John M. Draus

Minimally invasive drainage of subcutaneous abscesses reduces hospital cost and length of stay.

Objective We compared outcomes among pediatric patients managed with minimally invasive (MI) packing techniques with those managed with traditional packing techniques for drainage of subcutaneous abscesses. Methods After institutional review board approval, medical records of children requiring drainage of subcutaneous abscesses between January 2010 and June 2011 were reviewed. Data were collected on patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay (LOS). The hospital accounting system was queried for direct and indirect costs. We compared LOS and cost data among groups managed with MI versus traditional packing techniques. Results Incision and drainage was performed on 329 children (57.8% girls, 72% white, mean age of 43 months [range <1 to 218]). Of the total abscesses 198 (60.2%) were located in the groin/buttocks/perineum. Methicillin-resistant Staphylococcus aureus was identified in 74% of culture specimens. A total of 202 patients (61.4%) underwent packing and 127 (38.6%) underwent MI drainage. MI drainage ranged from 0% (0/110) in January to June 2010 to 34.6% (44/127) in the July to December 2010 transition period and reached 90.2% (83/92) in 2011 (P < 0.001). Median LOS decreased from 2 days (interquartile range 1–2) in the packing-only period to 1 day (interquartile range 1–2) in the predominantly MI period (P < 0.001). Hospital costs decreased with the transition to the MI technique (P < 0.001). MI drainage was associated with a

Lipoma as a pathological lead point in a child with ileocolic intussusception.

520 reduction in median direct costs and a

Chondromyxoid fibroma of the second rib

385 reduction in median indirect costs (P < 0.001). Conclusions Soft tissue infections requiring incision and drainage are common in the pediatric population, with the majority caused by methicillin-resistant Staphylococcus aureus. Infections requiring drainage most frequently occurred in the diaper area of girls younger than 3 years old. Changing to an MI technique significantly decreased the hospital costs and LOS in our patient population.

Injury Prevention and State Law as Strategies for the Reduction of Child Maltreatment Fatalities

Intussusception is a common cause of mechanical bowel obstruction among children. Most cases occur during the first year of life. Intussusception can occur anywhere along the gastrointestinal tract, but most frequently originates near the ileocecal valve. Children presenting at older ages are more likely to have a pathologic lead point causing the intussusception. Herein we present a case of pediatric ileocolic intussusception with 3 intestinal lipomas as its pathologic lead point. Lipomas are rare tumors of the gastrointestinal tract with no malignant potential. Children with a discrete pathologic lead point generally require surgical exploration and bowel resection.

Laparoscopic ladd procedure : A minimally invasive approach to malrotation without midgut volvulus

Chondromyxoid fibromas are benign tumors which are found most frequently in the metaphyses of long bones. They comprise less than 1% of primary bone neoplasms and display a hypermetabolic appearance on PET imaging. Oftentimes, they are misdiagnosed as chondrosarcomas and are excised due to concern for malignancy. We present a case of a condromyxoid fibroma originating from the second rib of a 15-year-old girl.

External iliac artery injury after a bicycle accident.

Purpose of ReviewThis review focuses on one state’s multidisciplinary legislative efforts to decrease the incidence of child maltreatment, including fatalities and near-fatalities. Such efforts have encompassed primary and secondary prevention modalities, including early support to parents, training, and education about recognition and reporting of child maltreatment for professionals who interact with children, review of all child deaths, and multidisciplinary in-depth case review of the most serious child maltreatment cases.Recent FindingsAlthough reliable trends can be difficult to determine based upon the complexity of the problem and multiple confounding variables, there are a number of indicators that suggest these cumulative efforts are beginning to have a favorable impact on the most serious child maltreatment cases, although heightened awareness has likely contributed to an increase in the total number of reported cases.SummaryMultidisciplinary collaborative efforts including governmental, academic, and non-profit entities may affect meaningful change in legislation and other interventions to decrease the incidence of the most serious cases of child maltreatment.