Prevention of post-operative nausea and vomiting in children--a prospective randomized double-blind study.

BACKGROUND/PURPOSE: Post-operative nausea and vomiting (PONV) are common complications related to surgery and anaesthesia. The aim of this study was to assess whether sevoflurane, with or without the use of an antiemetic such as ondansetron, increases or not the incidence of PONV in children. METHODS: One hundred and ten children, 2 months to 14 years undergoing inguinal hernia, hypospadias and penile deformity repair, were randomly allocated into one of two groups, according to whether they received ondansetron or placebo (47 vs. 63). Induction and maintenance of anaesthesia was with Sevoflurane in both groups. Regional anaesthesia was performed on all children (inguinal nerve, penile or caudal block). No opioids were used. In post-operative period, children were assessed for PONV, every 4 h for the first 24 h. RESULTS: Vomiting was very low in both groups (8 cases: 7.3%). No significant statistical difference of post-operative nausea (p = 0.296) and vomiting (p = 0.462) (Fisher's exact test) was found between the group that received ondansetron and the placebo group. CONCLUSION: We found that the use of ondansetron did not change the incidence of PONV, the avoidance of opioids and the adequate analgesia may contribute to this. Post-operative oral intake of liquid, (within the first 4 h), increases the risk for PONV.

Prevention of complications related to traumatic brain injury in children and adolescents with creatine administration: an open label randomized pilot study.

BACKGROUND: There has been an enormous focus on the discovery and development of neuroprotective agents that might have clinical relevance after traumatic brain injury (TBI). Based on experimental facts, we studied administration of creatine to patients with TBI. METHODS: A prospective, randomized, comparative, open-labeled pilot study of the possible neuroprotective effect of creatine was performed on 39 children and adolescents, aged between 1 to 18 years old, with TBI. The creatine was administered for 6 months, at a dose of 0.4 gr/kg in an oral suspension form every day. For categorical variables, we used the chi test to identify differences between controls and cases. Statistical significance was defined as a p value <0.05 and not statistically significant if p value >0.1. RESULTS: The administration of creatine to children with TBI improved results in several parameters, including duration of post-traumatic amnesia (PTA), duration of intubation, intensive care unit (ICU) stay, disability, good recovery, self care, communication, locomotion, sociability, personality/behavior and neurophysical, and cognitive function. Significant improvement was recorded in the categories of Cognitive (p < 0.001), personality/behavior (p < 0.001), Self Care (p = 0.029), and communication (p = 0.018) aspects in all patients. No side effects were seen because of creatine administration. CONCLUSION: Preliminary data suggest that the administration of creatine may be beneficial to patients with traumatic brain injury.

Deep venous thrombosis in a child associated with an abnormal inferior vena cava.

Congenital anomalies of the inferior vena cava (IVC), such as absence or atresia, although well documented, are uncommon and result from aberrant development during embryogenesis. Absence or atresia of the IVC is usually discovered accidentally. Patients are typically asymptomatic of the condition itself. Many concurrent cardiovascular-associated abnormalities have been described. We report a 10-y-old boy admitted to the emergency room with painful swelling of his right lower limb without previous trauma or surgery. After 3 d, swelling also involved the left lower limb. A Doppler ultrasound of the lower limbs revealed bilateral thrombosis of the vena iliaca communis, vena iliaca externa, femoral vein communis and superficial extending to the IVC. Magnetic resonance imaging (MRI) of the abdomen was performed. On MRI, we demonstrated a hypoplastic IVC. The results of blood coagulation studies, including levels of antiphospholipid antibodies, proteins C and S, and antithrombin III, were normal. The patient was treated with intravenous heparin for 8 d and discharged with oral warfarin therapy, which has been recommended for life. Therapy against deep venous thrombosis must be focused on its prevention in the future. An abnormal inferior vena cava should be considered in young patients with deep venous thrombosis without apparent cause.

Hypertrophic pyloric stenosis in twins: same genes or same environments?

The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Cases in twins, usually monozygotic, have been sporadically reported as evidence for the genetic origin of the disease. We present a case of IHPS in a pair of dizygotic male twins together with a review of the literature, focusing on the question of whether the twin cases actually support a genetic or an acquired nature of IHPS.

Early exploration in perinatal torsion of the spermatic cord: a case report.

Perinatal testicular torsion is a rare condition presenting with signs of an acute scrotum. Review of the literature indicates that there is controversy about optimal management, particularly as regards the risks and the benefits of immediate versus delayed surgical treatment. We report a case that was treated by immediate surgical intervention.

Cat scratch disease simulating a malignant process of the chest wall with coexistent osteomyelitis.

A 6-y-old girl developed fever, soft-tissue mass in the right chest wall, osteomyelitis of the 10th rib and hepatic granuloma. Cat scratch disease was diagnosed by histological examination of the mass and serological tests. The patient was treated successfully with antibiotics and recovered completely, as shown by a 10 month follow-up.

Soccer injuries in childhood.

A prospective study of soccer injuries, involving 287 male youth players, from the ages of 12-15 was conducted in 24 Greek soccer clubs, during the course of one year. A total of 193 players sustained 209 injuries. The incidence of injuries was 4.0 injuries per 1000 h of soccer time per player, and the most common types of injuries were sprains and strains. Surprisingly, it was found that an increase of injury incidences occurred during practice. Fifty-eight injuries required medical assistance. The majority of injuries (80%) were located in the lower extremities. Collision with other players was the most common activity at the time of injury, accounting for 40% of all injuries. The conclusion of this study and the evidence from other studies suggests that youth soccer is a relatively low risk sport. However, a substantial amount of injuries could be prevented. It is necessary to identify the risk factors, which are associated with these types of injuries.

13 Years' experience with the combined hormonal therapy of cryptorchidism.

PURPOSE: We analyze the results of the combined treatment with luteinizing hormone releasing hormone (LH-RH) and human chorionic gonadotropin (HCG) of a large series of patients with cryptorchidism. MATERIALS AND METHODS: Between 1987 and 1999 and after strict differentiation between cryptorchid, retractile and gliding testes, 2,467 boys with 2,962 cryptorchid-gliding testes were treated with the combined hormonal therapy. LH-RH was administrated as a nasal spray at a dosage of 1.2 microg daily for a period of 4 weeks. HCG was injected intramuscularly, 5 times at 2-day intervals at a dosage adjusted according to the age. RESULTS: In the prospective study 2,476 boys with 2,962 cryptorchid testes were hormonally treated. Of the 2,962 evaluated cases 1,200 (40.52%) have been treated surgically after the hormone therapy. In 1,762 cases, 59.48% of cryptorchid testes were in the scrotum after combined hormone treatment. CONCLUSIONS: Treatment with LH-RH and HCG induced the descent of the testes to a normal scrotal position of boys with cryptorchidism in 59.48% of the evaluated cases. The combined treatment was effective for inducing descent of cryptorchid and gliding testes. According to the evaluated intraoperative findings, the failure of the combined therapy in 40.52% of the cases is due to the fact that the free descent is limited by local factors such as anatomical alterations of the inguinal canal, epididymal abnormalities or ectopic distal attachment of the lig. testis.

A local cluster of achalasia in a province of Crete.

Achalasia has a largely obscure aetiology and is uncommon in childhood. We report three cases of otherwise well children, residents of a small province of Crete, two of them female cousins. This cluster probably indicates an autosomal recessive trait of inheritance. All three children were surgically treated (Heller cardiomyotomy combined with Nissen fundoplication), with excellent results.

Spontaneous gastric perforation in premature twins.

Two pairs of identical and non-identical premature neonates proceeding from twin pregnancies were operated on for spontaneous gastric perforation. The newborns in our case, one girl and one boy two different pregnancies were delivered by emergency cesarean section. Their gestational ages were 30 and 32 weeks, and their birth weight 1400 and 2100 g, respectively. Both of the neonates were being treated in the Neonatal Intensive Care Unit when the perforations were diagnosed. They presented clinically abrupt symptoms of abdominal distension and pneumoperitoneum. The sites of the ruptures were located at the anterior gastric wall near the gastroesophageal junction. The sibling twins were consequently also observed very carefully and fortunately they did not develop any similar clinical symptoms. All four twins were finally discharged from the hospital in good condition.

Seamless care in the health region of Crete: the Star* case study. Seamless Telematics Across Regions.

Seamless collaboration and medical information exchange among health care experts is an open question on existing health care systems. The patient record is usually scattered all over the health care network making access to crucial medical information troublesome. The Star* (Seamless Telematics Across Regions) project provides a set of solutions towards this direction which will soon be applied at Crete. Initially two health care structures will be involved in the process but later on and after tests have been completed successfully in real world applications, results will be defused over the whole health care region of Crete.

Deep assessment of machine learning techniques using patient treatment in acute abdominal pain in children.

Learning from patient records may aid knowledge acquisition and decision making. Existing inductive machine learning (ML) systems such us NewId, CN2, C4.5 and AQ15 learn from past case histories using symbolic and/or numeric values. These systems learn symbolic rules (IF... THEN like) which link an antecedent set of clinical factors to a consequent class or decision. This paper compares the learning performance of alternative ML systems with each other and with respect to a novel approach using logic minimization, called LML, to learn from data. Patient cases were taken from the archives of the Paediatric Surgery Clinic of the University Hospital of Crete, Heraklion, Greece. Comparison of ML system performance is based both on classification accuracy and on informal expert assessment of learned knowledge.

[Abnormalities of the stomach]. / Missbildungen des Magens.

Malformations of the stomach are rare, their complications can be very dangerous in infancy. Clinical picture and diagnosis are discussed using 5 own cases (one 2-years-old girl with membraneous atresia, one 3-day-old boy with pylorus atresia, one 2-years-old boy with bleeding diverticulum of the stomach and a newborn with tubular hypoplasia (i.e. microgastria)). The treatment of these malformations is always surgical. Only cases of membraneous stenosis of the stomach may be treated endoscopically.

[Disease picture of intra-abdominal hernias in childhood]. / Zum Krankheitsbild der intraabdominellen Hernien im Kindesalter.

Through the demonstration of 3 cases (6-year-old-girl with right mesenterico-parietal hernia; 2 year-old-boy with a transverso-mesocolic hernia; 10-months-old-boy with a hernia in the mesenterium of a M.D.) we discuss the problems of intraabdominal hernia. The evaluation of the disease can take many forms. Only one third of the children remains without symptoms; the other third has a chronic evaluation and the last third an acute abdomen. Once diagnosed internal hernia must soon be operated.

[Omento-porto-duodeno-pexy in the treatment of bile-duct atresia and hypoplasia in infants]. / Die Omento-Porto-Duodeno-Pexie zur Behandlung der Gallengangsatresis und -hypoplasie im Säuglingsalter.

From 1975 to 1982, central lymph drainage was performed in our hospital, on 12 infants with atresia of the intrahepatic bile ducts. The greater omentum was used for the drainage. It was mobilized and attached to the incised hilar lymph nodes and lymphatic vessels of the hepatic-duodenal ligament and to the decapsulated duodenum. In two children, this method was combined with Kasai's operation. These two children developed cirrhosis of the liver. Only one of the other 10 children, who underwent our own procedure, has developed cirrhosis so far. The remaining 9 children show no signs of liver damage.