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Pediatric bleeding

Takaki Emura, Kenji Hosoda, Shota Harai, Noboru Oyachi, Takeyuki Suzuki, Ken Takada, Koji Kobayashi, Hisatake Ikeda
BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis...
October 19, 2016: Journal of Medical Case Reports
Pilar Anton-Martin, Bruno Braga, Stephen Megison, Janna Journeycake, Jessica Moreland
Severe trauma may cause refractory life-threatening respiratory failure requiring extracorporeal membrane oxygenation (ECMO). Concurrent traumatic brain injury, however, complicates the use of ECMO because of the major risk of intracranial bleeding with systemic anticoagulation. Craniotomy and/or craniectomy for hematoma evacuation during ECMO are extremely high-risk procedures secondary to ongoing anticoagulation, and there are only a few such case reports in the literature.We present the case of a child with multiple thoracic injuries and life-threatening respiratory failure supported on ECMO...
October 4, 2016: Pediatric Emergency Care
Chandni Sinha, Bindey Kumar, Umesh Kumar Bhadani, Ajeet Kumar, Amarjeet Kumar, Alok Ranjan
BACKGROUND: Caudal block is a reliable regional analgesic technique for pediatric urogenital surgeries. Various adjuvants have been tried to enhance the duration of action of bupivicaine. Though clonidine is extensively used as an adjuvant in caudal anaesthesia, it can have troublesome adverse effects like bradycardia, hypotension and sedation. Lately dexamethasone has become popular as an adjuvant in paediatric caudals due to its safety profile. AIM: The aim of this study was to compare dexamethasone and clonidine coadministered with bupivicaine caudally in paediatric patients undergoing urogenital surgeries in terms of analgesia and adverse effects...
September 2016: Anesthesia, Essays and Researches
Mehmet Bosnak, Seher Erdogan, E Habibe Aktekin, Ali Bay
We report two children who were diagnosed as having primary hemophagocytic syndrome and who successfully underwent therapeutic plasma exchange (TPE). The first patient was a 6-month-old girl diagnosed with HLH who was admitted to the pediatric intensive care unit. The patient's clinical condition worsened on the 9th day of the HLH-2004 treatment protocol. Her ferritin level was found 50.000 ng/mL, and TPE was performed for 9 sessions, after which her clinical condition and laboratory findings improved. The patient is still on the HLH-2004 protocol and waits for a suitable stem cell transplantation donor...
September 28, 2016: Transfusion and Apheresis Science
Beata Pucher, Jaroslaw Szydlowski, Wieslaw Smoczyk, Katarzyna Jonczyk-Potoczna, Michal Grzegorowski, Aleksandra Korytowska
Tonsillectomy and adenoidectomy are the most common surgical procedures in pediatric otolaryngology. The incidence of primary hemorrhage after tonsillectomy in children ranges from 0.38 to 6%. The prevalence of secondary bleeding occurs in 0.5%-9.3% cases [1]. Authors present a case of an 11-year-old girl who experienced 6 delayed, massive post-tonsillectomy bleedings as a result of presence of vascular malformation and the activation of collateral circulation as a result of the left ECA ligature.
November 2016: International Journal of Pediatric Otorhinolaryngology
Madhuradhar Chegondi, Jun Sasaki, André Raszynski, Balagangadhar R Totapally
OBJECTIVE: To evaluate the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU). METHODS: Retrospective chart review study. Tertiary care PICU. Critically ill pediatric patients requiring blood transfusion. No intervention. RESULTS: We analyzed the charts of all children between 1 month and 21 years of age who received packed red blood cell (PRBC) transfusions during a 2-year period. The target patients were identified from our blood bank database...
July 2016: Transfusion Medicine and Hemotherapy
Luana Sicuro Correa, Yara Hahr Marques Hökerberg, Raquel de Vasconcellos Carvalhaes de Oliveira, Danielle Martins de Souza Barros, Helenara Abadia Ferreira Alexandria, Regina Paiva Daumas, Carlos Augusto Ferreira de Andrade, Sonia Regina Lambert Passos, Patrícia Brasil
OBJECTIVE: The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system. METHODS: Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0...
2016: PloS One
Amy M DeLaroche, Helene Tigchelaar, Nirupama Kannikeswaran
BACKGROUND: Epistaxis is a common emergency department (ED) complaint; however, this entity is rare among children younger than 2 years of age. In this age group, epistaxis may be a presenting sign of a bleeding disorder or nonaccidental trauma. CASE REPORT: We present a case of a 2-month-old infant who was evaluated in the pediatric ED for epistaxis and discharged home. The infant returned 2 days later with facial swelling and irritability, and was found to have significant head trauma...
October 3, 2016: Journal of Emergency Medicine
Júlio Rocha Pimenta, Alexandre Rodrigues Ferreira, Paulo Fernando Souto Bittencourt, Camilo Brandão de Resende, Eleonora Druve Tavares Fagundes, Isabela Maria Lopes da Silva
Background: The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. Objective: The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. Methods: This is a cohort study encompassing 26 cirrhotic patients...
October 2016: Arquivos de Gastroenterologia
Thomas Kühne
Evidence-based medicine is growing in immune thrombocytopenia (ITP), but solid clinical data are still lacking in many areas. A majority of children has self-limited ITP, but chronic symptomatic ITP exists also in pediatrics. Management includes a watch-and-wait strategy for children with newly diagnosed ITP and no or mild bleeding, and immunoglobulins and corticosteroids, if more bleeding and mucous membrane involvement is present. Treatment endpoints differ in clinical research and in clinical practice. The requirement of platelet enhancing drugs needs to be better defined in guidelines...
October 4, 2016: Hämostaseologie
Nadia Roumeliotis, Thierry Ducruet, Scot T Bateman, Adrienne G Randolph, Jacques Lacroix, Guillaume Emeriaud
BACKGROUND: There are no well-designed prospective studies evaluating transfusion practices in pediatric trauma. We sought to describe red blood cell (RBC) transfusion practices in trauma patients who were admitted to a pediatric intensive care unit (PICU). STUDY DESIGN AND METHODS: This study is a post-hoc analysis of a prospective, 6-month observational study in 30 PICUs. We studied a total of 580 patients aged less than 18 years who had been admitted to a PICU for more than 48 hours, including 95 who were trauma patients...
October 2, 2016: Transfusion
Pratima Chowdary, Emma Fosbury, Anne Riddell, Mary Mathias
rFVIIIFc (efraloctocog alfa, Eloctate(®)) is an extended half-life (EHL) factor VIII licensed for use in patients with hemophilia A for prophylaxis and treatment of bleeding and surgical episodes. Pharmacokinetic studies in adults have shown a mean 1.5-fold increase in half-life compared to full-length factor VIII. When compared to adults, the half-life is decreased by 8% in adolescents between 12 and 17 years, by 18% in children 6 to <12 years, and by 33% in children between the ages of 2 and <6 years...
2016: Journal of Blood Medicine
Gautam Ray
There is rising incidence and prevalence of inflammatory bowel disease (IBD) in India topping the Southeast Asian (SEA) countries. The common genes implicated in disease pathogenesis in the West are not causal in Indian patients and the role of "hygiene hypothesis" is unclear. There appears to be a North-South divide with more ulcerative colitis (UC) in north and Crohn's disease (CD) in south India. IBD in second generation Indian migrants to the West takes the early onset and more severe form of the West whereas it retains the nature of its country of origin in migrants to SEA countries...
September 28, 2016: World Journal of Gastroenterology: WJG
Martina Fanna, Amandine Baptiste, Carmen Capito, Rocio Ortego, Raffaella Pacifico, Fabrice Lesage, Florence Moulin, Dominique Debray, Samira Sissaoui, Muriel Girard, Florence Lacaille, Caroline Telion, Caroline Elie, Yves Aigrain, Christophe Chardot
This study analyzes the preoperative risk factors for intra-operative bleeding in our recent series of pediatric LTs. Between November 2009 and November 2014, 84 consecutive isolated pediatric LTs were performed in 81 children. Potential preoperative predictive factors for bleeding, amount of intra-operative transfusions, postoperative course, and outcome were recorded. Cutoff point for intra-operative HBL was defined as intra-operative RBC transfusions ≥1 TBV. Twenty-six patients (31%) had intra-operative HBL...
September 29, 2016: Pediatric Transplantation
Nicola Brodie, Elizabeth A Silberholz, Nancy D Spector, Amy E Pattishall
PURPOSE OF REVIEW: The present article addresses recent research related to three key facets of adolescent preventive care and health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding. RECENT FINDINGS: Recent studies suggest that long-acting reversible contraception use results in significantly lower rates of unintended pregnancies, and is well tolerated by nulliparous adolescent females. Additionally, a strong recommendation from a pediatric primary care provider is extremely effective in ensuring human papillomavirus vaccination prior to sexual debut...
September 26, 2016: Current Opinion in Pediatrics
Tymon Skadorwa, Bogdan Ciszek
BACKGROUND/AIMS: Tumors of the cranial vault occur at every age of childhood. Although they are mostly benign lesions, their symptomatology is variable and requires extended diagnostics. The choice of therapeutic strategy strongly depends on histopathological diagnosis, and therefore surgical excision is the elective treatment in such cases. Despite several published papers, the literature still lacks reliable clinical characteristics regarding this heterogeneous group of lesions in pediatric patients...
September 27, 2016: Pediatric Neurosurgery
Takaaki Imaizumi, Hiroshi Murakami, Hiroki Nakamura, Shogo Seo, Hiroyuki Koga, Go Miyano, Manabu Okawada, Takashi Doi, Geoffrey J Lane, Tadaharu Okazaki, Atsushi Arakawa, Takashi Yao, Atsuyuki Yamataka
PURPOSE: We reviewed all rectal mucosal/submucosal biopsies (RMSBx) performed between 1986 and 2015 focusing on specimen quality, incidence of complications during and after biopsy, and parental satisfaction. METHODS: From 1986 to 2004, RMSBx were performed without general anesthesia (GA) (N-GA; n = 98) and from 1995 to 2015 were performed under GA (GA; n = 525). In GA cases, some sections were stained intraoperatively and examined by a pathologist and pediatric surgeon immediately to identify ganglion cells...
September 23, 2016: Pediatric Surgery International
Danielle Usatin, Melissa Fernandes, Isabel E Allen, Emily R Perito, James Ostroff, Melvin B Heyman
OBJECTIVES: To systematically review risks and summarize reported complication rates associated with the performance of endoscopic retrograde cholangiopancreatography (ERCP) in children during the past 2 decades. STUDY DESIGN: A systematic literature search of MEDLINE, Embase, and Web of Science from January 1995 to January 2016 was conducted for observational studies published in English. Studies reporting ERCP complications in patients <21 years without history of liver transplant or cholecystectomy were included...
September 20, 2016: Journal of Pediatrics
Brian F Flaherty, Hannah E Moore, Jay Riva-Cambrin, Susan L Bratton
BACKGROUND: Although some pediatric patients with small traumatic epidural hematoma (EDH) are observed without surgical drainage, clinical practice remains variable. OBJECTIVES: Create a prediction rule to identify patients with EDH unlikely to fail hospital observation. METHODS: Retrospective review at a level I pediatric trauma center between 2003 and 2014. Presenting clinical and radiographic features were compared between those successfully to failed observation...
September 15, 2016: Journal of Pediatric Surgery
Sofía Verdaguer D, Juan Cristóbal Gana A
BACKGROUND: There is a paucity of good quality research about the diagnosis of esophageal varices and the prophylaxis and treatment of variceal bleeding in pediatric patients with portal hypertension There is little consensus and practically no evidence-based approach about the management of these patients. AIM: To describe the behavior and preferences of pediatric gastroenterologists in Chile in the management of portal hypertension in children. MATERIAL AND METHODS: An online survey was sent to Chilean pediatric gastroenterologists, with questions evaluating the physicians’ approaches to screening of esophageal varices in children with portal hypertension, and their preferred methods of prophylaxis and initial management of variceal bleeding...
July 2016: Revista Médica de Chile
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