Falls from highchairs.
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Accidental Falls↗
Biomedical subjects
Johannes Schalamon
Publications and source records attributed to Johannes Schalamon.
Management of acute scrotum in children--the impact of Doppler ultrasound.
BACKGROUND: Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken. METHOD: Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scrotal DUS, and standard laboratory analysis. Depending on scrotal DUS findings, the children were treated either nonoperatively (normal or increased testicular blood flow) or surgically (reduced or absent testicular blood flow). A follow-up investigation 6 weeks after discharge included a scrotal DUS. RESULTS: In 66 children (84%), the result of DUS determined the management; 26 children with hyperperfusion (epididymitis and orchitis), 18 children with appendix testis torsion (ATT), and 9 children with normal perfusion (edema and hematoma) were treated nonoperatively. The follow-up examination revealed no testicular atrophy and confirmed the primary diagnosis. Ten children without testicular perfusion and suspected torsion and 3 children with orchitis and pyocele were surgically explored, and again, the initial DUS diagnosis was verified. In the remaining 13 patients (16%), the result of the ultrasound examination was unclear. Of these, 6 children were noncompliant and refused to undergo ultrasonography. Another 4 children were explored because of persistence of symptoms. In 3 additional patients, a testicular tumor was suspected. All these 13 children underwent surgical exploration, revealing inflammation (epididymitis) in 6 children and acute ATT in 4 children, whereas the suspected tumor emerged as postacute ATT in 3 boys. CONCLUSION: In 84% of children with acute scrotal pain, the DUS was able to differentiate between surgical emergencies and other etiologies. In 16% of our pediatric patients, the DUS remained unclear, thereby necessitating surgical exploration.
Adolescent↗
Minimally invasive correction of pectus excavatum in adult patients.
OBJECTIVE: The repair of pectus excavatum by minimally invasive surgery (Nuss procedure) is well established among pediatric surgeons. Studies on adult patients are rare. We analyzed the efficacy of minimally invasive pectus repair in a series of adult patients. METHODS: We prospectively included all adult patients with minimally invasive repair of funnel chest treated from 2000 to 2005. The pectus bar was inserted under thoracoscopic control. On the right side a stabilizer was used to prevent bar displacement. Postoperative pain control was provided by epidural catheters. Clinical checks were performed 2 weeks, 3 months, and then annually after discharge. RESULTS: Forty-three adult patients (39 men, 4 women) with a mean age of 22 years (range 18-39 years) were included. Mean duration of the operative procedures was 70 minutes (range 29-125 minutes); mean length of hospital stay was 9.3 days. Bars were removed from 15 patients 3 years after implantation. Minor complications occurred in 8 patients (19%), with intrapleural effusions being most frequent (n = 5). Three patients (7%) had major complications: drainage of a pneumothorax (n = 2) and bar displacement (n = 1). The cosmetic results were excellent and patient satisfaction was high. CONCLUSIONS: We conclude that the Nuss procedure was beneficial in adult patients. Dislocation of the pectus bar can be prevented by submuscular placement. The use of corticosteroids may be helpful in case of repeated, uncontaminated pleural effusions. Patient satisfaction and the acceptable number and kind of complications are encouraging.
Adolescent↗
Analysis of dog bites in children who are younger than 17 years.
OBJECTIVES: This study focuses on the pattern of incidence, mechanisms, and circumstances of accident and injury in a series of pediatric patients who sustained dog bites. METHODS: In our retrospective survey, the medical charts of all children who were younger than 17 years and sought medical attention after a dog bite between 1994 and 2003 were reviewed. To obtain the total number of each dog breed in the administrative district, we analyzed 5873 files from the community dog registers. For establishment of a risk index, the representation of a dog breed among the total canine population was divided by the frequency of dog bites from this breed. RESULTS: A total of 341 children (mean age: 5.9 years) were identified. The annual incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age. Incidence was highest in 1-year-old patients and decreased with increasing age. The relative risk for a dog attack by a German shepherd or a Doberman was approximately 5 times higher than that of a Labrador/retriever or cross-breed. The vast majority (82%) of the dogs were familiar to the children. Most (322; 94%) of the children had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body regions were injured. Of 357 injuries, the face, head, and neck region was the leading site affected (50%). Inpatient treatment was required in 93 (27%) patients. CONCLUSIONS: Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Therefore, prevention strategies should focus on public education and training of dogs and their owners. Children who are younger than 10 years represent the high-risk group for dog attacks.
Adolescent↗
Somatosensory evoked potentials in children with severe head trauma.
UNLABELLED: We evaluated the predictive value of somatosensory evoked potentials (SEP) in a series of children with severe traumatic brain injury (TBI). The prospective clinical investigation was performed in a Level I paediatric trauma centre. We included 26 consecutive comatose paediatric patients aged from 1 month to 17 years (median age 11 years) following severe TBI (initial Glasgow Coma Score (GCS) 8 or below). Besides SEP recordings, the intracranial pressure and the results of an initial cranial CT scan were filed. The Glasgow Outcome Scale (GOS) was used to assess outcome at discharge. Thirteen children had normal SEP measurements, three patients had abnormal SEP recordings and a cortical response was bilaterally absent in ten children. Out of 26 children, 10 died whereas two remained in a persistent vegetative state. Only one child suffered from significant neurological deficits (GOS 3) at discharge. Seven patients survived with a GOS of 4 and six children survived without neurological impairment (GOS 5). Normal SEP indicated a favourable outcome in most children but did not rule out the occurrence of death, while absence of SEP was related to unfavourable outcome in all cases. CONCLUSION: Measurement of somatosensory evoked potentials provides valuable data for determining the prognosis at early coma stages. Our data show that an unfavourable outcome can be predicted with higher precision than a favourable outcome.
Brain Injuries↗
Williams-Beuren syndrome associated with caudal regression syndrome and coagulopathy--a case report.
Williams-Beuren syndrome is a genetic disorder caused by a heterozygous deletion at 7q11.23. The present report describes a female patient with Williams-Beuren syndrome combined with caudal regression syndrome and two forms of coagulopathy. Besides the typical developmental abnormalities such as mental and growth retardation, a distinctive facial appearance, and cardiovascular anomalies, our patient showed fusion of fourth and fifth lumbar vertebra and a sacrococcygeal agenesis. Blood coagulation tests revealed a deficiency of coagulation factor XI and XII. Magnetic resonance imaging angiography showed multiple vascular stenoses mainly in the abdominal aorta and its major branches as a consequence of the insufficient elastin gene. Previous reports identified a deletion of HLXB9 as a possible genetic cause of the caudal regression syndrome, which could not be identified in the present case. This unusual combination of the above-mentioned genetic disorders has not been published so far.
Adult↗
Quantitative ultrasound assessment in children with fractures.
UNLABELLED: BMD of children with fractures was compared with healthy controls using QUS. We found significantly lower SOS values in children suffering from fractures. None of the studied environmental factors could explain the difference in BMD measurements. INTRODUCTION: The aims of this study were to compare the results of quantitative ultrasound (QUS) in children with fractures with the respective values in children without fractures and to identify possible environmental factors influencing speed of sound (SOS) in our study cohort. MATERIALS AND METHODS: BMD was measured by QUS in 50 children who had sustained an acute fracture and in 154 healthy children as controls. SOS values were obtained from the proximal phalanges of the last four fingers of the dominant hand. Nutritional habits and activity level of the children were documented by a standardized questionnaire. RESULTS: Children with fractures had a significantly lower SOS compared with children without a history of fractures. This difference in SOS could not be explained by differences in diet, body mass index, or physical activity. CONCLUSIONS: Previous studies have suggested that low BMD levels might contribute to an increased prevalence of fractures in patients with systemic diseases. Our study showed that, in an otherwise healthy pediatric population, the SOS values are lower in children with fractures compared with healthy controls. Despite statistical significance, the biological impact of the results remains unclear. The difference in SOS values could not be explained by any of the studied environmental factors.
Age Factors↗
The use of a hand-held metal detector for localisation of ingested metallic foreign bodies - a critical investigation.
UNLABELLED: Ingested metallic foreign bodies (MFBs) are usually diagnosed by taking X-ray films of the neck, chest and/or abdomen. This study evaluates the use of a hand-held metal detector (HHMD) for the diagnosis and localisation of MFBs. In a prospective study, 53 consecutive paediatric patients with history of a swallowed MFB were examined with X-rays and HHMD. In 47 children, the MFB could be verified radiologically. Coins were most frequently swallowed. The HHMD could detect and locate all coins but only 47% of other MFBs. There were no false-positive results. A HHMD is an effective tool for screening the location of suspected ingested coins. This method is easy, inexpensive and free of radiation. Very small MFBs cannot be reliably detected. CONCLUSION: If an innocuous metallic foreign body is clearly identified with a hand-held metal detector in the stomach or lower gastrointestinal tract of an asymptomatic child, additional radiological confirmation is not required.
Adolescent↗
Multiple trauma in pediatric patients.
We analyzed the causes and diagnoses, the treatment, short and long-term outcome of a consecutive series of 70 pediatric polytrauma patients. From 1989 to 1996, 70 children (aged 10 months to 16 years, mean 7.4 years) presented with multiple trauma. A follow-up investigation was performed 4.2 years (mean) after the accident. Traffic accidents (68%) were the leading cause of injuries. Among all injuries (mean ISS 24.6 range 17-57), injuries of the head/neck area were most frequent (87%) followed by extremity fractures (76%) and 135 operations were performed on 55 children, mostly for fracture stabilisation. All multiple injured children survived. At discharge 25 children were still impaired (36% of 70). At follow-up 58 patients were revisited, 11 (19% of 58) presented with impairments, 8 of those (73% of 11) following severe head trauma. This study showed a 10% rate of late impairment due to the severity of the primary head trauma.
Adolescent↗
Endoscopic follow-up in esophageal atresia-for how long is it necessary?
PURPOSE: The aim of this study was to find out how long it is necessary to follow-up esophageal atresia patients endoscopically to prevent irreversible mucosal changes. METHODS: Seventy-four of 79 long-term survivors with esophageal atresia and primary anastomosis underwent a total of 322 esophagogastroduodenoscopies during a follow-up period of 0.5 to 19 years (mean, 10.3) after the primary operation. For analysis, the biopsy findings were divided into 2 groups: good, histologically normal or only mildly inflamed mucosa; unfavorable, moderate or severe esophagitis or gastric metaplasia. Fundoplication irrespective of indications was considered unfavorable. The results were analyzed using actuarial survival analysis; the changing point was when a "good" turned into "unfavorable." RESULTS: Forty-five patients (61%) remained in the "good" group throughout the study period; 15 of those (20%) had completely normal findings. Nine patients (12%) had moderate, one (1%) had severe esophagitis, and 13 patients (18%) had gastric metaplasia. Fundoplication was performed on 21 patients (28%). CONCLUSIONS: About 40% of esophageal atresia patients eventually have significant esophageal mucosal pathology or need to have a fundoplication. The majority of these changes appear before the age of 3 years. Routine endoscopic follow-up of esophageal atresia patients is recommended at least to the age of 3 years.
Anastomosis, Surgical↗
Injuries in children associated with the use of nonmotorized scooters.
BACKGROUND/PURPOSE: Since 2000, a substantial increase in injuries related to nonmotorized scooters (kickboards) has been observed among children. The authors conducted a population-based prospective study to characterize these injuries in comparison with skateboard-related injuries during the same period. METHODS: All children (age <16 years) presenting with a scooter-related injury between July and October 2000 in Graz (Austria) and all children presenting with a scooter- or skateboard-related injury between June and September 2001 in Helsinki, Finland were interviewed at the time of seeking medical attention. RESULTS: One hundred thirteen patients with scooter injuries and 72 patients with skateboard injuries were recorded. The 4-month calculated incidence in children less than 16 years of age was 0.72 per 1,000 for scooter injuries and 0.68 per 1,000 for skateboard injuries. The scooter injuries accounted for 1.9% and the skateboard injuries for 2.6% of all pediatric traumas within the respective catchment areas. The majority of the patients in both groups were boys. The patients with scooter injuries were younger than the patients with skateboard injuries (mean age 10.2 +/- 2.7 v 12.5 +/- 2.4 years; P <.001). Most of the scooter-related accidents were claimed to be caused by the wheels of the scooter getting caught by uneven ground, whereas most skateboard accidents occurred during attempted trick maneuvers. Protective gear was seldom used. More than half of the scooter-related injuries were minor bruises, wounds, or contusions. One third of the patients sustained a fracture, usually involving the upper extremity distal to the elbow. The only life-threatening injury was a ruptured spleen in a skateboarder. The injury pattern of scooter and skateboard injuries was similar. CONCLUSIONS: Public awareness of the potential dangers related to scooter riding should be increased and the use of protective gear encouraged.
Adolescent↗
[Skateboarding and scooter-related injuries in children and adolescents].
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Adolescent↗