appendicectomies were performed in 21 hospitals by 134 surgeons. Patients in SPCs had lowest overall rates of laparoscopic surgery (48% v 66% (HVGHs) v 70% (MVGHs) v 57%(LVGHs), p < 0.001). In SPCs 30-day readmission rates were lower for younger children (5.3% for 5-8-year olds v 6.7% (HVGHs) v 7.3%(MVGHs) v 10.5% (LVGHs), p = 0.023). HVSs performed more laparoscopic appendicectomies on younger patients (0-4 years: 40% v 6% (MVSs) v 17%(LVSs), p < 0.001) but performed the least on older children (13-16 years: 76% v 82%(MVSs) v 82%(LVSs), p < 0.001). Conclusion Children younger than 8 years undergoing appendicectomy in HVGHs or SPCs, or by HVSs, have marginally better outcomes. In older children, marginally shorter in-hospital stays and higher laparoscopic rates are seen in those looked after outside of high-volume or specialist units. Our results show that nonspecialist centres provide an essential, and safe,

摘要： In this paper titled Atlantoaxial instability treated with free-hand C1-2 fusion in a 3-year old boy with Morquio syndrome, the authors, Eun Ji Moon, MD, Sang Joon Chong, MD, PhD and Jin Hoon Park, MD, PhD describe the case of a just 3-year Morquio old boy presenting with a 5-month history of progressive quadriparesis and severe neck pain [1]. The preoperative cervical imaging showed a compressive myelopathy at C1-2 and atlantoaxial subluxation. Atlantoaxial fixation and decompression were performed successfully with posterior C1-2 fusion using a free-hand technique. After the operation, the patient had improved neck pain and quadriparesis, and finally, he had been able to walk independently after postoperative 8 months. The authors conclude that this is the first report dealing with a paediatric Morquio patient treated just with C1-2 screwing and fusion with a free-hand technique. As far as I realize, the most important topic of this paper is the biochemical considerations on Morquio syndrome, the odontoid malformations, the surgical options and the intraoperative assistance.

关键词： Paediatric   Pediatric   Surgery   COVID-19   Pandemic   SARS-CoV-2  

摘要： Purpose The COVID-19 pandemic has placed an unprecedented test on the delivery and management of healthcare services globally. This study describes the adaptive measures taken and evolving roles of the members of the paediatric surgery division in a developing country during this period. Methods We adopted multiple adaptive strategies including changes to stratification of surgeries, out-patient services by urgency and hospital alert status, policy writing involving multidisciplinary teams, and redeployment of manpower. Modifications were made to teaching activities and skills training to observe social distancing and mitigate reduced operative learning opportunities. Roles of academic staff were expanded to include non-surgical duties. Results The planned strategies and changes to pre COVID-19 practices were successful in ensuring minimal disruption to the delivery of essential paediatric surgical services and training. Despite the lack of established guidelines and literature outlining strategies to address the impact of this pandemic on surgical services, most of the initial measures employed were consistent with that of other surgical centres. Conclusion Changes to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines.

ISBN: (纸本)9787571004088

关键词： COronaVIrus Disease 19 (COVID-19)   Chilblain   Pediatric   Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2)   Skin  

摘要： Since the beginning of the pandemic of Coronavirus disease (COVID-19) an increasing number of skin manifestations have been reported. Most reports concern adult patients and describe various patterns of skin eruptions, in most of cases with low specificity and no univocal temporal association with the onset of systemic symptoms of COVID-19..

摘要： Administrators and providers worry about an overwhelming shortage in critical life-saving ventilators for adults during the COVID-19 pandemic. Attention has focused on developing algorithms for ventilator allocation using several factors, including: pre-existing illness, likelihood to return to baseline health, and length of ventilation (a negative factor in adults) (1). These factors, however, do not easily translate to pediatric medicine nor does ventilator allocation represent an urgent crisis for pediatric medicine.

关键词： acute stress   augmented reality   local anaesthesia   paediatric   salivary cortisol   simulator  

摘要： Background Augmented reality (AR) is a simulation of a three-dimensional environment created using hardware and software that provides the user with realistic experiences and ability to interact. The aim of the study was to evaluate the impact of AR simulator on the perception of learning and acute stress level in students administering local anaesthesia to paediatric patients relative to standard teaching methods. Material and methods The prospective study included 21 fourth- and fifth-year students enrolled in 5-year dental programme. In addition to conventional training, the students of the study group used the augmented reality simulator in a dental office 2 hours weekly in 2 weeks. The level of salivary cortisol was measured before and after the anaesthetic procedure as one of the indicators of acute stress. Results A statistically significant shorter time to perform infiltrative anaesthesia technique for the anterior superior alveolar nerve was observed in students using the AR technique (28.91 +/- 9.06 seconds in the study group and 39.80 +/- 9.29 seconds in the control group). The level of cortisol before and after anaesthesia was statistically significant in all subjects (cortisol concentration was 0.53 mu g/dL before anaesthesia and 2.44 mu g/dL after the procedure);however, there was no statistically significant difference between the groups. Conclusion The AR concept may influence better manipulation and control of the syringe in students administering their first anaesthetic injection to paediatric patients, but may not reduce acute stress.