Subject(s)
Hypertension/complications , IgA Vasculitis/complications , Child , Humans , Hypertension/urine , IgA Vasculitis/urine , MaleABSTRACT
"Lytic cocktail" is the customary sedation before percutaneous renal biopsy. Owing to deficient sedation and respiratory depression, this approach is no longer advised. The intravenous combination of a benzodiazepine plus ketamine, which has been found to be effective and safe in several conditions, was therefore used for 60 pediatric biopsies. In addition to pulse oximetry, a physician trained in airway management monitored the patient. The quality of sedation was acceptable (n = 7) or optimal (n = 53) in all cases. None of the patients required ventilation or intubation. A mild oxygen desaturation lasting 4 min or less was detected in 6 patients. None of the patients experienced major change in respiratory rate or blood pressure. The administration of ketamine and, in some cases, the biopsy puncture were associated with a mildly increased heart rate. In conclusion, a benzodiazepine plus ketamine provides effective deep sedation for renal biopsy in childhood.
Subject(s)
Anesthetics, Intravenous , Anti-Anxiety Agents , Biopsy/methods , Hypnotics and Sedatives , Ketamine , Kidney/pathology , Adolescent , Anesthesia Recovery Period , Child , Child, Preschool , Diazepam , Female , Humans , Infant , MaleSubject(s)
Down Syndrome/complications , Urethra/abnormalities , Adolescent , Adult , Child , Child, Preschool , Female , Humans , MaleABSTRACT
We evaluated the records of 139 pediatric patients with Schönlein-Henoch purpura (aged 0.4 to 15.1 years, median 5.4 years), referred from 1974 to 1993 to the University Children's Hospital, Berne. An acute febrile illness preceded Henoch-Schönlein purpura in 83 (60%) out of the 139 children. The purpuric papules were distributed over the lower extremities and the buttocks in 68 patients (49%), and more extensively in the remaining 71 (51%). Joint tenderness or swelling was observed in 110 patients (79%). Abdominal involvement occurred in 92 patients (66%): abdominal pain (n = 63), melena or hematemesis (n = 23), and intussusception (n = 6). The following rather rare features were observed: scrotal swelling (n = 11), neurologic involvement (n = 3), and stenosing ureteritis (n = 1). A remission lasting at least 4 weeks occurred within 4 weeks in 84, within 5-8 weeks in 19, and within 9-53 weeks in 18 out of 121 patients. A relapse was observed in 10 subjects. Renal involvement occurred in 60 patients. Severe renal involvement, defined as proteinuria exceeding 40 mg/[m2 X h], occurred in 18 of the patients with renal involvement. Progredient renal failure developed in one male. Children with renal involvement tended to be older (6.6 versus 4.1 years) and to have more prolonged extrarenal manifestations (6 versus 3 weeks). It is concluded that in children with Schönlein-Henoch purpura extrarenal involvement often lasts more than one month. Its outcome is almost always favourable. Children with heavy proteinuria tend in some cases to develop renal failure. For these patients, new treatment regimens aimed at preventing renal failure warrant evaluation in prospective controlled studies.
Subject(s)
IgA Vasculitis/complications , Abdominal Pain/etiology , Adolescent , Child , Child, Preschool , Female , Hematemesis/etiology , Humans , IgA Vasculitis/epidemiology , Infant , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/prevention & control , Male , Melena/etiology , Proteinuria/etiology , Switzerland/epidemiologyABSTRACT
Rhabdomyosarcoma is the most common soft-tissue tumor in childhood. In infants it is frequently localized in the pelvis and in the prostata or bladder region. The aim of treatment should be to eradicate the tumor and yet maintain as normal function as possible. Effective preoperative chemotherapy has enabled one to frequently achieve this aim. We report on two patients both with a rhabdomyosarcoma of the bladder-prostata. One of them in 1983 was operated and treated with chemotherapy and cysto-prostatectomy and the other in 1991 with chemotherapy and eradication of the tumor without cystectomy. Both children are now tumor-free after 10 years/2 years resp. Both approaches are discussed.
Subject(s)
Cystectomy , Prostatectomy , Prostatic Neoplasms/surgery , Rhabdomyosarcoma/surgery , Urinary Bladder Neoplasms/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Child , Child, Preschool , Combined Modality Therapy , Follow-Up Studies , Humans , Infant , Male , Neoplasm Staging , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Rhabdomyosarcoma/drug therapy , Rhabdomyosarcoma/pathology , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/pathology , Urinary DiversionABSTRACT
Between 1983 and 1992 22 children with urolithiasis were treated at the Department of Paediatric Surgery and Paediatrics of the University Hospital of Berne. There were 8 girls and 14 boys with a mean age of 7.3 years. Metabolic disease was found in 6 children. There were 12 renal stones, 12 ureteral stones, 1 bladder stone and 1 urethral stone. Conservative therapy, ESWL, and surgery were used as treatment each in one third of the children. Studying our patient-group and analyzing the recent literature, the place of the different therapeutic methods of the childhood stones will be discussed.
Subject(s)
Urinary Calculi/therapy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Lithotripsy , Male , Surgical Procedures, Operative/methods , Urinary Calculi/etiology , Urinary Calculi/surgery , Urologic Diseases/complicationsABSTRACT
Between 1975 and 1991 74 children with a renal injury after blunt abdominal trauma were treated at the Department of Pediatric Surgery of the University Hospital of Berne. There were 22 girls and 52 boys with a mean age of 9.4 years. 55 patients were treated conservatively and 19 operatively. The mean follow-up was for the operated patients 2.6 years and for the not operated 2.5 years. The conservatively treated patients had a shorter hospitalization time, were fewer days on the ICU, needed less blood transfusions and had a minor complication rate compared with the operated ones.
Subject(s)
Kidney/injuries , Nephrectomy/methods , Postoperative Complications/etiology , Wounds, Nonpenetrating/surgery , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Kidney Function Tests , MaleABSTRACT
The persistent Müllerian duct syndrome is a rare disorder of sexual development. We report on a 4 month-old male who presented with a left-sided inguinal hernia and undescended testes. During the repair of the hernia 2 testes, 1 fallopian tube and an uterus were observed. The clinically suspected diagnosis of hernia uteri syndrome was confirmed by laboratory investigations. At the age of 18 months laparotomy was performed and the 2 fused gonades were descended into the right scrotum.
Subject(s)
Disorders of Sex Development/diagnosis , Mullerian Ducts , Chronic Disease , Cryptorchidism/etiology , Cryptorchidism/surgery , Disorders of Sex Development/complications , Disorders of Sex Development/surgery , Hernia, Inguinal/etiology , Hernia, Inguinal/surgery , Humans , Infant , Male , Mullerian Ducts/abnormalities , Reoperation , SyndromeABSTRACT
Between 1974 and 1990 in 16 children (5 boys and 11 girls) with a duplex kidney and bifid ureter surgery was indicated. The mean age of the 15 already operated patients was 7 years (0.3-12 years). 14 had uretero-ureteric reflux, 1 had a stenosis of the ureteric bifurcation, and 1 had a lower pole pelvi-ureteric junction obstruction. An interpyelic anastomosis was performed in 14 and a ureteroneocystostomy "en bloc" in 1. The follow-up was 3-10 years with a mean of 5 years. All 15 patients had normal uroradiological findings, and out of the 9 patients with longer follow-up (more than 3 years) 7 had a significantly diminished infection rate.
