Which tissue adhesive for wounds?

We studied the three available tissue adhesives comparing their ease of technique, wound healing, satisfaction, merits and complications when treating childhood lacerations. Children presenting with uncomplicated wounds <2.5cm and <6h since the injury were studied. There were 17 children in each group. Results were compared for the individual tissue adhesive and the technique-contact and non-contact. The application was considered pain free in 82% of the non-contact technique and 56% for the contact technique-pain in 18 and 44%, respectively (P=0.062). Parents were satisfied in 88 and 94% for the contact and non-contact techniques, respectively (P=0.505) and the authors in 76 and 94% (P=0.119). The glove stuck to the wound in nine instances and was damaged once while breaking the container. The scab persisted in all scalp applications for 9-25 days. The adhesive effect was similar in all three. Indermil was considered to be the best among the three. Non-contact, droplet instillation (rather than contact application as was suggested for Dermabond and Histoacryl) was felt more comfortable.

Isolated finger injuries in children--incidence and aetiology.

Details were recorded prospectively in a specifically designed questionnaire for all children presenting to the Accident and Emergency Department with isolated finger injuries over a period of 6 months, in order to understand the incidence and aetiology. Among the 426 injuries in 283 children, most occurred at home (59%) more in the <5 year age group (38%), involving the middle finger (25%) and terminal phalanges (47%). "Jamming/crushing" was the commonest reason (48%), mostly caused by a child (59%) at the living room door (32%) and more commonly at the hinge side (49%). Nail injuries were seen in 48% of cases and 16 amputations of terminal phalanges were noticed in 15 children. Tendon injuries were only caused when cut by sharp objects, and were not caused by jamming/crushing. Both children and adults should be educated about causation, reiterating that damage to fingers can be prevented or reduced by observing safety measures.

Injury surveillance in a children's hospital--overcoming obstacles to data collection.

OBJECTIVE: To understand the problems involved in collection of injury surveillance (Glasgow Children Hospital Injury Reporting and Prevention Programme, CHIRPP) forms. METHODS: Glasgow CHIRPP forms were issued by the clerical staff to all eligible child carers for details of the injury or ingestions by the child, and the retrieval rate of forms was monitored. Reasons for the poor collection of forms were identified and rectified. RESULTS: The collection rate of Glasgow CHIRPP forms was poor when the system was introduced in 1993. It improved when the forms were issued by nursing staff, and considerable improvement was noted when the triage nurse was made responsible. CONCLUSIONS: When a named individual was made responsible there was an improvement in the retrieval of Glasgow CHIRPP forms. A few other simpler problems relating to the retrieval of forms were identified and rectified.

Metal detector and swallowed metal foreign bodies in children.

OBJECTIVE: To evaluate a metal detector to diagnose swallowed radio-opaque metal foreign bodies (MFBs) in children, and whether they can detect non-radio-opaque MFBs. METHODS: In a prospective study, 231 children, who presented to the accident and emergency department with a history of swallowing MFBs, were evaluated by the metal detector as well as radiography to confirm and locate the presence or absence of MFBs. RESULTS: A definite history of swallowing a MFB by the child was given by 186 (81%) parents. The metal detector located MFBs in 183 children and radiographs confirmed radio-opaque MFBs in 181. In the remaining 45 (19%), when swallowing was suspected and not definite, both metal detector and radiography confirmed the presence of a MFB in only four. CONCLUSION: A high detection rate of swallowed MFBs was observed in this study, using a metal detector. It is also of value to detect non-radio-opaque MFBs like aluminium. The detection of MFBs is high when the history of swallowing is definite.

Childhood finger injuries and safeguards.

OBJECTIVE: To understand the epidemiology, sites, and mechanism of finger injuries in children and to consider safety measures. SETTING: Accident and emergency department of a children's hospital in Glasgow. METHODS: A prospective study was carried out with a specifically designed questionnaire. Altogether 283 children presenting with isolated finger injuries were identified over six months. Available safety measures to avoid or reduce damage from such injuries were considered. RESULTS: Finger injuries were common (38%) in those under 5 years. Most of these occurred at home (59%), commonly (48%) because of jamming between two closeable opposing surfaces, and mostly (79%) in doors at home and school. The doors were commonly (85%) closed by someone and often (60%) by a child. Sixteen (6%) were treated for amputation. CONCLUSION: Finger injuries are common, especially at the preschool age, and are mostly caused by jammed fingers in doors, at home. Safeguards should be considered according to location, like home or institutions, and expense.

The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in the UK: a pilot study.

OBJECTIVES: To assess the feasibility, strengths and weaknesses, and preventive utility of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) in a paediatric setting in the UK. DESIGN: Implementation and operational evaluation of CHIRPP. SETTING: A paediatric accident and emergency department in Glasgow, Scotland, UK. METHODS: CHIRPP forms were used to collect and analyse data on the circumstances, mechanisms, and types of injuries in 2516 children (age range 0-13 years) presenting to the accident and emergency department over the period of 1 April 1993 to 31 January 1995. The strengths and weaknesses of CHIRPP were assessed by direct observation, discussion with staff, operation of the CHIRPP software, and scrutiny of the output. RESULTS: After initial technical problems, CHIRPP ran smoothly. Although parental compliance was high, staff compliance was low, and this resulted in a low capture rate. Tabulations indicated the potential of the system for identifying both hazardous environments and vulnerable population subgroups at whom specific preventive measures can be targeted. Specific proposals for enhancing the efficiency and preventive utility of CHIRPP in this setting were formulated. CONCLUSIONS: CHIRPP offers hospitals, public health departments, and government agencies in the UK a promising tool for planning national, regional, and local injury prevention.

Retrograde ureteroplasty using balloon dilatation in children with pelviureteric obstruction.

Congenital and acquired pelviureteric junction obstruction (PUJ) were treated with balloon dilatation, using a Fogarty/Gruntzig catheter introduced through the cystoscope in 11 children (12 renal units). Stents were not used, and the hospitalization period was only 1 day for uncomplicated cases. Follow-up (maximum period, 4 1/2 years) has shown better drainage and function for all. In one child, who had solitary left kidney, acute obstruction developed; the patient underwent temporary percutaneous nephrostomy. Macroscopic hematuria was noted in one case, resulting in a 3-day hospital stay. Technical problems, advantages, and disadvantages are discussed. Retrograde ureteroplasty using balloon dilatation is a simple and effective procedure for children in whom the obstructed PUJ is in lower part of the pelvis.

Pelviureteric obstruction in children treated by retrograde ureteroplasty.

Pelviureteric obstruction was treated by dilatation with a Fogarty balloon catheter in 2 children. The catheter was introduced through the cystoscope without any percutaneous procedure, ureteric stents or drainage. Follow-up for 18 months indicated improved drainage and renal function. The merits and demerits of this technique are discussed.

Congenital benign mesenchymoma of the head and neck.

Congenital benign mesenchymoma of the head and neck is rare. One such case, presenting as a mass in the neck, is reported and the literature reviewed. Pathologic nature of the lesion is discussed. Prognosis after adequate local excision is good.

Spleno-gonadal fusion. A case report.

Examination of a two-year-old boy with bilateral inguinal hernia revealed a firm, smooth, non-tender mass continuous with the upper pole of the testis and extending upwards to the inguinal canal. Histological examination revealed splenic tissue. The article describes the details of this case of splenogonadal fusion and quotes 50 further references from literature.

Crossed ectopic testis--case report and review.

A case of crossed ectopic testis is reported. On reviewing the literature according to the definition of the condition only 30 cases can be accepted as authentic cases. Analysing the clinical and other investigations, it is suggested that this is a local phenomenon without any endocrinal derangement, due to a developmental insult resulting in failure of gubernacular mechanism and consequently failure to open the inguinal rings and the descent to the opposite side is due to adhesions to the testis with normal gubernacular mechanism and inguinal rings.

Obstructed umbilical hernias in childhood in Kuwait - Richter - and other types.

Obstruction of umbilical hernia in children is uncommon, but seven out of 51 operations for umbilical hernia were done as emergencies for obstruction, in 38 months, in Kuwait. Unusual conditions like Richter type obstruction and gangrenous omentum were noted in two children. Solid faeces is considered to be the precipitating factor for obstruction.

Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children.

Preoperative total and differential leucocyte counts were made in 225 children with acute appendicitis, 50 children with a normal appendix and 100 children with acute abdominal pain which resolved without any therapy. When adjusted to age, neutrophilia in 96 per cent, 30 per cent and 32 per cent and leucocytosis in 41.8 per cent, 4 per cent and 3 per cent was noted in the respective groups, the levels being significantly higher in the acute appendicitis group than in the other two groups. Among children with appendicitis, infections were observed in 62.8 per cent of the group with leucocytosis and in 13.7 per cent of the group with a normal leucocyte count; the difference is statistically significant. It is suggested that in acute appendicitis neutrophilia supports the diagnosis and leucocytosis indicates the prognosis. The rate of infection increases as the total leucocyte count rises above the upper normal limit. The difference of opinions on the significance of leucocyte counts in acute appendicitis is discussed.

Progress of acute appendicitis: a study in children.

The results of six simple investigations are compared with the duration of the disease in 100 children with acute appendicitis. The results indicate that during the first day on which the appendix becomes inflamed the local defence mechanisms of the appendix are impaired sufficiently to allow invasion by the bacterial organisms in its lumen. This initially inflamed and subsequently infected appendix may develop in the manner indicated. Local and/or generalized complications may follow, i.e. acute appendicitis in its successive stages of development, which may be regarded as (a) inflamed, (b) infected and (c) complicated, and these changes take place at intervals of 1 day. Bacterial and faeoliths are present in the lumen of the appendix, whether inflamed or not, and it is suggested that they complicate the disease rather than being responsible for causing it.