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Many clinicians develop their wound repair practices by word-of-mouth and by other forms of informal training. Pediatric training may involve between zero and 6 months per year in emergency rotations. Further, much of the work on important aspects of care was published without careful attention to sample size, study design, and statistical analysis. Nonetheless, it is prudent to identify and adhere to principles of wound care which are proven to contribute to optimal results. This article reviews the major aspects of wound care and attempts to distinguish scientifically valid concepts from unfounded oral tradition in order to identify the most sound clinical practices. After a review of wound healing, the sections follow a sequence similar to the typical wound care encounter: evaluation; local anesthesia, wound preparation; general closure techniques; specific wound types; and aftercare. Finally, the article concludes with sections on problems commonly associated with pediatric care, namely, the parental request for a surgical specialist, and the anxious or uncooperative child. Wound Physiology Pediatric Lacerations Page 5 the tissue layers relevant to lacerations are the epidermis, dermis, subcutaneous tissue, and deep fascia (Figure 1). These layers, which together constitute the skin, are tightly adherent and clinically indistinguishable. The subcutaneous layer is a fascial plane seen clinically as fat within the wound, and contributes little to the strength of a repair. Investing the underlying muscle and occasionally requiring repair is the deep fascial layer. Shear forces resulting from sharp objects have better cosmetic outcomes and fewer complications than those produced by impact mechanisms. Tension forces from blunt injuries and compressive forces from crush injuries deliver more energy to a larger amount of tissue and cause greater disruption and higher infection rates. New blood vessels appear and contribute to the early erythematous appearance of uninfected healing wounds. Remodeling involves a balance of collagen synthesis, lysis and cross-linking with a nadir in tensile strength approximately one week after wounding. The wound matures and develops its ultimate strength and appearance over 6 to 12 months. Evaluation Attention to the wound and its repair should await a rapid trauma evaluation. Specific historical factors related to the injury include time elapsed since wounding, wound mechanism, care rendered prior to evaluation, associated Pediatric Lacerations Page 6 injuries, and a consideration of the possibility of inflicted trauma. Assessment of the wound includes a general description of location, size, and shape.

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It lasts less than 24 hours it may be isolated or associated with focal neurological decits. Evidence of causation demonstrated by both of by non-traumatic intracerebral haemorrhage, associated the following: with focal neurological signs of the intracerebral haem 1. Any new headache fullling criteria C and D and radiological features according to its various 1 B. Notes: the headache is usually overshadowed by focal def icits or coma, but it can be the prominent early feature 1. The three months should be counted from stabiliza of some intracerebral haemorrhages, notably cerebellar tion, spontaneously or through treatment, rather haemorrhage; this may require emergency surgical than onset of the subarachnoid haemorrhage decompression. Evidence of causation demonstrated by at least noid haemorrhage, older age, sensorimotor dysfunc two of the following: tion, stereotyped aura-like spells and absence of 1. The most common reasons for misdiagnosis are failure to obtain appropriate neuroimaging, or Note: misinterpretation of it, or failure to perform lumbar puncture in cases where this is required. Isolated cases or small series have mostly been reported Description: Headache caused by non-traumatic acute by neurosurgeons. International Headache Society 2018 78 Cephalalgia 38(1) but usually it is associated or followed by a rapid 6. An unruptured saccular aneurysm has been Description: Headache caused by non-traumatic intra diagnosed cranial haemorrhage and persisting for more than C. Evidence of causation demonstrated by at least three months after the haemorrhage has stabilized. The intracranial haemorrhage (of whichever type) b) headache has resolved after treatment of has stabilized, spontaneously or through treatment the saccular aneurysm C. Research is needed to identify risk factors for such a Note: persistent headache; previous history of 1. Any new Coded elsewhere: New headache attributed to ruptured onset headache can reveal a symptomatic but unrup vascular malformation is coded as 6. Depending on the type of malformation, half of patients with an aneurysmal subarachnoid haem the headache may have a chronic course with recurrent orrhage reported the occurrence of a sudden and severe attacks mimicking episodic primary headaches, or an headache within the four weeks prior to diagnosis of acute and self-limiting course. Given that at epilepsy or focal decits with or without haemorrhage least one in three patients with aneurysmal subarachnoid and migraine-like symptoms much more rarely. In particular, intracranial haemorrhage has been excluded by appropriate investigations. Any new headache fullling criterion C orrhage or seizure secondary to cavernous angioma is B.

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Morphological and biological predictors for treatment outcome of transurethral microwave thermotherapy. Predictives regarding outcome after transurethral resection for prostatic adenoma associated with detrusor underactivity. Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. Analysis of prognostic factors regarding the outcome after a transurethral resection for symptomatic benign prostatic enlargement. How many uncomplicated male and female overactive bladder patients reveal detrusor overactivity during urodynamic study. Transurethral radiofrequency thermal ablation of prostatic tissue: a feasibility study in humans. The development and validation of a quality-of-life measure to assess partner morbidity in benign prostatic enlargement. Trends in repeat prostatectomy after surgery for benign prostate disease: application of record linkage to healthcare outcomes. Congenital megalourethra: outcome after prenatal diagnosis in a series of 4 cases. Drug resistance in prostate cancer cell lines is influenced by androgen dependence and p53 status. Influence of p53 and bcl-2 on chemosensitivity in benign and malignant prostatic cell lines. Diagnostic approach to prostate cancer using total prostate specific antigen-based parameters together. Immunophenotype of infiltrating cells in protocol renal allograft biopsies from tacrolimus-versus cyclosporine-treated patients. Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Clear cell adenocarcinoma of the male urethra in association with so called nephrogenic metaplasia. Efficient diagnostic test sequence: applications of the probability-modifying plot. Re: A double-blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3 year follow-up. Erectile dysfunction: an underdiagnosed condition associated with multiple risk factors. Cardiac failure and benign prostatic hyperplasia: management of common comorbidities. Transcutaneous electrovesicogram in normal volunteers and patients with interstitial cystitis, neurogenic bladder, benign prostatic hyperplasia, and after cystectomy. Usefulness of basal cell cocktail (34betaE12 + p63) in the diagnosis of atypical prostate glandular proliferations. Comparison of the basal cell-specific markers, 34betaE12 and p63, in the diagnosis of prostate cancer.

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Androgen receptor versus erbB-1 and erbB-2 expression in human prostate neoplasms. Is there a scientific basis for the therapeutic effects of serenoa repens in benign prostatic hyperplasia Re: Transurethral microwave thermotherapy for benign prostate hyperplasia: separating truth from marketing hype. Prevalence of Balkan endemic nephropathy has not changed since 1971 in the Kolubara region in Serbia. The effect of antibiotics on elevated serum prostate specific antigen in patients with urinary symptoms and negative digital rectal examination: a pilot study. Pathologic effects of neoadjuvant cyproterone acetate on nonneoplastic prostate, prostatic intraepithelial neoplasia, and adenocarcinoma: a detailed analysis of radical prostatectomy specimens from a randomized trial. Expression analysis of delta-catenin and prostate-specific membrane antigen: their potential as diagnostic markers for prostate cancer. Diabetes and benign prostatic hyperplasia progression in Olmsted County, Minnesota. Changes in collagen metabolism in prostate cancer: a host response that may alter progression. Hypnosis reduces distress and duration of an invasive medical procedure for children. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Impact of surgical treatment on nocturia in men with benign prostatic obstruction. A placebo-controlled double-blind study of the effect of phenoxybenzamine in benign prostatic obstruction. The role of minimal surgery with renal preservation in abnormal complete duplex systems. Mode of administration of international prostate symptom score in patients with lower urinary tract symptoms: physician vs self. Short-term subjective efficacy of doxazosin in predicting probability of prostatectomy in the management of benign prostatic hyperplasia in patients with severe symptoms. The efficacy of an abbreviated model of the International Prostate Symptom Score in evaluating benign prostatic hyperplasia. The role of urine cytology in the assessment of patients with lower urinary tract symptoms. Computerized tomography findings in pediatric renal trauma-indications for early intervention. Effects of systematic 12-core biopsy on the performance of percent free prostate specific antigen for prostate cancer detection. Early enteral nutrition in critically ill patients with a high-protein diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet. Cost effect of managing methicillin-resistant Staphylococcus aureus in a long-term care facility.