Biomedical subjects
Publications and source records attributed to H Hájková.
The article addresses the issue of splenic pseudocysts and their treatment. It reports on two patients treated over the past three years at the Department of Paediatric Surgery of the Prague-based Postgraduate Medical and Pharmaceutical Institute. While the pseudocyst healed spontaneously in one child after 9 months, the other patient underwent laparotomy with subsequent segmental resection of the splenic parenchyma involved.
Since 1980 in the department of paediatric surgery in Prague-Krc injury of the spleen is no longer an absolute indication for laparotomy and splenectomy. During the period from 1980-1990 46 children were admitted with an injured spleen. Of these 35 (76%) were treated conservatively, 11 children were operated. The number of conservatively treated patients increased in the course of time--during the initial period before 1985 65% children were treated conservatively, from 1986 to 1990 already 90% children. Only 16% children with an injured spleen treated conservatively needed a blood transfusion (on average 18.1 ml/kg body weight). This experience indicates that the great majority of children with an injured spleen can be treated by non-surgical methods. It is necessary to respect certain criteria which are given in the paper. Laparotomy is necessary in children with unstable vital functions, associated intraabdominal injuries and those to whom more than 30 ml blood per kg body weight must be administered.
The authors review diagnostic possibilities of acute osteomyelitis in children. They emphasize above all isotope examinations as the method of choice. In the subsequent part they focus attention on possible differentiation of acute osteomyelitis from inflammations of soft tissues-phlegmons. To this end they used a modified method of Israel published in 1987, based on a chronologically different uptake of 99mTc-MDP in normal bone and bone affected with osteomyelitis. According to this method it is possible to differentiate with a 90% accuracy acute osteomyelitis from phlegmons.
In traumatological practice there is so far no uniform view as regards the classification of injuries. The authors recommend to do away with the vague traumatological terminology and replace in by a similar classification: to use the term "monotrauma" when one bodily system is affected and the term "associated injury" when two or more systems are effected; to use for more accurate definition of the severity of injury a scoring system. For paediatric traumatological practice the Pediatric Trauma Score P.T.S./is simple and suited best. The authors evaluated in a retrospective study a group of 257 children associated injuries. Based on the results of this investigation the authors consider P.T.S. a suitable scoring system for the objective evaluation of the general condition of the injured child and recommend its introduction into practice.
The authors discuss the classification and evaluation of child injuries. In our literature so far no uniform conclusion was reached how classify injuries; the term "polytraumatism" or "multiple" is not accurately defined and is not used in the Anglo Saxon literature. The authors recommend therefore to differentiate only isolated injuries and "associated" injuries (injuries of two or more areas of the body). The severity of "associated" injuries can then be determined by some scoring system. For paediatric traumatological practice the Pediatric Trauma Score (PTS) is most suitable because it takes into account also the child's body weight, and thus indirectly his age, and is very simple.
The authors observations with prophylactic administration of metronidazole manufactured by the Gedeon Richter Company, Hungary (trade mark Klion) in children with phlegmonous appendicitis are reported. The drug was administered in three doses to 51 children. Results of bacteriology could be assessed in 42 children. The results of prophylactic administration of Klion in phlegmonous appendicitis were excellent. In our group there were no inflammatory wounds and/or intraperitoneal complications. For comparison, in a cohort of 1.008 children with phlegmonous appendicitis, without prophylaxis the rate of inflammatory complications was 3.62%. Klion has minimal side effects and is well tolerated and seems to be a superb drug for prophylaxis.
The great majority of child injuries are treated at the outpatient department and only in case of serious injury the child is admitted to hospital. In addition to the absolute number of injuries in our Republic it is also important to know how child injuries are treated, i. e. by whom, what are the material conditions for treatment in different departments and what is the standard of treatment. In an attempt to answer at least partly some of these questions the author sent questionnaires to 82 surgical and orthopaedic departments. Replies were obtained from 65 departments (80% of those addressed). From the answers ensued lack of uniform care of child injuries in out-patients' as well as in-hospital care. The majority of child injuries is treated by general surgeons (some 80%) and children with injuries are hospitalized in surgical, orthopaedic and paediatric departments.
In 27 children (12 boys and 15 girls) aged 3 months to 3 years, the plasma levels of albumin, prealbumin, orosomucoid and C-reactive protein (CRP) were determined after burn trauma. The results of these measurements were used to calculate the prognostic inflammatory and nutritional index (PINI). The children were assigned to two groups: a group with burns covering less than 10 per cent of the body surface area (BSA) (minor burns), and those with burns covering 11-20 per cent BSA. The lesions involved were either dermal burns (Class IIB) or full skin thickness burns (Class III). While the group with minor burns showed only a small decrease in albumin and prealbumin levels, the decrease in children with extensive burns was well below values on the first 7 days. On days 2, 5 and 7 after burning, the differences between both groups were statistically significant. Orosomucoid levels were somewhat elevated in the group with extensive burns. This difference, however, was not statistically significant compared with the group with minor burns whose values were slightly below the normal range. The levels of C-reactive protein were statistically significantly increased in children with extensive burns compared with those with burns. The PINI value correlated positively with the burn area given in per cent (for day 5 of follow-up, the regression line equation was y = 9.346 + 1.65 x). These data indicate that there are no pronounced changes in plasma protein levels in the group with minor burns.(ABSTRACT TRUNCATED AT 250 WORDS)
In the submitted paper the authors give an account of their experience with the treatment of a patient with severe scrotal hypoplasia which is a very rare inborn defect. In a group of 1403 boys operated in the last ten years on account of cryptorchism this anomaly recorded only once, i.e. in 0.071%. The authors recommend a two-stage operation. In the first stage they use a V-Y plastic operation to create a neoscrotum. In the second stage orchidopexy is performed. Collaboration with a child endocrinologist is important. The aim of endocrinological examination is not only evidence of the presence and function of the gonads by a hormonal test, but in case of associated anomalies, also the assessment of genetic, genital and gonadal sex.
The authors draws attention to possible postnatal changes the position of the testicle in the sensent of ascent. According to data in the literature and the author's own experience this ascent usually occurs as late as during school age. Causes of the altered position of the testicle are discussed. The condition is nowadays accepted but it is rare. From the practical aspects it is, however, necessary to examine the genitals of boys repeatedly and not only by a single examination. In case of a permanently inguinal position of the testicle the boy should be referred to a surgical department to prevent secondary damage of the testis by its incorrect position.
The authors defined a uniform classification of abnormal positions of the testes. They recommend also a uniform therapeutic procedure: after the first year of life treatment with human chorionic gonadotropin in one or two curves, if orchiopexy fails.
The authors present their experience with the prophylactic administration of metronidazole of Richter Co. Hungary (trade name Klion) in children with phlegmonous appendicitis. The preparation was administered in three doses to 51 children. The bacteriological results were evaluated in 42 children. The results of Klion administration in phlegmonous appendicitis were excellent. In the investigated group there were no wound inflammatory nor intraabdominal complications. For comparison the authors mention a group of 1008 children with phlegmonous appendicitis without prophylactic provisions where the number of inflammatory wound complications was 3.62%. Klion has minimal side-effects, was well tolerated and proved excellent for prophylactic administration.
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Inflammation and injury influence plasma proteins and immunoglobulins. They respond to noxious agents by a rise of c-reactive protein (CRP), orosomucoid, fibrinogen, haptaglobulin, alpha-1 antitrypsin, ceruloplasmin, C 3 and C 4 components of complement. The rate of rise and return to normal values varies. CRP reacts most'promptly. The following substances react by a decline of the levels: albumin, prealbumin, transferrin, alpha-1 lipoprotein and immunoglobulins. Investigation of the patient's immunological state is of prognostic value. CRP, orosomucoid, albumin and prealbumin are considered the most valuable indicators; from their values the so-called PINI index can be calculated and the patients can be divided into five prognostic zones. To threatened patients all-round care must be devoted incl. aimed provision of ATB and immunoprotective substances.
Proximal femoral fractures in children can be divided into three groups: femoral neck fractures, apophyseal trochanteric separations and subtrochanteric fractures. Femoral neck fractures are extremely rare. They are classified according to Delbet and Colonna into four types. The more lateral is the line of the fracture, the better is the prognosis, and the less sequelae occur. The treatment of femoral neck fractures in children is in nearly all cases surgical, only in some pertrochanteric and in the minority of non-complete basicervical fractures conservative treatment can be considered. The surgical treatment is either a closed manipulation with internal fixation, or an open reduction with fixation. The authors prefer closed manipulation, if it is possible to perform. They have themselves treated 5 pathological separations of the femoral head of the coxxa vara adolescentium origin. These injuries are aligned with femoral neck fractures, because they are caused by a traumatic mechanism, and are to be treated like a fracture. Further the authors have treated two cervicotrochanteric fractures by open reduction and 4 patients with pertrochanteric fractures conservatively by skin traction. Apophyseal trochanteric separations are convenient to be treated conservatively, only in case of greater displacement of the greater trochater can an open reduction and internal fixation by traction cerclage be recommended because of the risk of a valgous deformation of the femoral neck. The authors have treated conservatively 3 patients with a separation of the lesser and 2 patients with a separation of the greater tochanter. Subtrochanteric femoral fractures are different from typical diaphyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors observed a lesion of the peripheral nerves in 13 of 401 children with supracondylar humerus fractures (3.2%). Most frequently, the radial nerve was injured. All patients with neural lesions healed spontaneously, a surgical revision of the nerve was not necessary. The authors' opinion is that neural lesions accompanying supracondylar fractures can be treated conservatively. Exceptions are clear indications for surgical revision, as persisting ischaemia of the forearm or extensive open fractures. When treating conservatively, it is necessary to make a thorough clinical and EMG investigation to set exactly the diagnosis of the neural lesion immediately after removing the plaster cast (mostly 3 weeks after the injury). This investigation is to be repeated regularly, as the reinervation dynamics of the affected region is to be followed up. At the same time it is advantageous to perform electrostimulation until reinervation potentials appear, vitaminotherapy and intensive active exercise with the involved extremity. If no signs of reinvertion in the affected area appear within 6 months, a surgical revision of the nerve is to be considered.
The osteosynthesis of epiphyseal injuries by a two-component fibrin glue was performed in five children. Three of them had finger fractures, two patients had slightly displaced distal tibial and fibular fractures. All children recovered without sequelae. They have been followed for three to twelve months after surgery and did not show any negative consequences. The glue osteosynthesis of physeal injuries will be appropriate only in more stable fractures where the fragments are not exposed to greater dislocating power because this type of synthesis is not very firm. In open injuries it is possible to add antibiotic to the glue, which represents a great advantage compared with the use of metal. It is essential to combine the osteosynthesis with plaster of Paris during the whole healing period.
The authors describe the case-history of a volvulus of the appendix which developed as a result of an inborn defect in the appendiceal mesenteriolume. The surgical finding did not suggest primary appendicitis but rather strangulation of the aboral part of the appendix.