Problem elbow fractures in children

In this article guidelines are given for the treatment of pediatric elbow fractures, including supracondylar, medial epicondylar, lateral condylar, proximal radial, and olecranon fractures. Treatment techniques are described in detail and suggestions are provided to minimize complications.     

Post-traumatic flank hernias. Report of two cases

Dissecting aneurysms of the hepatic artery are extremely rare. We report herein the case of a 51-year-old man with massive hepatic metastases from rectal carcinoma, who was found incidentally to have a left hepatic artery aneurysm by a preoperative angiography. After replacing the left hepatic artery with a 2-cm segment of long saphenous vein, an extended right lobectomy with partial resection of the left lateral segment for multiple metastases was successfully performed. To prevent thrombus formation at the anastomosis, the Pringle maneuver was not used during dissection of the hepatic parenchyma. Histological examination of the resected specimen showed a dissecting aneurysm of the left hepatic artery, but there were no findings to suggest the etiology of this disease. The patient is currently alive 13 months after his operation without any evidence of further recurrence of the carcinoma. To the best our knowledge, 12 case reports of this anomaly have been documented, but only one of these describes a successful operation. The clinical features and etiology of the hepatic artery aneurysm that develops independent of other vascular diseases are discussed following this case report.     

Developmental issues in relocation cases involving young children: When, whether, and how?

Many divorced parents seek the court's permission each year to move their children to a new location away from their other parents. Such moves stress and often disrupt psychologically important parent-child relationships, and this may in turn have adverse consequences for children. This article discusses the development of attachment relationships in infants and toddlers and the ways in which relocation is likely to affect young children of different ages; recent trends in judicial decisions regarding relocation; factors to consider when deciding whether or not to permit relocation; ways of promoting long-distance relationships between young children and their nonmoving parents; and implications for legal policy and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sustained ventricular tachycardia in older children. Spontaneous regression in 3 cases]

Extensively described since Gallvardin's reports, the electrical features of salves of ventricular tachycardia in an apparently healthy heart are now well known. The usual benign nature of this arrhythmia is acknowledged, seldom contradicted by isolated clinical cases. Although chronicity is the rule in young adults, there have been a few publications concerning the natural history of these tachycardias in the paediatric age group. The authors report three cases of episodic sustained ventricular tachycardia in older children, presenting at an average of 7 years of age (range 5 to 9 years) and followed up for an average of 7 years (range: 5.5 to 9 years). These three children were treated for an average of 4.5 years (range: 3 to 5.5 years). All treatment was finally withdrawn when stable permanent sinus rhythm without ventricular extrasystoles was restored and confirmed over an average period of 2 years (range 10 months to 3.5 years), an average of 4 (range 3 to 7) successive normal Holter recordings at several months' interval. The outcome in children to spontaneous regression after several years would seem to make radiofrequency ablation more dangerous than useful given the benign nature of the arrhythmia and its good response to pharmacological intervention.     

Fatal asphyxiations in children involving drawstrings on clothing

Injuries account for more deaths and hospital admissions among children and adolescents than all diseases combined. The authors report two deaths by asphyxiation that resulted from drawstrings on the children's clothing becoming entangled on slides. Although such incidents are not common, they are preventable. The authors urge physicians to counsel parents and guardians to remove drawstrings from children's clothing, and they call upon the government and the clothing industry to work toward improving the safety standards for the design, manufacture and importation of children's clothing and banning the sale of children's clothing with drawstrings in Canada. In addition, they provide several resources for readers interested in helping reduce playground hazards in their communities.     

Recurrent parotitis in children and HIV infection. Apropos of 4 cases]

Over a 2-year period at our institution, 6 patients underwent metallic stent treatment, 5 for malignant conditions and 1 for a benign condition of the esophagus. The use of expandable metallic stents for benign strictures has paralleled malignant indications but is limited and less understood from a clinical standpoint. A review of current literature in the treatment of benign strictures is presented. Treatment of benign strictures is associated with high morbidity and mortality as demonstrated by the cumulative experience of 21 patients. Migration, hyperplastic tissue obstruction at the terminal ends, reflux, and complications of perforation occur at a prohibitive rate. We conclude that expandable metallic stents should be reserved for palliative treatment of esophageal malignant obstructions and tracheoesophageal fistulas. Pharmacological management, necessary dilatations and operative corrections (antireflux procedures, esophagectomy) are recommended treatments for benign strictures.     

Os supratrochlear dorsale of the elbow: a report of two cases

The os supratrochlear dorsale, an accessory ossicle of the elbow, has rarely been described in the literature. Rather than being caused by trauma, it is subject to trauma by elbow extension with secondary chondrometaplasia, resulting symptomatology. The aim of this report is to remind readers that its presence is crucial for both diagnostic and therapeutic purposes. Arthroscopic removal may be required to relieve persistent pain, catching and limited range of motion.     

Seizures involving the supplementary sensorimotor area in children: a video-EEG analysis

Most reports of supplementary sensorimotor seizures have been of adults with medically refractory epilepsy. Typically, supplementary sensorimotor seizures have onset in childhood. We describe the electroclinical features in 12 children. Cases were selected from an EEG laboratory population in whom video-EEG was performed routinely on all children. Supplementary sensorimotor seizures were diagnosed when there was bilateral tonic posturing of the upper or lower extremities, preserved consciousness, and lack of postictal confusion. Sensory auras were reported by 8 of 9 children aged > 3 years who had daytime seizures. Speech arrest occurred in all patients in whom it could be assessed, and abnormal vocalization was observed in 7 children. Interictal EEGs were often normal (49% of recordings), and ictal EEG changes could be subtle. An etiology was demonstrated in only 2 children, and brain imaging studies were normal in the other 10 patients. Seizures were controlled with antiepileptic drugs (AEDs) in 6 of the 12 children. The clinical manifestations of supplementary sensorimotor seizures in children are similar to those reported in adults; misdiagnosis is common at all ages.     

Invagination in children]

Although rare, childhood intussusception is one of the most common causes of small bowel obstruction in infancy. In these very young patients it can sometimes be difficult to interpret the clinical signs and symptoms correctly. This retrospective study comprises 79 children (median age 7.5 months; 24% girls and 76% boys) who experienced 83 episodes of intussusception. At admission the diagnosis made by the referring physicians could be confirmed in only about one-third of the cases. A barium enema was part of the inhospital diagnostic process. Non-operative treatment was attempted in 70 patients (89%), and barium enema reduction was successful in 64%. Laparotomy was required in 33 (42%) of the patients. No mortality, bowel perforation, or any other major complications were encountered. The diagnosis of childhood intussusception seems difficult to achieve in many cases, and the interpretation of, at times vague clinical signs and symptoms remains a challenge for all clinicians who are involved in the care of these very young patients.     

Therapist-patient sexual intimacy involving children and adolescents.

A survey of 90 psychologists showed that 22 reported instances of sexual intimacy between therapists and minor patients. A total of 81 instances were reported, with 56% involving female patients (aged 3–27 yrs) and 44% involving male patients (aged 7–26 yrs). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal problem solving in young children.

24 children at each of 3 age levels (4, 6, and 8 yrs) were asked a series of class inclusion questions presented verbally, visually, and kinesthetically. Four-year-olds performed significantly better under the verbal condition than they did under the visual or kinesthetic condition. There was no effect of condition for 6- or 8-yr-olds on response accuracy. Analysis of correctness of reasons showed main effects of Age and Condition. The majority of the reasons given across ages were based on a comparison between the 2 subclasses, providing support for the misinterpretation hypothesis as an explanation for children's errors. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inferential problem solving in young children.

Children younger than 7–8 yrs of age have been considered incapable of inferential problem solving, defined as the combination of separately acquired behavior segments in order to solve a novel problem. This lack of inferential ability has been attributed to a deficit in spontaneous mediation. The present paper reports an experiment which demonstrates that 5–6-yr-olds are capable of inferential problem solving. Ss were 40 children, aged 5 yrs, 0 mo to 5 yrs, 11 mo, who had a mean score of 105.72 on the English Picture Vocabulary Test. The finding cannot be explained by the mediation-deficit hypothesis. An alternative interpretation is offered which argues that young children's inferential performance is constrained not by an inability to integrate separate or past experiences, but by their understanding of the separate elements involved. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)