Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children's Hospital in Cape Town is the only children's hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13.This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.

Sonoelastography may be superior to other US modalities in elucidating different cervical lymph node biopsy helping to distinguish benign from malignant lesions. This may replace the lymph node biopsies in the future. Moreover, its use in the follow-up of patients with cervical malignancies may reduce the number of future biopsies. Further studies with more patients may be needed for a better assessment of results.

The closure of the cystic duct using the LVSS is feasible and effective in laparoscopic cholecystectomy in children. However, it is important to keep a safe distance from other intra-abdominal structures when using thermal energy devices to prevent thermal collateral damage.

BackgroundAppendicitis is the most common surgical emergency in children; yet, diagnosis of equivocal presentations continues to challenge clinicians.AimThe objective of this study was to investigate the hypothesis that the use of a modified clinical practice and harmonic ultrasonographic grading scores (MCPGS) may improve the accuracy in diagnosing acute appendicitis in the pediatric population.Patients & MethodsMain outcome measuresSensitivity, specificity, and accuracy of the modified scoring system. Five hundred and thirty patients presented with suspected diagnosis of acute appendicitis during the period from December 2000 to December 2009 were enrolled in this study. Children's data that have already been published of those who presented with suspected diagnosis of acute appendicitis- to whom a special clinical practice grading scores (CPGS) incorporating clinical judgment and results of gray scale ultrasonography (US) was applied- were reviewed and compared to the data of 265 pediatric patients with equivocal diagnosis of acute appendicitis (AA), to whom a modified clinical practice grading scores (MCPGS) was applied. Statistical analyses were carried out using Z test for comparing 2 sample proportions and student's t-test to compare the quantitative data in both groups. Sensitivity and specificity for the 2 scoring systems were calculated using Epi-Info software.ResultsThe Number of appendectomies declined from 200 (75.5%) in our previous CPGS to 187 (70.6%) in the MCPGS (P > 0.05).Specificity was significantly higher when applying MCPGS (90.7%) in this study compared to 70.47% in our previous work when CPGS was applied (P < 0.01). Furthermore, the positive predictive value (PPV) was significantly higher (95.72%) than in our previous study (82.88%), (P < 0.01). Overall agreement (accuracy) of MCPGS was 96.98%. Kappa = 0.929 (P < 0.001). Negative predictive power was 100%. And the Overall agreement (accuracy) was 96.98%.ConclusionsMCPGS tends to help in reduce the numbers of avoidable and unnecessary appendectomies in suspected cases of pediatric acute appendicitis that may help in saving hospital resources.

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