Thoracoscopic ligation of the thoracic duct in a child with spontaneous chylothorax

We report a case of a 2-year old girl with a spontaneous chylothorax who presented with respiratory distress. The management of this condition, which included thoracic duct ligation using a thoracoscopic technique, is discussed, and we review the literature on chylothorax.

Effective instruction of vascular anastomosis in the surgical skills laboratory

BACKGROUND

A greater emphasis has recently been placed on laboratory-based training of core surgical skills and tasks, such as vascular anastomosis. Despite this emphasis, little objective data exist regarding the effectiveness of vascular anastomosis instruction in the laboratory setting.

METHODS

Residents of all postgraduate levels received laboratory-based vascular anastomosis training. Each individual fashioned an end-to-side anastomosis between synthetic graft and porcine aorta before instruction (pretest). All subjects then received standardized anastomosis training with practice time. After training, the anastomosis was then repeated (posttest). Metrics included time to completion, anastomotic leakage, and visual characteristics of the completed product.

RESULTS

Postteaching improvement was demonstrated by all residents (n = 32). Posthoc analysis showed statistically significant improvements in junior residents only.

CONCLUSIONS

Laboratory-based training can effectively improve the ability of residents to perform vascular anastomosis immediately after training. Junior residents may gain a greater advantage from laboratory teaching.

Congenital anomalies of the esophagus

Normal anatomy, embryology, and congenital anomalies of the esophagus are discussed in this article. The classification, epidemiology, embryology, diagnosis, and management, including outcome following repair of esophageal atresia with or without an associated tracheoesophageal fistula, are described. The diagnosis and management of less common anomalies, such as congenital esophageal stenosis and congenital esophageal duplication, are outlined.

Lapbelt injuries and the seatbelt syndrome in pediatric spinal cord injury

BACKGROUND/OBJECTIVE

Approximately 250,000 patients are presently living with spinal cord injury (SCI) in the United States. Approximately 20% of patients with SCI are less than 20 years old, and 15% are less than 15 years old. The most common cause of pediatric SCI is a motor vehicle collision (MVC; approximately 40%); lapbelt injuries and the seatbelt syndrome are seen more often in children involved in MVCs.

METHODS

A search and analysis of current literature on lapbelt injuries, seatbelt syndrome, and pediatric SCI using PubMed.

RESULTS

Children involved in MVCs who are improperly restrained are at higher risk of sustaining injuries. The risk of significant intra-abdominal injuries is increased almost fourfold in these children. Presence of abdominal wall ecchymosis (AWE) was associated with intra-abdominal injuries in up to 84% of children, with hollow viscus injury being the most common. Likewise, presence of AWE is associated with vertebral fractures, including Chance fractures, in up to 50% of patients. Vertebral fractures were associated with SCI in up to 11%. The presence of AWE in an improperly restrained child should warrant a thorough search for intra-abdominal injuries, vertebral fractures, and SCI.

CONCLUSIONS

Lapbelt injuries and the seatbelt syndrome are often associated with pediatric SCI in improperly restrained children. This injury complex and its associated abdominal injuries are difficult to diagnose unless a high index of suspicion is maintained; delay in diagnosis increases morbidity, and early surgical intervention should be considered.